Since 1978, 39 states have enacted laws permitting the use of medical marijuana, but most of the laws relied on a supply of cannabis from federal government sources or on federal authorization of marijuana use and were never implemented. In the meantime, six of those state laws have expired or been repealed. Since 1996, however, 16 states and the District of Columbia have enacted practical medical marijuana legislation that extends some form of legal protection to patients using marijuana for medical purposes. These include Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington. Legislation passed in Maryland recognizes the medical benefits of marijuana, but did not provide legal protections for its use.
So, how do the laws in those states and DC differ? According to Article 18 of the Colorado Constitution, marijuana may be used by persons suffering from debilitating medical conditions such as cancer, glaucoma or HIV positive status or AIDS or their treatment, or a chronic or debilitating disease or medical condition, or treatment for such conditions, which produces one or more of the following: cachexia; severe pain; severe nausea; seizures, including those that are characteristic of epilepsy; or persistent muscle spasms, including those that are characteristic of multiple sclerosis. A medical marijuana patient in Colorado may have up to six (6) plants, three (3) immature and three (3) flowering, and up to two (2) ounces of useable marijuana or its equivalent.
However, the medical conditions for which patients may use marijuana in other states vary, in some cases quite considerably from those approved in Colorado, as do the amounts of marijuana and the number of plants allowed. Washington, for example, allows medical marijuana patients to have up to 24 ounces of marijuana and 15 plants, while New Jersey allows a patient to have up to 2 ounces of usable marijuana, but not to grow their own plants.
Most states allow marijuana to be used to treat the same conditions as in Colorado, though California also allows marijuana to be used for “other chronic or persistent medical symptoms,” leaving the determination of what those are to a patient’s doctor. Hawaii allows marijuana to be used to treat “severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Crohn’s disease.” Maine’s medical marijuana law initially didn’t mention pain as a qualifying condition, but was amended by a ballot initiative in November of 2009 to include chronic intractable pain as well as hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Crohn’s disease, Alzheimer’s disease and nail-patella syndrome, in addition to severe and persistent muscle spasms and multiple sclerosis itself.
Michigan—and Oregon, recently—allows marijuana to be used for the agitation of Alzheimer’s disease. New Jersey allows marijuana to be used for muscular dystrophy and inflammatory bowel disease, but not Alzheimer’s disease, and in patients with “terminal illness” whose doctors have determined that they have twelve months or less to live. New Mexico adds post-traumatic stress disorder (PTSD) to the list of approved conditions as well as use by hospice patients.
There is obviously no general agreement on the medical conditions for which marijuana is effective treatment. What research findings support New Mexico’s decision, for example, to include PTSD in its list of diseases that respond to marijuana while failing to include the muscular dystrophy that patients in New Jersey can use marijuana to treat? The answer is complex. In some cases the decision to include one condition but not another is based on little more than good lobbying efforts by patient groups, while in others, the decisions were based on scientific evidence. In coming months, we will examine some of that evidence. Please stay tuned.
Alan Shackelford, M.D., graduated from the University of Heidelberg School of Medicine and trained at major teaching hospitals of Harvard Medical School in internal medicine, nutritional medicine and hyperalimentation and behavioral medicine. He is principle physician for Intermedical Consulting, LLC and Amarimed of Colorado, LLC and can be contacted at Amarimed.com.