History of Medical Cannabis (Marijuana) in the US

An Internet exchange on medical marijuana between:

• Betsy Mellinger, Northern Nevada Join Together:
• Dr. Norman Wetterau, a private physician in New York; and
• Bernard H. Ellis, Jr., MA, MPH, a public health epidemiologist and medical marijuana user and provider who faces prison for those acts

Betsy Mellinger wrote (on November 5, 2003) to a large number of people via the Internet:

Hi,

The pro-marijuana camp is beginning to run ads a full 12 months in front of next year's presidential election. An ad ran on last night's news on the NBC affiliate, KRNV-News Channel 4 Reno, which indicated "that 67% of Nevada's high school seniors admitted to smoking marijuana compared to 28% of students the same age in the Netherlands where the adult use of marijuana is regulated." (see the actual ad text on their web site). The ad associates lower teen use in the Netherlands to the sanctioning of adult establishments that card for age. Hmmm -- glad there's no problem with fake ID's here in Nevada -- unless you include the fake ID machine reportedly operating at a discreet location convenient to numerous UNR students.

The web link to this ad is found at: http://www.stopteenuse.com/home/ (Their campaign logo -- view the expanded version of this photo and notice the male model is wearing what appears to be a police officer's uniform) Their web site http://www.mpp.org/ indicates that it...

"...will serve to highlight the facts and dispel the myths about youth marijuana use, marijuana's effects on health, and the effects of our current marijuana policies. It can be used as both a research and a reference tool. We encourage you to view our public education TV commercial and its supporting documentation. StopTeenUse.com seeks to inform Nevadans so that we can create policies that better protect our teens from marijuana."

While the MPP states it is promoting 'harm reduction,' this campaign seems to fly in the face of harm reduction because decriminalizing recreational marijuana use would likely increase the recreational use of this drug. It seems that smoking anything -- catnip, tobacco, banana peels, or marijuana -- would pose certain health risks.

For those arguing in favor of marijuana use for cancer patients, it is my understanding (after speaking with a few professionals in the medical and substance abuse field) that there are numerous legal RX drugs available to help cancer patients curb nausea and pain, which are far more effective than marijuana. Are you familiar with any published or peer-reviewed studies on this subject that you could forward to me?

What is your impression of this campaign? Are there valid arguments for supporting the decriminalization of marijuana under certain circumstances? If so, what types of circumstances?

I hope to hear back from you on this. Thanks!

Betsy Mellinger
Join Together Northern Nevada
1325 Airmotive Way, Suite 205, Reno, NV 89502

Here is Bernard H. Ellis, Jr.’s response, sent to the same people who received Betsy’s first message:

Subject: A reply to Betsy Mellinger re: NBC runs ads on primetime evening news for the Marijuana Policy Project
Date: Mon, 01 Dec 2003 13:17:52 -0600
From: Bernie
To: Betsy Mellinger

Dear Betsy,

I don't know if we have ever met, but I was one of the many people to whom you sent the email message (below) back on November 5. I have been reading your message occasionally ever since, wondering if anyone had ever responded to you. Since I haven't received any replies to your first message, I thought it would be worth a few minutes to respond to your questions. If any of the other people you wrote to have opinions on the following issues, I would love to hear from them also.

Before I respond to your message, I thought it might be worthwhile to introduce myself. I am a public health epidemiologist with almost three decades experience working to reduce the consequences of serious substance abuse in this country. I have had the opportunity to fight Big Tobacco at the state and national level, including testifying as an addiction expert in one of the first federal-level trials against R.J. Reynolds, back in 1984. (As a repayment for that testimony, Reynolds thugs torched a car in my driveway to send me a message.) I have also worked to reduce the stranglehold of the alcohol industry on alcoholics and state legislatures, with varying results. (I helped convince the New Mexico legislature to close their drive-up windows for alcohol sales several years ago; and, in 2000, I opened and ran the largest alcohol crisis center in Wyoming on the Wind River Indian Reservation.) In recent years, I have also played a key role in combating the resurgence of methamphetamine in the West. (This activity was chronicled by the U.S. Department of Justice in its article: "Wyoming's Methamphetamine Initiative: the Power of Informed Process". That article can be obtained at the following link: http://www.ncjrs.org/pdffiles1/bja/186266.pdf). So I am coming to this response from a position of genuine concern about the need to reduce the negative consequences of serious substance abuse in the U.S. and throughout the world.

Having said that, I believe that the harms associated with enforcing the current severe legal penalties that come with marijuana use, and the needless pain caused by preventing sick people from accessing cannabis as medicine, far outweigh any benefits that come from maintaining our current policies against this drug. I am strongly in favor of reclassifying cannabis from a Schedule I drug to a less egregious classification that would reduce the criminal penalties tied to this medicine and return cannabis to its formerly useful place in our medical pharmacoepia. I am also in favor of eliminating the stranglehold which the DEA has maintained for years against meaningful medical research on cannabis in the U.S. I also favor removing criminal penalties on recreational use of cannabis by adults, similar to the recent positions taken by Great Britain as well as the state of Alaska (and which are now under consideration in a host of other countries, including Canada).

Every national study commissioned by the U.S. federal government from the presidencies of Richard Nixon through Bill Clinton has recommended that we reclassify marijuana to a less restrictive medicinal category and that we reduce the criminal penalties for its use. Every U.S. state which has placed a medical marijuana referendum before its citizenry has seen that referendum approved at least once, with the margins of victory ranging from 10% (Oregon) to 30% (Arizona). So far, eight states have passed successful medical marijuana referenda, as has the District of Columbia, whose initiative passed by a 38% margin of victory (only to have the implementation of its medical marijuana program blocked by a Republican congress). Today, one in every five Americans lives in a state which has voted to approve medical marijuana for use by its sick citizens. Even the DEA's Chief Administrative Law Judge Francis Young's own review of the issue (in 1988) led to a ruling that marijuana should be reclassified from Schedule 1 (considered to be potentially addictive and with no current medical use) to Schedule 2 (potentially addictive but with some accepted use), a decision that has been ignored by the DEA ever since.

Virtually all U.S. medical organizations which have reviewed the medical marijuana issue have recommended its availability as medicine. These U.S. organizations include the AIDS Action Council, American Academy of Family Physicians, American Cancer Society, American Medical Association, American Medical Student Association, American Nurses Association, American Preventive Medical Association, American Public Health Association, American Society of Addiction Medicine, Congress of Nursing Practice, Federation of American Scientists, Kaiser Permanente, Lymphoma Foundation of America, National Academy of Sciences' Institute of Medicine, National Association for Public Health Policy, National Nurses Society on Addictions, the National Institutes of Health and the New England Journal of Medicine. Medical organizations at the state level have made the same recommendations, including medical groups in Alaska, California, Colorado, Florida, Hawaii, Mississippi, New Jersey, New Mexico, New York, North Carolina, Virginia and Wisconsin. Similar recommendations have been made by medical organizations in other countries, including Australia, Canada, Belgium, France, the Netherlands and the United Kingdom. Thus, it should not be surprising that many of these states and foreign countries, after a lengthy and informed discussion, have moved to allow access to medical marijuana by their citizens.

What is surprising is that the United States federal government has steadfastly ignored the wealth of informed and consistent advice over the past four decades to follow the same course. In fact, the Bush administration has moved aggressively to shut down the medical marijuana programs in all U.S. states and to threaten trade sanctions against other countries, particularly Canada, that have established similar programs. Fortunately, recent federal verdicts in California have attempted to blunt this wrongheadedness by the Bush administration. Last week's verdict (where three leaders of the Los Angeles Cannabis Resource Center received probation instead of an anticipated 30 month federal prison sentence) included a statement by the presiding federal judge expressing admiration for the LACRC's work. Judge A. Howard Martz also stated that the federal prosecution was "badly misguided" in its efforts to close down the program and he said that he was baffled and disturbed that the DEA and federal prosecutors had wasted so much time and money in pursuing the case.

While this and other recent rulings in California have shown some promise of relief for persons in states with approved medical marijuana programs, the majority of Americans who use or provide cannabis for medical purposes do not share that same hope for relief from federal prosecution. This year, over three-quarters of all Americans arrested for drug-related crimes will be arrested for marijuana-related offenses. In addition, over half of all adolescents forced into substance abuse treatment this year by the U.S. criminal justice system will be there because of their marijuana use, most of them for use that could best be described as casual or sporadic. Both groups will face potentially serious lifelong consequences of being labeled as criminals or drug addicts, and both groups will take up prison space or treatment beds that could certainly be put to better use by persons who commit more serious crimes or who battle more damaging addictions.

Let me be clear: I am not in favor of adolescent marijuana use – I am, however, against incarceration or forced treatment of adolescents as a consequence of that use. Fewer than one in ten persons who have ever used marijuana become dependent on it, even for a short time. That figure is less than half the proportion of alcohol users who become dependent, and fewer than one-fifth the number of tobacco users who become dependent, users who face serious lifelong medical and/or social order consequences as the result of their addictions. While over 600,000 people die each year in the U.S. as the result of alcohol or tobacco dependence, there has still not been one death documented in this country as the result of a marijuana overdose, despite ONDCP's recent wave of "scare tactic" ads to the contrary.

And the disproportionate nature of our marijuana-related punishments make no distinction between persons who grow marijuana for their own use (or the use of sick people) versus those who grow for the vastly over-inflated profits that our current illegal market provides. Persons convicted of manufacturing marijuana not only face long prison sentences (on average, twice as long at the federal level as the sentences now handed out for committing manslaughter), but they face the loss of their homes and other possessions. In fact, persons who are acquitted in a federal trial for marijuana manufacture can still lose their homes through a federal civil forfeiture procedure, even when they are found "not guilty" of the criminal offense. Murderers and rapists do not face similar risks of property loss, and neither do the serious corporate criminals who have bankrupted thousands of hard-working families in recent years while their misdeeds merit hardly a glance by Ashcroft's Justice Department and the other national politicians whose "friendship" they have bought.

Obviously, any serious discussion of medical marijuana – or of the pressing need to reconsider our current criminal penalties for marijuana users – could go on for some time. I hope that the issues I have raised briefly will encourage others who are concerned about some of the negative consequences of our current substance abuse policies to speak up on these issues. If my own comments in this response have sounded both frantic and frustrated, there is a reason. You see, I have been involved in the medical marijuana movement for the past 13 years, since the time I helped run the Tennessee AIDS program back in the late 1980s. For years, I have provided cannabis (free of charge) to any sick person who asked for it, while ensuring that none of that cannabis ever reached the streets of my rural community.

Last summer, after I refused to sell to a local drug dealer, he turned me in to the Tennessee Marijuana Eradication Task Force. As a result and at this moment, I face a federal prison sentence of between two and five years, and the loss of a 187 acre farm that has been my home for 35 years, even though I have an otherwise clean criminal record and a clear conscience regarding my relationship with cannabis. It has been a painful, but an eye-opening process, to learn about the penalties I face through this prosecution. It has also made me much more aware of the life-changing nature of being sucked into the federal criminal justice system. I have been told that – had my case remained at the state level – I would have faced no more than two years' probation and an $8,000 fine, instead of the years of confinement and the six-figure financial loss that I now face. Many of my friends and colleagues believe that my case became a federal one precisely because of my support for medical marijuana. (If any of you are interested in more details on my case, just write me back.)So as all the readers of this response go forward in your own efforts to reduce serious substance abuse in your communities and in this country, keep in mind that there are two sides to most issues in the drug policy debate (particularly in the debate regarding medical marijuana); and that there are faces (and forestalled lives and careers) behind all the statistics we sometimes glibly banter about. Thanks for reading this response, and I look forward to hearing back from anyone, regardless of your opinions on these issues. Have a restful, peace-filled holiday -- and count your blessings.

Bernard H. Ellis, Jr., MA, MPH

Here's the somewhat surprising reply Bernie got an anti-drug coalition leader from Colorado:

December 5, 2003

Bernie -- Excellent reply.

I think one of the biggest problems in the substance abuse field is the tendency to label as "pro-drug" anyone who dares to question the wisdom of the drug war or who advocates a medical/health approach rather than a criminal approach. Your reply gives me hope that more people in the field are advocating for change - keep up with your efforts.

Thanks,
Bert Singleton
Partnership for a Drug-Free Colorado

Three weeks later, this response arrived from Dr. Norman Wetterau, of New York:

(12/24/03): A reply to Barnard Ellis’s Email on Medical Marijuana

As the year ends I wanted to replay to the e mail you sent. in early Dec.. I very much disagree with much of what you said. First, There are possible uses for medical marijuana. The AMA has a report and statement. You can find this report on their web site and search for medical marijuana and then find the CSA report full text. You could also go to http://www.ama-assn.org/ama/pub/article/2036-6124.html This report has 194 references. The report and AMA resolution recommends research and delivery systems other than smoking. Marijuana , if found effective, should be treated as any other drug and available by presciription, probably as a controlled substance, but not necessarily schedule 1. Most reported benefits of medical marijuana have little evidence and often the side effects are very troublesome. the Institute of medicine report again urges research, trying to find active ingredients that are effective and alternative delivery systems. They do not advocate anyone who feels marijuana may help them for just about anything using it.

The AMA and most medical groups are in favor of treatment and not prison. But your letter really knocked treatment. You talked about adolescents being forced into unnecessary treatment. I am not sure anyone is advocating adolescent marijuana use. I have been in family practice for 30 years and have seen the lives of hundreds of teens ruined due to pot smoking. Their grades go down, they drop out of all extra activities and often on to other drugs. Many are still using 20 years later and their lives are often in shambles. Most parents just sit by and watch this happen but a few make it clear to their teens that continued marijuana use is not acceptable and if they continue they will have to go into treatment. Also many are arrested for other things and treatment is presented as an option to jail. You are suggesting that none of this treatment is necessary.Finally you attack the Bush administration for the tight control on marijuana and also on research for marijuana. I agree that more money needs to be spent for research Oral marijuana is already available for HIV patients. More research needs to be done. In defense of Bush, how can you advocate more money for research when some advocates of medical marijuana could care less. The medical marijuana laws of some states only require that the physician suggest you use it and for almost anything. How many patients in California who use medical marijuana have tried oral prescription marijuana first. The pro marijuana community sometimes appear against oral marijuana or against any restrictions. I wish they would advocate for more research and agree with the AMA that it should only be used for conditions where it is clearly shown to work, and where other drugs are not available or useful.

Finally I am not aware of any terminally ill patient in our area who was arrested for smoking marijuana, but there are plenty of people with other ills and who are using other illegal drugs who have been.

Norman Wetterau MD

Here is Bernie's reply to Dr. Wetterau, posted the same day:

December 24, 2003
To: Norman Wetterau, MD
From: Bernard H. Ellis, Jr., MA, MPH (the correct spelling of my name)
Subject: All I want for Christmas is a more just and compassionate national drug policy, based on a medical model of intervention rather than a criminal justice approach of incarceration

I appreciate your response to my email exchange with Betsy Mellinger, which I sent back in early December. Betsy and I have exchanged several e-mails since then, and I have also heard from someone with a statewide Drug-Free Partnership, who agreed with my positions. I do want to respond to your message, and to copy it to the others who have received the earlier messages. However, I also want to encourage the audience to weigh in if they have opinions or to let us know if they don't want to receive any more of these messages. Lord knows, we all get much more than we want from the Internet these days.

My first reaction to your response is that – even though you stated that you "very much disagree" with me – the statements you make for the most part agree with my own positions as stated in my earlier message. Let me be specific, both on issues where we agree and differ. Below are statements you make ([indented] and in quotation marks), followed by my position.

" First, There are possible uses for medical marijuana. The AMA has a report and statement. You can find this report on their web site and search for medical marijuana and then find the CSA report full text. You could also go to http://www.ama-assn.org/ama/pub/article/2036-6124.html This report has 194 references. The report and AMA resolution recommends research and delivery systems other than smoking. Marijuana , if found effective, should be treated as any other drug and available by presciription (sic), probably as a controlled substance, but not necessarily schedule 1. Most reported benefits of medical marijuana have little evidence and often the side effects are very troublesome. The Institute of Medicine report again urges research, trying to find active ingredients that are effective and alternative delivery systems. They do not advocate anyone who feels marijuana may help them for just about anything using it."

We agree that there are possible medical uses for marijuana.

We agree with the AMA and the IOM, who support more research on medical marijuana. (I also listed in my earlier memo seventeen other national medical organizations, twelve state medical associations and national commissions in six other countries which have taken the same position.)

We agree that marijuana should be available by prescription, and we agree that it not be continued as a Schedule I drug. In fact, I believe that one of the biggest weaknesses of existing state marijuana programs is that they do not provide for a centralized supply of medical cannabis, but simply allow patients or caregivers to grow this medicine once they are approved. Last year's GAO report on state medical marijuana programs stated that many people (with HIV/AIDS, cancer, MS and other conditions that would benefit from medical cannabis) have not been able to access it in a timely manner because of the lack of a centralized supply of medical cannabis available by prescription.

However, we disagree that the benefits of medical marijuana have "little evidence" and that "often" the side effects are very troublesome. Among many existing references, I would refer you to last year's GAO report (http://www.gao.gov/new.items/d03189.pdf), and the summary of the two year study conducted by the Canadian Senate report recommending that country's medical cannabis program be expanded (http://www.medicalmarihuana.ca/pdfiles/senatesummary.pdf) (The full Canadian report is over 700 pages long.) There are also several other web-sites which address medical cannabis issues in detail that would be useful to review. These include the Science of Medical Marijuana (http://www.medmjscience.org/), NORML's summary of medical marijuana issues (http://www.norml.org/index.cfm?Group_ID=3472), and an organization, Americans for Safe Access, that is focused on assisting eligible patients to access medical cannabis without risking prison (http://www.safeaccessnow.org/)

As a physician, I imagine that you are aware that all eight U.S. states that have approved medical cannabis programs (as well as the other countries with similar programs) have identified benefits of medical cannabis use for persons with cancer, HIV/AIDS, multiple sclerosis, glaucoma and chronic pain. For a more comprehensive list of medical conditions for which medical cannabis use has been shown to be beneficial, I would also recommend that you visit the web-site of David Hadorn, MD, PhD. Dr. Hadorn has worked with hundreds of medical cannabis patients in California and his web-site does an excellent job of covering many of the medical practice issues that you may be concerned with (http://davidhadorn.com/). Dr. Hadorn's research and medical practice has demonstrated the benefits of medical cannabis in the treatment and amelioration of symptoms of a wide-ranging list of medical conditions (the following list is not exhaustive):

Now back to your memo:

"The AMA and most medical groups are in favor of treatment and not prison. But your letter really knocked treatment. You talked about adolescents being forced into unnecessary treatment. I am not sure anyone is advocating adolescent marijuana use. I have been in family practice for 30 years and have seen the lives of hundreds of teens ruined due to pot smoking. Their grades go down, they drop out of all extra activities and often on to other drugs. Many are still using 20 years later and their lives are often in shambles. Most parents just sit by and watch this happen but a few make it clear to their teens that continued marijuana use is not acceptable and if they continue they will have to go into treatment. Also many are arrested for other things and treatment is presented as an option to jail. You are suggesting that none of this treatment is necessary."

Both you and I agree with the AMA and most medical groups that treatment is preferable to prison.

In addition, both you and I agree that adolescent marijuana use is inadvisable for many reasons. In reviewing my letter, however, I don't find any statement that suggests that I "knocked" treatment. On the contrary, I indicated that I had established and run the largest alcohol crisis center in Wyoming and that my substance abuse epidemiological research had helped influence that state's legislature to increase its substance abuse reduction funding 40-fold, much of which went into expanding treatment services. I did not mention that I have also conducted the largest substance abuse treatment outcome study ever attempted in the U.S. (The Alabama Substance Abuse Treatment Outcome and Process (STOP) Study), which tracked over 11,000 state-supported treatment clients in that state and which helped distinguish those AL treatment centers that were having a positive behavioral effect on their clients from those (unfortunately too many) AL treatment centers whose treatment effects were negligible or nonexistent. I am very much in favor of expanding treatment services for all populations that need them. (You can find references to these and other studies I have conducted on my web-site: www.bernardellis.com ) At no time did my memo indicate that "none of this treatment" is necessary.

I agree with you that some teens' (and adults') lives are ruined by marijuana use. However, my belief is that, for many of them, the negative life-long consequences they face have more to do with the criminal records they receive if they are caught using marijuana than from any long-term health or addiction problems that they develop. If teenagers are caught using alcohol or tobacco (both of which are illegal for them to use), relatively few face the prospect of a court-mandated treatment episode and systemic labeling of them as "drug addicts", even though both of these substances have much more serious immediate and long-term health and social order consequences for their users, and a much greater likelihood of developing a dependence on the substance (according to the 1999 study from the Institute of Medicine and all reports from the "Monitoring the Future" studies and the National Household Surveys on Drug Abuse). Unfortunately, adolescent pot smokers are often saddled with mandated treatment and a lingering criminal record, both of which sometimes bring serious iatrogenic consequences, only for using marijuana in the absence of "other things", by which I presume you were referring to other criminal activity.

I do not mean to discount your own clinical experience. Nor do I disagree that some people develop a dependence on marijuana which can be difficult to overcome and which brings with it negative consequences. However, tobacco use is a much more serious health risk and my own epidemiological research suggests that it is much more difficult to overcome. In my study of over 1,000 childbearing age women in Wyoming who were seen in both public and private health clinics (this study is also available on my web-site), over 90% of the women who had ever smoked tobacco were still using it, over half who had ever used tobacco said that they had been dependent on tobacco and slightly under half who had ever used tobacco were currently dependent on it.

On the other hand, around 40% of women in my study who had ever used marijuana were still using it (and this is probably because we had enrolled a relatively young study population). In addition, only 8% of the women who had ever used marijuana said that they had ever been dependent on it, and only 4% stated that they were currently dependent on it. In this study population, among "ever users" of marijuana and tobacco, current marijuana use declined sharply with age, while current tobacco use did not. This research would suggest that early intervention and mandated treatment would be more beneficial (and necessary) for the young tobacco smoker than for the young marijuana smoker. However, the reverse is true with our current drug control policies. By the way, over half of our study population was currently pregnant and tobacco use is one of the leading causes of miscarriage and stillbirth. Should we have locked up all of those women who could not stop smoking cigarettes while pregnant, despite their awareness of the health risks to their unborn children, in order to prevent the serious harm that could result from their maintaining their addiction? I certainly would not be in favor of that approach, and would also not be in favor of locking up the current marijuana users in that study population (a risk that all of them faced), though the risks of perinatal marijuana use are not nearly as well-documented.

To repeat, I do not favor adolescent use of any potentially harmful substances and I am strongly in favor of expanded early intervention and treatment services for both adolescents and adults who are powerless over their dependence on alcohol, tobacco and other drugs; and whose lives have become unmanageable as a result. However, the fact that almost half of all adolescents who now enter substance abuse treatment in this country do so for marijuana use (most of them court-ordered for doing nothing more than using marijuana), while fewer than 7% of adults enter treatment for marijuana dependence, suggests that we are devoting many more treatment resources and scarce treatment beds now to treat a behavior (marijuana use) which is much more temporally self-limiting than either alcohol or tobacco use and which is much less a health or social order risk than either alcohol or tobacco.

Now to your final points:

"Finally you attack the Bush administration for the tight control on marijuana and also on research for marijuana. I agree that more money needs to be spent for research Oral marijuana is already available for HIV patients. More research needs to be done. In defense of Bush, how can you advocate more money for research when some advocates of medical marijuana could care less. The medical marijuana laws of some states only require that the physician suggest you use it and for almost anything. How many patients in California who use medical marijuana have tried oral prescription marijuana first. The pro marijuana community sometimes appear against oral marijuana or against any restrictions. I wish they would advocate for more research and agree with the AMA that it should only be used for conditions where it is clearly shown to work, and where other drugs are not available or useful. Finally I am not aware of any terminally ill patient in our area who was arrested for smoking marijuana, but there are plenty of people with other ills and who are using other illegal drugs who have been."

Again, we both agree that more time and effort needs to be given to medical cannabis research. However, I am critical of the Bush administration (and all others that preceded Bush since the mid-70s) which continues to block medical cannabis research. No U.S. researchers are currently being allowed to study medical cannabis without being forced to use the highly inferior product being produced by the DEA's pot farm at the University of Mississippi. Those researchers that have tried to establish their own cannabis production facilities have been blocked at every turn. The best documented case involves the three year effort at the University of Massachusetts at Amherst to establish a medical cannabis production facility, a research activity that the DEA continues to fight (http://www.maps.org/mmj). However, medical cannabis researchers, particularly those in California, can cite many other examples of the federal government's heavy-handed interference with needed research.

At present, there is no oral marijuana medicine that is legally available in the U.S. I presume you are referring to Marinol, which contains a synthetic form of THC. Marinol does have some positive medical effects, but it has been shown to be less effective than natural marijuana in several clinical trials (conducted outside the U.S.), perhaps because natural marijuana contains over 50 other bio-active substances besides THC and perhaps because synthetic THC is less efficacious than naturally derived THC. Besides its relative ineffectiveness, Marinol is sixteen times more expensive than equivalent doses of medical cannabis, which severely limits its availability under many current U.S. medical insurance programs. (By the way, my major criticism of the current Canadian and Netherlands medical cannabis programs, which currently provide the medicine through pharmacies (or are moving to do so) is that they are charging the same prices as the illegal markets charge for high-quality marijuana. There is no reasonable justification for maintaining the high costs of medical cannabis in these countries, since most of that cost is the result of the scarcity and risks associated with the illegal markets, not what high-quality medical cannabis would actually cost to produce.)

It is easy for both of us to recommend more money for research, as the U.S. government has spent almost nothing over the past four decades to support this research. However, I think many medical cannabis advocates believe that the current research base (again, primarily conducted outside the U.S.), as well as the experiences of many thousands of sick people in the U.S. whose lives have been improved by using this medicine, would support greater legal availability of medical cannabis now – rather than waiting many more years for our belated research efforts (which – again – are still being actively blocked by the Bush administration) to confirm what international research and the experiences of many patients and medical practitioners already have demonstrated.

As far as promising approaches to making medical cannabis more available, I am very strongly supportive of the efforts of G.W. Pharmaceuticals, a British company which is manufacturing and researching medications that are distilled directly from several medically beneficial strains of cannabis. This company (whose research can be accessed at http://www.gwpharm.com/ ) is developing alternate delivery systems for this medicine, including aerosolized cannabis tinctures, that have demonstrated both efficacy and safety in this company's clinical trials. However, most medical cannabis patients and advocates are already familiar with alternate methods for delivering this medicine, including the use of vaporizers which allow the bio-active components to be inhaled by heating (without burning) cannabis to release the medically useful oils. Regardless, I strongly support G.W. Pharmaceuticals' research and efforts to bring cannabis-derived medicines back into the available pharmacoepia and wish them better success at accessing the U.S. and other international markets than they have experienced thus far.

Your last point, that you are

"... not aware of any terminally ill patient in our area who was arrested for smoking marijuana ...,"

is something I cannot comment on directly. However, the New York state legislature's own deliberations this past year regarding establishing a state medical marijuana program included many testimonials from sick New Yorkers (and their caregivers) who have experienced harassment and arrests for using this medicine. I would refer you to Assembly member Dr. Gottfried, the sponsor of A05796 and to Senator Montgomery, sponsor of the parallel S04805 – New York's medical marijuana bills currently being deliberated. I would also refer you to the NORML New York chapter or to Americans for Safe Access, both of which can give you many stories of state and federal prosecution of medical cannabis users in your state.

I would also strongly recommend that you review the experiences of the hospice patients at the Wo/men's Alliance for Medical Marijuana in Santa Cruz, CA, who were shackled to their beds and taken to jail last year when the DEA raided this state-approved program. (http://www.wamm.org/) I would also recommend that you review the case of Don Nord in Colorado, a state-approved medical cannabis user (who takes 20 other medications daily for cancer, diabetes, phlebitis and other medical problems), whose house was ransacked and whose cannabis was seized by the DEA. (While a Colorado judge has ordered the DEA to return Don's cannabis plants, the DEA still refuses to do so.) Finally, you should review the recent federal appeals court decision regarding two very sick California medical cannabis patients, Angel Raich and Diane Monson, whose medical cannabis was seized and who were arrested for violating federal marijuana laws. The 9th Circuit ruled that the DEA violated the 5th, 9th and 10th amendments to the U.S. Constitution by prosecuting these very ill women. (To check out the decision go to http://www.ca9.uscourts.gov/ and click on "opinions" at the upper left. Then select "Raich vs. Ashcroft")

Finally, I want to remind you that, although I have a spotless criminal record, a strong three decades-long professional career devoted to combating serious substance abuse in this country (including the alcohol and tobacco industries, who still maintain a stranglehold on our local, state and national governmental bodies) and a decade-long history of providing medical cannabis without charge to sick people in my community; I now face a 2-5 year prison sentence and the loss of my farm (if I cannot come up with $200,000+ in the next 45 days) simply for the charge of manufacturing cannabis. I have already lost the right to vote, to serve on juries and to pursue my professional public health career by accepting a guilty plea for this offense. I may not live in New York, but my own story has been repeated all-too-often in recent years in most states across this country.

In closing, I want to remind you (and the readers) of this response that you and I agreed on most of the issues that you raised in your response to my December 1 response to Betsy Mellinger's original memo. Where we disagree, I hope that I have provided sufficient documentation to allow you and the other readers to review the basis for my positions. I do hope that if nothing else comes out of my prosecution and imprisonment, my experience will illustrate the badly distorted drug control policies that our country currently suffers under and the waste (in human lives and potential and in resources to fight serious crime in this country) that our continued persecution of cannabis users represents.

Have a restful holiday season, and live (respectfully) one day at a time. That is all we are promised. Today, I am free to spend the rest of this day cutting firewood for some neighbors in need and to sleep in my own bed, on my farm of 3+ decades. For all of those things, I am grateful. Take care.

Bernard H. Ellis, Jr., MA, MPH