1996: first state permits medical marijuana

For more than a few drugs, substance abuse has been an unintended consequence of having the medicine available to treat ailments. For no substance, though, are the issues of medical and recreational use as complex as they are for marijuana.

In the US, decades-long attempts to reconcile illicit use to induce intoxication with its potential to help people feeling pain and discomfort has reached a crescendo at the US Supreme Court, which has decided that it is up to the federal government -- not the states -- to permit patient access to legal marijuana.

Cannabis is listed as a remedy in a book on herbal medicines attributed to Shen Neng, the mythical Chinese emperor and deity. The traditional date of this book is 2737 B.C., though the work probably wasn't compiled until centuries later.

Medical attention to cannabis spiked in the 19th century. With this renewed scientific attention, however, also came a growing fondness for marijuana-induced euphoria. Backlash led to the Marihuana Tax Act of 1937, which effectively banned the substance in the US.

In 1964, two Israeli chemists, Raphael Mechoulam and Yehiel Gaoni, isolated 1-3,4-trans-tetrahydrocannabinol (9-THC) as the active compound in Cannabis sativa.

Research into cannabis has been on the upswing since that time. Little is known about the effectiveness of smoking marijuana on disease. "The problem is that, although cannabis has been used in human medicine for some 4,000 years, we do not have rigorous scientific evidence either for its safety or its effectiveness, except in a very few isolated cases," writes Leslie L. Iversen in "The Science of Marijuana," published by Oxford University Press in 2000.

Over the years, however, hundreds of patients have asserted that marijuana has eased their suffering. Perhaps the most famous of these is Robert C. Randall, who in 1972 was diagnosed with glaucoma that was expected to blind him. He soon discovered that smoking maijuana improved his vision.

Studies have shown that marijuana helps glaucoma patients by lowering intraocular pressure. Randall was arrested for growing marijuana, had the charges dropped, and by 1976 was receiving legal supplies from a University of Mississippi farm licensed to grow marijuana for research purposes. He retained his sight until he died in 2001.

According to Health Canada, combating nausea in cancer patients undergoing chemotherapy is perhaps the most studied use of medical marijuana. Oral 9-THC has been shown to be effective versus a placebo, and smoked marijuana has been reported to alleviate symptoms in patients. Marijuana, usually illegal, is reportedly popular among patients with AIDS as a way to boost appetite and stem the wasting associated with that disease.

Chemotherapy and AIDS wasting are also the targets of synthetic cannabinoids that are already legal in some places. Marinol (dronabinol) is a synthetic 9-THC marketed by Solvay Pharmaceuticals. In 1985, the Food & Drug Administration approved it for nausea and vomiting from cancer chemotherapy. In 1992, it was approved to treat anorexia and weight loss in AIDS patients.

Many patients with multiple sclerosis believe that marijuana lowers spasticity. Other ailments in which there is interest in medicinal marijuana include epilepsy, general pain relief, disorders such as Parkinson's disease and Tourette's syndrome, and mood disorders such as depression.

There has been a groundswell of support for legalization for medical use in the US. Opponents see the medical marijuana issue as a Trojan horse for broader legalization of the drug. Indeed, some proponents do want broader legalization. Others, however, aren't terribly interested in getting high but want marijuana available if it can comfort sick people.

By passing Proposition 215 in 1996, California became the first state to permit medical use of marijuana. Nine other states followed, and more are considering similar measures. Medical marijuana is also available in Canada.

In 2002, Drug Enforcement Agency agents seized the cannabis plants belonging to Diane Monson, who had severe back spasms. She and another patient, Angel Raich, sued the federal government.

The case, Ashcroft v. Raich, was argued before the US Supreme Court in November 2004. On June 6, 2005, the court decided in a 6-to-3 vote that medical marijuana was a matter of interstate commerce and thus the federal government's jurisdiction trumps the states'. Justice John Paul Stevens called the potential influence of legal marijuana on the illicit market "not just plausible, but readily apparent."

Justice Sandra Day O'Connor countered that the decision stifles an express choice by some states to permit medical marijuana use. (info & photo from Chemical & Engineering News)