In recent years, there has been a growing interest in and acceptance of medicinal cannabis. More commonly known as medical marijuana, this therapy has been a controversial topic in both the medical community and the political sphere for quite some time. This is, of course, complicated by the fact that marijuana is still illegal according to federal law. That can make it a bit more complicated for those who want to seek out medical marijuana as an alternative treatment for a health condition.
An increasing number of states have started to permit the sale and use of medical marijuana. More Americans are using cannabis to help treat a number of conditions and alleviate painful or disruptive symptoms. In this guide, we’ll take a closer look at how this came to be and discuss states where medical marijuana is legal.
History of Medical Marijuana
Marijuana’s use for medicinal purposes stretches back much further than the recent debate in the U.S. In fact, Emperor Shen Neng of China prescribed marijuana for a number of ailments as early as 2737 B.C. At that time, marijuana was used to treat ailments like gout, malaria, and rheumatism. Evidence of medicinal cannabis use in centuries past has also been found in Asia, the Middle East, and the eastern coast of Africa. It was used for a wide variety of purposes, including small issues like earaches and major medical events like childbirth.
In more recent history, proponents of medical marijuana continued to advocate its use. Irish doctor William O’Shaughnessy was one of the biggest proponents. He had seen marijuana relieve symptoms of rheumatism, cholera, tetanus, and rabies while working with the British East India Company. He was largely responsible for the popularization of medical marijuana use in England and America. In 18th-century American medical journals, hemp seeds and roots were also recommended for the treatment of incontinence, inflamed skin, and venereal disease.
Throughout this time, medical marijuana use was legal in the U.S. But in the early 20th century, the tide began to shift. The Pure Food and Drug Act and the Food and Drug Administration were both established in 1906, highlighting a shift in drug policy that caused chemical substances to be regulated by the U.S. government. In 1914, the Harrison Act made drug use a crime, and by 1937, 23 states had outlawed marijuana use. The federal government also passed the Marihuana Tax Act in 1937 to make nonmedical use of marijuana illegal, which significantly increased the stigma surrounding the drug.
Shortly thereafter, medical marijuana began to fall out of favor. It was eliminated from the United States Pharmacopeia in 1942. The Boggs Act of 1951 and Narcotic Control Act of 1956 created legal penalties for possession of marijuana, and it was prohibited under federal law in the Controlled Substances Act of 1970. These laws also stunted medical marijuana research and made it very difficult to procure cannabis for academic purposes.
Uses for Medical Marijuana
Today, the U.S. Drug Enforcement Administration (DEA) categorizes marijuana a Schedule I drug, which is defined as a drug having “no currently accepted medical use and a high potential for abuse.” Schedule I is the same classification given to heroin, LSD, and ecstasy.
However, marijuana is said to be effective in treating a number of serious health conditions, including:
- Alzheimer’s disease
- Appetite loss
- Crohn’s disease
- Eating disorders, such as anorexia
- Mental health conditions like schizophrenia and post-traumatic stress disorder (PTSD)
- Multiple sclerosis
- Muscle spasms
- Wasting syndrome (cachexia)
Some of the research published so far suggests that cannabinoids (the active chemicals in medical marijuana) may:
- Reduce inflammation
- Relieve pain
- Reduce anxiety
- Relax tight muscles
- Reduce the frequency and/or severity of seizures
- Stimulate appetite and improve weight gain in patients with AIDS or cancer
- Control nausea and vomiting caused by chemotherapy
- Kill cancer cells and slow tumor growth
While a number of medical marijuana studies have been conducted, the status of cannabis as a Schedule I drug has hampered research efforts on the effects of medical marijuana and limited the number of published studies overall.
It’s also important to note that, in addition to alleviating symptoms, use of medical marijuana has allowed many patients to limit the number of pharmaceutical medications they need to take. This can help lead to fewer drug side effects and less expensive treatment for many individuals. In particular, many health professionals consider marijuana to be safer than opioids for pain management.
What States Have Medical Marijuana?
The debate over medical marijuana in the U.S. has been heating up over the past few decades. The earliest instance of medical marijuana legalization occurred in 1996. At that time, California became the first state to legalize medicinal cannabis through the enactment of the Compassionate Use Act. This act began as a ballot initiative and was initially promoted by activist Dennis Peron. He wanted to push for medical marijuana legalization in memory of Jonathan West, his partner who had used marijuana to treat his symptoms of AIDS. The initiative passed with 55.6 percent support.
After the Compassionate Use Act, the number of medical marijuana states slowly began to increase. Four more states (Washington, Oregon, Alaska, and Maine) and Washington, D.C. passed medical marijuana laws in the 1990s. During this time, marijuana became more mainstream, especially in regards to its use as a medical therapy. Some states even passed laws legalizing recreational marijuana.
Today, there are 33 medical marijuana legal states, along with Washington, D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The full list includes:
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Puerto Rico
- Rhode Island
- U.S. Virgin Islands
- Washington, D.C.
- West Virginia
According to the National Conference of State Legislatures (NSCL), the territories and states with medical marijuana listed above all have comprehensive medical cannabis programs. The criteria for a comprehensive program includes:
- It protects against criminal penalties for using marijuana for a medical purpose.
- It includes access to marijuana through home cultivation, dispensaries, or another system that is likely to be implemented.
- It allows a variety of strains or products, including those with more than “low THC.”
- It allows either smoking or vaporization of some kind of marijuana products, plant material, or extract.
- It is not a limited trial program.
In addition, there are 13 states which allow the restricted use of medical marijuana, meaning that they do not meet all of the criteria for a comprehensive program:
- North Carolina
- South Carolina
States with Pending Medical Marijuana Legalization
There are a number of states that appear to be on the verge of legalizing medical marijuana. Some of these states include:
- Wisconsin: Newly elected Gov. Tony Evers has stated his support for medical cannabis and decriminalizing marijuana.
- Kansas: Newly elected Gov. Laura Kelly wants to follow in the footsteps of neighboring Oklahoma and Missouri and legalize medical cannabis allowing for use with a doctor’s recommendation.
- Texas and South Carolina: Advocates are aggressively pursuing lawmakers in an effort to legalize medical cannabis in a response to increased support for marijuana decriminalization.
- Mississippi, Nebraska, and South Dakota: These states are considering including a ballot question on medical marijuana on the upcoming 2020 presidential election.
The states listed above are anticipated to be next on the list for legalizing medical marijuana, but it’s unclear how soon those changes might occur.
Outcomes of Medical Marijuana Legalization
One of the main concerns among lawmakers when considering medical marijuana legalization is what types of consequences can be expected. Fortunately, there have been many positive outcomes associated with legalization. In fact, medical marijuana states have reported the following:
- According to a 2016 study, states that legalized medical cannabis saw significant drops in violent crime. A 2017 study found that medical marijuana legalization led to a reduction in violent crime in states bordering Mexico.
- A Journal of Law and Economics study from 2013 reported that medical marijuana legalization was associated with an 8 to 11 percent reduction in traffic fatalities.
- A 2016 study in the Journal of Drug Issues found significant drops in violent crime in states that have legalized medical cannabis. A 2017 study in The Economic Journal found that the introduction of medical cannabis laws caused a reduction in violent crime in American states that border Mexico.
- In 2018, a study in Social Science Research found that residents of neighboring states near those that legalized medical cannabis became increasingly tolerant in regards to marijuana regulations.
- In several states, states with legalized medical marijuana have found decreased rates of opioid use and abuse.
- A number of studies have found that there is no increase in marijuana use among teenagers in states with legal medical cannabis.
Some newer studies have found correlation (but not causation) between legalized medical marijuana and an increase in binge drinking. These studies are important to consider, but overall the positive effects of legalizing medical marijuana seem to have outweighed any perceived negative consequences.
Current Support for Medical Marijuana
The tide continues to shift in favor of marijuana legalization. According to a Quinnipiac University poll from October 2016, 81 percent of Americans favored legalization of marijuana for medicinal purposes. By 2018, a Harris Poll found that number had increased to 85 percent.
It’s worth noting that support for marijuana legalization in general (not only for medicinal uses) has also increased significantly in recent years. In 2018, the Pew Research Center reported that 62 percent of Americans support the legalization of marijuana. This percentage is more than double what it was in 2000 when only 31 percent of Americans agreed that marijuana should be made legal. This shift in public thought has also led to an increase in support for medical marijuana.
Unfortunately, changes in public opinion have not been reflected on a federal level. There have been repeated efforts since the 1970s to have cannabis removed as a Schedule I drug. These petitions have largely been ignored. In 2014, the FDA conducted an analysis at the request of the DEA to decide whether marijuana should be downgraded to a Schedule II or Schedule III drug. In 2016, the DEA announced that it would not change the Schedule I classification. However, the agency did end restrictions on supplying marijuana to researchers and drug companies.
How to Get Medical Marijuana
Requirements for obtaining medicinal cannabis vary by state. However, in most states, the process to get medical marijuana usually involves the following steps:
- Be diagnosed with a condition that qualifies for treatment with medical marijuana. Each state has its own list of qualifying medical conditions.
- Get a written recommendation from a licensed physician in a state where medical marijuana is legal. Not all doctors are willing to recommend it, so patients may need to search for a different doctor who supports medical marijuana.
- Obtain a medical marijuana ID card and/or register with the state’s medical marijuana program.
- Visit a licensed dispensary to purchase medical marijuana.
In most states, you need to be at least 18 years or older in order to qualify for medical marijuana use. However, certain states have allowed the use of medical marijuana by underage patients with certain conditions, such as cerebral palsy, cystic fibrosis, muscular dystrophy, and severe epilepsy.
Ways to Take Medical Marijuana
Most medical marijuana dispensaries offer a variety of ways to take medical marijuana, including:
- Smoking dry flowers
- Vaping an oil concentrate or dry flowers
- Eating food infused with marijuana (also known as “edibles”)
- Applying it to the skin in a cream, lotion, spray, or oil
- Taking a tincture or spray by mouth
Each method can deliver different results. For example, vaping and smoking medical marijuana usually produces faster effects, while consuming edibles usually doesn’t produce any effects for about one to two hours.
Medical marijuana is more accepted than ever before, but it can still be difficult or impossible to obtain in many states. If public opinion continues to trend towards support for marijuana legalization, it’s likely that more states will enact laws that allow for medical marijuana use.