Medical marijuana, American federalism, and the Supreme Court.

federal law enforcement authorities could criminally prosecute patients for possessing marijuana prescribed by a physician in accordance with state law. 1 The Court did not overturn state medical marijuana laws but did open the door to criminal prosecution under federal drug statutes. The Court also did not foreclose future challenges to federal enforcement on other constitutional grounds (eg, an unwarranted invasion of patient-physician privacy). Explaining the significance of Raich requires examination of 2 issues. The first concerns American federalism and raises an important constitutional principle about the appropriate scope of federal public health powers. The second issue concerns the use of marijuana as a medical treatment and raises intriguing questions about the practice of medicine and the patient-physician relationship. In Raich, the Supreme Court pointedly questioned the wisdom of prosecuting patients: " The case is made difficult by respon-dents' strong arguments that they will suffer irreparable harm because. .. marijuana does have valid therapeutic purposes. The question before us, however, is not whether [the policy] is wise, [but] whether Congress has the power to regulate. .. medicinal substances. .. produced and consumed locally. " Gonzalez v Raich California's Compassionate Use Act of 1996 (enacted by Proposition 215) was designed to ensure that " seriously ill " residents have access to marijuana for medical purposes to relieve suffering. The act exempts physicians, patients, and primary caregivers from criminal prosecution for possessing or cultivating marijuana for medicinal purposes with a physician's approval. Notably, the act states that physicians shall not be " punished, or denied any right or privilege , for having recommended marijuana to a patient for medical purposes. " and Vermont—allow use of marijuana for medical purposes. Angel Raich and Diane Monson (respondents) use marijuana prescribed by board-certified family physicians who concluded that it is the only drug that provides effective treatment. Ms Raich has an inoperable brain tumor and wasting syndrome, and Ms Monson has a degenerative spine condition with chronic back pain. On August 15, 2002, county sheriffs and Drug Enforcement Administration (DEA) agents went to Ms Monson's home: the sheriffs found her use of marijuana to be entirely lawful, but the federal agents seized and destroyed all 6 of her cannabis plants. The respondents sued to prohibit the enforcement of the federal Controlled Substances Act (CSA). 3 The CSA, enacted in 1970 as part of President Nixon's " war on drugs, " regulates controlled substances. Marijuana , …