Marijuana Can Benefit Millions In Pain

Amendment 2 or the right to Medical Marijuana would make the use of medical marijuana legal under certain health conditions. Patients or caregivers with an issued license by a physician would also be allowed to attend registered marijuana treatment centers (Ballotpedia 2014). Not just anyone can get a medical marijuana license though. Individuals must be diagnosed with a “debilitating medical condition” such as cancer, HIV or glaucoma. The Florida Department of Health would be responsible for regulating medical marijuana and it would also issue identification cards and develop procedures for treatment centers. In the following passages I will discuss the pros and cons of marijuana, how poor people can obtain it if they can’t afford it and how I personally feel about amendment 2 and the legalization of marijuana.

Medical marijuana has many health benefits such as relieving chronic pain due to an illness or relieving stress after a long or busy day. The evidence is proven by research that marijuana can relieve certain types of pain, nausea, vomiting, and other debilitating symptoms caused by such illnesses as cancer and AIDS in patients all around the globe (ProCon 2014). Sanjay Gupta, MD, Chief Medical Correspondent for CNN mentioned that marijuana doesn’t have a high potential for abuse and there are very legitimate applications. Also “Sometimes marijuana is the only thing that works”, said Gupta. Arthritis is another common disease, usually in older adults, with no current cure and marijuana has been proven to help alleviate the symptoms of this disease as well. Rheumatology reported in 2006 that “In comparison with the placebo, the CBM [cannabis-based medicine] produced statistically significant improvements in pain on movement, pain at rest and quality of sleep (ProCon 2014). Although there are several legitimate benefits of medical marijuana, there are still those who disagree and argue that the legalization of medical marijuana would be harmful to society.

The ones who are against Amendment 2 and the legal use of marijuana argue it may be detrimental to society by causing an increase in crime. Bishop Ron Allen claimed that marijuana would increase crime and poverty in Berkeley and he explains, “Research tells us that marijuana has the same effects on the pleasure central system in the brain as heroin and crack cocaine.” (OpposingViews 2014) Supporters of marijuana like Mason Tvert, of the Marijuana Policy Project disagree with Allen, stating that Allen didn’t know what he was talking about and marijuana has been proven to be less toxic and less addictive than other drugs. “The fact is that Medical associations across the country and more than 80% of Americans think marijuana can help seriously ill people (Opposing Views) states Tvert.” A study conducted by the University of Texas at Dallas found that legalized marijuana may reduce crimes like robbery and homicide (Ferner 2014).

Another downfall of marijuana is that it is said to be a gateway or stepping stone to other harmful drugs such as cocaine or heroine. The Eagle Forum mentioned in a statement that “Since THC is continually in the body the “high” from pot gradually diminishes so pot smokers usually take other drugs to get a kick (ProCon 2014).” Sue Rosche, Founder and President of the National Families in Action says, “This issue received intense press coverage and California’s teenagers got the message, their past month marijuana use increased by nearly one-third that year, from 6.5% to 9.2% according to the National Household Survey on Drug Abuse. It’s still continuing to rise: 1997-6.8%, 1998-7.4, and 1999-8.4%. Even if the use of marijuana continues to rise and it is legalized, how will the poor households obtain it if they can’t afford it?

The City of Berkeley, Calif. recently announced a new law in which marijuana dispensaries will have to donate 2% of their cannabis to low-income people starting in August of next year (OpposingViews). This could be a good law that other states like Florida can use to regulate to use of marijuana if they do decide to make it legal. With the donation law, poor individuals can get access to the marijuana they need which is known to sell for at least $400 an ounce in California. This price is only the street value of the plant-form (what you smoke) of medical marijuana, so other forms such as liquid or extracted may cost more. The most important part about state regulation is that poor families with “debilitating medical conditions” will have a way to obtain the medical marijuana they need to alleviate their symptoms.

With all the factual evidence pointing to the amazing benefits of medical marijuana, I agree and vote yes on amendment 2 which will legalize medical marijuana. I have a grandmother who has epilepsy seizures and if a dose of prescribed marijuana will help alleviate her or any other patient’s symptoms, why not give her or other patients dosages by pill? The Epilepsy Foundation released a statement earlier this year that supported the rights of patients and families living with seizures and epilepsy to access physician-directed care, including marijuana (OpposingViews). There is no factual evidence of anyone dying from marijuana and my research concluded mostly positive benefits. Weighing out the benefits of medical marijuana and the fact that poor households may have a way to obtain it, gives the state of Florida all the reasons and factual evidence it needs to legalize marijuana.

Medical Marijuana Implementation in the State of Arizona

I wouldn’t be a good attorney unless I prefaced this article with a few disclaimers: 1) Marijuana is still a controlled schedule I substance and is illegal in the eyes of the Federal Government of the United States; 2) This article is not to be construed as legal advice, nor is intended to take the place of the advice of an attorney, and you should consult with an attorney before taking any actions in furtherance of the subject matter of this article. Ok, let’s begin.

In the month of November, the State of Arizona passed Proposition 203, which would exempt certain people from controlled substances laws in the State of Arizona. However, it will still take some time before medical marijuana is implemented as policy in Arizona. The Arizona Department of Health Services has released a proposed timeline for the drafting of the rules surrounding the implementation of Proposition 203. So far, these are the important time periods that should be paid close attention to:

December 17, 2010: The first draft of the medical marijuana rules should be released and made available for comment on this date.

January 7, 2011: This will be the deadline for public comment on the first draft of rules mentioned above.

January 31, 2011: The second draft of the rules will be released on this date. Once again, it will be available for informal comment as in the draft referred to above.

February 21 to March 18, 2011: More formal public hearings will be held about the proposed rules at this time, after which the final rules will be submitted to the Secretary of State and made public on the Office of Administrative Rules website.

April 2011: The medical marijuana rules will go into effect and be published in the Arizona Administrative Register.

It is important that at all times throughout the consultation process, interested parties submit briefs and/or make oral presentations when permitted. Groups with interests contrary to those of medical marijuana advocates may also be making presentations, and may convince the State to unnecessarily restrict the substance or those who may qualify to access it if there is no voice to advocate in favor of patients’ rights.

Some key points about Proposition 203′s effects

-Physicians may prescribe medical marijuana for their patients under certain conditions. “Physician” is not defined in a way limited to normal medical doctors. Osteopaths licensed under Title 32, Chapter 17; naturopaths licensed under Title 32, Chapter 14; and homeopaths licensed under Title 32, Chapter 29 may all be eligible to recommend marijuana for their patients.

-In order to be prescribed medical marijuana, a person must be a “qualifying patient.” A qualifying patient is defined as someone who has been diagnosed by a “physician” (as defined above) as having a “debilitating medical condition.”

-Debilitating medical conditions include:
• Cancer, glaucoma, HIV positive status, AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, or agitation of Alzheimer’s disease or the treatment of these conditions.
• A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: Cachexia or wasting syndrome; severe and chronic pain; severe nausea; seizures, including those characteristic of epilepsy; or severe and persistent muscle spasms, including those characteristic of multiple sclerosis.
• Any other medical condition or its treatment added by the Department of Health Services pursuant to Section 36-2801.01.

This last qualifying condition is underlined because it is vitally important during the rulemaking process. Although Proposition 203 allows for the public to petition the Department of Health Services to exercise its discretion to add conditions under this section, bureaucracy is notoriously difficult to get to change any law. The initial discretionary rules for additional treatments could be exercised during the public consultations that occur between December and March, though this is not certain.

It is therefore important that, in the event that the addition of medical conditions is considered during the consultations, any stakeholder who wishes for a medical condition not listed in the first two bulleted items above to lobby during the public consultation periods for the Department to add the additional medical condition to the list of debilitating medical conditions. In order to increase the prestige of any presentations made to justify adding medical conditions under Section 36-2801.01, it may be helpful to solicit the testimony of sympathetic Arizona-licensed medical doctors who can testify on paper and at the public hearings about why the proposed condition should be added. Documents showing that other jurisdictions, both in the United States and elsewhere, currently use marijuana as a treatment for the proposed condition may be helpful, as would medical journals on the subject.

It should be remembered that despite his cheery YouTube videos about the medical marijuana rule drafting process, Director of Health Services Will Humble wrote a submission in opposition to the passing of Proposition 203. He did so on the grounds that the FDA does not test the drug, and even though the federal government’s anti-marijuana policy is well-known it should not be relied on as an authority for unbiased medical marijuana research. There is no reason to believe that Director Humble will be any less inclined to obstruct the use of medical marijuana during the rulemaking stage, and all proponents of medical marijuana should be sure to make their voices heard at the consultations to prevent the obstruction of the intent of Proposition 203.

Extent of Rulemaking during Consultations

There are other provisions in Proposition 203 which will be discussed during the initial rulemaking process, and they will probably be the main focus of the consultations. The consultations will create rules:
• Governing the manner in which the Department of Health Services will accept the petitions from the public previously mentioned, regarding the addition of medical conditions to the list of the already enshrined debilitating medical conditions.
• Establishing the form and content of registration and renewal applications submitted under the medical marijuana law.
• Governing the manner in which the Department will consider applications for and renewals of medical marijuana ID cards.
• Governing the various aspects around the newly legalized nonprofit medical marijuana dispensaries, including recordkeeping, security, oversight, and other requirements.
• Establishing the fees for patient applications and medical marijuana dispensary applications.

The most crucial part of the consultation period will be regarding the rules governing the establishment and oversight of medical marijuana dispensaries. If interest groups lobby the Department to make the recordkeeping, security, oversight, and other requirements around dispensaries too restrictive, it will have the effect of reducing the availability of medical marijuana to patients and driving up the price of medical marijuana due to the lack of supply. It could simply become too costly to comply with all of the regulations.

During this stage, it is important that stakeholders-particularly medical marijuana dispensaries from out-of-state, and perhaps pharmacists with a bit of economic knowledge-submit briefs explaining why certain proposed rules may have a negative effect on the patients this Proposition is supposed to help. The proposed rules have not come out yet, but when they do, they should be closely scrutinized for the possible negative impact that unnecessarily tough security and recordkeeping on nonprofit dispensaries might have on patients.

The other major factor in the rulemaking will have to do with the fees. The Department will be setting fees for medical marijuana dispensaries during the consultation period. Proposition 203 provides that the fees may not exceed $5,000 per initial application, and $1,000 per renewal. However, with some lobbying during the public consultation, it is possible that the actual fees will be much less since these are simply the maximum that the Department may charge.

Discrimination against Medical Marijuana Users

Under Proposition 203, discrimination against medical marijuana users will be prohibited in certain circumstances. Based on our analysis, a person may not:

• As a school or landlord, refuse to enroll someone or otherwise penalize them solely for their status as a medical marijuana cardholder, unless not doing so would result in the loss of a monetary or licensing related benefit under federal law or regulations.
• As an employer, discriminate against hiring someone, or terminate them or impose any conditions on them because they are a medical marijuana cardholder, unless not doing so would result in the loss of a monetary or licensing related benefit under federal law or regulations. Employers may still terminate employees if the employee is in possession of or impaired by marijuana on the premises of the place of employment or during the hours of employment.
• As a medical care provider, discriminate against a cardholder, including in matters of organ transplants. Medical marijuana must be treated as any other medication prescribed by a physician.
• Be prevented, as a cardholder, from having visitation custody or visitation or parenting time with a minor, unless the cardholder’s behavior “creates an unreasonable danger to the safety of the minor as established by clear and convincing evidence.”
Although there are certain prohibitions on discrimination, there are also provisions which permit discrimination against medical marijuana cardholders:
• Government medical assistance programs and private health insurers are not required to reimburse a person for their medical marijuana use.
• Nobody who possesses property, including business owners, is required to allow medical marijuana on their premises (this seemingly includes landlords who, although they cannot refuse tenants based on their being a cardholder, are permitted to prevent cardholders from bringing marijuana onto the landlord’s property).
• Employers are not required to allow cardholders to be under the influence of or ingest marijuana while working, though the presence of marijuana in the body which is not of a sufficient concentration to cause impairment does not establish being under the influence of it.

Rules Related to the Establishment of Dispensaries

Although the final rules around security, recordkeeping, and other requirements for medical marijuana dispensaries will not be established until April 2011, there are certain requirements which are enshrined in Proposition 203 itself and can be known ahead of the time that the final rules come out. These minimal requirements may not be as restrictive as the final requirements which are published in April 2011.

• Medical marijuana dispensaries must be nonprofit. They must have bylaws which preserve their nonprofit nature, though they need not be considered tax-exempt by the IRS, nor must they be incorporated.
• The operating documents of the dispensaries must include provisions for the oversight of the dispensary and for accurate recordkeeping.
• The dispensary must have a single secure entrance and must implement appropriate security measures to deter and prevent the theft of marijuana and unauthorized access to areas containing marijuana.
• A dispensary must not acquire, possess, cultivate, manufacture, deliver, transfer, transport, supply, or dispense marijuana for any purpose other than providing it directly to a cardholder or to a registered caregiver for the cardholder.
• All cultivation of marijuana must take place only at a locked, enclosed facility at a physical address provided to the Department of Health Services during the application process, and accessible only by dispensary agents registered with the Department.
• A dispensary can acquire marijuana from a patient of their caregiver, but only if the patient or caregiver receives no compensation for it.
• No consumption of marijuana is permitted on the property of the dispensary.
• A dispensary is subject to reasonable inspection by the Department of Health Services. The Department must first give reasonable notice of the inspection to the dispensary.

Comparison to California’s Medical Marijuana Law

The Arizona law is by no means the same as the law in California. There are certainly some differences between the two, though in some respects they are comparable. This is a comparative analysis of the two laws.

Similarities:
• Both laws, as a practical matter, allow for broad discretion on the part of a physician to prescribe marijuana to patients who suffer from pain. In the Arizona law, “severe and chronic pain” is the legislated standard. In the California law, any “chronic or persistent medical symptom” that substantially limits the life of the patient to conduct one or more major life activities as defined by the Americans with Disabilities Act of 1990, or that if not alleviated, will cause serious harm to the patient’s physical or mental safety, qualifies.
• Both laws have a number of illnesses which are automatically considered qualifying illnesses for the prescription of medical marijuana. These include, but are not limited to, AIDS, cachexia, cancer, glaucoma, persistent muscle spasms, seizures, and severe nausea.
• Both laws require the use of an identification card by those who have been prescribed medical marijuana, after the cardholders have gone through an initial application process in which the use of the drug has been recommended by a physician.
• Both states do not factor in the unusable portion of the marijuana plant in determining the maximum weight of marijuana that is permissible for possession by a cardholder.

Differences:
• Though the rules have not been finalized, the Arizona law appears as though it will be regulated on the state level and therefore uniform across Arizona. The California law, however, is regulated significantly on the municipal level, and therefore the rules around dispensaries can vary greatly from one municipality to the next.
• The Arizona law provides a broader spectrum of people who are considered a “physician” for the purpose of prescribing medical marijuana. In California, only medical doctors and osteopaths are considered to be physicians. In Arizona, in addition to medical doctors and osteopaths, naturopaths and homeopaths will also be permitted to prescribe medical marijuana.
• In California, patients or their caregivers may grow marijuana plants in lieu of using a medical marijuana dispensary. In Arizona, patients may only grow marijuana or designate someone else to do so in lieu of visiting a dispensary on the condition that there is no dispensary operating within 25 miles of the patient’s home.
• The maximum possession limit for marijuana in California is eight ounces per patient, whereas the limit is only 2.5 ounces per patient in Arizona.

The Michigan Medical Marijuana Act: The First 24-Months

This article chronicles the implementation of the Michigan Medical Marijuana Act, passed via referendum in the 2008 general election. As expected, once applied to our human tapestry, the MMA has been subjected to some already-classic judicial interpretations, with a strong promise of more to come.

The Michigan Legislature passed the MMA on December 4, 2008, making Michigan the 13th state to allow the cultivation and possession of marijuana for medical purposes. The Act cited a series of findings related to the beneficial uses of marijuana in treating nausea, pain and other effects from a variety of debilitating medical conditions. The Act also notes that according to the FBI, 99% of all marijuana possession arrests nationwide are done pursuant to state, rather than federal law. It is important to note that possession of the drug remains illegal under federal law.

The MMA defines a “debilitating medical condition” as cancer, glaucoma, HIV, hepatitis C, and other diseases along with other chronic afflictions which cause pain and nausea. A “primary caregiver” is defined as, “a person who is at least 21 years old and who has agreed to assist with a patient’s medical use of marijuana and who has never been convicted of a felony involving illegal drugs.” A “qualifying patient” is “a person who has been diagnosed by a physician as having a debilitating medical condition.”

The basic mechanics of the Act provide that qualifying patients and primary care providers (marijuana growers) must possess a “registry identification card”, issued by the Department of Community Health. Tens of thousands of applications have been processed; many thousands remain pending with more filed every week; the demand for certification, for marijuana, is seemingly insatiable here in Michigan.

The high demand is understandable. Cardholders are not subject to arrest or prosecution for marijuana possession/distribution provided the patient keeps less than 2.5 ounces of smokeable pot. Care providers are allowed to maintain up to 12 plants for each qualified patient; stems, seeds and unusable roots do not count toward the plant limitation.

Physicians also have immunity from prosecution relative to their certification of the patient’s need for the drug, so long as they conduct an assessment of the patient’s medical history. A legitimate physician-patient relationship is required.

Since the U.S. Supreme Court decided the case of Conant vs Walters in 2003, physicians have been able to recommend a patient’s use of marijuana (but cannot prescribe pot by placing the recommendation on a prescription form). Doctors can also make notes regarding their recommendations in the patient’s chart and can testify on behalf of a patient’s medical use of marijuana in a court of law. The Supreme Court’s Conant decision paved the way for passage of the MMA.

Primary care providers may receive compensation for their marijuana. Selling marijuana paraphernalia also is allowed under the MMA, and such paraphernalia cannot be seized.

Persons merely present during the use of marijuana for medical purposes likewise are not subject to arrest.

Sound too good to be true? When marijuana is distributed to persons other than qualifying patients, the registration card is revoked, and the provider is subject to a 2-year felony. Also, driving while under the influence of marijuana remains illegal, as does smoking in public. Use or possession of pot on school premises or on school buses remains prohibited. And yes, it remains illegal to smoke in a jail or a penitentiary, regardless of your medical condition.

The Act set a short timetable (120-days) for the Department of Community Health to promulgate regulations for the administration of the possession/distribution credential. The delay in the promulgation of these regulations gave way to confusion among law enforcement, the public and some judges as to what is legal and what is illegal.

For example, the 2009 Redden case from Madison Heights involved a couple arrested during a drug-raid. The couple had applied for certification cards prior to their arrest and received the cards a month after their arrest. In dismissing the case brought against the two defendants, 43rd District Judge Robert Turner characterized the MMA as, “the worst piece of legislation I’ve seen in my life”, according to the Detroit News. Judge Turner’s dismissal was appealed by the Oakland County Prosecutor where it was affirmed in the Oakland County Circuit Court.

Earlier this year, the Michigan Court of Appeals affirmed Oakland Circuit Court Judge Martha Anderson’s reinstatement of the criminal charges against Redden and Clark. Now, the accused Madison Heights couple will either have to plead or go to trial.

At the time of the raid on the couple’s residence, the Oakland County Sheriff seized 1.5 ounces of pot, some nominal cash, and about 21 small plants. Three weeks prior to the raid, each defendant had submitted to a medical certification exam with Dr. Eric Eisenbud (not making it up) of Colorado (and of the recently founded Hemp and Cannabis Foundation Medical Clinic) and applied for a medical marijuana card pursuant to the MMA. Their cards, however, had not been issued at the time of the raid.

At the couple’s preliminary examination before Judge Turner, the prosecutor argued that: a) the defendants were required to abstain from “medicating” with marijuana while their applications to the State of Michigan’s Department of Community Health were pending; and b) the defendants did not have a bona fide physician-patient relationship with Dr. Eisenbud.

Judge Turner indicated that the MMA was confusing relative to what constituted a reasonable amount of marijuana. The defendants in this case were found with an ounce and a half; the MMA allows 2.5 ounces.

Judge Turner made the following ruling:

For that reason, I believe that section 8 entitles the defendants to a dismissal, even though they did not possess the valid medical card, because section 8 says if they can show the fact that a doctor believed that they were likely to receive a therapeutic benefit, and this doctor testified to that. And Dr. Eisenbud is a physician licensed by the State of Michigan. And that’s the only requirement that the statute has. You don’t have to be any type of physician, you just have to be a licensed physician by the State of Michgan.

So, based on that, I find section 8 does apply. And I believe I’m obligated to dismiss this matter based on section 8 of the statute.

Under the applicable court rules, the prosecutor appealed the district court dismissal to the Oakland Circuit Court. In reversing her district court counter-part, Judge Anderson held that Judge Turner improperly acted as a finder of fact in dismissing the case. Judge Anderson also questioned whether the couple could avail themselves of the MMA’s affirmative defenses at all, due to their purported failures to comply with the provisions of the act; i.e. keeping the pot segregated and locked-up, and waiting until they received their cards from the Department of Community Health prior to growing their pot.

At the time of the Madison Heights bust, however, the couple could not have received marijuana cards because the DCH had not started issuing the cards. To date, almost 30,000 certifications have been issued.

In their September 2010 opinion affirming Judge Martha Anderson, the Court of Appeals held that the MMA’s affirmative defenses were available to defendants even though they did not have their cards at the time their pot was confiscated. The Court of Appeals held against defendants, however, on the basis that, at the time of their preliminary examination in district court, their affirmative defense under the MMA was incomplete and thus created fact questions.

The Court found the following fact issues to be unresolved at the conclusion of the exam: the bona fides of the physician-patient relationship; whether the amount of marijuana found in the residence was “reasonable” under the Act; and whether the marijuana was being used by defendants for palliative purposes, as required by the Act.

The most interesting thing about the Court of Appeals’ Redden decision is the scathing concurring opinion of Judge Peter D. O’Connell. Judge O’Connell wrote separately because he would have more narrowly tailored the affirmative defenses available in the MMA, and because he wished to “elaborate” on some of the general discussion of the Act set forth in the briefs and at oral argument.

Elaborate he did. Judge O’Connell’s 30-page opinion first notes that the possession, distribution and manufacture of marijuana remains a federal crime and further notes that Congress has expressly found the plant to have “no acceptable medical uses.”

In what will undoubtedly become a classic line from his opinion, Judge O’Connell writes, “I will attempt to cut through the haze surrounding this legislation.” The judge is skeptical that folks are really using pot to “medicate” and suspects that they are using the plant for recreational purposes.

He also takes note of the poor quality of the legislation to the extent that it conflicts with other provisions set forth in the Health Code.

Judge O’Connell next takes a tour de force through the legislative history of the MMA. Here, we learn that the act was based on model legislation proposed by lobbyists known as the Marijuana Policy Project of Washington D.C. The group advances both the medicinal and recreational uses of marijuana.

“Confusion”, and lots of it, is how Judge O’Connell views the MMA. In one of the many footnotes to his opinion, the Judge warns against all marijuana use until the score is settled, once and for all, by the Michigan Supreme Court:

Until our Supreme Court provides a final comprehensive interpretation of this act, it would be prudent for the citizens of this state to avoid all use of marijuana if they do not wish to risk violating state law. I again issue a stern warning to all: please do not attempt to interpret this act on your own. Reading this act is similar to participating in the Triwizard Tournament described in Harry Potter and the Goblet of Fire: the maze that is this statute is so complex that the final result will only be known once the Supreme Court has had an opportunity to review and remove the haze from this act.

Euan Abercrombie, 1st year student at the Hogwarts school would probably remark; “Wow”.

For their part, the criminal defense bar, commenting via listserv, have basically gone wild over the concurring opinion, with its multiple web site references and pictures of marijuana advertisements. The consensus among the defense bar, however, is that the majority opinion is correct and that Judge Anderson, at the end of the day, got it right; Redden was not the cleanest case to dismiss under the Act.

The Oakland County Sheriff and Prosecutor correctly anticipated the Court of Appeals’ September decision. A few weeks prior to the Redden decision, they conducted a series of dispensary raids, ruffling tons of feathers along the way.

Of course, an application for leave to appeal has been filed with the Michigan Supreme Court.

For additional procedural guidance, we have prepared a legal guide for the MMA for those seeking to use marijuana for legitimate palliative purposes under the Act. Take note, however, that at least one appellate jurist would have folks managing chronic “pain” with prescription meds until the medical marijuana mess is sorted out by our Supreme Court.

Redden is not the only case causing some MMA consternation. Rodney Koon’s case has received notoriety. Koon was convicted of a misdemeanor because he admitted to police that he used marijuana to “medicate” earlier in the day that he was pulled-over by the police. Koon also admitted to consuming a beer, but his blood alcohol was within legal limits. Without sufficient funds to appeal, Koon is stuck with his conviction, even though he had a pot card at the time of his arrest.

Ordinances have sprung-up across the state to truncate the scope of the MMA. Bloomfield Hills, for example, passed an ordinance in October requiring card-carrying certified medical marijuana users to register with the Bloomfield Township Police Department. The ordinance also requires the submission of a form to the police disclosing the “patient’s” drivers license number and date of birth, whether the patient owns or rents their home, and identifying how many other patients share their home.

In addition, the ordinance limits the number of medical marijuana patients that can live at one address and prohibits growing medical marijuana anywhere in Bloomfield Township. Violation of the ordinance is a 93-day misdemeanor carrying a $500 fine.

Bloomfield Hills is among several municipalities that have passed ordinances that restrict the provisions of the Medical Marijuana Act, criminalize conduct authorized by the Act, or both.

Now the ordinance is the subject of a lawsuit filed against the township by two crafty [their "clients" are John and Jane Doe] veteran criminal defense attorneys: Tom Loeb and Neil Rockind. The lawsuit, undoubtedly heading to the Michigan Supreme Court, does not seek money damages but rather, declarative and injunctive relief.

Township by township, the MMA is coming under fire for a glaring flaw: it is a ruse for recreational pot users. Yes, there are legitimate medical marijuana users out there, in spades, for whom the MMA was designed to help. There are also many “patients” whose medical records were reviewed with a passing glance by a physician more interested in the high-volume review fees than in determining whether the person has a genuine chronic medical condition of the sort required by the MMA. The LawBlogger wonders how many certified users, among the tens of thousands of backlogged applicants, are under the age of 25; or are college kids whose only chronic condition is their desire to party down.

As these legal challenges grind through the court system over the next two or three years, the MMA will be subject to death-by-ordinance on a township-by-township basis. Attorneys Rockind and Loeb remarked in their press conference announcing their lawsuit that the ordinance in Bloomfield Hills cannot stand to the extent it contradicts a valid Michigan law.

While it may not be the best example of tightly drafted legislation; while it undoubtedly suffers from problems of perception/deception, the MMA is a valid state law. The appellate courts will have no choice but to invalidate ordinances that limit the scope of the Act, or criminalize it’s legitimate purposes.

This past fall, the recent election was a set-back for progressive marijuana laws. California’s Proposition 19 lost by a vote of 56% to 44%. If successful, the proposed law would have been the first in the country to legalize the recreational use of marijuana.

In Arizona, the medical marijuana proposition lost.

In California, the pot initiative lost because too few voters under age 26 turned out and moderate voters rejected the initiative. Recent violence with Mexican drug gangs in both California and Arizona did not help either initiative.

Mixed messages float around the issue here in Michigan. Recently, a huge pot-expo scheduled for the Pontiac Silverdome, billed as the largest pot-party in the world, was canceled at the last minute.

All this raises the questions: do we really need to legalize pot? Is ours a pot-smoking nation? Does marijuana have genuine palliative properties?

One of the major problems of perception with medical marijuana laws is that folks are simply going through the administrative steps to get “medically” certified to use pot, but are smoking on a recreational basis.

No good comes of a law that sets requirements that are perceived as a farce. It would perhaps be better to legalize marijuana outright, then regulate its production, sale, and distribution.

California was really looking forward to billions in pot-derived state revenue. Here in Michigan, there is confusion about who can legally grow pot and how it should be grown and distributed to “patients”. In Arizona, the question is too close to call 3-days after the mid-term elections.

So then, what are they smoking? That’s what Detroit-based Cannabis Counsel lawyer Matthew Abel is asking of the Michigan Senate Judiciary Committee, who met earlier this year, in January, in order to discuss a package of bills which would amend the public health code so that medical marijuana must be dispensed by pharmacists, and to classify medical marijuana as a schedule 2 controlled substance.

“It seems that if the legislature ever passed these bills, they would be in conflict with the medical marijuana statute,” Abel said. “So they’d need a 3/4 vote to supersede the law, and you know that they can’t even get 3/4 of the legislature to agree on lunch, let alone this.”

Southfield-based lawyer Michael Komorn, who also serves as the treasurer for the Michigan Medical Marijuana Association, said the bills are similar to bills introduced last year; last year, the bills which also would have allowed for 10 marijuana growing facilities to be affiliated with a pharmacy, got no traction.

This year’s incarnation of the bills would essentially make all production of medical marijuana illegal, though use would still be protected by law, Komorn said.

“It’s like the stamp act, arcane and without any understanding of what really is going on with patient needs,” Komorn said. “Bottom line, this is an attempt to repeal the Michigan medical marijuana act.”

It’s impossible, Abel said, to require dispensing of medical marijuana through pharmacies.

“They don’t have a supply, and no way to get it. There’s just no way for them to do it,” Abel said.

Still, he’s resting easy with the idea that the bills are going nowhere, and are really more about grandstanding for political popularity than they are about the Michigan medical marijuana law.

Now that the MMA has been around long enough to generate some interesting cases and controversies, we must wait until one of them percolates through the Michigan Supreme Court in order to get a true sense of this legislation. Our blog takes the position that the MMA is flawed and thus, exposed to failure, so long as it can be used to mask recreational pot use. Perhaps the most common sense thing to do at this point is what Peter Tosh called for world-wide: just legalize it.

Physical and Pharmacological Effects of Marijuana

Introduction:
Cannabis is not only the most abused illicit drug in the United States (Gold, Frost-Pineda, & Jacobs, 2004; NIDA, 2010) it is in fact the most abused illegal drug worldwide (UNODC, 2010). In the United States it is a schedule-I substance which means that it is legally considered as having no medical use and it is highly addictive (US DEA, 2010). Doweiko (2009) explains that not all cannabis has abuse potential. He therefore suggests using the common terminology marijuana when referring to cannabis with abuse potential. For the sake of clarity this terminology is used in this paper as well.

Today, marijuana is at the forefront of international controversy debating the appropriateness of its widespread illegal status. In many Union states it has become legalized for medical purposes. This trend is known as “medical marijuana” and is strongly applauded by advocates while simultaneously loathed harshly by opponents (Dubner, 2007; Nakay, 2007; Van Tuyl, 2007). It is in this context that it was decided to choose the topic of the physical and pharmacological effects of marijuana for the basis of this research article.

What is marijuana?
Marijuana is a plant more correctly called cannabis sativa. As mentioned, some cannabis sativa plants do not have abuse potential and are called hemp. Hemp is used widely for various fiber products including newspaper and artist’s canvas. Cannabis sativa with abuse potential is what we call marijuana (Doweiko, 2009). It is interesting to note that although widely studies for many years, there is a lot that researchers still do not know about marijuana. Neuroscientists and biologists know what the effects of marijuana are but they still do not fully understand why (Hazelden, 2005).

Deweiko (2009), Gold, Frost-Pineda, & Jacobs (2004) point out that of approximately four hundred known chemicals found in the cannabis plants, researchers know of over sixty that are thought to have psychoactive effects on the human brain. The most well known and potent of these is ∆-9-tetrahydrocannabinol, or THC. Like Hazelden (2005), Deweiko states that while we know many of the neurophysical effects of THC, the reasons THC produces these effects are unclear.

Neurobiology:
As a psychoactive substance, THC directly affects the central nervous system (CNS). It affects a massive range of neurotransmitters and catalyzes other biochemical and enzymatic activity as well. The CNS is stimulated when the THC activates specific neuroreceptors in the brain causing the various physical and emotional reactions that will be expounded on more specifically further on. The only substances that can activate neurotransmitters are substances that mimic chemicals that the brain produces naturally. The fact that THC stimulates brain function teaches scientists that the brain has natural cannabinoid receptors. It is still unclear why humans have natural cannabinoid receptors and how they work (Hazelden, 2005; Martin, 2004). What we do know is that marijuana will stimulate cannabinoid receptors up to twenty times more actively than any of the body’s natural neurotransmitters ever could (Doweiko, 2009).

Perhaps the biggest mystery of all is the relationship between THC and the neurotransmitter serotonin. Serotonin receptors are among the most stimulated by all psychoactive drugs, but most specifically alcohol and nicotine. Independent of marijuana’s relationship with the chemical, serotonin is already a little understood neurochemical and its supposed neuroscientific roles of functioning and purpose are still mostly hypothetical (Schuckit & Tapert, 2004). What neuroscientists have found definitively is that marijuana smokers have very high levels of serotonin activity (Hazelden, 2005). I would hypothesize that it may be this relationship between THC and serotonin that explains the “marijuana maintenance program” of achieving abstinence from alcohol and allows marijuana smokers to avoid painful withdrawal symptoms and avoid cravings from alcohol. The efficacy of “marijuana maintenance” for aiding alcohol abstinence is not scientific but is a phenomenon I have personally witnessed with numerous clients.

Interestingly, marijuana mimics so many neurological reactions of other drugs that it is extremely difficult to classify in a specific class. Researchers will place it in any of these categories: psychedelic; hallucinogen; or serotonin inhibitor. It has properties that mimic similar chemical responses as opioids. Other chemical responses mimic stimulants (Ashton, 2001; Gold, Frost-Pineda, & Jacobs, 2004). Hazelden (2005) classifies marijuana in its own special class – cannabinoids. The reason for this confusion is the complexity of the numerous psychoactive properties found within marijuana, both known and unknown. One recent client I saw could not recover from the visual distortions he suffered as a result of pervasive psychedelic use as long as he was still smoking marijuana. This seemed to be as a result of the psychedelic properties found within active cannabis (Ashton, 2001). Although not strong enough to produce these visual distortions on its own, marijuana was strong enough to prevent the brain from healing and recovering.

Emotions:
Cannibinoid receptors are located throughout the brain thus affecting a wide variety of functioning. The most important on the emotional level is the stimulation of the brain’s nucleus accumbens perverting the brain’s natural reward centers. Another is that of the amygdala which controls one’s emotions and fears (Adolphs, Trane, Damasio, & Damaslio, 1995; Van Tuyl, 2007).

I have observed that the heavy marijuana smokers who I work with personally seem to share a commonality of using the drug to manage their anger. This observation has evidenced based consequences and is the basis of much scientific research. Research has in fact found that the relationship between marijuana and managing anger is clinically significant (Eftekhari, Turner, & Larimer, 2004). Anger is a defense mechanism used to guard against emotional consequences of adversity fueled by fear (Cramer, 1998). As stated, fear is a primary function controlled by the amygdala which is heavily stimulated by marijuana use (Adolphs, Trane, Damasio, & Damaslio, 1995; Van Tuyl, 2007).

Neurophysical Effects of THC:
Neurological messages between transmitters and receptors not only control emotions and psychological functioning. It is also how the body controls both volitional and nonvolitional functioning. The cerebellum and the basal ganglia control all bodily movement and coordination. These are two of the most abundantly stimulated areas of the brain that are triggered by marijuana. This explains marijuana’s physiological effect causing altered blood pressure (Van Tuyl, 2007), and a weakening of the muscles (Doweiko, 2009). THC ultimately affects all neuromotor activity to some degree (Gold, Frost-Pineda, & Jacobs, 2004).

An interesting phenomena I have witnessed in almost all clients who identify marijuana as their drug of choice is the use of marijuana smoking before eating. This is explained by effects of marijuana on the “CB-1″ receptor. The CB-1 receptors in the brain are found heavily in the limbic system, or the nucleolus accumbens, which controls the reward pathways (Martin, 2004). These reward pathways are what affect the appetite and eating habits as part of the body’s natural survival instinct, causing us to crave eating food and rewarding us with dopamine when we finally do (Hazeldon, 2005). Martin (2004) makes this connection, pointing out that unique to marijuana users is the stimulation of the CB-1 receptor directly triggering the appetite.

What is high grade and low grade?
A current client of mine explains how he originally smoked up to fifteen joints of “low grade” marijuana daily but eventually switched to “high grade” when the low grade was starting to prove ineffective. In the end, fifteen joints of high grade marijuana were becoming ineffective for him as well. He often failed to get his “high” from that either. This entire process occurred within five years of the client’s first ever experience with marijuana. What is high and low grade marijuana, and why would marijuana begin to lose its effects after a while?

The potency of marijuana is measured by the THC content within. As the market on the street becomes more competitive, the potency on the street becomes more pure. This has caused a trend in ever rising potency that responds to demand. One average joint of marijuana smoked today has the equivalent THC potency as ten average joints of marijuana smoked during the 1960′s (Hazelden, 2005).

THC levels will depend mainly on what part of the cannabis leaf is being used for production. For instance cannabis buds can be between two to nine times more potent than fully developed leaves. Hash oil, a form of marijuana developed by distilling cannabis resin, can yield higher levels of THC than even high grade buds (Gold, Frost-Pineda, & Jacobs, 2004).

Tolerance:
The need to raise the amount of marijuana one smokes, or the need to intensify from low grade to high grade is known clinically as tolerance. The brain is efficient. As it recognizes that neuroreceptors are being stimulated without the neurotransmitters emitting those chemical signals, the brain resourcefully lowers its chemical output so the total levels are back to normal. The smoker will not feel the high anymore as his brain is now “tolerating” the higher levels of chemicals and he or she is back to feeling normal. The smoker now raises the dose to get the old high back and the cycle continues. The smoker may find switching up in grades effective for a while. Eventually the brain can cease to produce the chemical altogether, entirely relying on the synthetic version being ingested (Gold, Frost-Pineda, & Jacobs, 2004; Hazelden, 2005).

Why isn’t there any withdrawal?
The flip side of the tolerance process is known as “dependence.” As the body stops producing its own natural chemicals, it now needs the marijuana user to continue smoking in order to continue the functioning of chemicals without interruption. The body is now ordering the ingestion of the THC making it extremely difficult to quit. In fact, studies show that marijuana dependency is even more powerful than seemingly harder drugs like cocaine (Gold, Frost-Pineda, & Jacobs, 2004).

With quitting other drugs like stimulants, opioids, or alcohol the body reacts in negative and sometimes severely dangerous ways. This is due to the sudden lack of chemical input tied together with the fact that the brain has stopped its own natural neurotransmission of those chemicals long ago. This is the phenomenon of withdrawal (Haney, 2004; Hazelden, 2005; Jaffe & Jaffe, 2004; Tabakoff & Hoffman, 2004).

While research has shown comparable withdrawal reactions is marijuana users as in alcohol or other drugs (Ashton, 2001), what I have witnessed many times in my personal interaction with clients is the apparent lack of withdrawal experienced by most marijuana users. Of course they experience cravings, but they don’t report having the same neurophysical withdrawal reaction that the other drug users have. Some marijuana smokers use this as their final proof that marijuana “is not a drug” and they should therefore not be subjugated to the same treatment and pursuit of recovery efforts as other drug or alcohol abusers.

The reality is that the seemingly lack of acute withdrawal is a product of the uniqueness of how the body stores THC. While alcohol and other drugs are out of a persons system within a one to five days (Schuckit & Tapert, 2004), THC can take up to thirty days until it is fully expelled from the body (Doweiko, 2009). When THC is ingested by the smoker, it is initially distributed very rapidly through the heart, lungs, and brain (Ashton, 2001). THC however, is eventually converted into protein and becomes stored is body fat and muscle. This second process of storage in body fat reserve is a far slower process. When the user begins abstinence, fat stored THC begins its slow release back into the blood stream. While the rate of reentry into the body’s system is too slow to produce any psychoactive effects, it will aid in easing the former smoker through the withdrawal process in a more manageable and pain free manner. The more one smokes the more one stores. The more body mass the smoker has, the more THC can be stored up as well (Doweiko, 2009). Thus, in very large clients I have seen it take up to thirty days before urine screens show a cleared THC level.

Similar to THC’s slow taper like cleansing is the slow rate of initial onset of psychoactive response. Clients report that they do not get high smoking marijuana right away – it takes them time for their bodied to get used to it before they feel the high. This is explained by the slow absorption of THC into fatty tissue reaching peak concentrations in 4-5 days. As the THC begins to release slowly into the blood stream, the physiological response will become heightened rapidly with every new smoking of marijuana resulting in another high. As the user repeats this process and high levels of THC accumulate in the body and continue to reach the brain, the THC is finally distributed to the neocortical, limbic, sensory, and motor areas that were detailed earlier (Ashton, 2001).

Physiology:
The neurology and neurophysiology of marijuana has been described thus far. There are many physical components of marijuana smoking as well. National Institute on Drug Abuse (2010) reports that marijuana smokers can have many of the same respiratory problems as tobacco smokers including daily cough, phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. They quote research showing evidence that chronic marijuana smokers, who do not smoke tobacco, have more health problems than non smokers because of respiratory illnesses.

The definitive research documenting the significant negative biophysical health effects of marijuana is not conclusive. We do know that marijuana smoke contains fifty to seventy percent more carcinogenic hydrocarbons than tobacco smoke does (Ashton, 2001; Gold, Frost-Pineda, & Jacobs, 2004; NIDA, 2010). While some research shows that marijuana smokers show dysregulated growth of epithelial cells in their lung tissue which can lead to cancer, other studies have shown no positive associations at all between marijuana use and lung, upper respiratory, or upper digestive tract cancers (NIDA, 2010). Perhaps the most eye opening fact of all is that all experts agree that historically there has yet to be a single documented death reported purely as a result of marijuana smoking (Doweiko, 2009; Gold, Frost-Pineda, & Jacobs, 2004; Nakaya, 2007; Van Tuyl, 2007).

Pharmacology – “Medical Marijuana”:
This last fact regarding the seemingly less harmful effects of marijuana smoking even in comparison with legal drugs like alcohol and nicotine is most often the very first quoted by proponents of legalizing marijuana for its positive medical advantages (Dubner, 2007; Nakaya, 2007; Van Tuyl, 2007). Nakaya (2007) points to the seemingly positive effects of marijuana on alzheimers, cancer, multiple sclerosis, glaucoma, and AIDS. While not scientific, personal experiences of the positive relief of sufferers from chronic illness is quoted as benefits that are claimed to outweigh the negative effects.

Van Tuyl (2007) states “almost all drugs – including those that are legal – pose greater threats to individual health and/or society than does marijuana.” She agrees that legalizing the smoking of marijuana would not justify the positive effects but posits still that the risks associated with smoking can be “mitigated by alternate routes of administration, such as vaporization” (pg. 22-23). The arguments point to clinically riskier drugs like opioids, benzodiazepines, and amphetamines that are administered by prescription on a daily basis. These drugs, like Vicodine, Xanex, or Ritalin, are internationally acceptable when deemed “medically necessary.”

Conclusion / Reflection:
While I am not comfortable weighing in on the controversy of the legalization of marijuana, in conclusion of this research paper there are clear implications for me as a practitioner. Alcohol too is quite legal, as is nicotine, but for the addiction counselor it is important to continue keeping a directive on the biopsychosocial considerations regarding the misuse of any substance. Because of the large lack of empirical knowledge regarding the neurobiological properties associated with exact brain functioning, a crucial focus moving forward will prove to be keeping tabs on breakthrough discoveries in the neuroscience of THC and other cannabanoids. The discoveries of particular importance for current practice are the pathology of marijuana’s relationship with emotional self-medication, tolerance, and most of all the withdrawal process. I have already begun to utilize the knowledge of the physical and pharmacological effects of marijuana expressed heretofore with personal success and look forward to continue utilizing farther research to do the same.

Bibliography:

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Ashton, C. H. (2001). Pharmacology and Effects of Cannabis: a Brief Review. The British Journal of Psychiatry 178(2) 101-106. Retrieved March 4, 2011

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Eftekhari, A., Turner, A., & Larimer, M. (2004). Anger Expression, Coping, and Substance Use in Adolescent Offenders. Addictive Behaviors 29(5). Retrieved March 3, 2011. doi:10.1016/j.addbeh.2004.02.050

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Hazelden (2005). The Matrix Model. Hazelden Publishing.

Hazelden (2005). The Neurobiology of Addiction (video). The Matrix Model. Hazelden Publishing.

Jaffe, J., & Jaffe, A. (2004). Neurobiology of Opioids as found in The American Psychiatric Textbook of Substance Abuse Treatment (3rd Ed., Ch. 2). American Psychiatric Publishing, Inc.

Martin, B. (2004). Neurobiology of Marijuana as found in The American Psychiatric Textbook of Substance Abuse Treatment (3rd Ed., Ch. 5). American Psychiatric Publishing, Inc.

Nakaya, A. (2007). Marijuana. Reference Point Press.

National Institute on Drug Abuse (2010). NIDA Info Facts: Marijuana. Retrieved March 6, 2011

Schuckit, M. & Tapert, S. (2004). Alcohol as found in The American Psychiatric Textbook of Substance Abuse Treatment (3rd Ed., Ch. 14). American Psychiatric Publishing, Inc.

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