Medical marijuana, physicians, and state law.

at their homes or offices and told them they must either give up their DEA registration or sever formal ties with proposed medical-marijuana dispensaries. These encounters were meant to intimidate the physicians and to discourage them from taking an active role in medical-marijuana dispensaries, and they have apparently succeeded. But there are differences between state and federal law, between talking to patients and selling drugs, and between acting as a physician and acting as a marijuana entrepreneur. With medical-marijuana laws poised to come into effect in a majority of states, it seems worthwhile to put medical marijuana in historical and legal context. Americans strongly support making marijuana accessible to sick people who might benefit from its use, with 86% believing that physicians should be able to recommend marijuana to their seriously ill patients. The DEA has been consistent in its campaign to discourage physicians from discussing marijuana with their patients, probably because the agency sees such discussions as legitimizing the use of a drug that it still apparently believes, in disregard of the evidence, was reasonably designated a Schedule I drug — a drug with no medical use and a high potential for abuse. In 1997, the editor-in-chief of the Journal argued that the federal drug laws that prohibited physicians from helping their suffering patients by suggesting that marijuana may be beneficial to them was “misguided, heavy-handed, and inhumane.”1 The editorial was responding to California’s firstin-the-nation broad medical-marijuana law and DEA agents’ subsequent threats to revoke the DEA registrations of California physicians who suggested that a patient might benefit from marijuana as permitted by the new law.2 California has now been joined by more than 20 additional states in permitting patients to possess marijuana on the advice of their physician (see table). There has, however, been no change in federal law — which still prohibits possession and sale of marijuana — and little change in the DEA’s tactics. State law cannot change federal law, and in late 1996 the Department of Health and Human Services, the U.S. attorney generMedical Marijuana, Physicians, and State Law