Policies and Positions of Americans for Safe Access

Background: Between 1840 and 1900, European and American medical journals published more than 100 articles on the therapeutic use of cannabis. In the early 1900s, pharmaceutical giant Eli Lilly produced whole plant cannabis extract for sale to patients whose physicians recommended it. Today, new studies are being published in peer-reviewed journals that demonstrate cannabis has medical value in treating patients with serious illnesses such as AIDS, glaucoma, cancer, multiple sclerosis, epilepsy, and chronic pain. The U.S. National Library of Medicine includes more than 6,500 published scientific articles on medical applications for cannabis. Although the federal government continues to ignore the medical efficacy of cannabis, many of the isolated compounds found in the cannabis plant are being researched and used medically. In fact, Nabilone and Dronabinol, which are isolated cannabis compounds, are currently prescribed and sold for medical use in the United States.

Findings: Numerous controlled clinical studies have confirmed cannabis's therapeutic benefit in relieving an array of symptoms for people living with Cancer, HIV/AIDS, Multiple Sclerosis, Alzheimer's, Hepatitis, Arthritis, and Chronic Pain, among many other conditions. In addition, in February 2010, the University of California’s Center for Medicinal Cannabis Research (CMCR) presented a report to the California legislature summarizing the findings of 10 years of research on cannabis and cannabinoids. As a result of their research, the CMCR presented evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or diseases of the nervous system, and for painful muscle spasticity due to multiple sclerosis.

Position: Clinical research affirms that cannabis can safely and effectively alleviate symptoms of serious and chronic medical conditions.

Background: State medical cannabis laws have been and continue to be passed in order to address a public health issue with the central focus being patients. However, this critical patient focus has often been lost in the practice and implementation of these laws.

Findings: Patients often pay exorbitantly high prices for their medication, which often includes sales tax and can also include additional excise taxes. Despite the high cost, medical cannabis is often inconsistent in quality and can be contaminated with pesticides, mold, and insects. Doctors who are willing to recommend medical cannabis can be difficult to find. State and local medical cannabis laws have often left private patient records easily accessible to law enforcement, thereby endangering the patients themselves.

Position: Patients deserve respect and protection under the law, as well as a bill of rights to ensure a consistent, quality controlled, and affordable supply of medical cannabis. A patient bill of rights, among other assurances, would also ensure access to physicians willing to recommend medical cannabis and that medical records and personal information will be kept private and inaccessible to law enforcement.

Background: With the passage of the Controlled Substances Act in 1970, cannabis was categorized as a Schedule I substance indicating no medical value and a high potential for abuse. Several presidential administrations since then have aggressively enforced federal cannabis laws even in states that have adopted laws to permit the use and distribution of cannabis for medical purposes. Despite the growing body of evidence to support therapeutic use of cannabis, the federal government continues to ignore the rescheduling recommendations of its own DEA Administrative Law Judge Francis Young, who ruled in 1988 that, “Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care.” The current attempt to reclassify cannabis by administrative petition was started in 2002 by the Coalition for Rescheduling Cannabis (the CRC includes groups like the American Alliance for Medical Cannabis, Americans for Safe Access, the National Organization for the Reform of Marijuana Laws, and Patients Out of Time). That petition is now pending before the DEA for final approval.

Findings: The federal status of cannabis as a dangerous drug with no medical value is at the heart of the conflict between federal and state laws. As long as cannabis remains classified as a Schedule I substance, medical cannabis patients across the country will lack reasonable, fair and equal protection. The refusal by the federal government to recognize the medical efficacy of cannabis has directly impeded efforts to implement various state medical cannabis laws. And, while sufficient evidence exists in the U.S. and elsewhere of the medical value of cannabis, the federal government, under the authority of the National Institute on Drug Abuse, keeps a stranglehold on research efforts, emphasizing harm-based studies over the investigation of medical efficacy.

Position: ASA strongly supports the reclassification of cannabis in order to expand research on this important and promising therapeutic substance and to better establish laws that reasonably, fairly and equally protect patients in the U.S. The easiest and quickest way to accomplish this is for the Obama Administration to grant the pending rescheduling petition filed in 2002 by the Coalition for Rescheduling Cannabis.

Background: During his presidential election campaign, Senator Obama pledged that he was “not going to be using Justice Department resources to try to circumvent state laws on this issue.” After Obama was elected President, his Administration made repeated statements upholding his campaign pledge, including the statement by U.S. Attorney General Eric Holder that his Justice Department would only “go after those people who violate both federal and state law.” Then, in October 2009, the Justice Department issued a memorandum to all U.S. Attorneys in medical cannabis states vowing to “not focus federal resources…on individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.”

Findings: Although patient advocates hailed Obama’s Justice Department memo as a major victory against the unnecessary and harmful enforcement efforts of the federal government, the memo was not an answer to all of the issues facing the patient community. While the non-binding memo has resulted in far fewer raids than under the G.W. Bush Administration, federal raids have not stopped and too much enforcement discretion is left up to current and future Administration officials. There are also other issues beyond just enforcement that face medical cannabis patients in the U.S. For example, investigations into the therapeutic benefits of cannabis are routinely stifled by Byzantine approval processes, and despite the popular support for medical cannabis laws, the Obama Administration has failed to establish a comprehensive and public health approach to this issue.

Position: ASA is currently pursuing clarification on the Obama Administration’s policy with regard to medical cannabis, both legislatively and directly through Administration officials. In addition, ASA is working with Administration officials to adopt a set of recommendations that include an end to federal enforcement in medical cannabis states, expanded research, and a sensible, comprehensive federal policy.

Background: It was never the intention of patients or the elected officials who have helped to pass medical cannabis laws that medical cannabis should only be for the dying. In fact, most of the patients who have pioneered such laws are not terminally ill, but suffer from such maladies as glaucoma, arthritis, multiple sclerosis, anorexia, HIV, and chronic pain. As such, all state medical cannabis laws that have been passed were adopted with the intention of protecting and providing safe access to a patient population that suffers from a wide array of medical conditions, not simply terminal illnesses.

Findings: The first medical cannabis law passed in the U.S. ensured that “seriously ill Californians have the right to obtain and use cannabis for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the persons health would benefit from the use of cannabis in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine or any other illness for which cannabis provides relief.” Subsequent state laws have also incorporated a wide array of medical conditions and have decided not to restrict medical cannabis use only to those patients who are terminally ill. These decisions have reflected reports and studies from countless patients who have treated serious but not necessarily life-threatening illnesses.

Position: Given that scientific studies have shown that cannabis counteracts or mitigates a number of illnesses and side effects from other treatments, patients deserve choices in their health care options and should not have to be terminally ill in order to take advantage of the proven benefits of medical cannabis.

Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.

Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.

Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.

Background: Examples of the medical use of cannabis have existed for thousands of years, not the least of which was the production and distribution of cannabis tinctures by pharmaceutical giant Eli Lilly at the turn of the 20th century. Yet, the scientific investigation into this important and promising therapeutic substance is not what it could be. Only in the last few years have we seen the needed increases in medical cannabis research, but such studies have predominantly been outside the U.S. Still, even studies inside the U.S. have shown that cannabis can be used to effectively treat neuropathic pain for people living with HIV/AIDS and multiple sclerosis, as well as treat nausea and stimulate appetite.

Findings: With the use of a science-based approach, several countries around the world are investigating the therapeutic qualities of cannabis and expanding our knowledge base. For example, scientists in Israel are uncovering ways of treating Alzheimer’s with cannabis, and researchers in Spain are studying the effects of cannabis on brain cancer. Unfortunately, in the U.S., a Byzantine approval process hinders scientists’ ability to obtain research grade cannabis for studies and clinical trials. The federal government maintains a monopoly on the production of research grade cannabis and uses an approval process run by the National Institute on Drug Abuse and the Drug Enforcement Administration, federal agencies with a clear bias against medical cannabis. As a result, scientists in the U.S. face federal hurdles that don’t exist in other countries, which skews and stifles meaningful research. Efforts to overturn the government’s monopoly and employ a more reasonable research approval process have so far failed. Yet, patient advocates continue to fight for increased research, not to establish the medical efficacy of cannabis, that’s been done; to expand our knowledge and understanding of this important therapeutic substance.

Position: According to the DEA’s own Administrative Law Judge Mary Ellen Bittner expanded medical cannabis research is “in the public interest.” ASA agrees. The federal government should better invest in the therapeutic research of medical cannabis. The monopoly on access to research grade cannabis should be dismantled to allow additional licensed facilities to produce a sufficient, consistent and high quality supply for scientists. The federal government must also create incentives for expanded research and retool the research approval process to eliminate a bias for abuse studies and the onerous requirements unique to the U.S.

Background: Many states have recognized the need for patients to self-cultivate medical cannabis.

Findings: Because cannabis comes in literally thousands of different cultivars with very different effects on the body, it is important for patients to be able to determine which cultivars work best for their particular condition and to be allowed to cultivate those cultivars for consistency and quality. In addition, obtaining cannabis through legal distribution centers can be prohibitively expensive for patients, whereas self-cultivation can significantly reduce that financial burden. Patients should not have to rely exclusively on a centralized production and distribution system, which often falls short in meeting their specific needs.

Position: Patients should have the right to grow their own medical cannabis in a variety of ways. Patient cultivation is necessary to ensure that patients have safe and affordable access to medical cannabis.

Background: The people of California passed the country’s first medical cannabis law, encouraging federal and state governments “to implement a plan for the safe and affordable distribution of marijuana.” Despite a failure by the federal government to help California develop such a plan, ingenuity and compassion on the part of patients developed a community-based solution for distribution. Community based access refers to innovative and flexible medical cannabis distribution plans developed by patients and providers to meet patients’ needs. Community based access may include personal and collective cultivation, local access to affordable medicine, and other services designed to meet the needs of patients. The California legislature adopted a system for locally authorized distribution in the form of dispensaries, and subsequently paved the way for hundreds of such facilities to operate across the state. Taking California’s queue, similar community-based dispensaries took root in states like Colorado, Washington and Oregon. This development has prompted the implementation of statewide distribution programs in New Mexico, Rhode Island, Maine and New Jersey.

Findings: Cannabis is a plant with thousands of different strains, which affect patients differently. Not only is it difficult to cultivate cannabis with consistency and optimum quality, it is often too difficult or too impractical for patients that reside in public housing. The vast majority of the hundreds of thousands of patients in the U.S. cannot grow medical cannabis themselves and, therefore, rely on dispensaries to access it. A 2006 study by Amanda Reiman, Ph.D. of the School of Social Welfare at the University of California, Berkeley, examined the experience of 130 patients spread among seven different dispensaries in the San Francisco Bay Area. The study found that “patients have created a system of dispensing medical cannabis that also includes services such as counseling, entertainment and support groups, all important components of coping with chronic illness.” She also found that levels of satisfaction with the care received at dispensaries ranked significantly higher than those reported for other health care services nationally. Dr. Reiman noted that, “support groups may have the ability to address issues besides the illness itself that might contribute to long-term physical and emotional health outcomes, such as the prevalence of depression among the chronically ill.” For cannabis to be successfully used therapeutically, patients need more help using it. It’s not possible to believe that any patient who is going to need cannabis can grow and harvest the medicine by the time they’re going to need it.

Position: ASA supports community-based access models because they are proven to bring safe access to medical cannabis to hundreds of thousands of patients in need

Background: Based on the positive impact of California’s distribution system, other medical cannabis states have decided to address this important issue of safe access. Some states like Maine, New Mexico and Rhode Island, preferred a state-regulated medical cannabis distribution system. While other states like California, Colorado, Michigan and Montana have preferred to regulate distribution at the local level. Regardless of the methodology, however, the trend is moving toward enhanced access to medical marijuana as a result of regulated distribution systems.

Findings: After conducting a study on the impact of local medical cannabis dispensary regulations in California, Americans for Safe Access found that reasonable regulations not only improve the lives of patients though increased access and availability, but that they also reduce crime and community complaints around those dispensaries. In many cases, dispensaries actually helped to revitalize struggling neighborhoods. On the other hand, unreasonable or onerous regulations can have the effect of cutting off access to medical cannabis and can act as de facto bans on distribution in communities that rely on such access.

Position: ASA supports the sensible regulation of dispensaries to the extent that such regulations recognize the legality of medical marijuana distribution and offer reasonable methods to comply with local and state laws.

Background: Ever since medical cannabis distribution centers began in California more than 15 years ago, the federal government has targeted them. Americans for Safe Access was formed in 2002 as a response to federal raids in California, which peaked during the last half of the G.W. Bush presidency with more than 200 raids in California alone. Aggressive federal actions were used for years to undermine efforts to implement state law through the establishment of localized distribution centers. Partly because of President Obama’s campaign promises to de-prioritize federal enforcement of medical cannabis, partly because of the overwhelming scientific evidence of medical efficacy, and partly because of popular acceptance and pressure from patient advocates, the federal raids of dispensaries have dropped precipitously.

Findings: Aggressive SWAT-style raids on dispensaries are harmful not only to medical cannabis patients and providers, but also for the surrounding communities that are inevitably terrorized by such enforcement actions. Federal agents, often with the help of local or state law enforcement, will raid dispensaries to seize cannabis, money, growing equipment, patient and financial records, as well as other property, but do not always make arrests. As harmful as raids are, putting countless medical cannabis providers out of business, federal prosecution is even more harmful, due to the lack of a defense in federal court. And, although the federal government has decreased the intensity of its raids, they are still occurring.

Position: If medical cannabis is to be dealt with as the public health issue it is, there must be a different approach taken to enforcement of the law. First, and foremost, the federal government must cease enforcement against clearly established medical cannabis distribution centers and leave such enforcement to local and state officials. Second, local and state officials should emphasize civil enforcement over the much more aggressive and harmful criminal enforcement. To the extent that medical cannabis distribution centers violate local land use laws or fail to comply with state law, those violations should not be handled in state criminal court, but in civil court with the use of remedies such as fines and injunctions.

Background: In 2001, the U.S. Supreme Court issued a ruling in a case known as U.S. v. Oakland Cannabis Buyers Cooperative (OCBC) that local medical cannabis distribution was illegal under federal law. The OCBC decision dealt a serious blow to medical cannabis patients and providers by declaring that a defendant cannot argue medical necessity or compliance with local or state laws as a defense against federal charges. Because federal medical cannabis defendants have been prevented from using medical necessity to defend themselves at trial, the OCBCdecision has forced dozens of patients to accept plea bargains. Those who chose to fight back and take their case to trial have been summarily refused a defense and consistently convicted as a result. Since the OCBC decision, federal prosecutions of medical cannabis cases have resulted in a total of more than 100 years of imprisonment for patients and their providers.

Findings: Despite the October 2009 Justice Department memorandum to U.S. Attorneys de-emphasizing federal enforcement of cannabis laws in medical cannabis states, the federal government has continued to arrest and prosecute medical cannabis patients. The federal government should, ideally, refuse to enforce federal cannabis laws when medical use is involved and, instead, should let local and state officials enforce violations of their own laws. However, as long as cases involving medical cannabis are prosecuted in federal court, patients and providers should have a right to argue medical necessity or adherence to state law. This right, not currently afforded to federal defendants, is embodied in federal legislation coined the “Truth in Trials” Act.

Position: The “Truth in Trials” Act is a logical and necessary complement to the Obama Administration’s medical cannabis policy guidelines. This federal legislation, which has been sponsored by ASA, would ensure that defendants have the ability to defend themselves and present evidence in federal court that may demonstrate compliance with state or local laws. Until the federal government stops prosecuting medical cannabis cases and develops a comprehensive, sensible policy with regard to this public health issue, patients and their providers need the “Truth in Trials” Act as a means of avoiding unnecessary and unfair imprisonment.

Background: For years, the Department of Veteran Affairs (VA) had a policy that prevented VA physicians from recommending medical cannabis to their patients, causing many VA physicians to also deny prescribed pain medication to state-compliant medical cannabis patients under their care. However, in July 2010, after patient advocates had applied years of political pressure, the VA issued a directive clarifying its position on medical cannabis. The VA policy now states that, “patients participating in state medical cannabis programs must not be denied VHA services,” but still prohibits VA physicians from recommending medical cannabis to their patients based on an erroneous assumption that such actions “could result in the Drug Enforcement Administration’s actual or threatened revocation of the physician’s registration to prescribe controlled substances, as well as criminal charges.”

Findings: Believing that the Department was adhering to federal law, the VA spent years denying patients critically needed pain medication unless all cannabis use was terminated. Patients suffering from chronic pain, many of whom had reduced their intake of strong narcotics as a result of their medical cannabis use, were told to choose between two types of medication that worked well for them even though their combined use had not caused any medical problems. Patients who benefit from the use of medical cannabis must still go outside the VA system to obtain recommendations from physicians who are not bound by the VA policy.

Position: Patient advocates applauded the change in VA policy to prevent its physicians from arbitrarily denying much needed pain medication to veterans who are also lawful medical cannabis patients. This policy of recognizing state medical cannabis programs and the potential of cannabis to benefit veterans under VA care places additional pressure on the rest of the federal government to adequately address this important public health issue. Americans for Safe Access is committed to working with groups like Veterans for Medical Marijuana Access to further change VA policy to enable VA physicians to recommend medical cannabis for their patients, an already established constitutional right in the U.S.

Background: One of the main arguments used by opponents of medical cannabis is that other medication works better. While this is often true, there are other factors to consider. Some effective pharmaceutical medication is also toxic with harmful side effects, whereas cannabis is relatively harmless and can diminish the need for pharmaceutical medication.

Findings: While some medical conditions may respond better to pharmaceutical medication, medical cannabis is often cheaper and more effective than pharmaceutical alternatives. For example, ASA has received countless reports from patients who have either significantly reduced or eliminated altogether their use of narcotics and pain medication by replacing it with medical cannabis.

Position: Medical cannabis is certainly not the BEST option for everyone, nor should it be the FIRST option for a physician to consider, but we believe most Americans agree with us that all patients and physicians should have as many effective options available to them as possible to combat pain or symptoms of a serious or chronic illness.

Background: Although most patients consume medical cannabis by smoking it, several other methods of ingestion are available. For example, in the early 20th century, pharmaceutical companies like Eli Lilly were selling medical cannabis extracts in tincture form. Since that time, medical cannabis extracts have been further developed into an array of alternative forms that aim to meet the varying needs of patients. These include concentrates made from rinsing flowers in cold water, pressing resin into blocks, or dissolving active ingredients in butter or oil. Unfortunately, law enforcement has often erroneously regarded concentrated forms of medical cannabis to be illegal.

Findings: Medical cannabis can be processed and extracted into many different concentrated forms, including hashish, resin of cannabis, oils and tinctures. Medical cannabis can also be extracted and processed into food-based medicine. Most extracted medical cannabis is digested, but some forms can be applied topically. Medical cannabis can also be vaporized, which heats the medicine below its combustion temperature so that the therapeutic components of the drug are released from the plant without the undesirable carbon compounds that come from combustion. Most patients, because of the ease of delivery and ease of titration, favor the smoked form of medical cannabis. But for those with respiratory issues or a bias against smoking, vaporized and extracted cannabis may be preferred. Because it is ingested, extracted forms of cannabis take longer to react with the body and doses are more difficult to regulate. Also, patients that use medical cannabis to address nausea often cannot ingest it and must resort to smoking or vaporization.

Position: Patients must be allowed to consume their medicine in whatever form is safe and effective for treating their illness or condition.

Background: Medical cannabis has been used safely for thousands of years, and there is no evidence to suggests that it represents a real harm to patients. With some medical cannabis laws in the final stages of implementation, more attention has begun to be placed on quality control. Because of the lack of interest and funding at the federal level in performing quality control testing of medical cannabis, such testing has been conducted more independently and at the local level.

Findings: Multiple findings over the years have concluded that cannabis is relatively harmless, not the least of which was from a 1988 Drug Enforcement Administration (DEA) review of marijuana’s classification as a Schedule I drug, in which Chief DEA Administrative Law Judge Francis L. Young stated that, “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.” Despite reluctance by federal and state governments to conduct quality control testing on medical cannabis, various independent organizations made up of concerned patients, providers, scientists and other experts are working to improve medicine safety and quality by establishing industry standards and guidelines for patients, large-scale cultivators and distributors alike.

Position: Although ASA is not aware of any serious harm that has resulted from consuming cannabis, contaminated or not, we believe that testing can help provide better information to patients about the medication they’re using as well as enhance their choice. Testing should be used as a way to enhance rather than restrict access.

Background: Difficult economic times have forced cash-strapped local and state governments to secure more creative sources of revenue. One such source is the taxation of medical cannabis. Starting off the trend, the California Board of Equalization (BOE) voted in 2005 to implement a policy that taxed the sale of medical cannabis. Since then, the BOE has collected millions of dollars from hundreds of dispensaries across California. Regardless of the financial windfall from taxing cannabis, sales taxes are inherently regressive and disproportionately impact “consumers,” in this case medical cannabis patients. Since then, other state and local governments have imposed taxes on medical cannabis.

Findings: Regressive sales taxes are harmful to patients and make medical cannabis more unaffordable than it already is. ASA has publicly opposed taxes on several grounds, including the hardship to patients, that prescribed medicines are non-taxable, and the real danger of self-incrimination. Taxes invariably and unintentionally restrict access to medical cannabis.

Position: Any tax on medical cannabis is a tax on patients. ASA opposes excessive taxes that are designed to raise revenue, but it does not oppose low-impact fee structures designed to offset administrative costs.

Background: Localized distribution of medical cannabis has been providing patients with safe access since before the Compassionate Use Act (CUA) was passed in 1996. Anticipating distribution to be an important part of state medical cannabis law, the authors of the CUA encouraged “federal and state governments to implement a plan for the safe and affordable distribution of marijuana to all patients in medical need of marijuana.” After passage of the Medical Marijuana Program Act in 2003, giving localities the ability to regulate local distribution, dozens of cities did so. Although not all cities in the state allow for and regulate dispensaries, more than a thousand facilities operate across California, bringing safe access to patients in both rural and urban communities.

Findings: The state legislature, the state and local courts, and the Attorney General’s office have all recognized medical cannabis dispensing collectives, or “dispensaries,” as legal entities in the State of California. After passage of the Medical Marijuana Program Act, which established the right of patients to associate collectively and cooperatively, the courts affirmed this right with landmark rulings in People v. Urziceanu (2005) and Williams v. Butte County (2009). In 2008, with the help of Americans for Safe Access, the California Attorney General drafted guidelines recognizing the legality of storefront dispensaries as long as they comply with state law requirements, such as paying sales tax and operating in a not-for-profit manner. Most recently, in 2010, the landmark ruling in Qualified Patients Association v. City of Anaheim held that local officials could not use federal law as an excuse to ban local distribution in California. Yet, despite the established legality of local distribution, local, state and federal law enforcement continue to disrupt and interfere in such practices.

Position: Medical cannabis dispensing collectives, or “dispensaries,” have been well established as legal entities under California law. However, Americans for Safe Access will continue to lobby and litigate at the local, state and federal levels to ensure that this important function of medical cannabis law is preserved and protected from unnecessary law enforcement interference.

Background: Law enforcement, media, and some local officials have accused state cannabis laws of being too relaxed and subject to significant abuse. Criticism tends to be against both doctors and patients. Doctors are accused of providing recommendations without conducting a proper examination, for concocting diagnoses, and for specializing in medical cannabis. Patients, on the other hand, are accused of obtaining a recommendation to use medical cannabis recreationally. Most accusations against patients are made merely by visual observation of patients. Law enforcement often contends that most medical cannabis patients are abusing the law, describing such abusers with derogatory terms like, “Young Able-Bodied Males.”

Findings: While there may be some physicians that abuse the law by conducting inadequate examinations, the medical boards in each medical cannabis state are tasked with enforcing such practices. In California, a number of physicians have been investigated, but only a handful of them have been found in violation of the state board’s requirements. Becoming a patient is a process that includes being diagnosed by a licensed physician, providing medical history records to the physician and, often, the requirement to obtain a state identification card. This process can be time consuming and usually involves a considerable amount of money. If a patient then obtains medicine from a dispensary, the cannabis is typically more expensive than that obtained from the illicit market. For those patients accused of abusing the law, and who are arrested and prosecuted, the vast majority is found to be in compliance with medical cannabis laws and their cases are quickly dismissed. Compared to California’s approximately 37 million people, a patient population of 400,000 (1-2% of the general population) is marginal at best and seriously undermines the argument of widespread abuse.

Position: While some abuse of state laws probably exists, law enforcement and opponents of medical cannabis have greatly exaggerated those claims. Much like other pharmaceutical and over-the-counter medications, the existence of abuse does not lessen the efficacy of medical cannabis, and patients across the country should not be punished for the sins of others. Safe access to medical cannabis can and should include proper controls to reduce or eliminate abuse. The abuse potential of cannabis should be considered while developing a comprehensive plan for access to medical cannabis; the abuse potential of cannabis should NOT be considered an insurmountable obstacle and/or used as a way to impede or prohibit access.

Background: As the national debate heightens around the legalization of cannabis (or marijuana) for recreational use, policy makers, the media, as well as ASA members and affiliates have called on ASA to take a position on these issues. ASA was founded to focus only on medical cannabis issues. Recreational use and medical use only have the criminal justice system in common.

Findings: Issues such as access, police harassment, and the price and quality of medicine will still be relevant to the patient community despite the adoption of a policy of legalization for recreational. The federal refusal to recognize the medical efficacy of cannabis causes more harm and difficulty for patients than any failure by local or state governments to adopt policies of legalization of cannabis for recreational use. Any system of regulation should not be built on the backs of current medical cannabis laws.

Position:  The legalization of cannabis for recreational use is a separate issue from safe and legal access to cannabis for therapeutic use. We caution policy makers against letting the debate surrounding legalization of cannabis for recreational use obscure the science and policy regarding the medical use of cannabis.