Accommodating the medical use of marijuana: surveying the differing legal approaches in Australia, the United States and Canada

While the scientific and medical communities continue to be divided on the therapeutic benefits and risks of cannabis use, anecdotal evidence from medical users themselves suggests that using cannabis is indeed improving their quality of life by alleviating their pain and discomfort. Notwithstanding the benefits anecdotally claimed by these medical users and the existence of some scientific studies confirming their claims, criminal drug laws in all Australian and most United States jurisdictions continue to prohibit the possession, cultivation and supply of cannabis even for medical purposes. However, in contrast to Australia and most parts of the United States, the medical use of cannabis has been legal in Canada for about a decade. This article reviews these differing legal and regulatory approaches to accommodating the medical use of cannabis (namely, marijuana) as well as some of the challenges involved in legalising it for medical purposes.

Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands

BACKGROUND

This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances.

METHODS

Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005-2006 were examined.

RESULTS

Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11-1.53) for Canadian boys and 1.55 (1.31-1.83) for girls, and 2.0 (1.73-2.31) for Dutch boys and 1.92 (1.62-2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR=.67; .46-.96).

CONCLUSIONS

The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.

Civic norms and etiquettes regarding marijuana use in public settings in New York City

This paper shows that active police enforcement of civic norms against marijuana smoking in public settings has influenced the locations where marijuana is smoked. It has subtly influenced the various marijuana etiquettes observed in both public and private settings. The ethnographic data reveal the importance of informal sanctions; most marijuana consumers report compliance with etiquettes mainly to avoid stigma from nonusing family, friends, and associates-they express limited concern about police and arrest.

Determination of Δ9-tetrahydrocannabinol in indoor air as an indicator of marijuana cigarette smoking using adsorbent sampling and in-injector thermal desorption gas chromatography–mass spectrometry

The marijuana leaves are usually mixed with tobaccos and smoked at amusement places in Taiwan. Recently, for investigation-legal purposes, the police asked if we can identify the marijuana smoke in a KTV stateroom (a private room at the entertainment spot for singing, smoking, alcohol drinking, etc.) without marijuana residues. A personal air-sampler pump fitted with the GC liner-tube packed with Tenax-TA adsorbent was used for air sampling. The GC-adsorbent tube was placed in the GC injector port and desorbed directly, followed by GC-MS analysis for the determination of delta9-tetrahydrocannabinol (delta9-THC) in indoor air. The average desorption efficiency and limit of detection for delta9-THC were 89% and 0.1 microg m(-3), respectively, approximately needing 1.09 mg of marijuana leaves smoked in an unventilated closed room (3.0 m x 2.4 m x 2.7 m) to reach this level. The mean delta9-THC contained in the 15 marijuana plants seized from diverse locations was measured to be 0.32%. The delta9-THC in room air can be successfully identified from mock marijuana cigarettes, mixtures of marijuana and tobacco, and an actual case. The characteristic delta9-THC peak in chromatogram can serve as the indicator of marijuana. Positive result suggests marijuana smoking at the specific scene in the recent past, facilitating the formulation of further investigation.

The legal status of medical marijuana

OBJECTIVE

To review the legal status of medical marijuana in the US.

DATA SOURCES

Relevant publications were located using LexisNexis (1982-October 2006), WestLaw (1996-October 2006), BNA Health Law Reporter (1996-October 2006), MEDLINE (1996-October 2006), EMBASE (1980-October 2006), International Pharmaceutical Abstracts (1970-October 2006), and an Internet search targeting government sites using the key words medical marijuana.

STUDY SELECTION AND DATA EXTRACTION

Federal and state medical marijuana laws were examined. Relevant cannabinoid-based drug products were reviewed. Federal and State Supreme Court and Appeal level cases involving medical marijuana were evaluated.

DATA SYNTHESIS

Marijuana is regulated as a Schedule I controlled substance and its use is prohibited under federal law. Dronabinol and nabilone are synthetic cannabinoids approved by the Food and Drug Administration and Sativex is a cannabis-based extract being evaluated in Phase III trials. The federal government sponsors a single patient compassionate use Investigational New Drug Application program providing medical marijuana for a small number of patients. Eleven states permit marijuana use for medical purposes and one state provides a defense of medical necessity. Employers do not have to provide workplace accommodations for employees using medical marijuana and can terminate them at will. Healthcare providers have First Amendment constitutional protections that allow them to discuss marijuana with patients.

CONCLUSIONS

Until the Supreme Court rules directly on the constitutionality of state medical marijuana laws, a conflict remains. Marijuana use remains illegal under federal law and states assume their medical marijuana laws to be constitutional.

What are the policy implications of the evidence on cannabis and psychosis?

OBJECTIVE

To explore the implications for mental health services, for health education about the risks of cannabis use, and for public policy toward cannabis use of observational evidence that cannabis use is a contributory cause of psychosis.

METHOD

Using comparative analyses of similar evidence for the harmful effects of alcohol, tobacco, and amphetamine use, we considered the relation between observational evidence and action on cannabis. We examined arguments on the grounds of public health prudence for discouraging cannabis use by young individuals. With the assumption that the relation may be causal, we considered recommendations for policy in mental health services, health education, and public policy toward cannabis.

RESULTS

The observational evidence and biological plausibility of the hypothesis that cannabis is a contributory cause of psychosis is at least as strong as evidence for causal relations between heavy alcohol and amphetamine use and psychosis. On public health grounds, there is a good case for discouraging cannabis use among adolescents and young adults. It remains uncertain how best to discourage use and at whom campaigns to reduce cannabis use should be targeted.

CONCLUSIONS

We should discourage young adults seeking treatment in mental health services from using cannabis and inform them of the probable mental health risks of cannabis use, especially of early and frequent use. We must exercise caution in liberalizing cannabis laws in ways that may increase young individuals' access to cannabis, decrease their age of first use, or increase their frequency of cannabis use. We should consider the feasibility of reducing the availability of high-potency cannabis products.

Causal relationship between cannabis use and psychotic symptoms or depression. Should we wait and see? A public health perspective

The aim of this paper is to update and critically analyze the public health relevance of available evidence about the causal relationship between cannabis use and psychosis or depression. There are conflicting views about this causal relationship. Two systematic reviews of existing evidence assessed this association and were published in 2004, but they came to different conclusions. From a public health perspective a thorough discussion is warranted before attributing any observed effect to potential biases. First, the impact of residual confounding in this causal relationship is discussed. We consider that the attenuation of estimates after controlling for confounding factors cannot be interpreted as evidence to support the claim that residual confounding fully explains this link. Secondly, taking into account the results of recent studies, the time-sequence and dose-response criteria of causality are discussed. The fact that unreported or subclinical psychological problems might have preceded and precipitated cannabis use is a very unlikely explanation when the cannabis-psychosis outcome link is assessed from different longitudinal studies. And finally, available evidence is interpreted with a broad view of public health and by taking into account the precautionary principle. We therefore provide reasons to support the case that stronger preventive actions against cannabis are still required in order to avoid the potential increased incidence of psychosocial health problems in the future.

What does it mean to decriminalize marijuana? A cross-national empirical examination

Although frequently discussed as a singular policy, there is tremendous variation in the laws and regulations surrounding so-called decriminalization policies adopted by Western countries, with many jurisdictions adopting depenalization policies rather than policies that actually change the criminal status of cannabis possession offences. This paper provides a discussion of the liberalization policies being adopted in Western countries, highlighting distinct elements about particular policies that are important for proper analysis and interpretation of the policies. It then discusses some of the environmental factors that also shape these policies, and hence influence their potential impact, using data from the U.S.A. as a particular example. The results clearly show that researchers should be careful conducting intra- or international comparisons of policies because important aspects of these policies are frequently ignored.

Public health issue brief: medical marijuana: year end report-2004

During the last few years, the debate over the use of marijuana for medical purposes has moved from the legislative arena into the public forum. Thirty six states and the District of Columbia have had statutes that address the medical utility of marijuana within the past 26 years. However, several of those states have either repealed the laws or allowed them to sunset. Since 1996, 11 states have enacted laws that allow individuals to use marijuana with a doctor's consent.

Alcohol and marijuana use among college students: economic complements or substitutes?

Previous research has shown that the recent tightening of college alcohol policies has been effective at reducing college students' drinking. Over the period in which these stricter alcohol policies have been put in place, marijuana use among college students has increased. This raises the question of whether current policies aimed at reducing alcohol consumption are inadvertently encouraging marijuana use. This paper begins to address this question by investigating the relationship between the demands for alcohol and marijuana for college students using data from the 1993, 1997 and 1999 waves of the Harvard School of Public Health's College Alcohol Study (CAS). We find that alcohol and marijuana are economic complements and that policies that increase the full price of alcohol decrease participation in marijuana use.

Legalization of marijuana: potential impact on youth

This technical report provides historical perspectives and comparisons of various approaches to the legal status of marijuana to aid in forming public policy. Information on the impact that decriminalization and legalization of marijuana could have on adolescents, in addition to concerns surrounding medicinal use of marijuana, are also addressed in this report. Recommendations are included in the accompanying policy statement.

Legalization of marijuana: potential impact on youth

As experts in the health care of children and adolescents, pediatricians may be called on to advise legislators concerning the potential impact of changes in the legal status of marijuana on adolescents. Parents, too, may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical purposes or to decriminalize possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization, and the accompanying technical report (available online) reviews what is currently known about the relationship between adolescents' use of marijuana and its legal status to better understand how change might influence the degree of marijuana use by adolescents in the future.

The effects of price and policy on marijuana use: what can be learned from the Australian experience?

This research examines the responsiveness of the demand for marijuana to changes in its money price and criminal status using data on individuals from the Australian National Drug Strategy's Household Surveys (NDSHS). The results suggest that both the prevalence of marijuana use and the conditional demand for marijuana in the general population are responsive to changes in its money price. Significant differences are found in the effect of price on participation in marijuana use across age-groups, with participation by youth more price sensitive than participation by older age-groups. Similarly, the effect of the legal status of marijuana use on the participation decision is found to differ across age-groups and gender. Specifically, decriminalisation is associated with an increases in the prevalence of use by males over the age of 25. There is no evidence that decriminalisation significantly increases participation in marijuana use by either young males or females, or that decriminalisation increases the frequency of use among marijuana users.