June 6, 2005 -- The federal government may prosecute patients who use marijuana even in states with laws allowing medicinal use of the drug, the Supreme Court ruled Monday.
In a 6-3 decision, justices supported the Bush administration argument that the federal Controlled Substances Act (CSA) trumps state laws when it comes to regulating controlled substances, even though some patients may suffer without the drug. "The CSA is a valid exercise of federal power, even as applied to the troubling facts of this case," Justice John Paul Stevens wrote for the majority.
The case, known as Ashcroft v. Raich, was one of the most closely watched Supreme Court suits this year. A ruling against the federal government would have had far-reaching legal implications but also would have been a major blow to aggressive White House antimarijuana policies.
What the case won't do is settle the question of whether marijuana is an effective medicine at all, or if so, whether voters or even state legislatures should be allowed to take on medical treatment questions usually reserved for the FDA.
The suit came after two California patients, Diane Monson and Angel Raich, went to court to prevent federal officials from arresting them for using marijuana under the state's 1996 law allowing medical use. A 2003 federal appeals court ruling in the patients' favor was quickly appealed to the Supreme Court, which heard oral arguments in the case last November.
White House Reaction
The Bush administration declared the ruling a victory Monday. White House officials have long argued that allowing states to classify marijuana as medicine undermines clear antidrug messages aimed at youth.
"Today's decision marks the end of medical marijuana as a political issue," says John P. Walters, director of the White House Office of National Drug Control Policy.
"Smoking illegal drugs may make some people 'feel better.' However, civilized societies and modern day medical practices differentiate between inebriation and the safe, supervised delivery of proven medicine by legitimate doctors," Walters says, in a statement.
Supporters of medical marijuana say the decision changes little in the 10 states that already allow qualified patients to use marijuana under a doctor's supervision. Another state, Maryland, allows defendants to use medical necessity as a court defense.
Just 16 federal raids on medical marijuana growers have taken place since 1996, all of them on large growing operations of 500 to 1,000 plants, according the Drug Policy Alliance, a pro-medical marijuana group.
"Legally nothing is different today than before Raich. The million dollar question is whether the fed government is going to all the sudden change the way it does business and start going after these individual sick people and their caregivers," said Dan Abrahamson, the group's director of legal affairs.
Several states, including Alabama, New Mexico, Connecticut, and Wisconsin are considering new medical marijuana exemptions. Monday's ruling could cause those states to think twice before going against federal drug policy backed by a fresh Supreme Court decision upholding it.
"I think there might be a potential chilling effect for awhile," Abrahamson says.
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.
Other cases testing the legality of marijuana are likely to follow. In another case currently in federal court in California, activists are trying to show that the Constitution gives patients the right to ease their suffering with now illegal marijuana.
"Raich will not be the end or the final work in the federal courts," Abrahamson says.