If you look at the criteria for drug scheduling in the US, you’ll notice that the medical use of the substance is a crucial factor. Schedule I drugs, for example, have “no currently accepted medical use” as well as a high potential for abuse.
With the rescheduling process for cannabis still ongoing, lawmakers clearly see the issue with putting cannabis in this category. But with 38 states allowing cannabis for medical purposes and such a huge range of qualifying conditions, shouldn’t we just accept that it has more benefits than downsides and legalize it altogether?
Continuing our series of the Best Arguments For and Against Cannabis, we’re taking an in-depth look at the medical uses for cannabis and how they should (or shouldn’t) inform our discussion about legalization.
Summary: Should Cannabis Be Legal Because it Has Medical Benefits?
Yes…
- Schedule I drugs supposedly have no currently accepted medical benefit. However, most states agree cannabis can help with many conditions including chronic pain, multiple sclerosis and chemotherapy side effects.
- Lists of qualifying conditions for medical cannabis vary by state. A patient in one state may be eligible for legal medical cannabis while an identical patient in another state would not be.
- Legalizing cannabis would acknowledge its obvious medical applications while equalizing access for medical patients across the country.
No…
- Just because something has medical benefits doesn’t mean it should be sold freely. Doctors prescribe morphine medically but we shouldn’t make it completely legal.
- Cannabis is addictive, and this is another key part of the definitions in the drug schedules. This justifies placing it somewhere like schedule III, but not legalizing.
- The inequalities in the medical cannabis state laws could be rectified with a unified set of science-based qualifying conditions for the whole country.
The Medical Benefits of Cannabis (and the Minimal Risks)
There are many accepted medical uses for cannabis, ranging from CBD for rare childhood seizure disorders through to THC-containing products for chronic pain.
The National Academies of Science, Engineering and Medicine looked through all of the evidence back in 2017, and concluded that there was substantial evidence of a benefit for chemotherapy-induced nausea and vomiting, chronic pain, and multiple sclerosis (MS). For other conditions, including anxiety, post traumatic stress disorder (PTSD), Tourette syndrome, and weight loss and appetite issues from HIV/AIDS, there is limited evidence. Finally, they found moderate evidence that cannabis can help reduce sleep disturbance associated with obstructive sleep apnea, fibromyalgia, chronic pain and MS.
This is a fairly conservative list, with some physicians arguing for benefits in many other conditions. For example, Harvard Medical School’s Dr. Peter Grinspoon suggests it can help reduce tremors in Parkinson’s disease, help with fibromyalgia more generally, interstitial cystitis, endometriosis and glaucoma. Importantly, when discussing the benefits for pain conditions, Dr. Grinspoon points out that part of the appeal is that it is much safer than the opioids commonly used for pain conditions.
There are many other academic reviews and discussions you can use to get more information about the potential medical benefits of cannabis. The key point is that physicians from the US and around the world acknowledge that there are legitimate uses. Multiple lines of evidence clearly show the medical benefits of cannabis.
If Cannabis is Medicine, Where Do We Draw the Line?
If we accept cannabis as medicine – as most states already have – then we have to ask “how do we decide who is allowed to use cannabis and who isn’t?”
This is not an easy question to answer. There is a substantial overlap between medical and recreational use. One study suggested that as many as 80% of medical users are also recreational users. The line between medical and recreational use is not as clear as lawmakers might naively hope.
Things get even more muddied when we consider that the scientifically-backed medical uses above don’t cover every medical use accepted by states. The lists of qualifying conditions for “medical marijuana” are way broader than that relatively limited selection. They often include conditions not mentioned above such as (depending on your state – these examples were taken from Connecticut, Delaware and New Jersey):
- Agitation of Alzheimer’s disease
- Amyotrophic lateral sclerosis
- Autism with self-injurious or aggressive behavior
- Cachexia
- Cancer
- Cerebral Palsy
- Decompensated cirrhosis
- Dysmenorrhea
- Inflammatory bowel disease, including Crohn’s disease
- Intractable skeletal muscular spasticity
- Migraine
- Muscular dystrophy
- Opioid Use Disorder
- Post Laminectomy Syndrome with Chronic Radiculopathy
- Severe Psoriasis and Psoriatic Arthritis
- Severe Rheumatoid Arthritis
- Seizure disorder, including epilepsy
- Sickle Cell Disease
- Terminal illness with prognosis of less than 12 months to live
- Vulvodynia and Vulvar Burning
And this is before we consider situations like in California, where the list includes “any other chronic or persistent medical symptom that either substantially limits a person’s ability to conduct one or more of major life activities.” Likewise, in New York, it includes, “any condition deemed clinically appropriate by your health care provider.” In short, some states allow basically anything your doctor agrees with.
Even using the list above, we can see problems immediately. Why should a woman with dysmenorrhea (i.e. painful periods) in New Jersey be able to access cannabis medically to manage the pain but not a woman in Delaware? Are we supposed to tell her she can use cannabis one week a month but never outside of this time? Imagine she ends up with migraines too. Should she have to go to the doctor again even though the same treatment would likely help her?
Any attempt to draw a firm line runs into such issues immediately. The alternative, much simpler, is making cannabis available more freely, both for recreational and medical users.
If it were very dangerous or not otherwise available, then perhaps there would be an argument for keeping things restricted. But as things stand, the risk is low and if people really want it, they can probably get it without a prescription with minimal difficulty. So why should we try to keep it “prescription only” when it might as well be “over-the-counter,” there for those who need it?
Counterpoint: Addictive Potential Matters Too
The two criteria for drug scheduling are accepted medical uses and potential for abuse and dependence. While cannabis has accepted medical uses, it also has potential for abuse and dependence. We don’t restrict opioid painkillers because we don’t think they have a medical use – they obviously do – but because despite this, they carry significant risk for abuse.
In the same way, even if cannabis is a medicine, allowing it to be sold freely opens people up to the risk of addiction. The overlap between medical and recreational use mentioned in the previous section makes this argument even stronger – clearly people are not just using medically, and free availability would just worsen this issue.
Counterpoint: Equalizing the System is Easy, But it Must Be Done Federally
Allowing states to set up their own qualifying criteria for “medical marijuana” has created an unequal situation, as mentioned above with the period pain example. But legalization or liberalization is not the only solution to this. The federal government could simply list acceptable medical uses of cannabis based on the actual evidence and not leave it to states to add any condition they think is valid at will.
If you believe that states should have the right to set their own laws to some extent, then this “inequality” is unavoidable – that’s what it means to have states decide. If you believe that rules should be fair across the board, this could just as easily be achieved with a scientifically-backed “master list” of qualifying conditions for medical cannabis as it could by a free-for-all legalization effort.
Our Take: Medical Use Doesn’t Justify Legalization, But It’s a Strong Point in Favor
It’s absolutely the case that the existence of medical uses for cannabis doesn’t mean it should be sold on every street corner. We restrict all types of medicines for very good reasons. But at the same time, even if it isn’t a standalone argument for legalization, it is one very important component of a larger case, taken alongside all the other arguments for cannabis.
Should the woman in New Jersey being able to smoke for period pain mean that every other state has to make this the law too? Of course not. But if it is safer than other pain medications and recreational drugs (such as alcohol) which society accepts, what exactly is the point in restricting it? Legalization would undoubtedly help many people who currently don’t have access to medical cannabis, not to mention all of the people who want to use it recreationally too.
The potential benefits are huge and the downsides such as addiction happen under a prohibitionist system anyway.
References
Bostwick, J. M. (2012). Blurred boundaries: The therapeutics and politics of medical marijuana. Mayo Clinic Proceedings, 87(2), 172–186. https://doi.org/10.1016/j.mayocp.2011.10.003
About the source:
- Peer reviewed? Yes, published in Mayo Clinic Proceedings.
- Methodology: A narrative review of evidence on the therapeutic potential and controversies surrounding “medical marijuana.”
- Main points: Discusses the history of the medical use of cannabis, relevant controversies (e.g. the relationship between psychosis and cannabis) and other points. Importantly for this article, it points out that there is substantial overlap between medical and recreational use.
- Other notes: Could be viewed as biased, owing to the author’s clear disagreement with the schedule I status for cannabis and the narrative nature of the review. However, both positive and negative points are discussed.
Grinspoon, P. (2020, April 10). Medical marijuana. Harvard Health. https://www.health.harvard.edu/blog/medical-marijuana-2018011513085
About the source:
- Peer reviewed? No, a blog post from Dr. Peter Grinspoon of Harvard Health.
- Main points: Medical cannabis is effective for many conditions, ranging from chronic pain control to Parkinson’s disease, weight loss and glaucoma.
- Other notes: This is perhaps a little more lax when it comes to quality of evidence than peer reviewed articles tend to be (for example, speaking positively about areas it acknowledges more evidence is needed). However, it is not an unfair assessment.
National Academies of Sciences, Engineering and Medicine. (2017). Therapeutic effects of cannabis and cannabinoids. In The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK425767/
About the source:
- Peer reviewed? No, but an official publication of the highly-respected National Academies of Sciences, Engineering and Medicine, based on peer-reviewed research.
- Methodology: A committee of experts systematically reviewed evidence on cannabis use and various health end-points. You can find more information here.
- Sample size: The committee reviewed 6,540 primary literature articles and 288 systematic reviews. The final sample included 207 primary literature articles and 44 systematic reviews. Note that these numbers are for the whole book (not just this chapter).
- Main results: Cannabinoids are effective antiemetics for chemotherapy-induced nausea and vomiting, can improve pain symptoms, improve patient-reported spasticity in MS patients and have many other potential effects with less convincing evidence.
- Other notes: It’s worth noting that the conclusions of this review are fairly conservative. They are not inaccurate, but many physicians and researchers would argue that cannabinoids help with more conditions.
Turna, J., Balodis, I., Munn, C., Van Ameringen, M., Busse, J., & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry, 102, 152188. https://doi.org/10.1016/j.comppsych.2020.152188
About the source:
- Peer reviewed? Yes, published in Comprehensive Psychiatry.
- Methodology: Self-reported survey of cannabis users. Users completed many diagnostic tests (e.g. to assess cannabis use disorder, anxiety, PTSD and other conditions). Researchers compared their habits and conditions based on whether they used medically, recreationally or both.
- Sample size: 709 cannabis users from Canada.
- Main results: Around 61% only used recreationally. Medical users tended to use cannabis more and were more likely to have problematic use and psychiatric symptoms. 80.6% of medical users also used recreationally.
- Other notes: The study relied on self reports, and the authors used a non-representative database for their sample.