Monday, January 17, 2011


                                                                                                     Resolution 2
   Introduced by:         Sunil Aggarwal, Aaron Flanagan, and Alicia Carrasco, University of Washington
                          School of Medicine; Sonya Khan and Liisa Bergmann, University of California, Los
                          Angeles, School of Medicine; Trace Fender, Northeastern Ohio Universities College
                          of Medicine; Leo Arko, University of New Mexico School of Medicine
   Subject:               Marijuana: Medical Use and Research
   Referred to:           MSS Reference Committee
                          (Despina Siolas, Chair)
   Whereas, The federal Controlled Substances Act of 1970 categorized marijuana as a Schedule I substance
   not permitted for prescription use1, yet 12 states (AK, CA, CO, HI, ME, MT, NV, NM, OR, RI, VT,
   WA)2 have laws that permit the use of marijuana when recommended by a physician; and
   Whereas, A ruling by the Ninth U.S. Circuit Court of Appeals reaffirmed and the Supreme Court let stand
   the right of physicians and patients to discuss the therapeutic potential of marijuana, but patients who
   follow their physicians’ advice are put at risk for up to one year in federal prison for possession of
   marijuana, and up to five years in federal prison for growing one marijuana plant, as federal law does not
   make a distinction between medicinal and other marijuana use3; and
11 Whereas, Legal access to marijuana for specific medical purposes has been supported by numerous
12 national and state medical organizations, including the National Academy of Sciences’ Institute of
13 Medicine, American College of Physicians, American Psychiatric Association’s Assembly, American
14 Academy of Addiction Psychiatry, American Academy of Family Physicians, California Medical
15 Association, Medical Society of the State of New York, Rhode Island Medical Society, American
16 Academy of HIV Medicine, HIV Medicine Association, Canadian Medical Association, British Medical
   Association, and the Leukemia & Lymphoma Society4; and
19 Whereas, The Institute of Medicine concluded after reviewing relevant scientific literature – including
20 dozens of works documenting marijuana’s therapeutic value – that “nausea, appetite loss, pain, and
   anxiety are all afflictions of wasting, and all can be mitigated by marijuana”5; and
23 Whereas, Subsequent studies since the 1999 Institute of Medicine report, including randomized, double
24 blind, placebo-controlled ones, continue to show the therapeutic value of marijuana in treating a wide
25 array of debilitating medical conditions, including relieving medication side effects and thus improving
26 the likelihood that patients will adhere to life-prolonging treatments for HIV/AIDS and Hepatitis C and
   alleviating HIV/AIDS neuropathy, a painful condition for which there are no FDA-approved treatments6;
28 and
30 Whereas, “Given marijuana’s proven efficacy at treating certain symptoms and its relatively low toxicity,
31 reclassification would reduce barriers to research and increase availability of cannabinoid drugs to
   patients who have failed to respond to other treatments”7; and
                                                                                                Resolution 2 (A-08)
                                                                                                              Page 2
   Whereas, “Only two cannabinoid drugs are currently licensed for sale in the U.S. (dronabinol [Marinol®]
   and nabilone [Cesamet®]), and both are only available in oral form” and while “useful for some, these
   drugs have serious limitations”8; and
   Whereas, Reclassifying marijuana as medically useful should draw from medical experience with opiates,
   which indicates that “opiates are highly addictive yet medically effective substances and are classified as
   Schedule II substances,” but “there is no evidence to suggest that medical use of opiates has increased
   perception that their illicit use is safe or acceptable”9; and
42 Whereas, “Preclinical, clinical, and anecdotal reports suggest numerous potential medical uses for
43 marijuana ... unfortunately, research expansion has been hindered by a complicated federal approval
   process, limited availability of research-grade marijuana, and the debate over legalization”10; and
46 Whereas, the National Institute on Drug Abuse (NIDA) generally supplies marijuana for the research of
47 harms and does not automatically provide marijuana to researchers who hold an FDA Investigational New
48 Drug (IND) and a Drug Enforcement Administration (DEA) Schedule I researcher’s registration for
   marijuana11; and
51 Whereas, The federal government has obstructed privately funded research through NIDA’s monopoly
52 over the production of marijuana for research, as well as through the DEA’s refusal to license any
53 privately funded marijuana production facilities, even though DEA-licensed, private facilities produce
54 LSD, MDMA, psilocybin, mescaline, and other Schedule I drugs; and
56 Whereas, Despite these obstructions, the accumulated scientific data regarding marijuana’s safety and
57 efficacy in certain clinical conditions and its increasingly accepted medical use in treatment can no longer
   be ignored12; therefore be it
60 RESOLVED, That our AMA support review of marijuana’s status as a Schedule I controlled substance,
61 its reclassification into a more appropriate schedule, and revision of the current protocol for obtaining
62 research-grade marijuana so that it conforms to the same standards established for obtaining every other
63 scheduled drug for legitimate research purposes; and be it further
65 RESOLVED, That our AMA strongly support exemption from federal criminal prosecution, civil
66 liability, and professional sanctioning for physicians who recommend medical marijuana in accordance
67 with state law, as well as full legal protections for patients who use medical marijuana under these
68 circumstances; and be it further
70 RESOLVED, That this resolution be promptly forwarded to the House of Delegates at A-08 for national
71 action.
   Fiscal note: TBD
   Date received: 4/10/08
   1. Drug Enforcement Administration (DEA) drug scheduling. Available at
   2.   USA Today. “Medical marijuana laws vary among states.” (2007) Available at
   3.   DEA federal penalties for marijuana. Available at
   4.   Endorsements document. Available at
        Joy, J., Watson, S., and Benson, J. Marijuana and Medicine: Assessing the Science Base. National Academy
        Press, 1999.
                                                                                                  Resolution 2 (A-08)
                                                                                                                  Page 3
6.   deJong B.C., et al, “Marijuana Use and its Association With Adherence to Antiretroviral Therapy Among HIV-
     Infected Persons With Moderate to Severe Nausea,” Journal of Acquired Immune Deficiency Syndromes,
     January 1, 2005; Sylvestre D.L., Clements B.J., and Malibu Y., “Cannabis Use Improves Retention and
     Virological Outcomes in Patients Treated for Hepatitis C,” European Journal of Gastroenterology and
     Hepatology, September 2006; Abrams D., et al, “Cannabis in Painful HIV-Associated Sensory Neuropathy,”
     Neurology, February 13, 2007.
7. American College of Physicians, “Supporting Research into the Therapeutic Role of Marijuana,” January 2008:
     10. Available at
8. Ibid, p 8.
9. Ibid, p 10.
10. Ibid, p 3.
11. National Institutes of Health. (1999) Announcement of the Department of Health and Human Services’
     Guidance on Procedures for the Provision of Marijuana for Medical Research. Available at
12. E Lawrence O. Gostin, JD, LLD (Hon), Georgetown Law Professor, “Medical Marijuana, American
     Federalism, and the Supreme Court.” JAMA. 2005;294:842-844.
Relevant AMA and MSS Policy:
H-95.952 Medical Marijuana
(1) Our AMA calls for further adequate and well-controlled studies of marijuana and related cannabinoids in
patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible
efficacy and the application of such results to the understanding and treatment of disease. (2) Our AMA
recommends that marijuana be retained in Schedule I of the Controlled Substances Act pending the outcome of such
studies. (3) Our AMA urges the National Institutes of Health (NIH) to implement administrative procedures to
facilitate grant applications and the conduct of well-designed clinical research into the medical utility of marijuana.
This effort should include: a) disseminating specific information for researchers on the development of safeguards
for marijuana clinical research protocols and the development of a model informed consent on marijuana for
institutional review board evaluation; b) sufficient funding to support such clinical research and access for qualified
investigators to adequate supplies of marijuana for clinical research purposes; c) confirming that marijuana of
various and consistent strengths and/or placebo will be supplied by the National Institute on Drug Abuse to
investigators registered with the Drug Enforcement Agency who are conducting bona fide clinical research studies
that receive Food and Drug Administration approval, regardless of whether or not the NIH is the primary source of
grant support. (4) Our AMA believes that the NIH should use its resources and influence to support the development
of a smoke-free inhaled delivery system for marijuana or delta-9-tetrahydrocannabinol (THC) to reduce the health
hazards associated with the combustion and inhalation of marijuana. (5) Our AMA believes that effective patient
care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these
alternatives between physicians and patients should not subject either party to criminal sanctions. (CSA Rep. 10, I-
97; Modified: CSA Rep. 6, A-01)
100.006 MSS Reclassification of Heroin for Therapeutic Use
AMA-MSS will ask the AMA to: (1) strongly support research into the therapeutic use of heroin as a Schedule I
drug in the context of addiction treatment, for those patients for whom other standard methods have been tried and
have failed; and (2) urge the Drug Enforcement Administration, Department of Health and Human Services, and
National Institute of Drug Abuse to allow such research with appropriate oversight and safeguards. (MSS Sub Res
20, A-98) (AMA Res 504, I-98, Not Adopted) (Reaffirmed: MSS Rep E, I-03)
H-95.995 Health Aspects of Marijuana
Our AMA: 1. discourages marijuana use, especially by persons vulnerable to the drug’s effects and in high-risk
situations; 2. supports the determination of the consequences of long-term marijuana use through concentrated
research; and 3. supports the modification of state law to reduce the severity of penalties for possession of
marijuana. (CSA Rep. D, I-77; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)
H-95.997 Marijuana
Our AMA:
1. recommends personal possession of insignificant amounts of that substance be considered a misdemeanor with
commensurate penalties applied; 2. believes a plea of marijuana intoxication not be a defense in any criminal
proceedings; and 3. urges that educational efforts be expanded to all segments of the population.
(BOT Rep. J, A-72; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)

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