Is the end of prohibition upon us?

Fortune Magazine’s article about how Medical Marijuana is giving activists in the United States a platform to show that as a legalized business marijuana can work, and how the end of prohibition may be upon us.

Reposted from http://money.cnn.com/2009/09/11/magazines/fortune/medical_marijuana_legalizing.fortune/?postversion=2009091116

(Fortune Magazine) — When Irvin Rosenfeld, 56, picks me up at the Fort Lauderdale airport, his SUV reeks of marijuana. The vice president for sales at a local brokerage firm, Rosenfeld has been smoking 10 to 12 marijuana cigarettes a day for 38 years, he says.

That’s probably unusual in itself, but what makes Rosenfeld exceptional is that for the past 27 years, he has been copping his weed directly from the United States government.

Every 25 days Rosenfeld goes to a pharmacy and picks up a tin of 300 federally grown and rolled cigarettes that have been sent there for him by the National Institute of Drug Abuse (NIDA), acting with approval from the U.S. Food and Drug Administration.

Rosenfeld smokes the marijuana to relieve chronic pain and muscle spasms caused by a rare bone disease. When he was 10, doctors discovered that his skeleton was riddled with more than 200 tumors, due to a condition known as multiple congenital cartilaginous exostosis. Despite seven operations, he still lives with scores of tumors in his bones.

Rosenfeld is one of four people in the United States whom the federal government supplies with medical marijuana. Each is a living anomaly because, officially, the U.S. Drug Enforcement Administration, NIDA, and the FDA all take the position that marijuana has “no currently accepted medical use.”

That’s the only way federal law can continue to classify marijuana, like heroin, as a “Schedule I controlled substance,” forbidden from being prescribed by doctors. (Numerous dangerous, psychoactive, and addictive opium derivatives, by contrast, are more leniently classified as Schedule II drugs, allowing prescription use.)

Over the years the government’s position has become progressively more embattled, if not untenable.

Thirteen states now have laws that let residents use marijuana medicinally, typically to alleviate chronic pain (particularly nerve pain caused by diabetes, AIDS, and hepatitis); manage movement disorders and muscle spasticity (especially for multiple sclerosis patients); as an anti-nausea and anti-vomiting agent (for those, say, undergoing chemotherapy); and as an appetite stimulant (yes, as in “the munchies”) for those with wasting diseases like AIDS and cancer.

Another 15 states are weighing legislation or ballot initiatives that could turn them into medical marijuana states by next year.

The acceptance of medical marijuana has implications that extend far beyond helping those suffering from life-threatening diseases. It is one of several factors — including demographic changes, the financial crisis, and the widely perceived failure of the war on drugs — reopening the country’s 40-year-old on-again, off-again shouting match over whether marijuana should be legalized.

This article is not another polemic about why it should or shouldn’t be. Today, in any case, the pertinent question is whether it already has been — at least on a local-option basis. We’re referring to a cultural phenomenon that has been evolving for the past 15 years, topped off by a crucial policy reversal that was quietly instituted by President Barack Obama in February.

First, some necessary background. Under President George W. Bush (and under President Bill Clinton before him, for that matter), the U.S. Justice Department treated state medical marijuana laws as nullities. Such laws were contradicted and therefore preempted by federal drug laws, the Justice Department reasoned, and the U.S. Supreme Court upheld that position in 2005.

Accordingly, the federal government has periodically raided and prosecuted defendants who at least claimed to be complying with state medical marijuana laws, and when it did, defendants were forbidden from telling juries about the existence of those laws.

In late February, President Obama signaled a new approach. His attorney general, Eric Holder, confirmed at a press conference that he would no longer subject individuals who were complying with state medical marijuana laws to federal drug raids and prosecutions.

This understated act — a simple pledge not to act, really — could have enormous consequences. It potentially leads to exactly the same endpoint as the Twenty-First Amendment, which repealed the federal prohibition on alcoholic beverage sales.

Here’s how. When states make a legal loophole allowing medical use of marijuana, they must grapple with the messy question of what precisely constitutes medical use. After all, doctors regularly prescribe powerful drugs like Valium, Viagra, Prozac, and — give us a break — Botox to patients who are hardly at death’s door.

If a state doesn’t tightly limit what “medical use” means, the camel can get its nose under the tent.

That’s what happened in California. Like most medical marijuana states, California permits doctors to “recommend” marijuana use for patients who suffer from specific serious diseases. (Drafters of the law avoided the word “prescribe” in an attempt to sidestep conflict with federal law.)

California’s law then adds a catchall provision that lets doctors also approve marijuana use for “any other illness for which marijuana provides relief.” In practice, doctors — largely protected from second-guessing by confidentiality privileges — have been free to make the final call as to which conditions those might be.

This is, after all, the norm vis-à-vis medicines. Once a pharmaceutical has been FDA-approved for one use, doctors can lawfully prescribe it for other, so-called off-label purposes, even though the drug has not yet been certified as safe or effective for them.

Accordingly, California doctors are authorizing patients to take marijuana to relieve such ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping. “You could get it for writer’s block,” comments Allen St. Pierre, the executive director of the National Organization for the Reform of Marijuana Laws.

Some California doctors voluntarily report the breakdown of patient medical conditions for which they have approved marijuana use in the Alameda, Calif., medical newsletter O’Shaughnessy’s.

They commonly report that more than a quarter of their marijuana authorizations have been prompted by patients suffering from conditions like “anxiety” or “insomnia.” (The most common complaint is “chronic pain.”)

As a result, in most of California’s coastal metropolitan areas, marijuana is effectively legal today. Any resident older than 18 who gets a note from a doctor can lawfully buy the stuff, and doctors seemingly eager to write such notes, typically in exchange for a $200 consultation fee, advertise in newspapers and on websites.

There are an estimated 300,000 to 400,000 medical marijuana patients in the state now, and the figure is rapidly growing.

More astonishingly, there are about 700 medical marijuana dispensaries now operating in California openly distributing the drug.

These dispensaries — called “compassionate-care clinics” by the solemn and “pot shops” by the skeptical — are decidedly outpatient facilities, with not a few patients arriving on bicycles, roller skates, or skateboards. (They often get discounts for doing so, because it’s greener than using a fossil-fuel-powered car

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Tags: Cannabis, Legalization, Medicinal Marijuana, United States