The United States of Marijuana – Part 1

Part 1: Where Are We & How Did We Get Here?

Author: Dr. Kamal Morar, MD, MBA

This blog post is the first in a series of posts from Dr. Kamal Morar, co-founder of Duber Medical and pain interventional specialist. In this series, Dr. Morar examines current day hurdles and solutions that medical marijuana can offer patients as they seek alternative and effective solutions to their chronic medical conditions.

As a practicing interventional pain physician for the past 16 years, I have seen several hundred patients die secondary to opioid-related complications. Meanwhile, I have seen several hundred patients taking street marijuana which resulted in adequate pain control as well as additional benefits such as anxiety reduction and help with sleep. None of these patients reported any complications. This experience and dichotomy has been the catalyst for my asking, “If these patients were doing so well with marijuana products off of the street without even knowing what they were taking, how much more would we be able to do for them if they had access to products that they knew more about, with the help of a physician guiding them.” 

This question now has led me down a journey of discovery, research and strategy for what is really needed if we are to seriously consider medical marijuana for the treatment of patients looking to use it for medicinal use. 

American physicians routinely prescribed marijuana until the late 1930s. It would not be until 1970 that the law would intervene to prohibit all uses of the herb. One of Richard Nixon’s first significant acts as president was to sign into law the Controlled Substances Act of 1970 (CSA), classifying medical marijuana as an illegal Schedule 1 drug[1]. However, medical marijuana is again gaining momentum in America, with more states legalizing its use. The effects of new states legalizing medical marijuana cannot be understated.

 At the federal level, marijuana remains a Schedule I substance, subjecting people involved in marijuana activities to harsh penalties and preventing a range of scientific research that could upend decades of propagandized misinformation driven by racism and fear. Despite an increasing number of states legalizing or decriminalizing marijuana, law enforcement made well over half a million marijuana arrests in 2018, with marijuana arrests accounting for more drug arrests in the U.S. than any other drug class, and more than for all violent crimes combined as reported by the FBI. 

What does legalizing marijuana look like in 2020?

There are different stages of legalization when it comes to marijuana. In general, it is broken down into three categories:

Decriminalization of marijuana means it would remain illegal, but the legal system would not prosecute a person for possession under a specified amount. Penalties could range from no penalties at all, civil fines, drug education, or drug treatment.

Legalized medical status ensures that under a physician’s recommendation, seriously ill patients have the right to obtain and use marijuana for the treatment of specified medical conditions such as: cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief. Any qualified patient may possess marijuana for personal medical use upon the recommendation or approval of a physician.

Legalization of cannabis is the process of removing all legal prohibitions against it. Marijuana would be available to the adult population for purchase and use at will, similar to tobacco and alcohol.

States across the country are in different stages of legalization, from fully illegal to legalization for recreational use. Voters in five states: Arizona, New Jersey, South Dakota, Montana, and Mississippi, cast ballots on marijuana in November 2020 for either full legalization or legalized medical status, with all five states passing the measures to make cannabis available to state residents in some form. This growing list of states where cannabis is available for recreational or medical use could serve as a huge opportunity for industry growth. Moreover, legalization could have a domino effect on other states — especially those looking to address budgetary and social justice issues that have deepened during the pandemic. At the federal level, the House of Representatives passed the MORE Act on December 4th, which would decriminalize cannabis at the federal, however, its passage through the Senate is uncertain, so while the list of state legalization is growing, it is unlikely we’ll see federal legalization roll out in the near future.