The Ethics of Legalizing Medical Marijuana

Ethical Inquiry is a monthly series that examines ethical questions, highlighting a broad array of opinion from journalism, academia and advocacy organizations. Our intent is to illuminate and explore the complexity of some of the most vexing ethical questions of our time.

July 2013

marijuana spilling out from a pill bottle onto an RX sheetMassachusetts recently became the 18th state in the country to adopt a medical marijuana statute. (The District of Columbia also has a medical marijuana statute.) Yet the debate over legalization of marijuana for medical purposes continues.

In this installment of “Ethical Inquiry” inquiry we explore the ethical implications of legalizing medical marijuana.

Impact on Health

The movement toward legalization of marijuana for medical purposes is based in part on the belief that the substance has beneficial medical effects. But there is debate on this point.

The debate over legalizing medical marijuana centers squarely on the definition of a Schedule I drug and whether cannabis should still be considered as such. According to the Controlled Substances Act, passed by Congress and signed into law by President Nixon in 1970, a Schedule I drug has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and lacks acceptable safety for use under medical supervision.

Marijuana was included in the “Hallucinogenic Substances” category as a Schedule I substance, so the sale, purchase, or consumption of marijuana became illegal. Thus the legal status of medical marijuana is determined by whether or not it has an “accepted medical use in treatment in the United States.”

The California Medical Association suggests marijuana could play a role in treatment of serious medical conditions.

In 2011, the California Medical Association (CMA) Council on Scientific and Clinical Affairs issued a set of recommendations for the use of marijuana for medicinal purposes. Pursuant to California law, a doctor may prescribe marijuana for patients suffering from AIDS, anorexia, arthritis, cancer, migraine headaches, seizures, severe nausea, glaucoma, and chronic pain.

While the CMA declares the evidence supporting the medical value of marijuana is inconclusive, they assert that marijuana is most efficacious when used to manage neuropathic pain, a form of “severe and often chronic pain resulting from nerve injury, disease, or toxicity,” and can be used effectively for “analgesia, appetite stimulation and cachexia; nausea and vomiting following chemotherapy; neurological and movement disorders, and glaucoma.”

The CMA asserts that there is plenty of anecdotal evidence to buttress the case of medical marijuana.

Popular singer/songwriter Melissa Etheridge famously discussed her own use of marijuana to “relieve the nausea, [and] relieve the pain” caused by chemotherapy treatment for her breast cancer. According to Etheridge, the marijuana was not addictive, nor did it create a high for her. Rather, it allowed her to “get out of bed” and “go see [her] kid.”

However the California Medical Association also cautions that there is a dearth of research in this field and that more conclusive evidence will require more data.

The American College of Physicians also suggests that more research is needed. In a position paper calling for the support of programs and funding for the research of potential therapeutic benefits of medical marijuana lead researcher Tia Taylor contends that there are many medical benefits of marijuana use. However, Taylor states that there is little evidence to support this because of the classification of marijuana as a Schedule I drug. According to Taylor, with the reclassification of marijuana, and greater research into its therapeutic benefits, scientists and doctors will be able to better analyze the benefits and harmful side effects of marijuana use.

The research already available regarding the potential medical uses of marijuana has found that:

  • Both oral and smoked marijuana stimulate appetite, increase caloric intake, and result in weight gain among patients experiencing HIV wasting.

  • Marijuana has been shown to have neuroprotective properties and to reduce high intraocular pressure, pupil restriction, and conjunctival hyperemia, all of which results in glaucoma.

  • Smoked marijuana provides relief of spasticity, pain, and tremor in some patients with multiple sclerosis (MS), spinal cord injuries, or other trauma.

According to this research, many of the negative side effects of marijuana — including increased risk of cancer, lung damage, bacterial pneumonia, poor pregnancy, among others — can be removed if marijuana is administered via methods other than smoking. For instance, Sativex, an oromucosal spray of natural cannabis, was approved in June 2006 for prescription use in Canada to treat neuropathic pain in patients with multiple sclerosis. The vaporization of marijuana provides the same therapeutic benefits of smoked marijuana without the negative consequences of administering marijuana via smoking.

Though the California Medical Association issued recommendations for the use of medical marijuana, the CMA references multiple health risks associated with marijuana use.

  • Addiction: 9% of adult marijuana users are addicted; this risk is heightened if the individual began marijuana use before age 18.

  • Short Term Cognitive Effects: intoxication causes impairments of memory, sense of time, sensory perception, attention span, problem solving, verbal fluency, reaction time, and psychomotor control.

  • Long Term Cognitive Effects: loss in the ability to learn and remember new information.

  • Adolescents and Young Adults: have greater vulnerability to the toxic effects of marijuana on the brain, at increased risk of addiction, at risk of developing mental illness, and at risk of performing more poorly at school and work.

  • Psychiatric Conditions: marijuana can cause transient mood, anxiety, schizophrenia.

  • Obstructive Lung Disease: increased risk of chronic obstructive pulmonary disease (COPD).

  • Reproductive Risks: marijuana use during pregnancy is associated with developmental delay and behavioral problems.

The American Cancer Society (ACS) concludes in a position paper on the medical use of marijuana, that marijuana delivers harmful substances to the body, similar to many of the cancer-causing substances found in tobacco smoke.

However, the American Cancer Society also states that marijuana can treat patients suffering from pain in ways that traditional medicine fails at doing. The ACS states that marijuana has potential to treat those suffering from pain, nausea, vomiting, poor appetite, and AIDS. According to their position paper on marijuana, “the ACS is supportive of more research into the benefits of cannabinoids. Better and more effective treatments are needed to overcome the side effects of cancer and its treatment. [However], the ACS does not advocate the use of inhaled marijuana or the legalization of marijuana.”

Some opponents contend that there will be negative impacts on health because medical marijuana will be [more easily accessible and therefore more] abused. In a letter to the editor of the Denver Post, Dr. Christian Thurstone, the director of an adolescent substance abuse treatment program, recounts a story about the ability of a 19-year-old he was treating for severe addiction to easily procure marijuana under the guise of medical need:

"He recently showed up at my clinic with a medical marijuana license. How did he get it? He paid $300 for a brief visit with another doctor to discuss his 'depression.' The doctor took a cursory medical history that certainly didn’t involve contacting me. The teenager walked out with the paperwork needed not only for a license to smoke it, but also for a license permitting a 'caregiver' to grow up to six marijuana plants for him. My patient, who had quit using addictive substances after a near-death experience, is back to smoking marijuana daily, along with his caregiver. However, because of the classification of marijuana as a Schedule I drug, little research has been done to prove definitively that the use of marijuana for medical purposes has no value."

Unintended Consequences ... And Incidental Benefits?

Whatever the medical benefits or harms of marijuana, there is also discussion of unintended consequences — both good and bad — of legalizing marijuana for medical use.

In Colorado, more than a dozen young children have been unintentionally poisoned with marijuana as a result of children consuming marijuana-laced cookies, brownies, sodas, and candy, according to researcher Dr. George Sam Wang of the Rocky Mountain Poison and Drug Center in Denver. Because of the perceived stigma attached to the use of marijuana, many parents are unwilling to report its use to health care providers when questioned regarding the child’s poisoning. Before the legalization of medical marijuana in Colorado, there were no reported instances of children being poisoned with the drug.

Some are concerned that legalization of medical marijuana will lead to wider acceptance of illegal drugs, that marijuana will serve as a “gateway” to other drugs.

According to a report published by the Yale Medical School, frequent marijuana use among young adults significantly increases the risk of greater involvement with other illegal drugs.

Further, another study performed by the Yale Medical School found that adolescents who use marijuana are at a greater risk for subsequent abuse of prescription opioids, more commonly known as pain killers.

Others hope that legalization of medical marijuana will lead to general legalization of marijuana. In November 2012 Colorado, a state that had legalized the medical use of marijuana, became one of the first states in the nation — together with Washington — to legalize the recreational use of marijuana.

However, this puts these states in direct contradiction to federal drug laws, and will ultimately depend on the federal government’s level of enforcement of current drug laws. In Colorado, and in the other states that permit the use of medical marijuana, the federal government has largely left its medical marijuana practice alone. In 2009, the Department of Justice issued a memorandum to the states that allow the use of marijuana for medicinal purposes indicating that the federal government would not interfere in their states’ marijuana policies (pdf).

Though not a case of direct harm to individuals using marijuana for medical purposes, a recent New York Times article, “Marijuana Crops in California Threaten Forests and Wildlife” reports that the cultivation of marijuana in California, a state where medical marijuana is legal, has led to the death of weasels, spotted owls, among other animals. Mourad Gabriel, a scientist from the University of California at Davis found that the contamination of the local environment originated with marijuana growers in deep forests spreading d-Con rat poison to protect their plants from wood rats. The growing of marijuana for medical purposes in California has also resulted in the leveling of hilltops, landslides caused by bulldozers, severe logging, clogging of streams with dislodged soil, and the decimation of streams caused by the sapping of the local water supply.

However, the San Francisco Bay Guardian found that moving the cultivation of marijuana from indoors to outdoors would help reduce the carbon footprint of marijuana cultivation. This would require less strict laws governing the production of marijuana and would happen only if marijuana be decriminalized or legalized. At present, “indoor pot production accounts for about 8 percent of California household energy use, costing about $3 billion annually and producing about 4 millions tons of greenhouse gases each year, the equivalent of 1 million automobiles.” Proponents of marijuana argue that a simple solution to this is to grow the plant outdoors, thereby reducing the carbon footprint of marijuana cultivation and lessening the detrimental impact on the environment.

Ethical And Religious Considerations

There is a debate based on issues other than pure medical effects of marijuana. Many individuals champion their own ethical or religious reasons for supporting or opposing the use of medical marijuana.

Bob Enyart, the pastor of the Denver Bible Church, makes a theological case opposing the use of marijuana, writing in the Huffington Post “It's wrong to get high. For in doing so you reject the counsel of the God who made you. And by intoxication you lose what should be a full control of your mental and moral faculties. You become a threat to yourself and a risk to those around you.” Here, the pastor makes a case in opposing any sort of drug that alters one’s brain chemistry, as that loss of control over thought in itself is contrary to the wishes of God.

Meanwhile, the American Civil Liberties Union issued a report (pdf) in June 2013 bemoaning the racial prejudice in arrests for possession of marijuana. According to the study, blacks are 3.73 times more likely than whites to be arrested for marijuana possession, even though blacks and whites use marijuana at comparable rates. To combat this discrepancy, the ACLU recommends the legalization of marijuana use and possession, basing its finding on the inequality that persists in the prosecution of individuals who use marijuana.

Political Questions

The debate over legalization of medical marijuana has a political dimension as well. The trajectory of public opinion trends towards greater acceptance for the use of marijuana, while most politicians, including the president continue to oppose the legalization of medical marijuana.

The White House’s Office of National Drug Control Policy continues to oppose the use of marijuana. According to the White House’s website, the Obama administration opposes marijuana because of its addictive properties, the chemicals inside it that change brain chemistry, its use resulting in respiratory and mental illness, among many other reasons. While the administration opposes the legalization of marijuana, it joins “major medical societies in supporting increased research into marijuana’s many components, delivered in a safe (non-smoked) manner, in the hopes that they can be available for medical professionals to legally prescribe if proven safe and effective.” This ultimately leaves the White House open to the use of medical marijuana, once they deem it haven been proven safe for medical use.

While the White House and most politicians continue to oppose the use of marijuana, the vast majority of Americans (77%) believe that doctors should be allowed to prescribe marijuana for serious illnesses.

However, full legalization of marijuana enjoys less public support, with a slight majority of Americans (52%) supporting marijuana legalization. Public support for marijuana legalization has grown in recent years, as “most Americans no longer see marijuana as a ‘gateway’ to more dangerous drugs, and most no longer see its use as immoral.” Moreover, most Americans believe that the federal government’s enforcement of its marijuana policies “cost more than they are worth.”

International Perspective

There are other countries that have liberalized marijuana policies. For example, in Peru “individuals are allowed up to 8 grams of cannabis in their possession as long as they don’t possess another drug,” and in Argentina the Supreme Court “legalized the private use of marijuana in small amounts, ruling that it would be ‘unconstitutional’ to ban it.”

In Portugal, the use of marijuana among youth actually fell between 2002 and 2006 after the country legalized marijuana in 2001. In addition to the decline in drug use, there was a subsequent reduction in drug deaths, and a lower prevalence of drug use in Portugal than in other European countries.

Final Thoughts

In recent years, the legal landscape in the United States regarding medical marijuana has shifted considerably, but the question of whether legalization is the right path is far from settled. Do detrimental effects outweigh therapeutic benefits? Are there nonmedical factors that justify one approach or another? How should competing concerns be reconciled?