Supreme Court quashes use of medical marijuana

Doctors who recommend cannabis for patients should be more cautious now that the U.S. Supreme Court has ruled that the federal government can prosecute patients who use the substance in states that have legalized it for medicinal purposes, California Medical Assn. executives say.

An earlier court ruling in a separate case protects physicians who talk about medical marijuana with their patients. But physicians need to understand that the federal government considers patients using medical marijuana to be in violation of federal law, and the court supports that position under the June 6 ruling, said CMA Executive Vice President and CEO Jack Lewin, MD.

That means if a patient is arrested, the physician who recommended the treatment could potentially have trouble with his or her DEA number or medical license, he warned.

"We were disappointed in the decision but not surprised," Dr. Lewin said. "It puts a chill on the doctor-patient relationship."

The California Medical Assn. does not take a position on medical marijuana.

With passage of a voter referendum, California in 1996 became the first state to allow residents to possess and use cannabis if a physician recommends it to treat a medical condition. Nearly a dozen other states have followed with similar laws.

California residents Angel McClary Raich and Diane Monson, who use the plant for serious medical conditions, filed a lawsuit asking the courts to find that it is unconstitutional to prosecute patients growing and using medical marijuana after a physician recommends it. Their lawsuit came after federal Drug Enforcement Administration agents in 2002 seized and destroyed Monson's six cannabis plants.

In a 6-3 decision in Gonzales v. Raich, the Supreme Court ruled that the federal government has the right to enforce the Federal Controlled Substances Act even if a state has passed its own law legalizing the drug for medicinal purposes. It overturned a lower court ruling on the issue.

"The case is made difficult by respondents' strong arguments that they will suffer irreparable harm because, despite a congressional finding to the contrary, marijuana does have valid therapeutic purposes," judges stated in the majority opinion.

"The question before us, however, is not whether it is wise to enforce the statute in these circumstances; rather, it was whether Congress' power to regulate interstate markets for medicinal substances encompasses the portions of those markets that are supplied with drugs produced and consumed locally. Well-settled law controls our answer," they added.

The high court noted in the close of its opinion that Congress could change the law.

"Perhaps even more important than these legal avenues is the democratic process, in which the voices of voters allied with these respondents may one day be heard in the halls of Congress," Justice John Paul Stevens wrote for the majority.

Attorneys for Raich and Monson said the opinion didn't overturn states' medical marijuana laws and they don't believe the decision would stop patients from using the treatment. The ruling preserved the status quo because federal agents argued they had the right to enforce the law before the court decision, they said.

"The only question was whether the federal authorities could come into California and enforce federal laws using federal dollars," said Robert Raich, Angel's husband and a member of the legal team. "For all intents and purposes, patients are safe because most drug laws are enforced by state and local law."

Raich said she would continue smoking marijuana because it is the only treatment that has helped her. One of her physicians believes that stopping the cannabis regimen would cause her "excruciating pain" and potentially could lead to her death, according to court records. Raich has been diagnosed with a number of serious medical conditions, including chronic pain and an inoperable brain tumor.

"Just because we did not win this battle, does not mean we won't have the opportunity to win the war," she said.

At a press conference held after the court released its decision, Raich said she hoped to be in Washington, D.C., in mid-June when the House of Representatives is scheduled to vote on an appropriations amendment that would stop federal money from being used for enforcement actions against patients who use cannabis in states that have legalized medical marijuana.

However, Director of National Drug Control Policy John Walters said the court's decision marks the end of medical marijuana as a political issue.

"We have a responsibility as a civilized society to ensure that the medicine Americans receive from their doctors is effective, safe and free from the pro-drug politics that are being promoted in America under the guise of medicine," Walters said in a statement. "Smoking illegal drugs may make some people 'feel better.' However, civilized societies and modern-day medical practices differentiate between inebriation and the safe, supervised delivery of proven medicine by legitimate doctors."

Doctors weigh in

AMA policy calls for further research to determine whether marijuana and related cannabinoids have efficacy in patients who have serious conditions for which preclinical, anecdotal or controlled evidence suggests possible efficacy.

The CMA's Dr. Lewin said there needs to be more research to determine when and how cannabis might be clinically useful before the California association can take a stance on the matter. He said the CMA chose to get involved in the Raich case by filing a friend-of-the-court brief because of the patient-physician relationship issues that were involved.

The CMA joined the Leukemia & Lymphoma Society, Pain Relief Network, AIDS Action Council, Compassion in Dying Federation, End-of-Life Choices and National Women's Health Network in filing a brief in support of Raich and Monson.