Medical Marijuana Use

The following research paper was my work effort for certification towards Drug and Alcohol Counseling.   I have considered the marijuana issue from a historical perspective and focus of  labeling  drug products and users.  Alcohol is a drug just like marijuana.  Today, common popular views of alcohol use are quite different than the legal and socially acceptable views of marijuana use.

This is an example of my professional research writing and interpretation of controversial and pertinent issues that every American citizen questions while discussing our laws and acceptable behavior. I have tried to examine and present a balanced report of a controversial subject.


Medical Marijuana Use by Elizabeth A. Pula

University of Nebraska, Kearney, 2010

Medical Marijuana Use

A January 2010 ABC news poll shows that 81 percent of Americans believed that medical marijuana should be legal in the United States.  This is popular public opinion, even though cannabis is a Schedule 1 substance and an illegal drug according to federal law in the US (Langer, 2010). In a 2009 article for Huffington Post, Ryan Grim reports that US Attorney General Eric Holder stated:

“It will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws of medical marijuana, but we will not tolerate drug traffickers who hide behind claims of compliance with state law to mask activities that are clearly illegal (Grim, 2009).”

Cannabis is illegal, since the passage of the 1970 Controlled Substance Act. However, since the 1970’s, states have been decriminalizing the substance according to individual state laws.  As a result, there are differences in enforcement of the state and federal legislations. Presently, there are many differences in opinion and in interpretation of existing cannabis laws on the local, state,and federal levels in the US.  Surprisingly, there are many issues about prohibition of marijuana during the last forty years that are similar to issues during the early 1900’s about prohibition of alcohol.  These issues, especially, revolve around facts relative to both substances being a “drug”, and both “drugs” having significant economic impact because of illegal and legal use.

Prohibition of alcohol, during the Great Depression, created a black market economy in the US for alcohol, in direct competition with the formal economy.  Alcohol was made at home. Stores sold products to support the home production.  Gangs profited from illegal interstate commerce.  Consumption of alcohol was illegal in public bars.  When prohibition was repealed, organized crime lost substantial profits to legal breweries and legal vendors.  After prohibition, states and federal government gained tax revenues, rather than incurring losses because of costs to enforce prohibition (“Prohibition in the United States”, n.d.).

Alcohol is no longer a black market product, and has been transformed into a popular consumer product rather than a “drug”.  Regardless of popular opinion and legislation, alcohol and marijuana are medically-defined drugs. Passage of the twenty-first amendment to the US Constitution repealed prohibition of alcohol. The change in federal legislation confirmed the state right to restrict or ban the purchase or the sale of alcohol.  Alcohol is still considered a drug, but is not regulated as a controlled substance according to federal law by the DEA or the FDA.

During the time period of the early 1900’s through the mid 1930’s, there were extensive economic and social changes in the entire US.  As a new pharmaceutical industry and new medical associations became influential; drugs were evaluated, controlled and prescribed differently.  Alcohol used to be prescribed by physicians. Physicians and pharmacists compounded individual medicines, using alcohol as the soluble base.  At that time, there was no pharmaceutical industry.  Alcohol does have specific therapeutic benefits.  Prior to repeal of prohibition, alcohol was known as an ancient therapy.  It had been used through the 19th century and during the 20th century as the prescribed medication for many medical symptoms such as anemia, high blood pressure, and heart disease.  Today, these medical symptoms are treated by many differing non-prescribed and prescribed medications, and surgery.  Treatment of medical symptoms changed.

The new pharmaceutical industry developed new and diverse consumer products. Alcohol was a popular medicine because of low cost and availability.  Until the 1930’s, physicians prescribed whiskey and brandy for medical symptoms.  A common dosage for an adult was about 1 ounce every 2-3 hours, for a child from 1/2 to 2 teaspoons every 3 hours.  As the pharmaceutical industry developed, physicians no longer prescribed, or used alcohol. Alcohol exited the drug prescription category and became a consumer product of the legal economy. The drug, alcohol, had an established prior medical use and extensive black-market business infrastructure, prior to becoming a legal consumer product (“Prohibition in the United States”, n.d.).

Prohibition of marijuana has created a similar black market economy.  In spite of federal law, that cannabis is illegal throughout the US, 14 states – Alaska, Colorado, Hawaii,New Jersey, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington – allow and regulate medicinal use of marijuana.  Three states – Arizona,Massachusetts, and Maryland – explicitly ban any use of marijuana, but have decriminalized medical use as a no-jail offense with a maximum penalty of $100 fine (“Legal history of cannabis in the United States”, n.d.).

As an illegal, black market product, cannabis is believed to be California’s number one cash crop. The cannabis crop is estimated at least at $14 billion, by far larger than vegetables ($5.7 billion), and grapes ($2.6 billion) produced and exported from the state annually (Stateman, 2009). Proposed 2010 state legislation intended to legalize and regulate marijuana to put infamous drug cartels, out of business, improve safety standards, allow for more open research about the drug, with possible economic stimulus of  $12-18 billion, and with potential increase of $1.4 billion state tax revenue (McLaughlin, 2010).

Since the 1930’s, the states complied with federal legislative authority for cannabis and alcohol. It has only been since the 1970’s federal prohibition of marijuana, that there has been a slow process of decriminalizing marijuana use by the states. The DEA acknowledges medical marijuana only as a pharmaceutical licensed product derived from THC. This product is prescribed by medical practitioners as legislated by existing state and federal laws.  After the 1970’s federal prohibition of marijuana, the process of state decriminalizing use of marijuana is to allow medical marijuana in the form of a “smoking” agricultural product. The real trend in state laws to allow “smoking” of marijuana as a medical use occurred after passage of the California 1996 Compassionate Use Act (Proposition 215).  State laws have been changed based on consensus from anecdotal reports that “smoking” marijuana is more effective for relieving differing medical symptoms without significant undesirable side effects. The pharmaceutical licensed marijuana product has anecdotal reports of significant undesirable side effects (“Legal history of cannabis in the United States”, n.d.).

Business infrastructure for a medical marijuana product, and specifically a medical “smoking” marijuana product is being established in the US, especially in California. The state of California has unionized marijuana growers, unionized retail marijuana dispensary workers. A cannabis business college, two blocks from the Oakland City Hall, has already graduated 7000 business students. There are an estimated 2,000 state approved medical dispensaries, co-operatives, wellness clinics and taxi delivery services in the business sector known as “cannabusiness”. In his 2010 article, McLaughlin notes: “That is more than all the Starbucks, McDonald’s and 7-Eleven outlets in the state put together”.

By 2010, the state of California issued at least 38,000, if not over 100,000 medical ID cards to medical ”smoking” marijuana users, as an optional, voluntary compliance to the state law (Grim, 2009). Noting his concerns about this “cannabusiness” activity in California, Gil Kerlikowske, director of the Office of National Drug Control Policy, mentions “that alcohol federal and state taxes are about $14.5 billion a year, but there are $185 billion in alcohol-related costs ” (McLaughlin, 2010).  This information can be used to determine the economic impact of the alcohol industry, as a legal drug industry, today.

Regardless of negative implications due to any human, social, or economic cost factors,the alcohol industry today is a major contributor to the legal economy.  By adding $14.5 billion tax revenues, and $185 billion social impact revenues, and $60 billion gross industry revenue, a total projected annual revenue that the total alcohol industry creates within the US economy is $199 billion, high-end annual revenues.  By adding $14.5 billion tax revenue, Alcohol Related Health Care Costs for US businesses of $35.8 billion (The Alcohol Cost Calculator for Business [ Alcohol Cost Calculator], n.d.) and  $60 billion gross alcohol industry revenues (Ibisworld, 2009), the amount is $110.3 billion, low-end annual revenues.  The legal alcohol industry contributes somewhere between a high $199 billion and low $110.3 billion cash flow in the US annual economy.

Bio-psycho-social effects of the legal drug industry, as it relates to alcohol use, and the illegal drug industry as it relates to marijuana use, can be determined by comparing individual voluntary admissions to drug treatment facilities.  Voluntary drug treatment admissions for the state of California for “alcohol only” are 26,701, for “marijuana only” are 28,106 of 211,791drug treatment admissions (, 2009). California, with a 2009 population estimate of 36,961,664, is the most populous state of the US (“Oakland California”, n.d.).  Approximately .6% of the California population is admitted for voluntary drug treatment.   Of the reported California voluntary drug treatment admissions,approximately 13% are treated for alcohol only issues, and approximately 13% for marijuana only issues.  Statistically, voluntary drug treatment admissions are similar for alcohol and marijuana only issues. However, the legal alcohol industry does not support legalization of medical marijuana in California.  If there are no significant differences in voluntary drug treatment admissions as a result of use of either drug, why not? The reason could be based on a perceived threat to drug industry market share (Tvert, 2010).

The increasing trend in illegal use of marijuana, as a “smoking” medical and non-medical product may be the more real threat to the legal liquor industry, legal US economy, US Public Health, and the legal world economy.

As each individual state in the US legislates medical marijuana, especially California, having the highest population counts, each state may really need to consider facts beyond state borders.  Recent media headlines focus on some of the immediate costs of the world illegal marijuana black market and some of the costs of the legal medical marijuana market.  In 2010, the estimated Mexican cartels earn between $25 to 40 billion dollars per year; in 2009, harvested Mexican marijuana acreage was 29,652 acres compared to 10,130 acres in 2001. In the US, retail price for legal medical marijuana sold is $5,500 to $7500 lb.; wholesale costs about $4000 lb.; if grown independently, $750 to $1,000 lb. (Havocscope website, n.d.).

As reported in the 2010, UN World Drug Report, marijuana is the most traded and used illicit drug in the world. Approximately 5% of the world’s population uses it. In 2010, 11% of the US population over the age of 12 uses cannabis annually; 28% of people 18-25 (United Nations Publications, 2010).

In 2010, the World Bank estimates the World GDP at $58 trillion, the US GDP at approximately $14 trillion and the World Exports at $13 trillion (United Nations Publications, 2010, 2006, 2005).   The World Black Market is estimated at $1.3 trillion. The world illicit drug industry is estimated at $411.4 billion The world illicit trade in cannabis is estimated at $141.8 billion.  The percentage of $141.8 billion to $1.3 trillion is approximately 11%. (Havocscope website, n.d.)

In 2010, the World Cannabis Black Market is approximately 11% of the total World Black Market. The World Black Market is equal to 10% of the legal World Exports and also equal to10% of US GDP. (Havocscope website, n.d.)

The Black Market Trade, especially cannabis trade, may be affecting the world economy significantly.  The illegal trade in cannabis is a significant world trade illegal drug industry.  It is practically equal to total legal US alcohol industry revenues. The legal alcohol industry is 1% ofthe US GDP for 2009 (“List of countries by GDP (nominal)”, n.d.).  And, the world illegal cannabis industry is also up to 1% of the US GDP. As significant portions of the legal world economy are stagnating, the black market in cannabis and the World Black Market has increased approximately 25%. This is an approximate increase of 25% over a seven-year period.  The bio-psycho-social costs to the legal US economy and world economy can very well become more significant over the next seven year period.

The ending of prohibition of alcohol allowed alcohol, a drug, to be available on the open market for consumer use, without patent rights assigned to specific pharmaceutical companies, and without prescription by the medical professional.  Today alcohol, one drug, supports up to a legal $180 billion, US homeland based industry. The production, sale, and consumption of alcohol is a drug industry. This specific drug industry has positive and negative bio-psycho-social effects within the society.  All industries create and cause similar positive and negative effects within societies.

In 2010, major medical “smoking” marijuana issues are being examined according to state laws. During the 1930’s federal legislation changed state right laws, medical rights of physicians, medical rights of the public, created a new pharmaceutical industry, and separate specific alcohol drug industry. Physicians who want the right to prescribe “smoking” cannabis may or may not support its legalization for use without a prescription. Physicians in the early 1900’s who wanted the right to prescribe alcohol were not all in favor of repealing prohibition of alcohol. Physicians were united in their opposition to what they saw as unwarranted government interference in the practice of medicine. The differing public activity and state actions to support use of medical “smoking” marijuana are forcing legal and operational business infrastructure to change at the local levels, especially in California. Many of these activities are not focused on medical issues at all, but are building business infrastructure. The state support of production, sale and consumption of medical marijuana, “smoking” marijuana, could cause federal re-evaluation of all legislation affecting the drug industry, including the alcohol industry, the legal status of medical marijuana and illegal marijuana industries, and the US Public Health System.

Various national agencies and organizations view medical marijuana use differently.  The California Medical Association and the American Medical Association have separately called for more research on marijuana:

The CMA consider the criminalization of marijuana to be a failed public healthpolicy; and be it further resolved that CMA encourage and participate in debate and education regarding the health aspects of changing current policy regarding cannabis use (“Legal history of cannabis in the United States”, n.d.).

In 2008, the American College of Physicians declared their position on medical marijuana, while noting that marijuana has been smoked for its medicinal properties for centuries, and that smoking may be a crude form of delivery:

“ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws… Marijuana has been smoked for its medicinal properties for centuries. Pre-clinical, clinical, and anecdotal reports suggest numerous potential medical uses for marijuana (American College of Physicians, 2008, p.1).”

The DEA notes there is legal medical marijuana and that there is no consensus of medical evidence that “smoking” marijuana helps patients.  The FDA has not approved “smoking” marijuana for any condition or disease.  So, in the popular, medical and official arenas, the medical “smoking” marijuana issue complicates the most basic use issues of any “medical” marijuana use.

In 2010-2011, the legislature of the State of California may still review proposed legislation, Marijuana Control Regulation and Education Act (A.B.2254).  This is the first bill to regulate the general sale and general use of marijuana in California.  This proposal is a bill to regulate and tax marijuana in a manner similar to alcohol, which exits marijuana from the status as a medical-use prescription product and positions marijuana to be sold as a state regulated consumer product.  This is highly significant legislative change, because the proposal changes medical marijuana use from a prescribed drug to enter use as a consumer product for general adult population use.

Proposition 19, on the California popular ballot this November 2010, did not pass the popular vote to “legalize the possession and cultivation of limited amounts of marijuana for personal use by individuals age 21, or older, and authorize various commercial marijuana-related activities under certain conditions”(“Marijuana Control, Regulation, and Education Act”,n.d.).  The state acknowledges that the “activities would continue to be prohibited under federal law, and it is not known to what extent” (“Marijuana Control, Regulation, and Education Act”,n.d.) federal enforcement would take place, and additional revenue from taxes, fees, and assessments would be allowed for marijuana-related activities. The popular vote would also have allowed marijuana to become a consumer product for general adult population use, rather than just continue use as a prescribed medical, agricultural source product.  California State legislative regulations are setting precedence that “smoking” marijuana from an agricultural product is medical use. This in-fact use can set precedence that defines medical use of “smoking” marijuana for the US.

Ironically, any legal change to allow production, and trade is based on the same reasons for prohibition.  In 1913, marijuana was originally prohibited because of agricultural labor conflicts, between large and small farms, and because of Mexican laborers bringing the substance into California.  The rest of the US passed similar legislation within approximately 10 years.

The A.B.2254 and Proposition 19, both indicate highly significant attempts to legislative change. Both of these proposals change medical marijuana use from a prescription only federally licensed drug to general adult use directly from an unregulated agricultural product. California regulations already allow adult medical prescription use of “smoking” marijuana, and limited licensing of approved growers and distributors.  A.B. 2254 would allow marijuana to enter general market sale as a consumer product, similar to the drug, alcohol, rather than remaining only in-fact a medically prescribed drug. There is a legal business infrastructure that supports production of legal medical marijuana, but there is also an illegal world trade infrastructure, now equaling almost 10% of the US GDP, that contributes significantly to the world black-market promotion of illegal marijuana use. The shifts to increasing black market trade and shifts in legislative change that are applicable to the drug, marijuana are similar to initial shifts that legalized the drug, alcohol.  A drug, once prescribed, and sold on the black-market, today generates a cash flow of up to $180 billion in the US legal economy. It remains to be seen what will happen to the status of the drug, marijuana, and legal medical use of marijuana,in the US.  Once again, one drug, and one state could very well cause considerable change to affect the US Public Health system, and US drug policy.


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2 thoughts on “Medical Marijuana Use

  1. I’m not sure what you are hoping that I will go along with…. However, your comment doesn’t seem to be too misleading in any direction.
    Medical marijuana, when legal, is available for appropriate treatments. It is important to respect the law, and reasonable attempts to
    provide reasonable treatments to people who need it.

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