Medical Marijuana: From the Fringe to the Forefront

It's a rainy mid-March afternoon in Annapolis, MD, dimming the grandeur of a Lowe House Office Building hearing room as state Delegate Donald Murphy makes a case for a bill before an incomplete but sufficient-for-a-quorum portion of the House Judiciary Committee.

These sorts of hearings are almost purely for show, an opportunity for the public to get a word in on bills whose fates will be decided in other, less public circumstances. Still, fellow legislators make a point on commending Murphy (R-Baltimore and Howard counties) for his courage and vision in sponsoring House Bill 1222, the Darrell Putman Compassionate Use Act, which would protect from state imprisonment Marylanders who can prove they smoke marijuana to alleviate the pain and nausea associated with numerous medical conditions and their treatments, primarily AIDS and cancer. The bill is named for a Frederick resident who found marijuana eased the side effects of chemotherapy for non-Hodgkins lymphoma, a form of cancer. Shortly after Putman passed away, Murphy filed the measure. This is the third year he has done so; the first two times, it died in committee.

"As someone who supports the bill, I applaud Murphy's efforts," says Del. Robert Zirkin, a young, dapper-looking Baltimore County Democrat, before launching into a question about the bill's possible conflicts with federal law.

On the other side of the U-shaped formation of wooden tables, Del. Carmen Amedori (R-Carroll County) joins the praise for Murphy, then asks whether insurance companies would be liable to cover the costs for the use of marijuana under the bill. (They would not.)

The medical community itself remains circumspect about the medical value of Cannabis sativa. The American Medical Association remains neutral on the matter. And even if Murphy's bill becomes law, medical users in Maryland would still be looking over their shoulders. The bill passed by the Judiciary Committee on March 23 and the full House of Delegates March 25 (and now awaiting action by the state Senate) would remove criminal penalties for medical use of marijuana, making such possession a civil offense punishable by a nominal fine, with no jail time. But it would not negate federal laws, which do not differentiate between medical and recreational use of the drug. Get busted with a baggie by federal authorities in Maryland -- say, national-park police -- and you will still face the full brunt of the law. Such is the case with medical-marijuana laws already on the books in several states.

That seeming contradiction has not slowed medical marijuana's march from a fringe sideshow of the pro-pot movement to a standalone political issue that has generated support even among staunch law-and-order Republicans. This year's version of the Compassionate Use Act is co-sponsored by 53 of the 141 members of the Maryland House, compared to nine in 2000 and 29 last year. Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington state have passed laws allowing individuals to smoke marijuana for medicinal purposes, and the Vermont and Wisconsin legislatures are considering such measures this year.

In a nation still purportedly fighting a "war on drugs," legislators attach themselves to medical marijuana with no apparent political cost. In discussing his reasons for resurrecting the bill after two defeats, Murphy goes so far as to note, "It's an election year." He cites a study by the Marijuana Policy Project (MPP), a Washington-based advocacy group, which found that 73 percent of Marylanders favor medicinal use of pot. In a poll commissioned by his office in January, 37 percent of respondents said they are more likely to vote for a candidate who supports a patient's right to use marijuana medically, while 18 percent said they are less likely to do so.

Buttressing the numbers are the personal stories that have become part and parcel of the political debate. At the March 13 hearing, Del. B. Daniel Riley (D-Harford County), a co-sponsor of HB 1222, shares a story about a constituent named Larry who was dying of lung and stomach cancer. Riley says he visited Larry numerous times and believes that marijuana might have alleviated the side effects of chemotherapy. "But Larry would not consider it. 'It would be breaking the law,'" the delegate says, echoing Larry's words, his voice quivering.

"We buried Larry two months ago," Riley concludes. "I just feel if the legislative body could have been more compassionate, maybe Larry would be alive today."



Like many medical-marijuana advocates, Murphy brandishes the green, hardbound book Marijuana and Medicine: Assessing the Science Base (available here), a 1999 summary of existing research on the subject compiled by the National Academy of Sciences' (NAS) Institute of Medicine.

Commissioned by the Office of National Drug Control Policy in light of a growing number of states passing medical-marijuana bills, the book is considered the most authoritative assessment to date on what is known about marijuana as medicine. Murphy showed it to members of the House panel as evidence that there is a scientific basis for using marijuana as treatment to relieve pain. If any of them read it, however, they'd discover that the study's own authors don't really agree with Murphy.

"The cases where the report calls for the usage of the drug are so narrow most patients wouldn't qualify for it," says Janet Joy, the NAS report's study director.

The passage of Marijuana and Medicine legislators and pro-pot advocates most like to quote comes from the introduction, which reads, "Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body . . . cannabinoids (of which marijuana is a part) are likely to have a natural role in pain modulation."

The study does report that some forms of cannabinoids are moderately well-suited for particular conditions, such as chemotherapy-induced nausea and vomiting and the wasting-away effects of AIDS. But NAS found that inhaled marijuana is the best option in only select types of cases for which there are no other options available. And with the active agents of marijuana being isolated and delivered in forms ranging from pills to inhalers (now undergoing clinical trials in Britain), those cases may be decreasing in number.

"When all options have failed, [smoking pot] should be an option," Joy says. "But the key is it should be given in a clinical setting where we can learn from the results." The most common use of medical marijuana now -- individuals smoking it on their own to relieve pain -- does little to further understanding of how the drug works. The NAS report advises that using marijuana for medical purposes be done under specific conditions -- for a period of six months or less, and only after the "failure of all approved medications to provide relief has been documented." It further recommends that medical-marijuana use be overseen by an institutional review board.

Joy says advocates on both sides of the medical-marijuana issue distort the report's findings. Pro-pot activists who say marijuana is more efficacious than other commercial medicines are basing their argument on drugs that have been on the market for years, even decades, she says, adding, "A lot more refined drugs have come onto the market in recent years." At the same time, the conservative Drug Free America Foundation cites the report to dismiss any claims of medical value for pot.

The scientific community generally stakes out a middle ground. A compound that can simultaneously reduce pain and nausea and increase appetite without the troubling side effects associated with more common opiate-based painkillers "would be a bit of a magic bullet," Joy says. The NAS report, however, notes that "[d]efined substances, such as purified cannabinoid compounds, are preferable to plant products, which are of variable and uncertain composition. Use of defined cannabinoids permits a more precise evaluation of their effects, whether in combination or alone. Medications that can maximize the desired effects of cannabinoids and minimize the undesired effects can very likely be identified."

(There are numerous studies underway to more closely evaluate the effects of marijuana-as-medicine, albeit many conducted by groups closely identified with the issue. The California Medical Research Center, a Sacramento-area marijuana dispensary that is legal in that state but was raided last fall by federal agents, is studying the results of pot use on California patients, and the International Cannabinoid Research Society, a Burlington, Vt.-based coalition of more than 200 researchers, is doing similar work worldwide.)

The "undesired effects" include heightened risk of lung cancer, likely buildup of tolerance to the drug's effects, and, to put it bluntly, getting stoned. Whether that is an undesired effect, of course, is in the eye of the beholder, but for patients who have never gotten high, the experience may be unpleasant or even frightening.

There is also the question of efficacy and safeguards, an issue not usually noted by pro-pot advocates. "We demand a lot of precaution from the Food and Drug Administration," Joy notes. "If a drug kills one person in 10,000, it is instantly pulled off the shelf." With intake levels that vary widely from person to person and dosage levels that vary widely from plant to plant, the actual effects of marijuana are virtually impossible to quantify in the way regulators oversee other medications.

If pot exists on the margins of medical research, and if the public at large doesn't seem keen on full-on drug decriminalization, how has the issue of medical marijuana gained such political traction, favored by majorities in polls and even legalized in some states?

Smart advocacy, primarily by one lobbying group, the Marijuana Policy Project. Since its formation in 1995 by two former employees of the National Organization for the Reformation of Marijuana Laws (NORML), MPP has succeeded in divorcing the medical use of marijuana from the shaggy-haired ideals of the much older legalization movement. While its larger goals -- overall reform of marijuana laws -- don't much differ from those of its forebear, MPP has put a human face on pot smoking, one that doesn't sport dreadlocks and red-rimmed eyes.

It's been a hard-won lesson for advocates, three decades in the making. Some form of campaign to legalize pot for medical use has been underway at least since 1972, when NORML filed a formal petition with the federal Drug Enforcement Administration (DEA) to reclassify marijuana under the newly minted Controlled Substances Act as a drug with possible medical benefits.

Keith Stroup had started NORML two years earlier -- not on medical grounds, but to lobby for the growing league of recreational pot smokers around the country. But since Congress had made control of marijuana's medical benefits an aspect of drug-control policy, NORML decided early on to fight for legalization along those lines.

Under the Controlled Substance Act, passed in 1970, all drugs are placed in one of five schedules. Schedule I drugs are considered to have high potential for abuse and no medical value, Schedule V the reverse. The schedule is overseen by the DEA, which can move substances from one schedule to another. Marijuana is a Schedule I drug; NORML petitioned the federal agency to move the drug from Schedule I to Schedule II, meaning high potential for abuse but some medical benefit. (Cocaine is a Schedule II drug.)

It would take 16 years for NORML to get a ruling -- and it was favorable. In 1988, Francis Young, then DEA's chief administrative law judge, issued a 68-page ruling concluding that "there is accepted safety for use of marijuana under medical supervision" and recommending that the agency move the drug to Schedule II. But the victory was temporary: DEA appealed twice to the courts, and in 1994 the D.C. Circuit of the U.S. Court of Appeals reversed Young's decision, ruling that there was not enough suitable scientific research to show marijuana had medical value. While NORML offered myriad anecdotal evidence of pot providing pain relief, there wasn't much in the way of large clinical trials supporting its use.

"We fought this issue for about 20 years and frankly we got our asses kicked," says Stroup, now 58 and still NORML's executive director. "We did everything right, but in the end we did not achieve the goal we wanted."

These days, NORML distances itself from the issue somewhat, instead focusing its efforts on other fronts, such as the DEA's recent ad campaign equating drug use with supporting terrorism.

"We continue to support medical-use bills, but we spend the majority of our resources trying to move beyond medical use," Stroup says. "Our feeling is that we got three out of four Americans already agreeing with us; what we want is to broaden the debate."

"If we took it off the table today, I think everyone here would be more than happy never to debate the issue of medical marijuana again, but it wouldn't take away anyone's zeal here for changing the laws," says Allen St. Pierre, executive director of the NORML Foundation, the organization's educational arm.

"I'll tell you where I think [medical marijuana] has been most helpful to the broader issue," Stroup says. "The government has relied on a strategy of 'reefer madness' to maintain the status quo," he says, referring to the notorious 1936 movie that made outrageous claims about the drug's dangers. "And for a long time they got by on it, because most people didn't know much about marijuana. The reefer madness doesn't stick any more. Part of the reason is that people smoke, but another part of the reason is marijuana's reputation as a medical therapy."

NORML has always viewed its mission as making marijuana palatable to the public at large. Stroup, an attorney who prior to starting NORML lobbied for the American Product Safety Commission and served with Ralph Nader on a presidential commission, says he organized NORML on a "Naderesque" model -- working within the system, wearing coats and ties.

"At the time, the marijuana was a way of saying, 'We reject your values system. We don't like what's going on in Vietnam, we don't like corporate greed, we don't like alcohol, we have our own drugs,'" Stroup says. "Police couldn't arrest protesters for being against the war, but they figured out that if there was peace sticker on the back of their car, if they pulled them over for a taillight being out, they'd probably find a marijuana seed on the floorboard."

Publicly, Stroup remains every bit the savvy K Street lobbyist, albeit probably the only one whose office waiting room offers visitors High Times magazine. Like any good lobbyist, he has a commanding presence and an ability to slice up arguments at a moment's notice with devastating precision. NORML raises about $1 million a year, most of it in small donations from individuals who simply want to legally "enjoy smoking a joint in the privacy of their own homes," Stroup says. The organization is open in acknowledging that it supports medical marijuana as a first step toward full decriminalization.

This casual acknowledgement makes good ammunition for medical marijuana's detractors, who claims pro-pot groups are merely exploiting ill people for their own purposes. NORML stocks copies of a videotape made by the Drug Free America Foundation that includes footage of former High Times reporter Ed Rosenthal at a speaking engagement. "I have to tell you I also use marijuana medically," Rosenthal says, to audience laughter. "I have latent glaucoma which has never been diagnosed." (More laughter). "The reason why it's never been diagnosed is because I've been treating it." Such wisecracks, the video's narrator huffs, show "the mockery that legalization advocates are making of their own medical-use argument," as well as the "blatant false pretenses of the medical-use campaign."

The camel's-nose-under-the-tent argument has long hung over pot-as-medicine advocacy like the smell of sinsemilla at a Grateful Dead show. It's a lesson ex-NORML staffers Robert Kampia and Chuck Thomas took to heart when they formed the Marijuana Policy Project in 1995, a year after NORML lost its medical-marijuana case and retreated from the issue's front lines.

Both groups state as their broad mission the reform of laws that put people in jail for smoking marijuana but delineate subtle but crucial differences in their respective approaches. NORML "tend[s] to address the issue in the first person -- 'We feel this law is unjust,'" Stroup says, whereas MPP will personalize the issue: "People are being hurt by this law."

More obvious is the way NORML associates itself with recreational pot smoking while MPP distances itself from the whole notion of getting high. MPP only works at repealing laws it considers to cause unnecessary harm to individuals, either by jailing them or thwarting their access to useful medication. It takes Stroup's coats-and-ties approach a step further, disassociating itself from activities that carry the whiff of ganja. Events such as smoke-ins and pro-hemp rallies may be fun for participants, MPP executive director Kampia says, but they "have about zero value as far as effecting any sort of legal change."

Kampia says MPP wants to see current laws replaced with those that steer "responsible marijuana use." Exactly what that would entail MPP doesn't define. "We leave that purposefully ambiguous," says Bruce Mirken, the organization's director of communications.

Publicly, MPP is anything but ambiguous. In the political arena it focuses almost entirely on the question of whether sick people should have access to something that can cause relief, avoiding the question of whether healthy people should have access to a particular intoxicant -- and thus kicking the false-pretenses argument out from underneath detractors. If the Drug Free America Foundation trots out high-living High Times editors, MPP counters with a parade of regular folks who swear marijuana has helped them cope with debilitating illness.

MPP's primary patron -- to the tune of about half of its $1.1 million budget this year -- is a longtime decriminalization advocate, Peter Lewis, chief executive officer of the automobile insurer Progressive Corp. (In January 2000, Lewis was arrested in a New Zealand airport and charged with possession of marijuana -- press accounts vary on the amount, ranging from three to five ounces -- but the charges were dropped under an agreement in which Lewis made a large donation to New Zealand drug-treatment center) The organization is also supported by a handful of wealthy investors who Kampia says are split about evenly between those who smoke pot and those who abstain, and about 6,000 dues-paying members.

Mirken says MPP's approach is "pretty much like any" lobbying organization. Much of its resources are devoted to fund-raising, what Kampia calls "mugging people with my words." It has a mailing list of approximately 60,000 people. It has done some advertising (including an ad, in the form of a letter asking President Bush to support legalization of medical marijuana, in the March 6 New York Times), but Mirken says MPP generally avoids that approach because "it is hard to say how effective it is." It also lobbies Congress, attempting to drum up support for legislation to bar the feds from interfering with medical use of marijuana in states that allow it. However, Mirken says he doesn't expect the measure to get out of committee this year.

Mostly, though, MPP works on changing laws state by state. In its early years, the organization pursued medical-marijuana laws largely through polling and state ballot referendums -- an expensive process, but the only one likely to succeed at a time when politicians would not touch anything that could paint them as soft on drugs. MPP's single-minded focus on pot as medicine paid rapid dividends: In 1996, medical-use laws were approved by wide margins in California (where a similar measure had been vetoed by the governor two years earlier) and Arizona. Over the next four years, six more states followed suit.

In 2000 Hawaii became the first state to have a medical-marijuana bill passed by its elected representatives, and since then MPP has sought to work through state legislatures, creating a template for medical-use bills and looking for willing sponsors. (MPP says that in Maryland Del. Murphy approached it.) Once a bill is in motion, MPP will employ what Mirken calls the "usual techniques" to build support: polling people on medical marijuana and publicizing favorable results; approaching the editorial boards of media outlets; sometimes advertising in the districts of recalcitrant legislators. MPP will also do the scut work of rounding up policy analysts, doctors, and pot-smoking patients to testify at hearings and visit legislators.

The MPP representative at the March 13 Annapolis hearing is Billy Rogers, the organization's director of state policies. Minus his bushy hair, Rogers would resemble a younger version of the Charles Emerson Winchester character from the TV series M*A*S*H. Before joining MPP, he was an experienced fund-raiser and pol whose résumé includes managing Democrat Garry Mauro's unsuccessful 1998 race against then-Texas Gov. George W. Bush.

Before the hearing, Rogers enthuses over the imminent approval of a medical-marijuana bill by the Vermont House of Representatives (it passed two days later), his previous stop before coming to Annapolis. He is particularly pleased because Vermont's House is Republican-controlled.

While Murphy, bopping about outside the hearing room before testimony begins, says he is confident that if the bill makes it out of committee it will be passed into law, Rogers is less certain; medical-marijuana use is far down on the Maryland General Assembly's priority list in this year of faltering finances and huge budget deficits.

Still, Rogers maintains, repeatedly running the bill through the legislative wringer is necessary, particularly as a tool to refine it. Each year the bill's scope gets narrower, a bit more precise, a bit harder to refute, he says; each year proponents get a better sense of what it will take to pass it. After Judiciary Committee chairperson Del. Joseph Vallario (D-Prince George's County), a staunch decriminalization opponent, derailed the bill on March 22 by canceling an expected vote (because he realized the bill would pass, according to MPP), it was quickly amended, resurrected, and approved the following day.

Murphy's original bill would have created a system by which medical-marijuana users could receive an ID card from the state Department of Health and Mental Hygiene that would protect them from arrest by state and local authorities. Under the new version, anyone caught possessing pot could still be arrested, but could claim medical use in court. Such a defense would not preclude conviction, but those found guilty of possession for medical use would avoid incarceration and pay a fine of no more than $100 (compared to six months in jail and $1,000 for a standard marijuana-possession conviction). It would be a civil violation only, akin to a parking or traffic ticket.

Like any good lobby, MPP declared the retreat a triumph. The amended bill "makes a clear distinction between patients using marijuana for medical purposes and recreational users," the organization cheered in a statement issued after the House committee vote. While medical use would remain technically illegal, Rogers predicted that Maryland prosecutors and judges "will not waste their time harassing medical-marijuana patients" to secure the equivalent of a traffic-ticket fine. "This victory for patients," he said, "is nothing short of miraculous."

Larry Silberman is a lanky man, 50 years old. About two years ago, he was diagnosed with non-Hodgkin's lymphoma, the same disease that killed Darrell Putman. On March 13, he traveled from Burtonsville to Annapolis at Murphy's invitation to talk to the House Judiciary Committee about it.

Silberman underwent several surgeries and chemotherapy, he tells legislators, and the treatment almost killed him. The steroids pumped into his body made him jittery, tense, and unable to sleep. The nausea made it almost impossible to eat. Prescription medications such as Prozac didn't help. Other patients at his chemo center suggested he try marijuana.

So two weeks into what turned out to be an eight-month therapy trial, Silberman started smoking marijuana. It has helped him relax enough to sleep, he says, and his appetite returned. "It literally saved my life," he tells the delegates. "You can't live through those therapies. They're inhuman."

Later in the hearing, Douglas Stiegler of the conservative Family Protection Lobby voices opposition to the bill. The Howard County-based organization considers HB 1222 "just a stepping stone for full legalization of marijuana and eventually all drugs," according to its Web site. Murphy challenges Stiegler, asking, "Would you put Mr. Silberman in jail for using marijuana?" Stiegler does not have an answer.

In the context of this hearing, there isn't one, at least one that doesn't seem arbitrary or heartless. Rightly or wrongly, that's the space in which the medical-marijuana movement, in the space of seven years, has lodged the decades-old pot debate.

Before the hearing, waiting his turn to speak, Silberman dons a novelty hat, a wreath of fake pot leaves his daughter bought for him at least year's HFStival. "You have to have a sense of humor about these things," he says, beaming.

It's like a mirror image of Ed Rosenthal on that Drug Free America Foundation video -- one advocate goofing on marijuana-as-medicine to justify smoking it for kicks, another goofing on pothead imagery before making an impassioned plea for medical use. Today's marijuana advocates have figured out which joke plays to the right crowd.

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