medical marijuana

This was for one of my political science classes and it discusses the controversy surrounding medical marijuana. It is by no means meant to endorse drug use, only call attention to how marijuana has been politicized. While it is long, and I don't except everyone to read all of it, I would like some feedback. The paper was handed in already (for an A score) but I am curious to see what members have to say about the topic.

                               INTEROFFICE MEMORANDUM

TO: Senator John Kerry

From: Andrew Regenstreich, Special Policy Adviser

Medical Marijuana

Date: November 2005

Introduction: 

 I have written this memorandum to discuss inform you of the issues surrounding medicinal marijuana. Whether or not marijuana has any medicinal benefits is presently a very contentious issue and the debate on both sides is passionate. Marijuana is a Schedule I drug under the present classification system.  This means that it has a high level for abuse and no safe acceptable medical use. [1] In 1970 the National Organization for the Reformation of Marijuana Laws (N.O.R.M.L.) sued the DEA to get Marijuana reclassified to a schedule II drug. This lawsuit was brought so that marijuana could go the through the formal FDA process, which I will discuss later.

      After twenty-years, the DEA finally set up an administrative panel to review the issue. An administrative Judge with the DEA, Francis L. Young, declared that, "in its natural form, (cannabis) is one of the safest therapeutically active substances known." The DEA simply ignored this ruling and decided that Marijuana would remain a schedule I drug.  This infuriated N.O.R.M.L and they eventually lost faith that the DEA would reclassify marijuana. In an interview with a representative from N.O.R.M.L., I was informed me that their present day strategy concentrated on obtaining more autonomy for individual states regarding medicinal marijuana.[2] However there are a couple problems with this. In June of 2005, there was a Supreme Court decision that allowed the DEA, under the Commerce Clause of the United States Constitution, to prosecute those who violated federal marijuana laws, even in states in which the possession, use, or cultivation of marijuana for medical purposes was legal. There is also a bill that is presently stuck in the United States House of Representatives, H.R. 2087, The States' Rights to Medical Marijuana Act. The bill, sponsored by Rep. Barney Frank, would also allow the states the right to decide for themselves whether they would allow physicians to prescribe marijuana. The bill has thirty-eight co-sponsors, but it has been languishing in the House sub-committee for health, and will likely stay there without a floor vote.  When I talked to the representative from N.O.R.M.L., he did speak with great enthusiasm about the bill. He considered it the best shot that proponents of medical marijuana had to make the drug available with a physicians' prescription. [3]

     The problem I had in making my recommendations was deciding which strategy to follow. It seemed to me that re-classifying marijuana, and giving the states the right to decide, have met equally tough resistance. I feel that in order to come up with a conclusive policy recommendation it was necessary to divulge deeper into both options and so, in the proceeding pages, I will do just that. 

I. The Problem and its History

Marijuana is the most commonly used illicit drug in the United States.  It is a dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis Sativa and it can be smoked as a cigarette, cigar wrap or out of a pipe. The main active chemical in marijuana is THC. The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana. [4]

        Currently Marijuana is a Schedule I drug under the Controlled Substance Act.  Schedule I drugs are classified as drugs with high abuse potential and have no accepted medical use in the United States. Other examples of Schedule I drugs include Heroin, LSD, and Methaqualone. The mid 19^th century did, however, see many reports of medicinal preparations containing a cannabis base. Marijuana was also available around the same time in Persian pharmacies. From 1915-1927 this started to change. Cannabis was systematically prohibited for non-medical use in the U.S. The South Western states, most notably California (1915), Texas (1919), Louisiana (1924), and New York (1927) led the charge.  In 1937 Cannabis become "illegal" throughout the U.S. with the passage of the Marihuana Tax Act. [5] The Marihuana Tax Act did not ban the use, distribution, or cultivation of Cannabis. What the Act did was to impose a token tax of one dollar on all buyers, sellers, importers, growers, physicians, veterinarians, and any other persons who deal in marijuana commercially, prescribe it professionally, or possess it.  The Act also set a five year period of imprisonment, a $2,000 fine, or both, for evading the sum (a very harsh penalty for such a low sum). In addition,  regulation No. 1 called for a web of affidavits, depositions, sworn statements, and constant Treasury Department police inspection in every instance that marijuana is bought, sold, used, raised, distributed, given away, and so on.  Physicians who wished to purchase the one-dollar tax stamp were forced to report to the Federal Bureau of Narcotics in sworn and attested detail, revealing the name and address of the patient, the nature of his ailment, the dates and amounts prescribed, and so on. [6] The list of provisions read like an Ad Hoc law.  The Federal government's view on marijuana was obvious, in that they were going to do everything they could to discourage and ultimately prohibit the drug. In 1970, the government went one step further and passed the 1970 Comprehensive Drug Abuse Prevention and Control Act (CSA). Title II of this Act became the legal foundation for the government's fight against marijuana and other illicit drugs.  The Federal government, as a result, now has a right to regulate the manufacturing and distribution of pot (slang).  CSA also created a scheduling system whereby controlled substances were classified into five distinct schedules. The characteristics of the schedules were, in part, based on their medicinal value, harmfulness, and potential for abuse or addiction. [7]

        Marijuana was determined to be a Schedule I drug. This meant that the DEA considered there to be a high potential for abuse and it had no apparent medical purpose. [8]

II) The Federal Government, FDA, DEA and what has been tried at the Federal level.

What has been done at the federal level to attempt to reclassify Marijuana?

On May 18, 1972, N.O.R.M.L was the first group to petition the DEA to reclassify marijuana from a Schedule I drug to a Schedule II drug.  At the time, the government cited their cooperation with various international treaties as the reason not to initiate reclassifying proceedings. NORML refused to give up though, and subsequently followed suit. The Court ruled in favor of NORML, and ordered the DEA to process the petition. The Court made it clear that the Controlled Substance Act (CSA) required a full scientific and medical evaluation. They also ruled that a fulfillment of the rescheduling process was necessary to evaluate any treaty commitments. After ten years NORML finally got a response. Francis L. Young, an Administrative Law Judge, agreed with the group, and declared that marijuana did in fact have an acceptable form of use for medical purposes. Judge Young's recommendation was to place marijuana in schedule II as opposed to Schedule I. The DEA responded by simply ignoring his recommendations, and, in 1994, a Court of Appeals decision upheld the DEA'S actions. [9]

           In 1995 Jon Gettman submitted another petition. The petition included research and other data, which Mr. Gettman had compiled. The research and other data had emerged after the record was closed in the prior proceedings before Judge Young, and focused primarily on whether cannabis has had a high potential for abuse. This was another requirement for a drug to be classified under the schedule I guidelines.  In 2002, a Federal court ruled that the petitioner did not have legal standing. The judge said that since he was not the injured party he could not sue for damages.[10]

         In 2002, the Coalition for Rescheduling Cannabis submitted a formal rescheduling petition. The group's goal was to demonstrate, through volumes of the latest scientific and medical research, that cannabis does not have a high potential for abuse, has a relatively low dependence liability, is safe for use under medical supervision and has acceptable medical use in the United States. At the confirmation hearing for the Secretary of Health and Human Services (HHS), Senator Jeffords (I-VT) asked Secretary Leavitt about the petitions.  The Secretary said that he would complete a review by August 2005. It is now almost December and there has been no such review. I have tried to contact Senator Jeffords office, without success.[11]

The Investigative New Drug Exemption

         Current Federal law requires that a drug be the subject of an approved marketing application before it can be transported or distributed across State lines. A sponsor will most likely want to ship the investigational drug to clinical investigators in many States, so, it must seek an exemption from that legal requirement. The IND is the means through which the sponsor technically obtains this exemption from the FDA. [12]

       In 1978 Robert Randall led the FDA to create an "investigational New Drug Program", which provided medical marijuana. The National Institute of Drug Administration  contracted with the Research Institute for Pharmaceutical Science at the University of Mississippi and worked together to grow the marijuana. The marijuana would then be accessible to a small number of patients. The program closed to new patients in 1992 and currently only six living patients continue to receive federal marijuana. [13]

      On the 28^th of November 2005 I talked to a representative from the FDA. The representative told me that physicians could still legally submit applications for IND exemptions in order to give their patients' marijuana for treatment. She also told me that, these applications were rarely accepted. When applications were accepted, detailed reports and constant oversight were mandatory. ( put in a citation)

III The Process for Obtaining a Waiver to Prescribe Previously Illegal Drugs 

      If reclassifying efforts were successful and applications for medical marijuana became acceptable, there would still be a long detailed process. The Federal Drug Administration is in charge of ensuring drug safety and effectiveness. The process for developing a new drug and gaining FDA approval is long and complicated. A sponsor first has to submit an Investigational New Drug application to the FDA. The sponsors can include persons, companies, research institutions, and other organizations, that will eventually market and make money off the drug. Pre-clinical testing is a requirement and the sponsors must show the FDA the results of this testing. They will then determine if it is safe to go further with human testing.  The next step is for a local institutional review board (IRB) to approve the clinical trials protocols, (the details of the trials). There are four stages of studies that ensue. 

       Stage one determines the drug's most frequent side effects, when, how often, and how the drug is metabolized and excreted. If the studies do not reveal any major toxicity then stage two may begin. Since most drugs are made to alleviate certain ailments, stage two studies try and determine if the drug in question will be an acceptable and effective form of treatment for that particular ailment. Stage three covers a larger subset of the population and Stage four only occurs only after the drug is approved. In stage four, new uses or new populations are explored, long-term effects are considered, and tests are administered to determine how participants respond to different dosages. After the clinical trails are completed, a drug sponsor submits a New Drug Application (NDA). This is where the sponsor asks the FDA for permission to approve the new drug for marketing in the United States. The FDA then has sixty days to decide whether to file it for subsequent review. The official review time is the length of time it takes to review a new drug application and issue an action letter, which is an official statement informing a drug sponsor of the agency's decision. [14]

Obtaining Marijuana for research

       The Federal government has not totally closed its eyes to marijuana and its potential use in treating certain medical problems.  The Department of Health and Human Services (HHS), which controls the FDA, has made marijuana available for researchers wishing to study its properties. There are however strict guidelines and regulations regarding the accessibility of medicinal marijuana. On May 21, 1999, a report came out to "provide guidance to the biomedical research community who intend to study marijuana in scientifically valid investigations and well-controlled clinical trials on the procedures of the Department of Health and Human Services for providing research-grade marijuana to sponsors." Since marijuana is a Schedule I drug, they have to follow the guidelines for conducting research on Schedule I drugs. This includes obtaining a special registration under the CSA (Controlled Substance Act).

      The Department of Health and Human Services  then determines if the researcher is qualified and competent. Assuming the person intends to study marijuana for use in the "cure, mitigation, treatment, or prevention of disease, they are then subject to the "drug" and "new drug" provisions of the Federal Food, Drug, and Cosmetic Act." Another major concern is the toxicity of smoked marijuana. Marijuana is a "crude drug delivery system that exposes patients to a significant number of harmful substances…" Any clinical trials must include isolating those harmful chemicals. (look up citations)

         It was determined that HHS would in fact make marijuana available for research purposes. HHS would then, "consider the extent to which proposed studies are most likely to yield high quality, scientifically valid data on the safety and effectiveness of marijuana."" The goal of this program must be to determine whether the cannabinoid components of marijuana administered through an alternative delivery system can meet the standards enumerated under the Federal Food, Drug, and Cosmetic Act for commercial marketing of a medical product."  [15]  In order for a researcher to conduct studies of marijuana, they first have to make an inquiry to National Institute of Drug Administration, to see if there is marijuana available at the time for use in clinical trials. Research-grade marijuana then become available on a cost-reimbursable basis.                

 Researchers as a result must include a plan to pay back the money as soon as possible. In addition, specific information has to be included about the number and potency of marijuana cigarettes, the bulk of marijuana needed, and the timing of the intended use of the marijuana. In order that the NIDA can maintain adequate supplies and future needs met, this information is updated annually. (http://www.mpp.org/guidelines/hhsguide.html)

IV) Medicinal Marijuana at the Local Level

      The National Organization for the Reformation of Marijuana Laws is the longest standing and most reputable organization currently involved in any issue relating to marijuana.  When I called their Washington D.C. office and talked to a N.O.R.M.L. representative, I listened with rapt attention as my questions about medical marijuana were answered. What I found in the process of doing my research was that their reports and public statements greatly impressed me. What the representative also told me was, "the fight to reclassify marijuana from a Schedule I drug to a Schedule II drug was near impossible." They had not given up hope at the Federal level, but for now they were going to concentrate on what opportunities there were on the local level. [16]

States

There are eleven states that have active medical marijuana laws. The states that have enacted medicinal marijuana laws include Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, Oregon, Vermont and Washington.  California has gained the most attention by far though.  In 1996 Californians voted overwhelmingly in favor of proposition 215. Prop 215 legalized the sale, possession and consumption of marijuana for medicinal purposes. Soon after prop 215 came into law, Ms. Raich and Ms. Monson, at the request of their doctors, began using marijuana for symptomatic relief of a variety of medical ailments. They were experiencing chronic pain, spasms, and a reduction in appetite which could be life threatening. [17]

       Shortly before proposition 215 passed, the Federal government, led by Attorney General Janet Reno, Drug Czar Barry McCaffrey and Health and Human Services Secretary Donna Shalala warned that a doctors' recommendation of marijuana would "lead to administrative action by the U.S. Drug Enforcement Administration to revoke the practitioner's registration. [18]The press conference in which Shalala made that statement sparked concern within the medical establishment. An editorial appeared in the New England Journal of Medicine, Federal Foolishness and Marijuana. The article by Jerome Kassirer, M.D., the editor-in-chief of the respected trade journal, characterized the U.S. governments policy as "misguided," "hypocritical," "out of step with the public," and "inhuman,". Dr. Kassirer called for the reclassification of marijuana from Schedule I to Schedule II. [19]

          The DEA had not made an idle threat,  and a wave of Federal arrests and prosecutions of State-authorized, California marijuana patients and providers ensued, including an August 15, 2002 DEA raid on Ms. Monson's six-plant medical garden. Ms. Raich, the other patient who was prescribed marijuana after the passage of Prop 215, subsequently joined Ms. Monson in a lawsuit against the Department of Justice.

The two patients sought to bar the Justice Department from taking legal action against them for their State-sanctioned use of medicinal cannabis. The constitutional basis that the Federal government's lawyers cited fell under the Commerce Clause of the United States Constitution. Lawyers for the two woman argued that the Federal government's prosecution of authorized patients, who possessed and cultivated marijuana for their own personal medical use, was an infringement of their rights under state law at the time.

[20]The 9^th Circuit Court of Appeals agreed with the woman in a 2-1 decision.

"we find the appellants' class of activities the intrastate, noncommercial cultivation, possession and use of marijuana for personal medical purposes on the advice of a physician is, in fact different in kind of drug trafficking. … Moreover, this limited use is clearly distinct from the broader illicit drug market… insofar as the medicinal marijuana at issue in this case is not intended for, nor does it enter, the stream of commerce. … This conclusion, coupled with the public interest considerations and the burden faced by the appellants if, contrary to California law, they are denied access to medicinal marijuana," warrants the court to find in favor of the appellants' request for injunctive relief from federal prosecution. [21]

       Predictably, the United States government appealed the decision.  Former United States Attorney General John Ashcroft and DEA Administrator Karen Tandy filed a petition for certiorari in the United States Supreme Court. On June 6, 2005, The Supreme Court decided against Ms. Raich and Ms. Monson. The court found that the federal prosecution of patients who had cultivated and possessed marijuana for their own medicinal use was a legitimate exercise of Congress' authority under the Commerce Clause. The Court struck down an injunction barring the Justice Department from arresting the respondents. (http://www.norml.org/index.cfm?Group_ID=6550).  By pursuing prosecutions, the Federal government was making it clear that they would not tolerate the practice of prescribing marijuana for medicinal purposes. The Supreme Court also made it clear that they had the right to stop the States, when necessary, from allowing physicians to prescribe marijuana for medical purposes.

H.R 2087 The States' Right to Medical Marijuana Act       

H.R. 2087, The States' Rights to Medical Marijuana Act is presently stuck in the House Sub Committee on Health. Rep. Barney Frank has sponsored the bill. What it would do is transfer marijuana from a Schedule I to a Schedule II class of the Controlled Substances Act.  In addition, the bill provides that the Controlled Substances Act and the Federal Food, Drug, and Cosmetic Act shall not, in a State in which marijuana may be legally prescribed; or recommended by a physician for medical use, prohibit or otherwise restrict;

(1) A physician from prescribing or recommending marijuana for medical use.

(2) An individual from obtaining and using marijuana from a prescription or recommendation by a physician for medical use.

(3) A pharmacy from obtaining and holding marijuana for such a prescription or recommendation; and

(4) An entity established by a State from producing and distributing marijuana for such a prescription or recommendation. [22]

When doctors recommend the use of marijuana for their patients and states are willing to permit it, I think it is wrong for the federal government to subject either the doctors or the patients to criminal prosecution. Nothing in this proposal makes marijuana more available for the general population. Conservatives often profess their support for states' rights, and if they truly believe in states' rights, they should support this bill.  [23]

          The reason I like this bill is because it combines both of the options that the representative from N.O.R.M.L. presented to me. These were the most realistic ways in which medicinal marijuana could become a reality.  For one, it attempts to reclassify marijuana from a Schedule I drug to a Schedule II drug. This would allow drug companies, research institutions and other potential sponsors to submit applications to the FDA for new drug approval. Secondly, the bill allows more local autonomy for states to decide how they want to deal with medicinal marijuana. The second option is the present day approach that groups such as N.O.R.M.L. are taking to legalize marijuana for medicinal purposes.

        It is important to note that in no way does this bill legalize marijuana for widespread consumption. The States Right to Marijuana Act only legitimizes what various people in the medical profession have been saying for years. Marijuana does have medicinal properties and should be included with the various opiates that physicians prescribe daily to patients dealing with a whole assortment of ailments. There is no widespread political support for the bill, but I did do a significant amount of research on the thirty-eight co-sponsors.

        The co-sponsors are as diverse in their political ideologies as the constituencies they represent. They come from the Midwest, Northeast, Southeast, and the West Coast. They represent rural and urban areas, with small and large populations. The thirty-seven co-sponsors include nineteen members from States where medical marijuana is legal, twelve of those coming from California. Together they represent over 50 million people, some of whom voted for President Bush in the last election, and a good portion of which voted for you. When I was In the process of writing this memo I tried to get in touch with every one of the co-sponsors, including Rep. Frank, but for the most part, I received little cooperation. I was asked to leave messages, which were never returned or directed to the congressmen's websites. There were some offices that were cooperative however. Some of the reasons that I was given for support of the bill included the fact that they thought marijuana did have some medical value and others who thought that the government had no right interfering with the affairs of the States. [24]

   V) Policy Recommendations  

     In the first half of this memorandum, I have tried to discuss with you, as extensively as possible, different strategies that can be used in the fight to get marijuana accepted for medical usage. Throughout my research, only two have stood out as particularly noteworthy: allowing States to decide for themselves and reclassifying marijuana from Schedule I drug to a Schedule II. While there are problems associated with both of these proposals, and politically they both have received stiff resistance, one or both of these options are the only legitimate ones available.

        Therefore, my recommendation to you, Senator, is to try to pass legislation similar to H.R. 2087. Since politically, reclassification has met the stiffest resistance, I would concentrate on giving States the right to decide for themselves for now.  I would also give the FDA executive oversight.

      Some Opiates that are illegal have been approved for medical use. They had to go through the new drug process administered by the FDA however, and this was only possible because they were a Schedule II drug. This is not an option for marijuana on the Federal level because it is a Schedule II drug. The FDA is the best qualified and most experienced agency in handling the review process for new and untested drugs, which marijuana still is. The FDA was not a part of The States' Right to Medical Marijuana Act, and I think this was a major mistake.

          Under my proposal, first there would be a moratorium on the implementation of medicinal marijuana, any state that violated the moratorium would lose a percentage of their Federal Medicaid money.  This is important because, even with the recent Supreme Court decision, there are still States that allow their citizens to possess a certain amount of marijuana for medical use, legally.

The issue in the <cite>Raich,</cite> case, infra, was whether the federal government has the power, under the Commerce Clause of the U.S. Constitution, to arrest, make seizures, and prosecute individuals for purely intrastate activities related to the use of marijuana in accordance with state law. The question of whether a state may make the possession of marijuana legal for medical purposes was not at issue. Under fundamental doctrines of federalism, it is and will continue to be completely within the power of a state to enact laws immunizing medical marijuana patients and their providers from arrest, seizure, and prosecution by state and local officials. [25]

       It is also clear that the only ones with the power to change the federal law would be the United States Congress. Federal law will stay the same, and the DEA will still have the right to prosecute patients who use marijuana under state law, unless Congress changes the law at the national level.

         If a Federal entity was in full control, I think Congress might change their stance on the issue. During that moratorium, the FDA would come up with detailed guidelines outlining the circumstances in which states could administer marijuana. They would decide what illnesses could be treated, how much a person was allowed to possess and cultivate as a way to keep track of those who qualified.  When the guidelines were completed, the States that had present laws on the books could then continue to allow their physicians to prescribe marijuana for medical purposes. This is by no means a way to legalize marijuana on the Federal level.  I would propose that the DEA hold off on prosecuting those who used, cultivated or possessed marijuana at the State level, where State law had allowed them to do so.  I would not make this an indefinite solution and the period of time would be limited to two years. During this time the States would also be required to submit detailed reports. The FDA could also pull the plug under extreme conditions in which the health of the patient receiving the marijuana was obviously in danger.         

     Right now the National Institute of Drug Abuse is the only government agency on the Federal and State level that can provide marijuana for research.  If this experiment is going to work and the States are voluntarily going to give up their medical marijuana programs, this is going to have to change. The States will need greater access to the research, so that their universities and hospitals can conduct more studies. The more studies that are conducted, the greater chance that the harmful affects of marijuana can be isolated, and the greater chance of the two year program being a success.  I don't believe it is feasible for the States to start growing their own marijuana, but I do believe the NDIA should provide a certain amount of the plant to each of the eleven states, so that they can adequately implement the FDA's recommendations. 

         At the end of the two years there would be hearings set up by the Health, Education, Labor and Pensions Committee and the Judiciary Committee. Present at the committee hearings would be doctors and patients from those eleven states who had directly benefited from the two year experiment. There would also be a team of specialists from various agencies, criminologists, medical experts, and first hand accounts from patients themselves. Their goal would be to determine the effectiveness of the experiment and to how  it might continue. The end result would be a continuation of the laws that had been in place before, or a change in the classification of marijuana from a Schedule I drug to a Schedule II drug.       

         States have oftentimes in the past acted as laboratories for radical programs that the federal government was not ready to implement. Workers compensation, unemployment compensation, and welfare started at the State level. They passed on the Federal level after they proved to be successful. Right now, the Federal government has refused to reclassify marijuana because of the stigma attached to the drug. They will eventually have to concede ground though. Eighty percent of the public considers marijuana a good way to treat chronic diseases such as AIDS and glaucoma. The best way to do this is to allow the States to decide for themselves. The Federal government would retain some control since the FDA still has oversight responsibilities.  For the most part experimentation would lie within the framework of State constitutions and State medical boards.     

  Media strategy and Publicity

         The media implementation and publicity is one of the most important facets of the policy making process. In the age of twenty-four hour news programs the American public has easy access to news and information via the internet.  Americans are more informed today then they ever were.  It is essential to come out with a clear and concise message early on.  This is the part of the process where organizations that have advocated long and hard for the reformation of marijuana laws should get involved. There can be no real "get out the message" campaign without the National Organization for the Reformation of Marijuana Laws. They are the oldest and most respected organization in existence and they have a celebrity advisory panel that includes Willie Nelson, Bill Mohr, and other influential figures. N.O.R.M.L. also has the ability to appeal to the politically desirable 18-34 year old demographic. They also have the informational and institutional infrastructure to institute a massive grassroots campaign.

       Senator, if you are going to get involved with an issue as controversial as medicinal marijuana, you are going to have to be 100% committed to the reforms you are advocating.  A nationwide speaking tour might be a good idea. An effective nationwide speaking tour would also have the added benefit of having certain constituencies wondering why their Senators and Congressmen weren't pressing for the reform of marijuana laws. In the 1980s New York passed the Rockefeller Laws, which tougher drug sentencing guidelines and stiffer penalties for drug related offenses. At that time, the public wanted tougher sentencing guidelines and stiffer penalties for drug related offenses. I believe the opposite can hold true.

           The internet has proven to be the single most important medium of the 21^st century and beyond. Howard Dean went from an obscure Governor of a small Northeastern State, as you well know to being the favorite to win the Democratic nomination for President. He was able to accomplish this because of the massive amount of coordination and accessibility of the internet. In the past, this has also worked for individual issues, such as the legalization of marijuana for medical purposes. What you would need is someone who specializes in the issue. You can tap into the mailing list that you built up during your'04 campaign and reach tens of millions of people.

       What kind of information would you want to include in these internet postings? You could put up statistical information on the number of drug related arrests, quotes from supportive medical organizations and celebrity interviews. You could also include comparative tables of other drugs that are legal for medical use, such as opiates. A link to House and Senate websites would also be useful, so that people throughout the country can then express their concerns in the form of emails and letters to their elected officials.

          Television is also still a very significant median for getting your message across. The various Statewide races and recent presidential election have shown that candidates still spend a substantial amount of money through T.V. advertising. You would want ads that really got your message across. The ads could include human interest stories; people who have suffered from chronic illnesses such as A.I.D.S, or glaucoma or are undergoing chemotherapy. You would want to show how marijuana has allowed them to regain their appetite, alleviated some of their sufferings and, even allowed them to live a longer life. At the bottom of the screen, in each of these ads, a number should be included so that a person can reach their Congressmen or Senator. An effective ad is not enough. If we are going to put pressure on legislatures at the Federal level, we are going to have to get their constituents involved.

         The last medium which you should certainty utilize is the print media. Many Americans read a newspaper or magazine at least once a week. If you gave interviews to magazines like Rolling Stone, Playboy, or even People, then you could reach a demographic that could help your cause dramatically. In addition, you could write editorials to the New York Times, Wall Street Journal, and other reputable news papers that have a large and significant influence on the tone of the American electorate. 

         As long as you stay on message and have a clear and concise point, the media strategy that you initiate can be your most powerful weapon. A lot of people do not have time to do their own research or formulate an educated opinion on most subjects. Therefore, if you present them with your views in the many different mediums that I have just described, then your work within the United States Senate will be substantially easier.

Legislative Strategy

       The most difficult part of my recommendations to implement will be the legislative strategy. If you have followed my previous recommendations, you have just finished a nationwide speaking tour, a full internet campaign is up and running, and advertisement space has been procured.  As a result, the issue of using marijuana for medicinal purpose has now gained national attention. Whether or not marijuana has legitimate medicinal properties and whether or not physicians can prescribe the drug, has become a topic of dinnertime conversation across the country. It is now important to strike while the iron is hot, and develop a comprehensive, in-depth plan to turn your proposals into legislative action.

       It is not trivial that eleven states have passed medical marijuana laws. The majority of citizens in eleven States have decided that marijuana has useful medical properties.  It is even more significant when you further explore the percentages by which these measures came to pass.

     In Alaska, fifty-eight percent of voters approved Ballot Measure #8 on November 3, 1998. Patients with cachexia; cancer; chronic pain; epilepsy and other disorders characterized by seizures; glaucoma; HIV or AIDS; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea were no longer subject to state-level criminal penalties. In California, fifty-six percent of voters approved Proposition 215 on November 5, 1996. The law took effect the following day. It removes state-level criminal penalties on the use, possession and cultivation of marijuana by patients with illnesses such as, arthritis; cachexia; cancer; chronic pain; HIV or AIDS; epilepsy; migraine; and multiple sclerosis. In Colorado sixty -four percent of the voters approved Amendment 20 on November 7, 2000, which amended the State's constitution to recognize the medical use of marijuana. The law took effect on June 1, 2001. It removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients with the following medical problems, cachexia; cancer; chronic pain; chronic nervous system disorders; epilepsy and other disorders characterized by seizures; glaucoma; HIV or AIDS; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea. In Hawaii, there was legislative action taken. Governor Ben Cayetano signed Senate Bill 862 into law on June 14, 2000. The law took effect on December 28, 2000. The law removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients with either cachexia; cancer; chronic pain; Crohn's disease; epilepsy and other disorders characterized by seizures; glaucoma; HIV or AIDS; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea.  Maine saw over sixty percent of voters approve question two on the ballot, on November 2, 1999.   The law took affect on December 22, 1999.   It removes state-level criminal penalties on the use, possession and cultivation of marijuana by patients with the following illnesses epilepsy and other disorders characterized by seizures; glaucoma; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea or vomiting as a result of AIDS or cancer chemotherapy. Maryland passed an affirmative defense law that allows a defendant at trial that he used marijuana because due to medical reasons. The maximum penalty would be $100 dollars. In Montana, sixty-two percent of voters approved Initiative 148 on November 2, 2004. The law took effect that same day. It removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients with cachexia or wasting syndrome; severe or chronic pain; severe nausea; seizures, including but not limited to seizures caused by epilepsy; or severe or persistent muscle spasms, including but not limited to spasms caused by multiple sclerosis or Crohn's disease. In Nevada, sixty-five percent of voters approved Question 9 on November 7, 2000, which amends the State's constitution to recognize the medical use of marijuana.  The law took effect on October 1, 2001.  The law removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients who have AIDS; cancer; glaucoma; and any medical condition or treatment to a medical condition that produces cachexia, persistent muscle spasms or seizures, severe nausea or pain.  People in Oregon approved measure 67, by 55-45 on November 3, 1998. The law went into affect on December 3, 1998.  It removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients who have cachexia; cancer; chronic pain; epilepsy and other disorders characterized by seizures; glaucoma; HIV or AIDS; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea. Vermont Patients diagnosed with the following illnesses are afforded legal protection under Senate Bill 76: HIV or AIDS, cancer, and Multiple Sclerosis. Finally in Washington, fifty-nine percent of voters approved Measure 692 on November 3, 1998. The law took effect on that day.  It removes State-level criminal penalties on the use, possession and cultivation of marijuana by patients with cachexia; cancer; HIV or AIDS; epilepsy; glaucoma; intractable pain (defined as pain unrelieved by standard treatment or medications); and multiple sclerosis. [26]

           The point of the last few pages was to illustrate a growing trend. In four of the eleven states, over sixty percent of voters approved a ballot measure eliminating State level penalties for medicinal marijuana. In four States, popular opinion was such that, the State Senate passed laws of their own. In three other States, the percentage of voters in favor of legalizing marijuana for medical purposes was over fifty-five. Taking this into account, there is ample reason to believe that the congressional delegations from these eleven states can be persuaded to support your proposals. After all, the same constituents who voted overwhelmingly for medical marijuana also vote in Congressional and Senatorial races. A small portion of congressmen from those eleven states and no United States senators have come out in favor of medicinal marijuana but there is still great potential for support.

      These legislatures are also important because a big part of my proposal involves the states. The states need to halt the implementation of their medicinal marijuana programs while the FDA comes up with their own set of guidelines. Besides the congressmen and senators, various federal agencies, and the Governors of these eleven states will have to cooperate.  I propose creating a liaison from your office to coordinate the efforts. In Alaska, the Department of Health and Social Services decides which diseases can be treated by marijuana, how much a person can possess, and how much they are allowed to cultivate.[27] In California, the same responsibilities fall to the Department of State Health Services. [28]In Colorado, the Department of Public Health and Environment and in Hawaii, the Department of Public Safety all have similar responsibilities.[29] In Maine, Maryland, and Montana there is no agency that overseas medicinal marijuana but the Governors of these states should be consulted.  The State Department of Human Resources in Nevada and Oregon, the Department of Public Safety in Vermont and the Department of Health in Washington are all responsible for how and when medical marijuana can be administered. [30]

        The liaison from your office would have a daunting task. He is going to have to convince the Governors and various agency heads of the merits of your proposal. The fact remains that the Federal government can still prosecute those who use, cultivate, or possess marijuana at the State level. If our proposals are enacted then the citizens of these States would no longer have to worry about Federal involvement, or possible prosecution. Halting existing practices and allowing the government to eventually intercede to develop their own standards might be a hard pill to swallow, but the benefits of a successful two year experiment would be monumental.  Since many States have similar guidelines on the books already, in all likelihood when the FDA came up with guidelines of their own, not much would change.

      There are also regional as well as national governors' conferences that the liaison should include in his lobbying efforts.  Since many States have medicinal marijuana programs are on the west coast, the west coast Governors Association would be a great place to start. Regional policy has been formulated on lots of different issues in their past meetings. A successful effort by a member of your staff could result in a majority of the states agreeing to submit to FDA guidelines, when physicians in their states wrote prescriptions for medical marijuana.   

       After the liaison finished his work within the States, work would then begin on the Federal level. President Bush likes to claim that he is an adamant supporter of State rights, and Candidate Bush was a proponent of allowing States to decide for themselves whether or not they wanted to allow marijuana for medical purposes. While he has since denounced such proclamations, if enough support was garnered in congress, it would be unlikely that he would veto any legislation.  Unfortunately a Republican majority controls the 109th Congress. This means that the Committee Chairman will be of the opposite party. This includes two committees that you will need to work with, if we are going to get anything accomplished on the Federal level. We need the DEA to stop prosecuting medical patients who use marijuana legally under their State laws, and we need the FDA to create a uniform set of guidelines to allow medical marijuana in these states. In the Senate, The Health, Education, Labor and Pensions committee (H.E.L.P.) has jurisdiction over the Department of Health and Human Services, which controls the FDA. The Judiciary Committee controls the Drug Enforcement Agency.

      At this point, the eleven states that have medicinal marijuana laws have agreed to a moratorium. They will not allow physici[31]ans to prescribe patients marijuana and they will punish anyone caught possessing, cultivating or using marijuana, for any purposes. The DEA is a non-factor at this point because they will have nobody at the state level to prosecute. Therefore, the FDA will be the next piece to the legislative puzzle. We must now work with members of the H.E.L.P. committee in trying to change existing FDA policy. Various medical organizations have agreed to help us in this cause.  The American Academy of Family Physicians, the American Nurses Association, and the American public Health Association all support some kind of physician-supervised access to the drug for medical purposes. They also have a substantial lobbying presence in Washington, and if they coordinated their efforts they could provide invaluable support. As someone who started off answering phones as a young intern, I know, first hand, the benefits of a national phone and letter writing campaign. These groups have legitimacy; in that they are all doctors or nurses and can back their lobbying efforts with substantiated medical arguments.

          Another group outside of the government that would provide a lot of guidance and support would be the National Organization for the Reformation of Marijuana Laws. N.O.R.M.L. has provided a voice in the public policy debate for those Americans who oppose marijuana prohibition, and favor an end to the practice of arresting marijuana smokers. A nonprofit public-interest advocacy group, N.O.R.M.L. represents the interests of the tens of millions of Americans who smoke marijuana responsibly.

        During the 1970s, N.O.R.M.L. led the successful efforts to decriminalize minor marijuana offenses in eleven states and significantly lower marijuana penalties in all others.

       N.O.R.M.L. has provided informational in the national media on marijuana-related stories, lobbied State and Federal legislators in support of reform legislation, publishes a regular newsletter. It hosts, along with the N.O.R.M.L. Foundation, an informative web site and an annual conference, and also serves as the umbrella group for a national network of citizen-activists who committed to ending marijuana prohibition and legalizing marijuana.

         The oldest and largest marijuana legalization organization in the country, N.O.R.M.L. maintains a professional staff in Washington, DC, headed by Executive Director (and N.O.R.M.L. founder) Keith Stroup, and a network of volunteer State and local N.O.R.M.L. Chapters across the country. [32]N.O.R.M.L. has already been instrumental in your initial media strategy and they could also be highly affective in lobbying the members of the Health, Education, Labor and Pensions committees to make the FDA change there existing policies.

       There are also Senators, from the States that have already passed medical marijuana laws, that are in support of any lobbying that the medical organizations or NORML plan on doing has to include these Senators.  Ted Stevens of Alaska is the longest serving Republican in the Senate, and would be a very significant ally because of the enormous influence that he has. Diane Feinstein and Barbara Boxer have both come out in support of Medicinal marijuana, and have been very vocal in the United States Senate. Wayne Allard is on the Budget and Appropriations committee therefore has considerable influence.  Hawaii's Senators combined have over seventy years experience in the Senate and their vote for medicinal marijuana would be important. Susan Collins and Olympia Snow are moderate Republicans from Maine, who could bridge the partisan gap that is so prevalent in Washington politics today. They have voted with the democrats on a number of issues and might agree to a proposal on medicinal marijuana. Paul Sarbanes is five term senator from Maryland, with considerable influence, and who would also be a considerable force if he took up the cause of medical marijuana. Nevada is home to the Minority leader Harry Reid, the most influential democrat in America right now.  If he listened to his constituents and came out in favor of medicinal marijuana, then the Senate democrats would not be very far behind. The Senators from Montana, Oregon, Vermont, and Washington are also important and should be lobbied, through phone calls, emails and letters.

        Universities and pharmaceutical companies could be great assets at this stage as well. Research institutions in the eleven states would stand to get large amounts of federal dollars, the fame that comes with developing a new drug and increased national exposure. Pharmaceutical companies could be sitting on a gold mine. If a company received patent rights to develop, manufacture, or distribute any new drugs their stock would absolutely skyrocket. If more marijuana was available on the local level, this possibility would increase dramatically. The Pharmaceutical companies represent one of the biggest and most influential lobbying forces in Washington D.C. They have billions of dollars to spend and in the past supported solely republican lawmakers. Therefore, if lobbyists for the pharmaceutical companies lobby influential Republican lawmakers, their voices would be heard and their advice would be heeded. They would also provide the money for advertisements, this would be helpful as another presidential campaign is underway and you would want to spend as little of your own money as possible. The goal would be to get these companies to fund the radio and T.V. ads, the speaking tour, etc.     

        Our eventual goal is to get the Committee on H.E.L.P to put pressure on the FDA, through the Health and Human Services committee and to develop guidelines in which medical marijuana would be legal in the States that had previous laws. We also wish to stop DEA prosecution of those who cultivated, possessed, or consumed marijuana under these state laws. This would take some effort, but, with a nationwide media strategy, a full court lobbying press, and widespread public support, I think that it can  be done.

       I assume that the DEA and the Judiciary committee will follow any guidelines the FDA initiated, but they do have jurisdiction under the Controlled Substance Act of 1970, and could still prosecute on the Federal level those who smoked, cultivated, or possessed marijuana, even if it was under FDA guidelines. Therefore, immediately after the FDA proposals were developed, we would switch our lobbying efforts into making sure that the DEA would in fact lay off prosecution. The Attorney General would also be brought in, as he has the last say in deciding whom to prosecute and for what reason.

Program Follow- up and Evaluation

         Almost as important as my policy recommendations are the follow-up and evaluation. Part of my recommendation called for a review after two years. The Judiciary and H.E.L.P committees would hold joint hearings. Agency heads, criminologists, patients, and medical experts would have the opportunity to weight in on what they thought of the last two years, and what they thought should be done in the future.

          The first group of people to testify would be the agency heads. There are numerous agencies that would be involved if marijuana was declared legal, for medicinal purposes. The Office of National Drug Control Policy is the agency responsible for "establishing policies, priorities, and objectives for the Nation's drug control program." (citation)  I would want John Walters, the head of the agency, to come and discuss the impact of the obvious changes in policy.  The next person I would want to come in and talk would be the Secretary of Health and Human Services. The HHS is the agency responsible for the FDA and the NIDA.  Michael J. Leavitt would discuss his views on the last two years, and whether or not he thinks a change in policy for the future is possible. The head of the FDA would talk more specifically about the effectiveness of the guidelines that the states had, and if he thought they should continue, needed working, or discontinued outright. The Head of the National Institute of Drug Abuse would also come in and testify. This was the agency responsible for giving the eleven states the marijuana to conduct there own research. The states were following FDA guidelines, but researchers could now appeal to the states instead of applying to the NIDA when they wanted marijuana for research purposes.

          The second group of people called on to testify would be law enforcement officials. The Attorney General would discuss the impact of the federal government ceding control of medicinal marijuana to the states. Does he have a serious problem not prosecuting those who smoke, cultivate, or possess marijuana, even if it is legal under that individuals' state law. The head of the DEA will also have to discuss his opinions before the committee. The DEA is the main federal agency in control of illegal narcotics. The right to control the flow of illicit substances is theirs under Federal statutes. How did they feel about not being able to prosecute those who the Supreme Court had previously given them full discretion to arrest?   The head of the Department of Corrections might also be welcome at the committee hearings. Marijuana related arrests and jail terms add considerable crowding to our local and federal prisons. Does the Commissioner notice any difference in marijuana related arrests? In addition, local law enforcement officials would offer valuable insights. For two years, States were given large quantities of marijuana. Did marijuana abuse increase? were there more local arrests? In addition, the places were the marijuana was kept, Were there any attempted robberies, corruption or abuse?

            The third group that should be present at the hearings would be the medical experts. Doctors from Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, Oregon, Vermont, and Washington would have the opportunity to come in and address the committee. The doctors are the ones on the front line in the debate, and their opinions are none partisan. If you wanted to see how a new tool would work on a car, then you would ask a mechanic. If you wanted advice on how a new drug is working, you would ask a doctor. Only a doctor can analyze the side affects patients are experiencing, determine if the benefits outweigh the costs, and make judgments on a patients' progress. When the doctors come in and testify, they will be defending their patients and their policies. These doctors would have two years of experience in dealing with individuals with HIV or AIDS, seizures, glaucoma, multiple sclerosis, migraines, and nausea. They will be the ones who can tell you if marijuana truly is an affective way to treat certain ailments.

             The fourth and last group I would call to testify, would be the patients themselves. If the doctors are on the front line of the medicinal marijuana debate, the patients would be the horses on which they charged into battle. If certain people didn't have HIV, or AIDS, or seizures, or glaucoma, or MS, or Migraines, or nausea then there would be no debate. These people have suffered from pain and suffering in a way that most of us can't relate to. Many times marijuana has been their only source of relief from the constant agony that makes up their lives. When a president decides to go to war, the human casualties are always the first thing he considers. The debate on medicinal marijuana is a war and has human casualties. They must be allowed to voice their opinions in front a congressional committee.

        After the committee hearings wrap up, the members will have a lot of work to do. They must decide, based on reports the doctors wrote in the last two years, and the testimonies before Congress, whether or not medicinal marijuana should become a political reality. If they concluded that the two year experiment was a success, then using the FDA guidelines and procedures, the rest of the fifty states could then administer marijuana for medical purposes. If the two year experiment was thought to have failed, then things would go back to the way they were before you Senator got involved. The eleven states that have laws on the books would still allow physicians to write prescriptions for marijuana and the DEA would still prosecute whomever they wanted, under the Commerce Clause of the United States Constitution.

Conclusion

          Through this memo I have attempted to outline the components that make up the medicinal marijuana debate. My recommendations were not made lightly, and I spent endless hours reviewing doctoral and witness testimonials, examining court documents and talking to congressional aids, representatives from the FDA, DEA, HHS, NORML and numerous attorneys. Political feasibility was a big factor in my recommendations but they could not lead me to any particular conclusion. Every recommendation that had been tried, reclassification and state autonomy in particular, has met stiff political pressure. That is the reason I came up with the innovative approach outlines in my policy recommendations. It was not possible to come up with an approach that would not be contentious, pretentious, controversial and difficult. If you are going to get involved at all the fight will be long and hard. Just ask the people form NORML, they have been fighting for thirty –years to get marijuana laws changed.

          You do have man allies though. Pharmaceutical companies, research institutions, universities and various medical associations are historical friends. They can be counted on to lobby legislatures, raise money, and raise awareness. There are also twenty-two senators and over ninety congressmen that hail from states were medicinal marijuana is already a reality.  You are an influential member of the United States senate and a former presidential nominee. If you devote enough time and energy into this I am positive that my recommendations can become a political reality. States would love to have the DEA off their backs, and the federal government would have to free up the resources and manpower that this issue has needed. You are a great leader and can make both sides happy.