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Unlike alcohol and tobacco, no one has ever died from using cannabis.And while cannabis isnt’ risk free, its risks are lower than many other synthetic substances.

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Cannabis (marijuana) has been used for medicinal purposes for millennia, said to be first noted by the Chinese in c. 2737 BCE. Medicinal cannabis arrived in the United States much later, burdened with a remarkably checkered, yet colorful, history. Despite early robust use, after the advent of opioids and aspirin, medicinal cannabis use faded. Cannabis was criminalized in the United States in 1937, against the advice of the American Medical Association submitted on record to Congress. The past few decades have seen renewed interest in medicinal cannabis, with the National Institutes of Health, the Institute of Medicine, and the American College of Physicians, all issuing statements of support for further research and development. The recently discovered endocannabinoid system has greatly increased our understanding of the actions of exogenous cannabis. Endocannabinoids appear to control pain, muscle tone, mood state, appetite, and inflammation, among other effects. Cannabis contains more than 100 different cannabinoids and has the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms.

The current and emerging research on the physiological mechanisms of cannabinoids and their applications in managing chronic pain, muscle spasticity, cachexia, and other debilitating problems indicates that medical cannabis is indeed effective medicine.the Institute of Medicine concluded after reviewing relevant scientific literature, including dozens of works documenting marijuana’s therapeutic value, that “nausea, appetite loss, pain, Jp Journal of Opioid Management 5:3 May/June 2009 157 and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.”63 Further, legal access to marijuana for specific medical purposes continues to be supported by numerous national and state medical organizations including the American College of Physicians, which has historically been quite conservative. Other major players on this list include the American Academy of Family Physicians, the American Psychiatric Association Assembly, the American Academy of Addiction Psychiatry, the Washington State Medical Association, the California Medical Association, the Medical Society of the State of New York, the Rhode Island Medical Society, the American Academy of HIV Medicine, the HIV Medicine Association, the Canadian Medical Association, the British Medical Association, and the Leukemia and Lymphoma Society, among others. 64,65 The American Medical Association (AMA)- Medical Student Section has already adopted a favorable position statement which the House of Delegates of the AMA is currently studying and considering for adoption. At the most recent AMA meeting (November 2008), support for this position was expressed by the Pacific Rim Caucus of state medical associations, which includes California, Hawaii, Alaska, and Guam.

The House of Delegates opted to commission a study by the AMA’s Council on Science and Public Health on whether the accumulated evidence supports the position that marijuana should be reclassified from a Schedule I controlled substance into a more appropriate schedule and on whether medical ethics demands that the AMA call for protection of both doctors and patients who act in accordance with state medical marijuana laws. The report is slated for release later this year. Clearly, there is a growing acceptability of the therapeutic practice of medicinal cannabis use amongst organized medicine groups, yet it is still classified as a Schedule I drug in the United States. Federal agencies such as the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) are required by law to make drug reclassifications based on scientific and medical considerations.

However, federal agencies continue to insist66 that marijuana “has no currently accepted medical use in treatment in the United States” and that “there is a lack of accepted safety for the use of” marijuana “under medical supervision”56 as grounds for maintaining its prohibition. In supporting these positions which are neither based on thorough scientific review nor any cogent line of logical reasoning (eg, given the fact that the most psychoactive constituent of cannabis, THC, is available as a Schedule III drug), federal and state agencies could be accused, based on the international bill of rights, of shrinking their specific legal “obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines,” engaging in the “deliberate withholding or misrepresentation of information vital to health protection or treatment,” and aiming for “the suspension of legislation or the adoption of laws or policies that interfere with the enjoyment of any of the components of the right to health.” These are all specifically enumerated violations of governmental obligations to respect the human right to health in international law.****

* For Original Article please see “Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future and directions” (Drs.Aggarwal, Carter, Sullivan, zumbrunnen. Morril, Mayer)