Medical Marijuana and California's
Medical Marijuana Initiative
Molecular Neurobiology and Neurochemistry
Molecular Cell Biology 165
Professor David Presti
Tomonori Kaneko
SID: 12576824
May 5, 1999
Key words: cannabinoid, cannabis club, Proposition 215, complementary and alternative medicine.
ABSTRACT:
Marijuana has shown to have therapeutic effects on the symptoms of many diseases. Marijuana therapy is more effective, efficient, controllable and affordable solutions to many of disease symptoms compared to commercially available drugs. Full benefits of marijuana therapy are yet to be adopted by majority of patients who can potentially benefit from it because of marijuana's illegal status in the United States. Many patients take the risks of getting arrested and use marijuana to alleviate their pain. Several recent researches on marijuana and its chemical components are reviewed to assess the benefit and risks of medical marijuana. Controversy surrounding California's Medical Marijuana Initiative and Cannabis Buyers' Club are discussed while opinions of popular media are evaluated. To provide sufficient resources and information regarding medical marijuana, the research on medical marijuana is necessary. Better understanding of marijuana both allows patients to weigh the risk of short- and long-term adverse effects against the desired benefits of marijuana therapy and implement a fairer, more careful marijuana therapy for individual cases.
MY MOTIVATION:
There are two main reasons that lead me choosing "marijuana" as the final paper topic for the class, Molecular and Cell Biology 165.
First, marijuana has had the most immediate consequence to my life compared to all other subjects that we have studied in MCB 165: Some of my friends are marijuana smokers and I had been exposed to it in several occasions. Trying to understand what marijuana really is, or does, had been very difficult to understand; my limited knowledge on marijuana all comes from the discussion of "marijuana myth" among ourselves without proper scientific backgrounds.
Secondly, though I have lived in California for past four years, I had had only a vague idea of marijuana's status in California and San Francisco. I had had no interest in political debate including the controversial issues surrounding California's Proposition 215. Being a foreign citizen without a voting right almost had isolated me from any political debate on the issues. My only exposures to the Proposition 215 were only through several articles printed on our lovely student newspaper, The Daily Californian. As a graduating senior (I hope I am graduating) I saw that this is a great opportunity to familiarize and explore the topics concerning marijuana and Proposition 215 before leaving Berkeley.
REPORTED MEDICAL BENEFITS, ADVERSE EFFECTS, AND SAFETY OF MARIJUANA USE:
There are diverse marijuana uses as therapy. Marijuana is used in treating many common disorders as well as for less common symptoms. There are more that 400 chemical compounds contained in marijuana smoke, including at least 60 cannabinoids (Smith, 1998). The speculation, supported by some scientific evidence, is that delta-9-tetrahydrocannabinol (delta-9-THC) is the main factor contributing to its therapeutic effects.
Common Medical Use of Marijuana (Grinspoon & Bakalar, 1998):
Nausea and vomiting of cancer chemotherapy glaucoma, epilepsy, the muscle spasms of multiple sclerosis, paraplegia and quadriplegia, the weight loss syndrome of AIDS, chronic pain, migraine, rheumatic diseases, pruritus, PMS, Menstrual cramps and labor pains, depression and other mood disorders
Less Common Medical Use of Marijuana (Grinspoon & Bakalar, 1998):
Asthma, insomnia, antimicrobial effects, topical anesthetic effects, antitumoral effects, dystonias, adult ADD, schizophrenia, systemic clerosiss, Chron's Disease, diabetic gastroparesis, pseudotumor cereebri, tinnitus, violence, PTSD, phantom limb poain, alcoholism and other additions, terminal illness and aging.
Marijuana, as many other available drugs on market, is not risk-free and all-purpose medicine. It is known as a mood-altering drug that is capable of producing dependency. In addition, marijuana also interferes with cognitive and motor performance, damages respiratory system, alters endocrine system and affects immune systems (Cermak, 1998). Below are the acute and chronic adverse effects that have resulted in some, or many, of individuals who use marijuana for either medical or recreational purposes.
Acute Adverse Effects (Cermak, 1998):
Anxiety, dysphoria, panic and paranoia; sedation and drowsiness; cognitive impairment, especially attention and memory; psychomotor impairment; exacerbation of preexisting or latent psychiatric symptoms; and relapse of chemical dependence.
Chronic Adverse Effects (Cermak, 1998):
Cannabis dependence; subtle cognitive impairment characteristic of frontal lobe dysfunction; impaired educational performance and professional performances; and exacerbation of preexisting or latent psychiatric symptoms.
Although there are overwhelmingly numerous adverse effects accompanying marijuana use, overall safety of marijuana use has been shown to be very positive. There have been no confirmed deaths from cannabis overdose, and the therapeutic index (the ratio of lethal dose to therapeutically effective dose) is estimated to be 40,000 to 1 (Gurley et. al., 1998). The safety of using marijuana can be understood when this value is compared to the therapeutic index of alcohol which is 4-10 to 1(Gurley et. al., 1998).
SOME OF THE MOST RECENT STUDIES ON MARIJUANA AND RELATED SUBJECTS:
Mesolimbic dopminergic decline after cannabinoid withdrawal (Dianna, et. al., 1998)
Demonstrating the withdrawal symptom of delta-9-THC has been very difficult. The progress in the investigation was hindered because the cannabinoids' long half-lives and the lack of pharmaceutical antagonist that is suitable for investigating this purpose. Recently, however, SR 141716A, a compound that possesses the antagonistic properties toward the central cannabinoid receptor (CB1) is found. With the aid of this compound, sudden block of CB1 receptor is possible and observation of the behavioral withdrawal syndrome in rat model was conducted.
Some of the rats were chronically exposed to large doses of delta-9-THC. When withdrawal was pharmacologically induced with SR 141712A, an acute and intense withdrawal behaviors were observed. In contrast, no significant withdrawal behavior was observed in the spontaneous withdrawal group (without SR 141716A administration). When the ventral-tegment area dopamine neurons of above two groups were examined, compared with the control group (groups that were not exposed to the chronic cannabinoids administration), the altered basal electrophysiological characters were found. Specifically, decreased firing rates, burst firing and spikes/burst of individual neurons were observed in the rat groups that were administered with delta-9-THC. Administration of SR 141716A to the control group did not alter the firing rate of mesolimbic dopamine neurons, contrasted to the SR 141716A induced withdrawal group. This indicates that after the chronic treatment with cannabinoid, the dopamine neurons of limbic system are at least partly driven by the activity of exogenous cannabinoids.
The results from these experiments indicate that chronic administration of delta-9-THC results in major change in the physiology, biochemistry of the mesolimbic dopamine system in the treated subjects.
NOTE: As seen in the cases of many abused drugs, marijuana contributes to a significant alteration on our physiology. Chronic marijuana users often claim that they can quit smoking marijuana any time they wish. Withdrawal symptom is unnoticeable because delta-9-THC and other cannabinoids have a long half-life and thereby leaving chemical remnants (including delta-9-THC) in the body for an extended period of time. In addition, the remnant cannabinoids supplement the roles of endogenous neurotransmitter during their presence in the body. Although the statement "one can quit using marijuana anytime" is valid, the conclusion derived from this that "marijuana has no addictive nature" is wrong. After chronic exposure, one can develop addiction to marijuana, but we are unable to perceive this addiction in our behavioral level. Adverse effects, if any, caused by the temporary supplement, or replacement, of endogenous component by exogenous cannabinoids is still to be investigated, the chronic marijuana users should be aware that marijuana does alter our physiology.
Cannabidiol and (-)delta-9-tetrahydrocannbinol are neuroprotective andtioxidants (Hampson, et. al., 1998).
Glutamate is an excitatory neurotransmitter. In ischemia, the release of large quantities of glutamate leads to the over stimulation of N-methyl-D-aspartate receptors (NMDAr) thereby triggering oxidative neuronal death. This neurotoxicity has been known to be reduced in vivo and in vitro when treated by antioxidants or antagonists to NMDAr and AMPA/kainate receptors that mediate neurotoxicity. In vitro experiment was conducted to investigate the potentials of psychoactive cannabinoids and non-psychoactive cannabidiol - both of which are contained in marijuana smoke - to prevent glutamate neurotoxicity, as neuroprotectants.
In the study, cannabidiol was shown to prevent the both glutamate neurotoxicity and reactive oxygen species-induced cell death; delta-9-THC also prevented the neurotoxicity in similar potency. Both offer better protection to neurons when compared with available dietary antioxidants, alpha-tocopherol and ascorbate. Cannabidiol was also shown to be non-toxic when chronically administered in humans (Cunha, 1980). These new experimental results reveal very promising therapeutic potentials for the naturally occurring cannabidiol as the neuroprotective agents against ischemia.
NOTE: This study emphasizes the potential of cannabidiol as a therapeutic agent because unlike cannabinoids, it has no associated psychoactive effects. Delta-9-THC also showed the equivalent effectiveness, although, according to the author, its value is plagued by cannabinoid's psychoactive nature. The experimental results imply a possibility of marijuana therapy for any oxidative neurological disorders, including cerebral ischemia.
The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder: Anecdotal Evidence and the Need for Clinical Research (Grinspoon and Bakalar, 1997).
Bipolar Disorder is treated mainly with lithium salts and anticonvulsant drugs, which is often accompanied by serious side effects. In fact, 30 or 40 0f the bipolar disorder patients can not tolerate either the standard treatments themselves or the side effects that accompany the treatment (Grinspoon & Bakalar, 1997). Extensive interviews with bipolar disorder patients, whom self-medicate the disease symptoms with marijuana, were conducted to assess marijuana's therapeutic benefits. The study reveals no physiological or biochemical mechanism that smoked marijuana provides; the report is based on the individual case analysis.
Most of the patients interviewed have tried legally prescribed drugs before starting to use marijuana as their medication or supplemental medication. Some of legal drugs that were prescribed to the interviewed patients include Marinol (dronabinol), Depakote (valproic acid), Trilafon (perphenazine) and Tegretol (carbamazepine). The patients and their family members all report how beneficial marijuana is in treating bipolar disorder and improving their family lives. Although they all understand that any consumption of marijuana is law-evading action, marijuana is an essential in their lives.
After testing marijuana treatment, one patient describes "the world no longer seemed hostile but more within my control. I could sleep easily and actually had craving for food. (Grinspoon & Bakalar, 1998)." Another says "just a couple puffs of marijuana brings me back to life . . . it brings me to a level of normalcy that everyone else achieves naturally (Grinspoon & Bakalar, 1998)."
One patient reports that marijuana alleviates the side effects that accompany lithium treatment. He reports, "When I was diagnosed and began treatment with lithium, I got almost immediate relief [from bipolar disorder], but also suffered from nausea, pounding headaches, hand tremors, and excess production of saliva . . . . [when marijuana was used with the lithium treatment] the mad tremors subsided, the headaches vanished, and the saliva factory resumed normal production levels. All I needed was one or two puffs on a marihuana cigarette. When lithium side effects get bad, the availability of cannabis has been an absolute godsend (Grinspoon & Bakalar, 1998)."
Finally, a mother shows her determination to provide a supply of marijuana to relieve her unfortunate son as follows: "At this point, I expect to be arrested some day . . . [but] I plan to grow a plant this summer for his use. I know I could end up in jail, but I also know that without some kind of medication that works, my son could end up in jail, institutionalized, or dead. What choice do I have? (Grinspoon & Bakalar, 1998)"
NOTE: Although no medical benefit of marijuana is accepted by the United States Government, the report clearly shows the relief gained by the individuals afflicted by bipolar disorder. If the purpose of medicine, or our society is to alleviate the pains of seriously sick, then no reference to, or understanding, of the chemical mechanism of marijuana treatment is necessary. Marijuana treatment has shown to have invaluable therapeutic value. Because no drug is completely safe (nontoxic) or always efficacious, a drug approved by the FDA has presumably satisfied a risk-benefit analysis (Grinspoon & Baker, 1998). What would be the results of a risk-benefit analysis, if it were to be done, on the cases for the individual discussed above? Should people be raid of the right to live a "normal life" because of their genetic predisposition? If God somehow decided that they deserve a miserable life, they might deserve our sympathy - a privilege given to alleviate their pain that most of us fortunately do not have to experience.
Use of Marijuana among the HIV- Infected Patient (Fairfield, K et. al. 1998):
Complementary and alternative medicine (CAM) use is common in the general population, accounting for substantial expenditures. Detailed telephone surveys and medical chart review was conducted for 289 patients with HIV at a university-based teaching hospital in Boston Massachusetts. Of 180 patients who agreed to be interviewed 24 % reported the using marijuana for medical purposes in the previous year, while 87 0f the reports found the treatment "extremely" or "quite bit" helpful. Among the HIV- infected patient, marijuana use is at high rate while most of the users help the treatment very helpful.
NOTE: Many of AIDS patients are aware of the reported therapeutic effects of marijuana that slow down AIDS related wasting. Among its users, self-rated effectiveness of marijuana is impressive. Instead of looking away from these results and condemning the use of an illegal drug as medicine, our government has a responsibility to provide the patients with proper information. The benefits and risk of using marijuana for this purpose should be evaluated, for most people would break a law when their life is on stake.
HISTORY OF MARIJUANA BATTLE:
The battle over the issues of medicinal marijuana use is no news. The battle began in 1972 when the National Organization for Reform of Marijuana Laws petitioned the Bureau of Narcotics and Dangerous Drugs - now renamed as Drug Enforcement Administration (DEA) - to change marijuana's status to Schedule II so that it could be legally prescribed for medical purposes (Grinspoon, 1995 JAMA). The marijuana's status has not been changed since 1972; it has been categorized in Schedule I, the category that houses the substances without any legal medical use in the United States. In 1986, after six years of avoiding the public hearing by legal maneuvering, DEA was forced into the public hearing trial (Grinspoon, 1995 JAMA). At the end of two years battle, in 1988, DEA's own Administrative Law Judge Francis L. Young concluded the following:
"It is unrealistic and unreasonable to require unanimity of opinion on the question confronting us. For the reasons there indicated, acceptance [of marijuana having a medical use] by a significant minority of doctors is all that can reasonably be required. This record makes it abundantly clear that such acceptance exist in the United States . . . . One must reasonably conclude that there is accepted safety for use of marijuana under medical supervision (Fine, 1997 American Prospect)." He has also added that marijuana was "one of the safest therapeutically active substances known to man (Grinspoon, 1995 JAMA)." DEA, despite above conclusion, ignored the recommendation. Today marijuana still remains in Schedule I status.
PROPOSITION 215 AND INTERPRETATION (WWW 1):
California, especially San Francisco has been known for its history of progressive political activism, and its reputation for innovation (Feldman and Mandel, 1998). Harbinger of Proposition 215 is proposition P, a local ordinate passes in 1992 that directed the San Francisco police department to make marijuana arrests its lowest priority (Feldman and Mandel, 1998). Most of the nation was surprised by the proposal of Proposition 215, however, for the close followers of California's political trend, it was not a surprise but a mere expected progress.
The Proposition 215 of California was passed in 1996, and called Medical Marijuana Initiative, or Compassionate Use Act of 1996. The Initiative does not legalize marijuana, but exempts patients with doctor's prescription from the laws penalizing marijuana medical use. It also protects doctors who recommended marijuana, allowing the doctors to openly work with their patients for the best purposes. The proposition was especially intended to help patients with cancer, glaucoma, and AIDS; marijuana reduces their pain or the nausea associated with chemotherapy and powerful drugs like AZT. Because by reducing nausea and stimulating appetite in severely and terminal ill patients, marijuana can help lengthen life span and improve quality of life. Any other ill health that can achieve relief from marijuana use is allowed to be treated with marijuana with doctor's prescription.
Proposition 215 also allows patients and his or her "primary care givers" to possess and cultivate marijuana for their personal use; however, the transaction of buying marijuana seeds and seedlings itself is still illegal and patients must go to black market to obtain them. The "primary care giver" is "the individual . . . who has consistently assumed responsibility for the housing, health or safety of that person (WWW 1)."
Finally, Proposition 215 does not allow patients to use medical marijuana anywhere and anytime. Consumption of marijuana and acting under influence where this can consequently harm other people and properties are still illegal, as in the case of alcohol.
WHY MEICAL MARIJUANA OVER COMMERCIALLY AVAILABLE DRUGS?
The active components of both marijuana and commercially available pills must be absorbed into the blood stream to be effective. The lung is a very efficient organ that is specialized in absorption, and smoking simply is a superior method in administering medicine over ingestion. Inhalation of active components also offer relief to the disease symptom in much timely manner, for an example, in the case bipolar symptom arises unexpectedly and suddenly, immediate relief is desirable. Also, the dose of the drugs can be titrated more carefully and precisely in use of marijuana smoking. While patients occasionally knock themselves out by over administration of prescribed pills, they have better control in administering marijuana therapy being able to control each puff they smoke in. In some cases, the health of a patient simply may not allow ingestion of a pill itself. Further more, commercially available drugs are very expensive. For an example, Marinol treatment (pure form of delta-9-THC) cost about $65 per day in a case of a bipolar disorder patient (Grinspoon and Bakalar, 1998).
Marijuana therapy is more effective, efficient, controllable and affordable solutions to the many of disease symptoms compared to commercially available drugs.
PROVIDING MEDICAL MARIJUANA: IMPORTANCE OF CANNABIS CLUBS (Feldman & Mandel, 1998)
Even after the passage of California's Proposition 215, a diseased individual who is qualified and finds the remedy in marijuana faced difficulty in obtaining marijuana for their medical use. The use and possession of medical marijuana were legalized, nonetheless marijuana transaction itself still remained illegal. The problem is worsened by the fact that marijuana cultivation proved to be even more difficult. Patients often did not have outdoor yard or balconies - when they did, there was a greater danger of thieves - and the expensive initial investment for indoor growing system was often unaffordable (Feldman & Mandel, 1998). In addition, ensuring a sufficient amount with the proper potency in order not to run short and identifying infestation and molds, which cause infection when smoked, were almost impossible tasks for inexperienced individuals (Feldman & Mandel, 1998).
This dead way situation has given a rise to Cannabis Buyers' Club (CBC) that provide the safest and least expensive commercial method for patients to purchase medical marijuana (Feldman & Mandel, 1998). CBC often is not a mere place to distribute medical marijuana. It also provides the place to socialize for those individuals "struggling not only with serious disease but who were frequently isolate, frightened and depressed . . . . they (patients) offered mutual help in a number of critical emotional areas: adjusting to a terminal illness, or managing the grief which accompanies the many deaths an epidemic like HIV/AIDS leaves in its wake (Feldman and Mandel, 1998)."
MEDIA ATTITUDES TOWARD CANNABIS BUYERS' CLUB:
Dennis Peron invented the concept of Cannabis Buyers' Club. The intention of CBC was to provide not only a cafeteria of cannabis products - including marijuana of varying potencies, cannabis pastries, and smoking paraphenaria - but to create a life space where person with life-threatening or seriously debilitating diseases could gather, relax, and consume their medications in an accepting, friendly, and colorful surroundings (Feldman & Mandel, 1998).
San Francisco CBC, which was operated by Peron, was an institution that distributed medical marijuana to the patients with doctor's recommendation. CBCs are now operating in dozens of cities nationwide to illegally provide marijuana to patients with doctor's recommendations. Various measures by the state and local governments protect CBCs' operation from the federal government interference (WWW 2). Despite its appraise-deserving intention, most popular magazines have had very critical opinions on the idea, operation and inventor of CBCs.
Hammer reports in Newsweek (Hammer, 1998): "Wheel Chair-bound veterans, AIDS patients and other sick and dying people waiting for their morning high . . . . .The pot has flowed freely here [at San Francisco CBC] to 8,000 customers since passage of California's Proposition 215 . . . Peron, racked up 15 drugs arrests and two convictions and spent two years in prison . . . . his lover died from AIDS in 1988."
The personality of Peron was illustrated by quoting him in Time (Shannon, 1997):
"He [Peron] sells pot for everything from premenstrual syndrome to the blues. 'All use of marijuana is medical,' says Peron. 'It makes you smarter. It touches the right brain and allows you to slow down, to smell the flowers. We're living in a very stressful world. It can and should be used for anxiety and depression.' . . . . Anti-drug activists fear that pot club, if allowed to thrive, could open the way to further relaxation of drug policy. . . . 'This is not about marijuana as medicine' he [Peron] says. 'This is a cultural war.'"
Popular magazines like Newsweek and Time can significantly influence the public opinions. Though Peron may deserve criticism for his behavior, comments, and attitudes toward CBC operation and marijuana use, indirect criticism of the initiative, Proposition 215, based on Peron's credential is simply unfair. Peron's "fifteen drug arrests" and dead "AIDS lover" have nothing to do with the ethical values of Proposition 215. Furthermore, neither all patients are waiting for "morning high," or marijuana flows "freely" in the CBC. Yet public evaluates the measure reading these articles. We often assume that a bold and liberal initiative is dangerous, especially when the credential of the person involved in the project is questionable one. We fear possible relaxation of drug policy might, in turn, worsen drug abuse problems creating an increasingly unsafe society.
A careful drug control must be maintained in order to prevent our society from delineating; however, fairer evaluation of the initiative is required to achieve our ultimate incentive - to better our society and sick. Understanding that mass media is often opinionated we must attentively take role in judging the value of Proposition 215, considering both benefits and shortcomings that are likely to accompany the initiative.
On the other hand, the person like Peron should not lead CBC, because it is a crucial institution that we cannot afford to lose. As a leader of such a bold initiative, one should act with true compassion. Peron was pictured on election night smoking a joint and saying, "Let's all get stoned and watch election night returns (Rosin 1997)." He was also quoted saying "I believe all marijuana use is medical - except for kids (Rosin, 1997)." Peron's personal behavior supports the opposing views and may make acquisition of medical marijuana difficult for the truly sick.
CLINICAL RESEARCH ON MARIJUANA IN THE UNITED STATES:
Donald Abrams of the University of California, San Francisco (UCSF) obtained approval for clinical research on the marijuana's effectiveness against AIDS-related wasting. This is the first officially approved trial in the United States evaluating the potential medical benefit of marijuana (Lehman, 1995). One can find the efforts Abrams have spent and processes he had to go through in order to gain this approval in the article titled, Medical Marijuana: Tribulations and Trials (Abrams, 1998). At the end of this article he encouragingly concluded: Much has been learned over the five years spent attempting to launch the study . . . persistence in the face of a continuing patient care question clearly pays off in the end . . . . Despite perceived road blocks, the scientific questions prevailed."
CONCLUSION:
Marijuana is not a risk-free, all-purpose drug; however, its use had proved to be effective, if not in all, in many cases. Medical and recreational users must be informed that marijuana use is accompanied by some adverse effect. Physiology and biochemistry of our body are significantly altered by the chronic exposure to marijuana even though this is difficult to be observed on behavioral level.
Marijuana therapy is more effective, efficient, controllable and affordable solutions to the many of disease symptoms compared to commercially available drugs. In addition, marijuana inhalation is very safe compared to some any medical or recreational drug in the market.
As many other pharmaceutical products have taken long time to appear in the market, unraveling the roles of marijuana might take significant time and efforts. While clinical study is being conducted, terminally ill patients should be able to have an option of using medical marijuana. We as a society may have much time to invest; however, the condition of individual patients may not grant us that time to compile a comprehensive documentation for fully justifying marijuana treatment.
To provide sufficient resources and information regarding medical marijuana, the research on the reported medical efficacy of marijuana is necessary. Results from such researches enable patients to evaluate the risk of short- and long-term adverse effects against the desired benefits.
California Proposition 215, or Medical Marijuana Initiative, is a measure passed by voters aiming to protect the patient from legal punishment for cultivation, possession, and use of medical marijuana. Cannabis Buyers' Club distribute reliable marijuana supply to those afflicted by serious illness. CBC operation is essential both its roles in providing marijuana supply and creating the place that can significantly alleviate mental states of sick through positive interaction among themselves.
As well expressed in The New England Journal of Medicine, "a federal policy that prohibit physicians from alleviating suffering by prescribing marijuana for seriously ill patients is misguided heavy handed and inhuman (Kassirer, 1997)." Improving lives of individuals and, in turn, our society must be the primary goal of our government as well as of individual. Thus, the medical use of marijuana should be promoted and its efficacy must be investigated for the good of our society.
REFERENCES:
Abrams, D. I. Medical Marijuana: Tribulations and Trials. Journal of Psychoactive Drugs 30 (2), Apr-June: 163-168 (1998).
Cermak, Timmen L. Addiction Medicine Perspective on the Medicalization of Marijuana. Journal of Psychoactive Drugs 30 (2), Apr-June: 155-162 (1998)
Cunha, J. M., Carlini, E. A., Pereira, A. E., Ramos, O. L., Pimentel, C., Gagliardi, R., Sanvito, W. L., Lander, N., and Mechoulam, R. Pharmacology (Medline) 21: 175-185 (1980) Referenced in Hampson et. al. 1998
Diana, M., Melis, M., Muntoni, A. L., and Gessa, G. L. Mesolimbic dopaminergic decline after cannabinoid withdrawal. PNAS Online. Vol. 95 issue 17: 10269-10207 (1998)
Fairfield, K. M., Eisenberge, D. M., Davis, Roger B., Libman, H., and Phillips, R. S. Patterns of Use, Expenditures, and perceived Efficacy of Complementary and Alternative Therapies in HIV-Infected Patients. Archives of Internal Medicine 158 (20): 2257-2264 (1998). Abstract in California Digital Library.
Feldman, H. W. and Mandel, J. Providing Medical Marijuana: The Importance of Cannabis Clubs. Journal of Psychoactive Drugs 30 (2), Apr-June: 179-186 (1998)
Fine, D., M. Grassroots medicine. (therapeutic use of marijuana). American Prospect 34: 51-56 (1997).
Grinspoon, L. and Bakalar J. B. Marijuana as medicine: plea for reconsideration. The Journal of the American Medical Association v273 (23): 1875-1876 (1998)
Grinspoon, L. and Bakalar J. B. The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder: Anecdotal Evidence and the Need for Clinical Research. Journal of Psychoactive Drugs 30 (2), Apr-June: 171-177 (1998)
Gurley, J. R., Aranow, R., Katz, M. Medicinal Marijuana: A Comprehensive Review. Journal of Psychoactive Drugs 30 (2), Apr-June: 137-145 (1998)
Hammer. J. The war over weed. (legal dispute over marijuana in California) Newsweek 131 (11): 32- 33 (1998)
Hamoson, A. J., Grimaldi, M., Axelrod, J. and Wink, D. Cannabinodiol and (-)delta-9-tetrahydrocannabinol are neuroprotective antioxidants. PNAS Online. Vol. 95 issue 14: 8268-8273 (1998)
Kassirer, J. P. Federal Foolishness and Marijuana. The New England Journal of Medicine 336 (5): 366-367 (1997)
Lehrman, S. US stalls over tests of marijuana to treat AIDS patients. Nature 374: 7-8 (1995)
Rosin, H. The return of pot: California gears up for a long, strange trip. (medical marijuana Proposition 215 passes). New Republic 216 (7): 18-25 (1997).
Shannon, E. Too high in California: for those in medical need, pot clubs offer help. But Washington may try to spoil the party atmosphere. (the head shop aura and lack of strict monitoring at some cannabis clubs may cause closing under federal laws) Time 150 (24): 84 (1997).
Smith, David E. Review of the American Medical Association Council on Scientific Affairs Report on Medical Marijuana. Journal of Psychoactive Drugs 30 (2), Apr-June: 127-136 (1998)
WWW 1. Proposition 215 and you: A Guide for Medical Marijuana Patients and Others.
WWW 2. MPP Tours Cannabis Buyers' Club.
WWW 3. Proposition 215.
Proposition 215
Medical Marijuana Initiative (WWW 3)
Section 1. Section 11362.5 is added to the Health and Safety Code, to read:
11362.5. (a) This section shall be known and may be cited as the Compassionate Use Act of 1996.
(b) (l) The people of the State of California hereby find and declare that the purposes of the Compassionate Use Act of 1996 are as follows:
(A) To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.
(B) To ensure that patients and their primary caregivers who obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal prosecution or sanction.
(C) To encourage the federal and state governments to implement a plan to provide for the safe and affordable distribution of marijuana to all patients in medical need of marijuana.
(2) Nothing in this act shall be construed to supersede legislation prohibiting persons from engaging in conduct that endangers others, nor to condone the diversion of marijuana for nonmedical purposes.
(c) Notwithstanding any other provision of law, no physician in this state shall be punished, or denied any right or privilege, for having recommended marijuana to a patient for medical purposes.
(d) Section 11357, relating to the possession of marijuana, and Section 11358, relating to the cultivation of marijuana, shall not apply to a patient, or to a patient's primary caregiver, who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.
(e) For the purposes of this section, "primary caregiver" means the individual designated by the person exempted under this act who has consistently assumed responsibility for the housing, health, or safety of that person.
Sec. 2. If any provision of this measure or the application thereof to any person or circumstance is held invalid, that invalidity shall not affect other provisions or applications of the measure which can be given effect without the invalid provision or application, and to this end the provisions of this measure are severable.
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