Medical cannabis in the United States

Historical Overview of Medical Cannabis in the U.S.

• Medical cannabis use traces back thousands of years.
• Western medicine embraced it in the 19th century for its analgesic and anticonvulsant effects.
• Entered the U.S. Pharmacopeia in 1850 but declined by the late 19th century due to dosage control issues.
• Popularized by William Brooke OShaughnessy.
• Cannabis placed in Schedule I under the Controlled Substances Act in 1970, prohibiting its use for any purpose.

State and Federal Legalization and Policies

• Medical cannabis is legal in 38 states, four territories, and D.C.
• Rohrabacher–Farr Amendment, signed in 2014, prevents federal interference with state medical cannabis laws.
• California was the first state to legalize medical cannabis in 1996.
• Variation in state laws includes production, distribution, consumption, and approved medical conditions.
• President Biden announced a review in 2022 to potentially reschedule cannabis from Schedule I to Schedule III.

Federal Enforcement and Programs

• Compassionate Investigational New Drug program started in 1978 but closed to new patients in 1992.
• Clinton, Bush, and Obama administrations had varying stances on medical cannabis enforcement.
• Federal enforcement efforts intensified during the Bush administration, with over 260 raids conducted.
• Obama administration saw a crackdown on medical cannabis despite initial support for state policies.
• The Justice Department issued the Cole memo in 2013 to address enforcement in medical cannabis states.

Research and Monopoly Issues

• Clinical research on cannabis in the U.S. requires FDA approval and DEA registration.
• NIDA held a monopoly on cannabis supply for research from 1974 to 2021.
• NIDA’s cannabis quality has been criticized for high levels of stems, seeds, mold, low THC content, and limited strain diversity.
• Schedule I classification imposes strict compliance requirements for research.
• The DEA’s refusal to issue more licenses maintained NIDA’s research monopoly.

Advocacy and Legislation

• Various advocacy groups like Americans for Safe Access and National Organization for the Reform of Marijuana Laws support medical cannabis policy reform.
• Organizations such as the American Legion and National Conference of State Legislatures advocate for changes in cannabis policy.
• The U.N. Single Convention on Narcotic Drugs influences U.S. cannabis policy.
• Legislation and legal battles have hindered efforts to obtain cultivation licenses for research purposes.
• Religious denominations and AIDS advocacy organizations also support medical cannabis.

Medical cannabis in the United States Data Sources