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Supreme Court Rules Against Medical Marijuana

Justices Say Federal Government Can Prosecute in States That Have Legalized Medical Marijuana

Marijuana as Medicine

Though it is not a direct part of Ashcroft v. Raich, the question of marijuana's status as legitimate medicine -- and not just as an abused drug -- has always been at the center of the debate. Many patients, like Raich, call the drug a lifesaver for its apparent ability to ease chronic pain and other disabling symptoms from certain chronic conditions.

According to court documents, Raich suffers from scoliosis, fibromyalgia, endometriosis, a brain tumor, and several other chronic conditions. "I owe my survival and my ability to lead a relatively normal existence to medical marijuana," Raich wrote on a web site dedicated to her case.

Frank Henry Lucido, MD, Raich's primary care physician, testified in court papers that she would suffer "imminent harm without access to cannabis" because of chronic pain, seizures, and an inability to tolerate most prescription drugs.

Other patients extol marijuana for its ability to quell nausea and vomiting of the kind often associated with cancer treatments. AIDS patients have long used the drug for its appetite-stimulating effects that can combat severe weight loss known as wasting.

A report issued by the Institute of Medicine acknowledged the ability of marijuana's active ingredient, THC, to provide pain relief, control nausea and vomiting, and to stimulate the appetite. But the group stopped far short of endorsing the drug as a medical treatment, noting that "smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances."

Debating the Role of the FDA

Medical marijuana opponents say that any of the drug's potential benefits can be realized by prescription forms of THC. One drug, Marinol, is available in the U.S. A liquid form, known as Sativex, was approved in April in Canada.

Opponents of medical marijuana also caution that states passing medical marijuana laws or popular ballot initiatives are dangerously bypassing the FDA.

The agency is set up to systematically review the risks and benefits of drugs using scientific evaluations that the public cannot access on its own, says Richard L. DuPont, MD, a professor of psychiatry at Georgetown University and former White House Drug Czar from 1973 to 1978.

"For a hundred years, we have worked out a system that is designed to protect the public health based on efficacy and safety. The idea that you would have medicines approved by ballot initiative is really frightening to me in terms of the public health," says DuPont, who co-authored an amicus brief supporting the Bush administration in the case.

Others, including California's biggest doctors' group, see the threat of federal drug raids as an inappropriate intrusion into the physician-patient relationship.

"We think that there's still a lot to learn about the efficacy of medical marijuana. But the government was deciding on behalf of doctors and patients what the appropriate care is, and that is inappropriate," says Jack Lewin, MD, a family physician and CEO of the California Medical Association.

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