Medical Marijuana Controversies

Medical Marijuana Controversies

Introduction

Medical Marijuana is a therapeutic plant which has received a lot of international attention in the recent past (Jin et al., 2017; Wan et al., 2017; McKenzie et al., 2018; Razvi et al., 2018). Debates have emerged within the ethical, societal and legal implication frameworks associated with its usage. Major controversies discussed include safe administering, dispensing, packaging, the health complications related to use, intoxication-related death and therapeutic indicators as a result of little information available complexing its treatment links (Klieger et al., 2017). According to the United States’ Comprehensive Drug Abuse Prevention and Control Act of 1970 and Drug Enforcement Agency (DEA), marijuana is regarded as a potentially excessively abused substance with lack of the minimum acceptable medical usage in the country (Cameron & Dillinger, 2011). Besides, there is a lack of agreeable safety information for its use within the medical framework (Curran et al. 2016). This article aim at assessing the historical significance, and societal and legal controversies and implications of medical marijuana use.

History of medical marijuana

Marijuana is a plant that traces its origin from ancient times. Research evidence has shown that cannabis was used extensively in Romania over 5000 years ago (Bridgeman & Abazia, 2017). This evidence indicates that tetrahydrocannabinol (THC) was found in ashes indicating that the plant had been used in around 400 AD for medicinal purposes. However, as described in 1850 by United States Pharmacopoeia in the United States, the plant was used extensively as a patented therapy in the 19^th and 20^th centuries. In 1937, the federal government restricted use and selling of the plant by enacting the Marihuana Tax Act which resulted in cessation of using the plant in 1942 by the Unites States Pharmacopoeia (Bridgeman & Abazia, 2017). In 1951, the legal penalties were increased to individuals found in possession of the substance and further prohibitions were enacted in 1970 with the introduction of the Controlled Substance Act. These legislative prohibitions and criminalization of marijuana use resulted in a reduction of procurement and growth of the plant for research and academic purposes (Bridgeman & Abazia, 2017).

Despite several legal actions being taken by the state government, the federal government still holds criminalization of marijuana use even for medical purposes (Marcoux et al., 2013). In 2009 there was a legal announcement by Eric Holder the Attorney General that pursuing individuals using marijuana for medical purposes was not a priority for the government. He, however, clarified that criminal elements that used the drug of illicit purposes would face the law. In 2011, the DEA refuted that marijuana could not be legalized for medical practice creating a discrepancy within the two positions (Marcoux et al., 2013). The two organizations have provided little effort to the medical professionals in the interpretation of the law regarding the extent to which the botanical marijuana can be used (Marcoux et al., 2013).

However, as the substance is regarded as a Schedule 1 controlled drug, there has been limited information on the acceptable usage amount for medical purposes creating a considerable risk of its abuse (Jin et al., 2017; McKenzie et al., 2018). Besides, limited information on the acceptable safety measures for its use within the medical framework and the associated stigmatization adjoining its possible harmful use implications has created huge controversies. The drug has been described as a potential gateway to the use of other toxic substances making it hard to form a transitional link from a harmful product to a useful medical content (Curran et al. 2016). The regulatory agencies such as FDA and United States Pharmacopoeia have encountered complex incidences in the regulation of the plant as a therapy based substance due to a high number of chemical compounds within the final product that have complex interactions (Cameron & Dillinger, 2011). The legal agencies have, therefore encountered difficulties while trying to fit the plant within the current drug regulatory framework.

Nevertheless, California State was the first state that legalized accessing and usage of botanical marijuana for medical purposes in 1996 under the close supervision of a qualified physician (Marcoux et al., 2013). This legalization was enacted in the Compassionate Use Act. Later on, other 28 states passed similar legislative acts for sales, distribution and usage of the substance for medical purposes (Klieger et al., 2017). These states include Guam, Puerto Rico and Washington D.C. District of Columbia and other 21 states later decriminalized its use eliminating laws that prohibited possession of small amounts of marijuana. Some other nine states such as Oregon, District of Columbia, Maine, Nevada, Alaska, Colorado, California, Washington, and Massachusetts later legalized the use of the substance for recreation purposes by the adults.

Social controversies and dimensions of medical marijuana

Currently, increased interests in the therapeutic use of botanical marijuana have been linked to having similar collateral effects with opioid abuse (Wan et al., 2017). Suggestions from the public indicate that people perceive the plant to be identical with other botanical products that supplement the use of synthetic medicines in symptoms relief and health improvement in case of disease persistence (Jin et al., 2017; McKenzie et al., 2018). However, researchers have identified some health risks similar to herbal supplements and preparations such as impaired effects, intoxications and psychoactive, although they have not been elucidating medically. There have been arguments that evidence exists indicating botanical marijuana treating various health conditions such as refractory conditions arising from therapeutic symptoms (Wan et al., 2017; Razvi et al., 2018). Besides, cannabinoids are beneficial with CBD and THC compounds being relatively safe with low reported death incidences (Jin et al., 2017; McKenzie et al., 2018). Marijuana therapy has been indicated to be self-titratable and cheaper while compared to other pharmaceutical substances (Razvi et al., 2018).

On the other hand, opponents of medical marijuana have argued that there is limited experimental data that shows the beneficial and harmful implications of the substance. Furthermore, they say that the product has not been approved through the FDA process, and there is a lack of a standardized system for the pharmacological quantities required. Besides, they have linked the use of the drug with other mental health complications, impaired judgement and coordination (Curran et al. 2016). Standardized packaging and preventive measures to control the use of the substance by the minors is lacking, which may create a possible interdependence addiction that may have costly burdens.

As mentioned in the above section, issues surrounding the use of marijuana have existed for a while with its advocates petitioning the government to enact laws that allow its legalization (Wan et al., 2017; McKenzie et al., 2018; Razvi et al., 2018). Similarly, groups that are against its legalization have continued to offer their opinions opposing the advocate petitions. Although a stringent law against use, sales or production of the plant was enacted in 1970, research studies show that people continue to use the substance extensively (Compton et al., 2004). A social work professor at Washington University, Roger Roffman asserted that there about 3.6 million individuals in America that use marijuana daily. This assertion was supported by Professor Peter Reuter from the University of Maryland who indicated that marijuana had been used extensively in the United States by the people as they grew up. His assertions indicated that close to half of the population had used marijuana by the time they attained 21 years of age. A survey by the World Health Organization has shown that the U.S has been the world’s leading consumer or marijuana per capita (World Health Organization, 2016).

Recently, the prevalence of marijuana addiction has increased tremendously (Curran et al. 2016). Studies have shown that there was a higher number of adults using the substance in 2001/2002 compared to 1991/1992, and the number has continued to rise significantly (Compton et al., 2004). Increase in marijuana dependence has been noted to more in young black adults and Latino adult men. Besides, an increase in independence among adult male between 45 and 64 years have been observed. Although the prevalence amongst the white male between 18 and 29 years have not increased significantly, the number of users remains high. This dependency has been attributed to the THC active ingredient that has problematic potency characteristics (Manseau & Goff, 2015). Besides, other environmental factors such as single-parenthood, truancy, economic constraints and education systems have contributed mostly in over-dependence to marijuana use.

Most local and statutory jurisdictions have ratified de-criminalization laws against medical use of botanical marijuana (Compton et al., 2004). These laws forbid employers from using any confrontational actions to employees who take marijuana as long as they do not use the substance at work or their work output is not impaired. However, due to the nature in which marijuana metabolizes within the human body’s system, traces of it can withstand for more than 30 days making it hard for them to determine whether the employee is impaired by marijuana use within the company time. This creates a massive liability for legal interpretations and executions of the drug policies.

Policies reviewing the criminalization levels of marijuana have indicated that care should be taken when taking actions against individuals who use the substance (Cameron & Dillinger, 2011). For instance, in 2015 a Colorado Supreme court indicated it does not preempt a complete tolerance of medical marijuana affirming that an employer has a right to terminate the contract of an employee that has tested positive for marijuana substance. Supreme court in California have also asserted that provided the employer complies with the proper testing and drug-free policies, and they have the right to terminate the contract of an employee that has tested positive for marijuana. Contrary in Arizona, the Arizona Medical Marijuana Act (AMMA) prohibits employers from terminating employees’ contract unless they were found in possession or using the substance within the company’s premise or during the working hours. Similarly, a Delaware court reinstated that an employee has legal jurisdictions to file a lawsuit against their employer who terminates their contract based on a post-accidental positive test of marijuana. The court justified that the law does not illegalize the employment of individuals who use marijuana neither does it legalize discriminatory, illegal atrocities by the employers.

Legal policy management strategies

Since 2013, about 21 states in the United States, as well as District of Columbia, have enacted policies that recognize the use of marijuana for medical purposes providing legal protections for individuals that use the substance within the law and under medical supervision (Klieger et al., 2017). This adoption strategy was enacted through a referendum which provided little regulations on the source of the marijuana supply. Due to this, there has been an evolution of policies related to control of dispensary marijuana allowance and systems of patient registration in response to compelling administrative, judicial and legislative actions (Klieger et al., 2017). Most states in the United States have either instituted a mandatory registration system for all the patients using medical marijuana or have enacted these policies after initially effecting the law (Cameron & Dillinger, 2011). However, states such as Washington do not have the registration system for the patients. In contrast, other states such as California have provided a voluntary registration system which does not make it mandatory for the patients to register their usage interests with the government agencies (Marcoux et al., 2013).

There is variation in statutory laws regarding the number of marijuana plants one can grow for medical purposes with most states allowing cultivation at home by the designated caregivers and patients (Cameron & Dillinger, 2011). Besides, there is variation in protection of dispensaries in operation within the jurisdiction of the state. Since 2009, it has been easier to identify laws that protect dispensaries compared to earlier statutory requirements as they were crafted to conform to the federal regulations (Klieger et al., 2017). Policy analysts and lawyers have asserted that a clear explanation on whether there is a legitimate presentation of dispensaries in pursuit of legal defence in a state law court. The law states that states have legal mandates to allow dispensaries to use marijuana for medical purposes if the dispensary was established or allowed explicitly by the agency and statute rulemaking. Besides, the state should not have a limitation on several patients that can be given care by the caregiver neither the state should have an allowable amount of the drug used per patient. Finally, the state can allow the use of marijuana by the dispensaries if they have official regulation and law that acknowledges the presence of the dispensary without their condemnation (Klieger et al., 2017). The American Society of Addiction Medicine has asserted that use of marijuana or its products should be subject to approval by qualified individuals who decide appropriate levels of the product as opposed to ballot initiatives approval within the state. With these regulations, some states such as Michigan and Washington have functional dispensaries within their municipalities, although they do not legally approve their operation (Marcoux et al., 2013).

It is, therefore, clear that there is a variation in the creation of laws for using marijuana for a medical purpose (Klieger et al., 2017). This has been affirmed by the American Cancer Society and the American Glaucoma Foundation which have indicated that before law enactments, supportive studies that evaluate health implications of their treatments should be conducted before legalization as opposed to ballot initiatives approval undertaken by the states. Important distinctions to legal frameworks on differential consumption effects of marijuana, especially among the youth and heavy users, rarely exist (Cameron & Dillinger, 2011). As opposed to general expectations, observations have been made that policies on medical marijuana have little impact on recreational use and have a small association with marijuana consumption based on behaviour and population. It is evident that indicators of single binary policies medical marijuana laws typically comprises of net diverse regulatory rules which influences how the policies are adopted. These policy indicators complex heterogenic structures of various policies suggesting a practical and statistical significance (Cameron & Dillinger, 2011). Specified policies have influential aspects to the users based on their use margins and age.

Since there is heterogeneity in legal framework enactments, policies change over time getting refined regularly to the extent that lack of individual assessments may result in inaccurate misinterpretation especially to the directly affected individuals (Klieger et al., 2017). Effects of law off-setting in marijuana-related policies suggest that they may have various mechanisms of influencing the community with some laws having more impact than the others. There is a continuous evolution of medical marijuana laws in the federal government framework as states continue to tolerate the policy spaces (Cameron & Dillinger, 2011). With these changes in the position of the central government, rules are increasingly changing in the manner in which they regulate the use and supply of medical marijuana. Therefore, constant policy developments show that in future, policies may have a different perception on an understanding of medical marijuana policies reducing the hostilities and consequences of using the substance compared to the early laws.

Importance of ethics in public health administration

Whether there is a general view that social justice provides constrains in the beneficial foundation of public health agencies and regulatory policies, a mutual agreement exists that ethical procedures should be followed in the improvement of systematic commitments to health promotion (Sagy et al., 2018). This creates an intimate link between the health sector, human rights and public health. A unique question that arises in this context is, who is responsible for generating an equal power to health. These duties require collective action by both the governments, social institutions, private sectors and the governing bodies.  These ethical practices command mutual respect for people’s health across all the borders.

Among the most crucial element of ethical consideration is breaking even difficulties in the improvement of proper functions and aggregation of collective health outputs. Consideration of these elements ensures that people in need of specific health intervention are not subjected to factors that can be controlled through cost-effective interventions such as medical supplementation, vaccination and immunizations which would significantly reduce such inequalities in health resource provision (Sagy et al., 2018). Besides, a collective efficiency consideration when providing systematic relief health needs should be looked upon by the regulatory agencies in the public health sector. The health regulatory policies should be comprehensive enough to include programs that affect all members of the community in a social justice manner without disproportions between the target groups (Marcoux et al., 2013).

In addition to the above, stigmatizing regulatory policies that may target specific minority people should be avoided to prevent stereotyping and undermining of these people (Sagy et al., 2018). This, in return, would result in the provision of an equal social justice that provides respect to all the people. In such instances, authorities in public health should make strategic decisions unto whether forming a commitment to social justice may require ignoring some effective policies to favour policies that may be ineffective or of less health advantage to the people to prevent the emergence of exacerbating disrespectful attitudes. Regulatory agencies should also conduct a cost-utility assessment of whether the regulations enacted and measures of diverse morbidities and mortalities have been formed within a single metric like the quality-adjusted life years (Cameron & Dillinger, 2011). The standards require an assessment of individual preferences on the available trade-offs between the benefits and health states. Moral problem assumptions should be avoided at various life stages and disability conditions to ensure a collective integration of health measures that are specific and determined in the provision of fair, equal measures. The measures provided by the public health agencies should be qualitatively commensurable with high benefits and low burden to both parties within the legal framework.

References

World Health Organization (2016). Management of substance abuse: Cannabis. Available at: www.who.int/substance_abuse/facts/cannabis/en.2016.

Cameron, J. M. & Dillinger, R. J. (2011). Narcotic Control Act. In: Kleiman MAR, Hawdon JE, editors. Encyclopedia of Drug Policy. Thousand Oaks, California: SAGE Publications, Inc; 543–545.

Curran, H. V., Freeman, T. P., Mokrysz, C., et al. (2016). Keep off the grass? Cannabis, cognition, and addiction. Nat Rev Neurosci. 17:293–306.

Bridgeman, M. B. & Abazia, D. T. (2017). Medicinal cannabis: History, pharmacology, and implications for the acute care setting. Pharmacy and Therapeutics, 42(3): 180-188.

Klieger, S. B., Gutman, A. Allen, L., Pacula, R. L., Ibrahim, J. K. & Burris, S. (2017). Mapping medical marijuana: State laws regulating patients, product safety, supply chains and dispensaries, 2017. Addiction, 112: 2206-2216.

Compton, W. M., Bridget, F. G. & Colliver, J. D., Glantz, M. D. & Stinson, F. S. (2004). Prevalence of Marijuana Use Disorders in the United States. The Journal of the American Medical Association, 291(17): 2114-2121.

Manseau, M. W. & Goff, D. C. (2015). Cannabinoids and Schizophrenia: Risks and Therapeutic Potential. Neurotherapeutics, 12(4): 816-824.

Sagy, I., Peleg-Sagy, T., Barski, L., Zeller, L. & Jotkowitz, A. (2018). Ethical issues in medical cannabis use. European Journal of Internal Medicine, 49: 20-22.

Marcoux, R. M., Larrat, P. E & Vogenberg, F. R. (2013). Medical marijuana and related legal aspects. Pharmacy and Therapeutics, 38(10): 612, 615-619.

McKenzie, E., Zaki, P., Chan, S., Lam, H., DeAngelis, C., Chow, E. & O’Hearn, S. (2018). Medical cannabis for the treatment of inflammatory bowel disease. J Pain Manage, 11(4): 353-358.

Wan, B. A., Diaz, M. P., Blake, A., Chan, S., Wolt, A., Zaki, P., Zhang, L., Slaven, M., Shaw, E., DeAngelis, C., Lam, H., Ganesh, V., Malek, L., Chow, E. & O’Hearn, S. (2017). Efficacy of different varieties of medical cannabis in relieving symptoms. J Plain Manage, 10(4): 375-383.

Razvi, Y., Chan, S., Lam, H., DeAngelis, C., Chow, E. & O’Hearn, S. (2018). Medical cannabinoids in treatment-resistant epilepsy disorders. J Pain Manage, 11(4): 345-351.

Jin, S., Wan, B. A., Chan, S., Smith, P. A., Blake, A., Wolt, A., Zhang, L., Lam, H., DeAngelis, C., Slaven, M., Shaw, E., Ganesh, V., Zaki, P., Drost, L., Lao, N., Malek, L., Chow, E. & O’Hearn, S. (2017). The effect of medical cannabis on alcohol and tobacco use in veterans with post-traumatic stress disorder (PTSD). J Pain Manage, 10(4): 407-413.