Your Government Is Lying To You (Again) About Marijuana

Your Government Is Lying To You (Again) About Marijuana ALLEGATION #1 “There is a serious drug problem in this country.” TRUTH America does have a serious drug problem and our public policy needs to better address this issue with health and science-based educational programs, and by providing more accessible treatment to those who are drug-dependent. Unfortunately, the bulk of America’s anti-drug efforts and priorities remain fixated on arresting and jailing drug consumers – particularly recreational marijuana smokers.1 In this sense, there is a serious drug enforcement problem in this country. Despite the notion that America’s drug war focuses primarily on targeting so-called hard drugs and hard drug dealers, data compiled by the FBI reports that 46 percent of all drug arrests are for marijuana.2 In 2003, the last year for which statistics are available, law enforcement arrested an estimated 755,186 persons for marijuana violations.3 This total far exceeds the total number of arrests for the violent crimes of murder, manslaughter, forcible rape, robbery, and aggravated assault.4 Today, state and local taxpayers spend between $5.3 billion5 and $7.7 billion6 dollars annually arresting and prosecuting individuals for marijuana violations. The federal government spends an additional $4 billion per year on marijuana-related activities.7 These monies would be far better spent targeting violent crime and protecting national security. Since 1990, over 7.2 million Americans have been arrested on marijuana charges,8 more than the populations of Alaska, Delaware, the District of Columbia, Hawaii, Montana, North Dakota, South Dakota, Rhode Island, Vermont, and Wyoming combined.9 Nearly 90 percent of these arrests were for simple possession, not cultivation or sale.10 Despite the fact that reported adult use of marijuana has remained relatively constant for the past decade, annual marijuana arrests have more than doubled since 1990.11 Arrests for cocaine and heroin have declined sharply during much of this period,12 indicating that increased enforcement of marijuana laws is being achieved at the expense of enforcing laws against the possession and trafficking of more dangerous drugs. Rather than stay this course, federal officials ought to take a page from their more successful public health campaigns discouraging teen pregnancy, drunk driving, and adolescent tobacco smoking – all of which have been significantly reduced in recent years.13 America did not achieve these results by banning the use of alcohol or tobacco products or by targeting and arresting adults who engage in these behaviors responsibly, but through honest, fact-based public education campaigns. There is no reason why these same common sense principles and strategies should not apply to marijuana and responsible adult marijuana use. ALLEGATION #2, “Nationwide, no drug matches the threat posed by marijuana.” TRUTH This statement is pure hyperbole. By overstating marijuana’s potential harms, America’s policy-makers and law enforcement community undermine their credibility and ability to effectively educate the public of the legitimate harms associated with more dangerous drugs like heroin, crack cocaine, and methamphetamine. In fact, almost all drugs – including those that are legal – pose greater threats to individual health and/or society than does marijuana.14 According to the Centers for Disease Control, approximately 46,000 people die each year from alcohol-induced deaths (not including motor vehicle fatalities where alcohol impairment was a contributing factor), such as overdose and cirrhosis.15 Similarly, more than 440,000 premature deaths annually are attributed to tobacco smoking.16 By comparison, marijuana is non-toxic and cannot cause death by overdose.17 In a large-scale population study of marijuana use and mortality published in the American Journal of Public Health, marijuana use, even long-term, “showed little if any effect … on non-AIDS mortality in men and on total mortality in women.”18, After an exhaustive, federally commissioned study by the National Academy of Sciences’ Institute of Medicine (IOM) in 1999 examining all of marijuana’s potential health risks, authors concluded, “Except for the harms associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications.”19 (It should be noted that many risks associated with marijuana and smoking may be mitigated by alternative routes of administration such as vaporization.)20 The IOM further added, “There is no conclusive evidence that marijuana causes cancer in humans, including cancers usually related to tobacco use.”21 A 2001 large-scale case-controlled study affirmed this finding, concluding that “the balance of evidence … does not favor the idea the marijuana as commonly used in the community is a major causal factor for head, neck, or lung cancer.”22 More recently, a 2004 study published in the journal Cancer Research concluded that cannabis use is not associated with an increased risk of developing oral cancer “regardless of how long, how much, or how often a person has used marijuana.”23, Numerous studies and federally commissioned reports have endorsed marijuana’s relative safety compared to other drugs, and recommended its decriminalization or legalization.24 Virtually all of these studies have concluded that the criminal “classification of cannabis is disproportionate in relation both to its inherent harmfulness, and to the harmfulness of other substances.”25 Even a pair of editorials by the premiere British medical journal, The Lancet, acknowledge: “The smoking of cannabis, even long-term, is not harmful to health.26 … It would be reasonable to judge cannabis as less of a threat … than alcohol or tobacco.”27 Indeed, by far the greatest danger to health posed by the use of marijuana stems from a criminal arrest and/or conviction. ALLEGATION #3 “60 percent of teenagers in treatment have a primary marijuana diagnosis. This means that the addiction to marijuana by our youth exceeds their addiction rates for alcohol, cocaine, heroin, methamphetamine, ecstasy and all other drugs combined.” TRUTH This statement is purposefully misleading. Although admissions to drug rehabilitation clinics among marijuana users have increased dramatically since the mid-1990s, this rise in marijuana admissions is due to a proportional increase in the number of people arrested by law enforcement for marijuana violations and subsequently referred to drug treatment by the criminal justice system.28 Primarily, these are young people arrested for minor possession offenses,29 brought before a criminal judge (or drug court), and ordered to rehabilitation in lieu of jail or juvenile detention. As such, this data is in no way indicative of whether the person referred to treatment is suffering from any symptoms of dependence associated with marijuana use; most individuals are ordered to attend supervised drug treatment simply to avoid jail time. In fact, since 1995, the proportion of admissions from all sources other than the criminal justice system has actually declined, according to the federal Drug and Alcohol Services Information System (DASIS).30 Consequently, DASIS now reports that 58 percent of all marijuana admissions are through the criminal justice system.31 Referrals from schools and health care/drug abuse care providers comprise another 15 percent of all admissions.32 By comparison, only 38 percent of those admitted to treatment for alcohol and only 29 percent of those admitted to treatment for cocaine are referred by the criminal justice system.33 ALLEGATION #4 “We may never rid this country of every crack pipe, or marijuana plant. However, research proves that we have made substantial success in reducing drug use in this country.” TRUTH In fact, marijuana enforcement has had no discernable long-term impact on marijuana availability or use. According to the National Center on Addiction and Substance Abuse at Columbia University, teenagers report that marijuana has surpassed tobacco and alcohol as the easiest drug to obtain.34 This result is hardly surprising, given that annual federal data compiled by the University of Michigan’s Monitoring the Future project reports that an estimated 86 percent of 12th graders say that marijuana is “fairly easy” or “very easy to get.”35 This percentage has remained virtually unchanged since the mid-1970s36 – despite remarkably increased marijuana penalties, enforcement, and the prevalence of anti-marijuana propaganda since that time. The percentage of adolescents experimenting with marijuana has also held steady over the long-term. According to annual data compiled by Monitoring the Future, 47.3 percent of 12th graders reported having used marijuana in 1975.37 Despite billions of dollars spent on drug enforcement and drug education efforts (such as the federally funded DARE program) since that time, today’s number (for the Class of 2004) is 49 percent.38, In addition, according to data compiled by the federal National Household on Drug Abuse survey, an estimated 2.6 million Americans tried marijuana for the first time in the year 2003, up from 1.5 million in 1990 and 0.8 million in 1965.39 Today, nearly one out of every two American adults acknowledges they have used marijuana, up from fewer than one in three in 1983.40 ALLEGATION #5 “The truth is that marijuana is not harmless.” TRUTH This statement is correct; marijuana isn’t harmless. In fact, no substance is, including those that are legal. However, any risk presented by marijuana smoking falls within the ambit of choice we permit the individual in a free society.41 According to federal statistics, approximately 80 million Americans self-identify as having used marijuana at some point in their lives,42 and relatively few acknowledge having suffered significant deleterious health effects due to their use. America's public policies should reflect this reality, not deny it. Marijuana’s relative risk to the user and society does not support criminal prohibition or the continued arrest of more than 750,000 Americans on marijuana charges every year. As concluded by the Canadian House of Commons in their December 2002 report recommending marijuana decriminalization, “The consequences of conviction for possession of a small amount of cannabis for personal use are disproportionate to the potential harm associated with the behavior.”43 ALLEGATION #6 “As a factor in emergency room visits, marijuana, has risen 176 percent since 1994, and now surpasses heroin.” TRUTH This statement is intentionally misleading as it wrongly suggests that marijuana use is a significant causal factor in an alarming number of emergency room visits. It is not. Federal statistics gathered by the Drug Abuse Warning Network (DAWN) do indicate an increase in the number of people “mentioning” marijuana during hospital emergency room visits. (This increase is hardly unique to marijuana however, as the overall number of drug mentions has risen dramatically since the late 1980s – likely due to improved federal reporting procedures.)44 However, a marijuana “mention” does not mean that marijuana caused the hospital visit or that it was a factor in leading to the ER episode, only that the patient said that he or she had used marijuana previously.45, For every emergency room visit related to drug use (so-called “drug abuse episodes”), hospital staff list up to five drugs the patient reports having used recently, regardless of whether or not their use of the drug caused the visit. The frequency with which any drug is mentioned in such visits is generally proportional to its frequency of use, irrespective of its inherent dangers.46, It is foolish for anyone – especially those in the administration’s anti-drug office – to imply that marijuana is in any way potentially more dangerous to one’s health than heroin. Marijuana is mentioned to hospital staff more frequently than heroin, not because it’s more dangerous, but simply because a far greater percentage of the population uses marijuana than uses heroin. It is also worth noting that alcohol is by far the drug most frequently reported to DAWN, even though it is reported only when present in combination with another reportable drug. Moreover, marijuana is rarely mentioned independent of other drugs.47 ALLEGATION #7 “Smoked marijuana leads to changes in the brain similar to those caused by the use of cocaine and heroin.” TRUTH Allegations that marijuana smoking alters brain function or has long-term effects on cognition are reckless and scientifically unfounded. Federally sponsored population studies conducted in Jamaica, Greece and Costa Rica found no significant differences in brain function between long-term smokers and non-users.48 Similarly, a 1999 study of 1,300 volunteers published in The American Journal of Epidemiology reported "no significant differences in cognitive decline between heavy users, light users, and nonusers of cannabis” over a 15-year period.49 More recently, a meta-analysis of neuropsychological studies of long-term marijuana smokers by the National Institute on Drug Abuse reaffirmed this conclusion.50 In addition, a study published in the Canadian Medical Association Journal in April 2002 reported that even former heavy marijuana smokers experience no negative measurable effects on intelligence quotient.51 Most recently, researchers at Harvard Medical School, performed magnetic resonance imaging on the brains of 22 long-term cannabis users (reporting a mean of 20,100 lifetime episodes of smoking) and 26 controls (subjects with no history of cannabis use). Imaging displayed "no significant differences" between heavy cannabis smokers compared to controls. "These findings are consistent with recent literature suggesting that cannabis use is not associated with structural changes within the brain as a whole or the hippocampus in particular," authors concluded.52 Claims specifically charging that marijuana leads to brain changes similar to those induced by heroin and cocaine are based solely on the results of a handful of animal studies that demonstrated that THC (delta-9-tetrahydrocannabinol, the main psychoactive ingredient in marijuana) can stimulate dopamine production under certain extreme conditions, and that the immediate cessation of THC (via the administration of a chemical blocking agent) will initiate some mild symptoms of withdrawal. These findings have little bearing on the human population because, according to the US Institute of Medicine, “The long half-life and slow elimination from the body of THC … prevent[s] substantial abstinence symptoms” in humans.53 As a result, such symptoms have only been identified in rare, unique patient settings – limited to adolescents in treatment for substance abuse, or in clinical research trials where volunteers are administered marijuana or THC daily.54 ALLEGATION #8 “One recent study involving a roadside check of reckless drivers (not impaired by alcohol) showed that 45 percent tested positive for marijuana.” TRUTH Though portrayed by politicians and police as a serious problem bordering on "epidemic," actual data is sparse concerning the prevalence of motorists driving under the influence of drugs, and more importantly, what role illicit drug use plays in traffic accidents.55 While it is well established that alcohol increases accident risk, evidence of marijuana’s culpability in on-road driving accidents is less understood. Although marijuana intoxication has been shown to mildly impair psychomotor skills, this impairment does not appear to be severe or long lasting.56 In driving simulator tests, this impairment is typically manifested by subjects decreasing their driving speed and requiring greater time to respond to emergency situations.57 This impairment does not appear to play a significant role in on-road traffic accidents when THC levels in a driver's blood are low and/or THC is not consumed in combination with alcohol. For example, a 1992 US National Highway Traffic Safety Administration review of fatally injured drivers found, "THC-only drivers [those with detectable levels of THC in their blood] had a responsibility rate below that of drug-free drivers."58 A 1993 study conducted by the Institute of Human Psychopharmacology at the University of Maastrict (the Netherlands) evaluating cannabis' effects on actual driving performance found, "THC in single inhaled doses ... has significant, yet not dramatic, dose-related impairing effects on driving performance. ... THC's effects on road-tracking ... never exceeded alcohol's at BACs of .08% and were in no way unusual compared to many medicinal drugs."59 A 2002 review of seven separate crash culpability studies involving 7,934 drivers reported that “crash culpability studies [which attempt to correlate the responsibility of a driver for an accident to his or her consumption of a drug and the level of drug compound in his or her system] have failed to demonstrate that drivers with cannabinoids in the blood are significantly more likely than drug-free drivers to be culpable in road crashes.” 60 More recently, a 2004 scientific review of driver impairment and motor vehicle crashes suggested that "recent cannabis use may increase crash risk, whereas, past use of cannabis as determined by the presence of THC-COOH (marijuana’s inactive metabolite) in drivers does not."61 An additional review by Drummer and colleagues further suggested that higher THC blood levels -- particularly those above 5 ng/ml, indicating that the cannabis use had likely been within the past 1-3 hours -- may be correlated with an elevated accident risk, noting, "The odds ratio for THC concentrations of 5 ng/ml or higher [are] similar to those drivers with a BAC of at least 0.15%."62 However, a meta-analysis by a German research team of 87 experimental studies on cannabis did not find such elevated impairment, suggesting "that a THC level in blood serum of 5ng/ml ... produces the same overall reduction in test performance as does a BAC of 0.05%."63 But, unlike with alcohol, the accident risk caused by cannabis -- particularly among those who are not acutely intoxicated -- appears limited because subjects under its influence are generally aware of their impairment and compensate to some extent, such as by slowing down and by focusing their attention when they know a response will be required.64 This response is the opposite of that exhibited by drivers under the influence of alcohol, who tend to drive in a more risky manner proportional to their intoxication.65 In short, the quantitative role of cannabis consumption in on-road traffic accidents is, at this point, not well understood. However, marijuana does not appear to play a significant role in vehicle crashes, particularly when compared to alcohol.66 As summarized by the Canadian Senate’s exhaustive 2002 report: “Cannabis: Our Position for a Canadian Public Policy,” “Cannabis alone, particularly in low doses, has little effect on the skills involved in automobile driving.” 67 ALLEGATION #9 “The truth is that marijuana is addictive. … Marijuana users have an addiction rate of about 10%, and of the 5.6 million drug users who are suffering from illegal drug dependence or abuse, 62 percent are dependent on or abusing marijuana.” TRUTH Marijuana use is not marijuana abuse. According to the US Institute of Medicine’s 1999 Report: “Marijuana and Medicine: Assessing the Science Base,” “Millions of Americans have tried marijuana, but most are not regular users, … [and] few marijuana users become dependent on it.”68 In fact, less than 10 percent of marijuana users ever exhibit symptoms of dependence (as defined by the American Psychiatric Association's DSM-IV criteria.)69 By comparison 15 percent of alcohol users, 17 percent of cocaine users, and a whopping 32 percent of cigarette smokers statistically exhibit symptoms of drug dependence.70 Marijuana is well recognized as lacking the so-called "dependence liability" of other substances. According to the IOM, “Experimental animals that are given the opportunity to self administer cannabinoids generally do not choose to do so, which has led to the conclusion that they are not reinforcing or rewarding.”71 Among humans, most marijuana users voluntarily cease their marijuana smoking by their late 20s or early 30s – often citing health or professional concerns and/or the decision to start a family.72 Contrast this pattern with that of the typical tobacco smoker – many of whom begin as teens and continue smoking daily the rest of their lives. That's not to say that some marijuana smokers do not become psychologically dependent on marijuana or find quitting difficult. But a comprehensive study released in 2002 by the Canadian Senate concluded that this dependence "is less severe and less frequent than dependence on other psychotropic substances, including alcohol and tobacco."73 Observable withdrawal symptoms attributable to marijuana are also exceedingly rare. According to the Institute of Medicine, these symptoms are “mild and short lived”74 compared to the profound physical withdrawal symptoms of other drugs, such as alcohol or heroin, and unlikely to persuade former smokers to re-initiate their marijuana use.75 ALLEGATION #10, “Average THC levels rose from less than 1% in the late 1970s to more than 7% in 2001, and sinsemilla potency increased from 6% to 13%, and now reach as high as 33%” TRUTH This statement is both inaccurate and misleading. No population en masse has ever smoked marijuana averaging less than one percent THC since such low potency marijuana would not induce euphoria. In many nations, including Canada and the European Union, marijuana of one percent THC or less is legally classified as an agricultural fiber crop, hemp.76 Although annual marijuana potency data compiled by the University of Mississippi’s Research Institute of Pharmaceutical Sciences does show a slight increase in marijuana’s strength through the years,77 this increase is not nearly as dramatic as purported by the White House Office of National Drug Control Policy. In addition, quantities of exceptionally strong strains of marijuana or sinsemilla (seedless marijuana) comprise only a small percentage of the overall marijuana market. The NIDA-sponsored Marijuana Potency Monitoring Project reports that less than 10 percent of DEA seized marijuana samples are above 15 percent. Less than 2 percent of marijuana seized from the domestic market contains more than 20% THC.78 Data from Europe also refutes claims of increased cannabis potency, concluding "the potencies of resin and herbal cannabis ... have shown little or no change, at least over the past ten years."79 The drug czar’s upper-level THC figures are clearly a scare tactic. Moreover, it’s worth noting that more potent marijuana is not necessarily more dangerous.80 Marijuana poses no risk of fatal overdose, regardless of THC content, and since marijuana’s greatest potential health hazard stems from the user’s intake of carcinogenic smoke, it may be argued that higher potency marijuana may be slightly less harmful because it permits people to achieve desired psychoactive effects while inhaling less burning material.81 In addition, studies indicate that marijuana smokers distinguish between high and low potency marijuana and moderate their use accordingly,82 just as an alcohol consumer would drink fewer ounces of (high potency) bourbon than they would ounces of (low potency) beer. ALLEGATION #11 “The truth is that marijuana and violence are linked.” TRUTH Absolutely not. No credible research has shown marijuana use to play a causal factor in violence, aggression or delinquent behavior, dating back to former President Richard Nixon’s “First Report of the National Commission on Marihuana and Drug Abuse” in 1972, which concluded, “In short, marihuana is not generally viewed by participants in the criminal justice community as a major contributing influence in the commission of delinquent or criminal acts.”83 More recently, the Canadian Senate’s 2002 “Discussion Paper on Cannabis” reaffirmed: “Cannabis use does not induce users to commit other forms of crime. Cannabis use does not increase aggressiveness or anti-social behavior.”84 In contrast, research has demonstrated that certain legal drugs, such as alcohol, do induce aggressive behavior. “Cannabis differs from alcohol … in one major respect. It does not seem to increase risk-taking behavior,” the British Advisory Council on the Misuse of Drugs concluded in its 2002 report recommending the depenalization of marijuana. “This means that cannabis rarely contributes to violence either to others or to oneself, whereas alcohol use is a major factor in deliberate self-harm, domestic accidents and violence.”85 Most recently, a logistical retrogression analysis of approximately 900 trauma patients by SUNY-Buffalo’s Department of Family Medicine found that use of cannabis is not independently associated with either violent or non-violent injuries requiring hospitalization.86 Alcohol and cocaine use were associated with violence-related injuries, the study found. Accordingly, fewer than five percent of state and local law enforcement agencies identify marijuana as a drug that significantly contributes to violent crime in their areas.87 ALLEGATION #12, “The truth is that we aren’t imprisoning individuals for just ‘smoking a joint.’ … Nationwide, the percentage of those in prison for marijuana possession as their most serious offense is less than half of one percent (0.46%), and those generally involved exceptional circumstances.” TRUTH This statement is grossly inaccurate and misleading. Police have arrested more than six million Americans for marijuana violations since 1994, and now average more than 750,000 arrests per year.88 The overwhelming majority of these arrests – 88 percent in 2003 – are for simple possession only, not marijuana cultivation or sale.89 While not all of those individuals arrested are eventually sentenced to long terms in jail, the fact remains that the repercussions of a marijuana arrest alone are significant – including (but not limited to): •probation and mandatory drug testing •loss of driving privileges •loss of federal college aid •asset forfeiture •revocation of professional driver’s license •loss of certain welfare benefits such as food stamps •removal from public housing •loss of child custody •loss of employment. In other words, whether or not marijuana offenders ultimately serve time in jail, hundreds of thousands of otherwise law-abiding citizens are having their lives needlessly destroyed each year for nothing more than smoking marijuana. Specific totals on marijuana offenders behind bars are seldom available because federal statistics do not categorize drug offenders by drug type or drug offense. However, according to a 1997 Bureau of Justice Statistics survey of federal and state prisoners, approximately 19 percent federal and 13 percent of state drug offenders are incarcerated for marijuana offenses.90 Based on those statistics, a 1999 paper published by the Federation of American Scientists estimated that nearly 60,000 inmates (roughly 1 in every 7 drug prisoners) were incarcerated for marijuana offenses at that time.91 A more recent analysis performed by the Washington DC think-tank The Sentencing Project now estimates this total to exceed 68,000 marijuana prisoners.92 ALLEGATION #13, “The truth is that marijuana is a gateway drug. … People who used marijuana are 8 times more likely to have used cocaine, 15 times more likely to have used heroin, and 5 times more likely to develop a need for treatment of abuse or dependence on ANY drug.” TRUTH Nonsense. According to the Canadian Senate’s 2002 study: “Cannabis: Our Position for a Canadian Public Policy,” “Cannabis itself is not a cause of other drug use.”93 This finding concurs with the conclusions of the US National Academy of Science’s Institute of Medicine 1999 study, which stated that marijuana is not a “gateway drug to the extent that it is a cause or even that it is the most significant predictor of serious drug abuse.”94 (The IOM further noted that underage smoking and alcohol abuse typically precede marijuana use.)95 Statistically, for every 104 Americans who have tried marijuana, there is only one regular user of cocaine, and less than one user of heroin, according to annual data compiled by the federal National Household Survey on Drug Abuse.96 For the overwhelmingly majority of smokers, pot is a 'terminus' rather than a gateway.97 ALLEGATION #14 “The truth is that marijuana legalization would be a nightmare in America. After Dutch coffee shops started selling marijuana in small quantities, use of the drug nearly tripled … between 1984 and 1996. While our nation’s cocaine consumption has decreased by 80 percent over the past 15 years, Europe’s has increased … and the Dutch government has started to reconsider its policy.” TRUTH This statement is inaccurate and greatly distorts the well-documented European drug policy experience. Most European countries – including Belgium, Germany, Italy, Luxembourg, the Netherlands, Portugal, Spain, Switzerland – do not criminally arrest marijuana users.98 Yet virtually every European nation, including the Netherlands, has drastically lower rates of marijuana and drug use among their adult and teen population compared to the United States.99 In fact, the national drug policy trends in Europe are currently moving toward more liberal marijuana laws, and away from US-styled drug policy.100 For example, Great Britain’s Parliament formally downgraded marijuana in 2003 so that its possession is no longer an arrestable offense.101 As to the White House Office of National Drug Control Policy’s specific claims regarding Dutch marijuana use, the truth is that lifetime reported use of marijuana by Dutch citizens aged 12 and older is less than half of what is reported in America.102 In addition, Dutch policy-makers downgraded marijuana offenses in the mid-1970s; this makes it unlikely that any purported increase in Dutch marijuana use during the 1980s was directly attributable to the change in law. In fact, most experts agree that marijuana’s illegality has little impact on marijuana use.103 According to a 2001 study published in The British Journal of Psychiatry, “The Dutch experience, together with those of a few other countries with more modest [marijuana] policy changes, provides a moderately good empirical case that removal of criminal prohibitions on cannabis possession (decriminalization) will not increase the prevalence of marijuana or any other illicit drug; the argument for decriminalization is thus strong.” 104 ALLEGATION #15, “The truth is that marijuana is not a medicine, and no credible research suggest that it is.” TRUTH This allegation is a lie, plain and simple. According to a 2001 national survey of US physicians conducted for the American Society of Addiction Medicine, nearly half of all doctors with an opinion on the subject support legalizing marijuana as a medicine.105 Moreover, no less than 80 state and national health care organizations – including the American Public Health Association,106 The American Nurses Association,107 and The New England Journal of Medicine108 – support immediate, legal patient access to medical marijuana.109 The medical community's support for medical marijuana is not based on "pseudo-science," but rather on the reports of thousands of patients and scores of scientific studies affirming marijuana’s therapeutic value. Modern research suggests that cannabis is a valuable aid in the treatment of a wide range of clinical applications. These include pain relief – particularly of neuropathic pain (pain from nerve damage) – nausea, spasticity, glaucoma, and movement disorders.110 Marijuana is also a powerful appetite stimulant, specifically for patients suffering from HIV, the AIDS wasting syndrome, or dementia.111 Emerging research suggests that marijuana's medicinal properties may protect the body against some types of malignant tumors112 and are neuroprotective.113 Recent scientific reviews supporting marijuana’s use as a therapeutic agent include a 1998 report by Britain’s House of Lords Science and Technology Committee concluding: “The government should allow doctors to prescribe cannabis for medical use. ... Cannabis can be effective in some patients to relieve symptoms of multiple sclerosis, and against certain forms of pain. ... This evidence is enough to justify a change in the law.”114 A 1999 review by the US Institute of Medicine (conducted at the request of the White House Office of National Drug Control Policy) added, “The accumulated data indicate a potential therapeutic value of cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation,”115 and recommended the US government allow immediate single patient clinical trials where upon patients could legally use inhaled marijuana medicinally in a controlled setting.116 It should be noted that the IOM also reviewed the medical efficacy of the legal synthetic THC drug Marinol, which it found to have “poor bioavailability,” slow onset, and adverse effects such as “anxiety, depersonalization, dizziness, euphoria, dysphoria, [and] somnolence” in approximately one-third of patients who use it.117 As such, authors noted that many patients prefer whole smoked marijuana over this legal alternative. An overview of marijuana’s medical efficacy was conducted by the Canadian Senate’s Special Committee on Illegal Drugs in 2002. The study advised Parliament to revise existing federal regulations legalizing the drug to qualified patients so that any “person affected by one of the following [medical conditions]: wasting syndrome; chemotherapy treatment; fibromyalgia; epilepsy; multiple sclerosis; accident-induced chronic pain; and some physical conditions including migraines and chronic headaches, whose physical state has been certified by a physician or