The Medical Use of Cannabis in California
States Approve Medical Marijuana
The use of marijuana, medicinal or otherwise has been illegal under federal law since 1937. Only Dronabinol, a synthetic pharmaceutical preparation of THC (tetrahydrocannabinol), a major active ingredient in marijuana, is currently approved for use as a Schedule I drug in the United States. As the federal laws have not allowed the use of cannabis as a legal medicinal prescription, several of the states in the US have sought an alternative route to ensure that patients with a need for its properties have access to it without penalty. As of 2013, 20 states – Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington – have approved of and regulate the medical use of marijuana. Each state has its own guidelines for use, including a specified list of medical conditions for which its use is approved, and the amount that can be grown, and possessed.
In November 1996, the voters of California passed Proposition 215, the “Compassionate Use Act of 1996.” The purposes of the act were “to ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person’s health would benefit from the use of marijuana….and to ensure that patients and their primary caregivers who obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal prosecution or sanction.”
According to a survey on the recommendation of cannabis in California, cannabis is indicated for over 250 conditions. The 20th annual report of the California Research Advisory Panel (1990) recommended that personal use and cultivation of marijuana be legalized: “An objective consideration of marijuana shows that it is responsible for less damage to society and the individual than are alcohol and cigarettes.”
A new state law took effect on Jan. 1, 2004, SB420, which protects Prop 215 patients from arrest provided they cultivate no more than 6 mature or 12 immature plants and possess no more than 8 ounces of dried marijuana. Many counties and cities have established higher guidelines than this state minimum.
Physician Guidelines in Recommending Marijuana
There was no good precedent to aid the physician in review of a patient’s need for medical marijuana and to make this recommendation legally known. Since cannabis was still illegal to prescribe by federal law, the advent of the physician “Recommendation” became a solution. In this case the physician recognizes the patient’s need for marijuana, advises in favor of its use, but is not able to “order” it for the patient as one would for a drug from a pharmacy. Nevertheless, guidelines for the recommending of marijuana have followed many of the same guidelines as those for pharmaceuticals. Before a physician prescribes a pharmaceutical the physician must advise the patient of the drug’s risks and benefits, so that the patient can make an informed decision as to whether or not to take the substance. Therefore, as with any medicine, the physician makes up to one year “recommendations”, and has follow-up visits with the patient to review the efficacy of the substance and monitor its effect on the patient’s health.
In January 1997 the Medical Board of California published standards for physicians when recommending medical marijuana. According to the board’s new statement, consultation should include:
- History and good faith examination of the patient
- Development of a treatment plan with objectives
- Provision of informed consent including discussion of side effects
- Periodic review of the treatment’s efficacy
- Consultation, as necessary
- Proper record keeping that supports the decision to recommend the use of medical marijuana
In May 2004 the Medical Board adopted a statement clarifying the implementation of California’s Compassionate Use Act to insure that California’s physicians and consumers receive appropriate guidance under the law. This provided that the recommendation of medical marijuana by physicians in their medical practice will not have any effect against their physician’s license if they follow good medical practice.
What makes California Unique in Marijuana Recommendation.
The stipulations of the states’ medical marijuana acts give California the most leeway due to the following distinctions –
Covered conditions – cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma arthritis, migraine, or any other illness for which marijuana provides benefit. Other states stipulate similar specified conditions, but require state approval for other illnesses, if such a clause exists at all. Consequently, the range of covered conditions for which marijuana is approved in California is the widest in the country. It is generally estimated that 40% of patients in CA have a diagnosis of chronic pain. Our work at MediCann Inc. supports this finding, with low back pain topping the list.
The state guidelines for most states restrict possession to the level of 1 to 3 ounces of marijuana. Two states, Oregon and Washington allow up to 24 ounces. The California state limit is 8 ounces, but, many counties have allowed greater than the state minimum, up to 3 pounds. The greatest population of patients having access to higher levels of product is, therefore, found in California.
Current estimates are 500,000 medical marijuana patients in California. The Drug Policy Alliance estimated a minimum of 115,000 registered patients in the US in 2005, of which 100,000 were in CA. Therefore approximately 80% of all registered medical marijuana patients were estimated to be in California! And this number is rapidly expanding. The concentration of medical marijuana patients varies between different regions of the state, being highest in Northern California, coincidentally where local county law is more favorable toward medical marijuana cultivation and possession.