Introduction
Marijuana (Cannabis Sativa) is one of the drugs that were placed in Schedule 1 of the Controlled Substances Act of 1970 (Williamson, 2010). At that time, medical experts resisted this decision citing the numerous medical benefits of marijuana. However, the public demand left the United States’ Congress with no option but to ban the use of this drug because of its perceived negative social impacts on the users, especially the youth. The public was concerned that access to marijuana was making it easy for the youths, including minors, to abuse this drug. It was blamed for rampant violence and general misbehavior among the students. Studies have also linked the drug with high rates of school dropouts, rising insecurity in the country, homicide, falling academic levels, and a host of other mental and social problems in the country (Ruschmann, 2004). Given that there were alternative drugs that could be used in place of marijuana, the government had no option but to ban its use within the country. Since then, the United States Food and Drug Administration (FDA)-the only body tasked with approving medicinal substances within the country- has neither recognized nor approved marijuana as a form of medicine.
According to Goldstein (2010), medical researchers have proven that marijuana is a very important medicinal plant that can help in the treatment of a host of diseases. Cancer and HIV management, glaucoma and inflammation treatment, pain and seizures management are some of the medical complications that can be managed using marijuana. However, the medical practitioners currently face the ethical dilemma of how to use the drug given that it is not approved by the Food and Drug Administration. Although some states have approved the medical use of this medicine, the federal authorities still arrest anyone who is found using or handling the drug because it is not approved by the relevant authorities. In this paper, the researcher seeks to determine the relevance of legalizing this drug for medical purposes.
Purpose of the study
When conducting a research, it is important to clearly define its purpose. This research primarily focuses on legalizing medicinal use of marijuana. According to a study by Minamide (2007), marijuana is one of the plants that were used traditionally to treat various diseases long before the evolution of modern medicine. Its medicinal benefits have been proven by many medical experts and it was once used among the American soldiers during the Vietnam War (Boire & Feeney, 2007). However, there is currently the issue of ethical dilemma that has to be addressed in the use of this drug. Studies have confirmed that when abused, marijuana may have far-reaching mental, social, and economic consequences on the society. The need to place it under controlled substances is, therefore, justifiable. However, a time has come when it is necessary to legalize the medical use of the drug. The only problem that the federal government faces is that when marijuana use is legalized for medical purposes, it becomes almost impossible for the federal authorities to regulate its use because it will not be easy to know when one intends to use it for medicinal purposes or otherwise. There is the fear that anyone found handling the drug will claim that it is meant for medication. The purpose of this paper is to find a way in which the medicinal use of this drug can be legalized and how it can be implemented without making it possible for people to abuse it. The researcher intends to find ways through which the drug can be used for medical purposes without easily finding its way to the public who may want to use it as a stimulant.
History of Using Marijuana Medically
A critical analysis of the history of marijuana use in the field of medicine may help in making informed conclusion about its relevance in the modern society. Gerber (2004) says that marijuana plant was used in many ancient empires as medicine and stimulant. History records that this substance was in use as early as the 2900 BC in China. Chinese Emperor Fu Hsi, who played a critical role in the Chinese civilization, widely promoted the use of marijuana for medical purposes in 2900 BC (Williamson, 2010). He strictly promoted the use of the drug for medicinal purposes only. In 2700 BC, Chinese Emperor Shen Nung is said to have discovered further healing properties of Cannabis Sativa and integrated it as part of the herbal medicine used in the kingdom (Williamson, 2010). The medical use of marijuana became popular in China for many years to come, especially in the management of pain.
Historical records indicate that marijuana was widely used in the Egyptian Empire for various medical purposes. A research study by Minamide (2007) discovered that the Egyptian medicine men had discovered the capacity of marijuana to treat glaucoma, enemas, and inflammation as early as 1213 BC. It was also used in the cooling of the uterus among mothers with abdominal problems after delivery (Ruschmann, 2004). The drug was highly valued in this kingdom and was rarely available among the commons. By 1000 BC, the use of bhang had spread to Indian where it was widely used as anesthesia. It would be mixed with milk and administered orally as an anti-phlegmatic and as an anesthetic.
The medicinal use of marijuana in the Middle East can be traced to as early as 700 BC. According to Minamide (2007), Zoroastrianism classified Cannabis Sativa as one of the most important medicinal plants. It was used for various medicinal reasons in the various kingdoms in Middle East. By 600 BC, Indian herbalists had determined the importance of bhang in the management of leprosy. At this time, leprosy was one of the most dreaded diseases that had no cure and was associated with sin and curse. However, these herbalists were able to discover the ability of this drug to manage leprosy. In 200 BC, bhang had become a popular drug in Greece used in the treatment of inflammation, edema, and earache. By 1 AD, Ruschmann (2004) says that herbalists all over the world had discovered the ability of this drug to treat over 100 ailments, including malaria, gout, absentmindedness, and rheumatism among others.
The Roman Empire used cannabis in the treatment of Earaches and in suppressing sexual desires among their soldiers. Pedanious Dioscorides, a great Greek physician who worked as a roman army doctor from 40-90 AD, is said to have used marijuana in managing various health complications among the Roman soldiers (Donovan, Smith, & Mooney, 2014). From 800-900 BC, the Arabic world started using bhang as a medicine to treat or manage migraines and syphilis. However, it was during this time that publications emerged classifying this drug as a lethal poison when used inappropriately (Boire & Feeney, 2007). A study by Gerber (2004) says that by 1500, Muslim doctors started using the drug as a way of reducing sexuality, especially during the holy month of Ramadhan.
Historical records show that marijuana found its way to North America for the first time in 1611 (Donovan et al., 2014). During this time, Jamestown settlers brought marijuana plant and popularized it as a cash crop. The locals were encouraged to convert their corn plantations into marijuana plantation. The ready market, shorter period of maturity compared to corn, and reduced labor needs made the plant very popular among the farmers in Virginia. According to the diaries of George Washington, it is clear that he was one of the Americans who grew Cannabis for its medicinal purposes. These diaries clearly demonstrate that he grew hemp from 1745 to 1775 (Goldstein, 2010). Having been a soldier, he knew the importance of the drug in management of pain. Gerber (2004) says that Thomas Jefferson’s diaries also indicate that he grew hemp as a cash crop from 1774 to 1824 and most of his clients were physicians who were trying to find ways of soothing pain of their patients.
Europe started using cannabis actively for medical purposes in 1790s when it was introduced in France by King Napoleon. Napoleon learnt of the medicinal features of the drug when he invaded Egypt. It is believed that William O’Shaughnessy introduced this drug to the United Kingdom in 1840. The historical records indicate that Queen Victoria used this medicine to manage menstrual cramps. It was also used in the management convulsions, rabies, tetanus, epilepsy, promotion of uterine wall contraction during childbirth, and as a sedative. It was mainly administered orally (Boire & Feeney, 2007).
According to Minamide (2007), marijuana became a mainstream medicine in the West in 1840. Its extracts were widely administered by doctors to suppress headaches, increase appetite, and aid people with sleep problems. In 1850, the drug became officially recognized in the United States as a medication for various health complications such as neuralgia, typhus, dysentery, cholera, alcoholism, anthrax, tonsillitis, uterine bleeding abnormal menstrual bleeding, and insanity among a host of other diseases (Goldstein, 2010). By 1900, this drug became widely used in the management of bronchitis and asthma.
The medicinal use of marijuana was put to question in the early 1900s when it became apparent that people were abusing it and the impacts were weighing heavily on the society’s well-being. The problem of addiction became real because those who used this drug for medical purposes for long became addicted even after being healed of their medical problems. In 1911, Massachusetts became the first state that outlawed the use of cannabis for any purpose, including its use as a form of medication. Other states such as Wyoming, Indiana, New York, Utah, Vermont, Colorado, Nevada, and California soon passed the same law prohibiting the use of marijuana. At this time, the United States was struggling with moral issues such as robbery, prostitution, prizefighting, gambling, and organized crimes which were associated with the use of cannabis. In 1930s, the use of marijuana was under serious attack as its negative social effects became very apparent in the society. Scientists also started struggling to find ways of getting alternative medication instead of marijuana. By 1936, medicinal use of marijuana had become prohibited in all the 48 states (Donovan et al., 2014).
The emergence of morphine and aspirin helped in phasing out the use of marijuana for medical purposes. The Marihuana Tax Act of 1937 further led to the decline in the use of cannabis in most of the American medical facilities. The drug was finally removed from the United States Pharmacopeia in 1942 as it was losing its therapeutic legitimacy. The final blow dealt on the medicinal use of marijuana came in 1970 when the Congress passed Controlled Substance Act which classified cannabis as a drug that has no acceptable medical use (Caulkins, Hawken, Kilmer, & Kleiman, 2012). In 1973, the government established Drug Enforcement Agency that was specifically tasked with fighting drug trafficking and use within the United States. NIDA was the only body that was allowed by the law to grow and be in possession of marijuana primarily for research purposes. The United Nations, through the member states’ conference, prohibited the use of marijuana.
The use of marijuana for medicinal purposes is finding its way back to many countries around the world after many years of ban. The Netherlands became the first country to decriminalize marijuana in 1976 (Boire & Feeney, 2007). In the United States, a Federal Court ruling made on November 24, 1976 held that use of marijuana by Robert Randall was a medical necessity. In 1978, New Mexico became the first state to pass a law that recognized the medicinal use of marijuana under Controlled Substances Therapeutic Research Act (Goldstein, 2010). Since then, over 30 states in the country have passed legislations that legalize medicinal use of marijuana, especially when it involves medical research. On June 22, 2015, the United States’ federal government removed all the legal obstacles in marijuana research. Institutes involved in medical marijuana state became immune to prosecution or any form of harassment by the relevant federal authorities, especially the DEA (Goldstein, 2010).
The DEA sent a letter to the federal lawmakers on April 4, 2016 stating that they intended to reclassify marijuana to Less-Restrictive Drug Schedule as a way of allowing its use in scientific research. This was a clear indication that the blanket ban on the use of this drug for medical purposes may soon come to an end. Hospitals are currently using the drug to treat glaucoma, seizures, inflammation, and a number of other diseases discussed above. Inasmuch as there are other states that still do not allow the use of marijuana as a form of medicine, the American society is slowly embracing the use of this drug and soon it may be available in medical institutions all over the world. The social challenges associated with the abuse of the drug are still real and problematic to the country. However, it has been confirmed that whether or not the drug is legalized, those who intend to abuse it will always find ways of accessing it. Advanced scientific research has also made it possible for the doctors to use this drug without exposing the patients to addiction.
The Problem with Marijuana Being Legal in Some States But Not Others
The use of marijuana received a complete ban in the 1930 when the Congress passed a law that prohibited the use of marijuana both for recreational and medical purposes. However, after years of research, the use of marijuana for medical purposes is becoming popular once again in the United States and many other countries around the world. According to Donovan et al. (2014), some states have already passed laws which legalize the medical use of marijuana. The following graph shows a growing support across the country for legalization of marijuana.
Table 1: Growing popularity of the medical use of marijuana
Some states have gone a step further and legalized the use of marijuana for recreational purposes, such as the state of Washington and Colorado. Others have only authorized the use of the drug for its medical purposes. However, there are numerous other states which still prohibit any use of marijuana except for the purpose of government-sponsored research. The figure below shows that majority of Americans support legalization of marijuana.
As shown in the figure above, most of the states in this country still prohibit the use of marijuana for medical purposes. This has posed serious ethical challenges because those who believe their conditions can only be treated through the use of marijuana are forced to travel to the states which legalize its use. Given that a number of states have already legalized the use of this drug for therapeutic purposes, it becomes very challenging for patients who are from other states to use these drugs at home when their prescriptions include these drugs. Most of them are often forced to stay in these states that legalized the use of this drug till they complete their dosage. It forces them to spend more on boarding facilities. Some are forced to get this medication through illegal processes as the only way of accessing the drug in their hometowns.
According to Boire and Feeney (2007), there is an ethical dilemma in the United States in regard to the use of marijuana for medical purposes. It is not easy to justify why some states still prohibit the use of the drug while others do not. The federal government, though various agencies such as FDA and DEA, is already relaxing its rule regarding strict prohibition on the use of cannabis for medical purposes. Medical researchers have confirmed that Cannabis Sativa has numerous medical benefits that make it almost impossible to ignore its use in the modern society. For instance, Cannabidiol (CBD) is one of the active cannabinoids that is present in marijuana. It is widely known for its therapeutic significance. In the United States, it is currently classified as a prescription drug, which means that its use has been legalized. It accounts for about 40% of the marijuana plant. Tetrahydrocannabinol (THC) is a psychoactive constituent of marijuana which is classified by FDA as a controlled substance (Goldstein, 2010).
Medical researchers have found a way of extracting CBD from the plant purely for the purpose of medication. They have found out that when THC is extracted out of the plant, then the psychological effects that the drug often has on its users when consumed as a whole is significantly reduced. Dr. Raphael Mechoulam, an Israeli doctor, came up with a way of synthesizing out the THC from the marijuana plant to ensure that it is safe for medical use. Removal of THC also reduces significantly the addictive effect of the drug. Some medical scholars and practitioners have argued that governments should only restrict the use of cannabis if THC ingredient is not eliminated. However, CBD plays a very vital role in the treatment of numerous aliments and as such it is irrational for its use to be restricted by government authorities.
Ethical Theory & Principles
Legalizing marijuana can be looked at from an ethical perspective. According to Morgan (2011), the primary reason why the government of the United States was forced to issue a complete ban on the use of marijuana for medical purposes was its addictive nature and the psychosocial impacts it had on those who were addicted to its abuse. However, medical researchers all over the world have been trying to find ways of making the use of this drug safe. Identification of THC as the main addictive ingredient with psychosocial effect on its users was seen as a major breakthrough because CBD, which is the main therapeutic ingredient in this drug, can now be extracted and used without exposing the patients to addiction. However, some states are yet to approve its medicinal use. Ethical theories and principles may be applied to help address the dilemma.
Universal Prescriptivism is one of the theories that can be used to explain how this dilemma should be addressed. According to Donovan et al. (2014), Universal Prescriptivism holds that “whoever makes a moral judgment is committed to the same judgment in any situation where the same relevant facts obtain.” 24 states have already enacted a law that permits the use of marijuana for medicinal purposes. Before making this judgment, they took into consideration a number of ethical concerns that were raised when the use of the drug was banned in the 1930s. The lawmakers were convinced that the argument presented before them was justifiable. Based on this theory, it becomes necessary for all other states to make the same judgment because they are faced with the same situation that requires same judgment. Universal ruling promotes the moral authority behind a given law. It indicates that the country is committed to taking a universal position when it comes to addressing issues that are affecting the state in the same magnitude.
Moral Absolutism is another theory that can help in addressing this dilemma that the country faces. As Morgan (2011) says, Moral Absolutism holds that “particular actions are intrinsically right or wrong.” The use of marijuana for medical purposes can either be wrong or right. Those who are still opposed to the use of this drug must have reasons that they can state to justify why it is wrong to use the drug. Given that a number of states have legalized the use of this drug, they must have had reasons that made them feel that it is right to use this drug. The remaining states have the ethical responsibility of determining whether they feel it is right or wrong to use this drug. Scientists have already stated that when CBD is safely extracted from the plant, it is very safe to use the drug for medicinal purposes. It means that there is already sufficient information that makes processed cannabis a good drug.
Opposing View Utilizing Ethical Theory and Principles
Some people are still strongly opposed to the use of drug for therapeutic purposes. Their argument is supported by a number of theories that are worth critically analyzing. Welfarism is one of the theories that can be used to support the view that it is justified for marijuana to be banned in some states even if other states have legalized its medical application. According to Morgan (2011, p. 89), Welfarism is “based on the premise that actions, policies, and/or rules should be evaluated on the basis of their consequences.” The theory emphasizes on the need to look at the broader picture when handling an issue of national interest such as legalization of marijuana. The impact of marijuana abuse on the medical, social, and economic welfare of people, especially the youth, within the American society is something that has been a concern for many years. Moral particularism also can help to further understand the need to oppose legalizing of marijuana. According to Elliot (2011, p. 45), the theory holds that “there are no moral principles and that moral judgment can be found only as one decides particular cases, either real or imagined.” Based on the Wellness Theory and Principles, as we look at the health benefits of marijuana, we need to also consider the socio-economic implications of legalizing such a drug. It is morally right for the medical scientists to find alternatives to marijuana so that we reduce the possibility of use of this drug (Elliot, 2011). This view strongly opposes the thesis of this study which promotes legalization of marijuana for medical purposes.
Deontology and utilitarianism are other theories that can be used to help explain why a section of the society is still strongly opposed to the idea of legalizing marijuana. Deontology is an ethical theory that makes judgment of an action on the basis of how well it adheres to rules (Goldstein, 2010). Currently, there are laws that prohibit the use of marijuana and as such, it should not be introduce in the field of medicine. Utilitarianism on the other hand argues that actions are considered right is they are beneficial to the majority (Elliot, 2011). The use of marijuana may have serious negative impact on the society, especially if used wrongly and as such, it may harm the majority. It is, therefore, justified to illegalize its use in whatever context. Virtue ethics may also help in making this difficult decision. It emphasizes on the need to uphold high moral standards and to ensure that consequences of an action is as fair as possible (Elliot, 2011). Based on this theory, one can argue that if there are alternatives to the use of marijuana in medical settings, then legalization of marijuana is not justified.
When analyzing the opposing views to the legalization of marijuana, it may be necessary to look at some of the ethical principles that may support the argument. The principle of respect for autonomy in clinical ethics holds that patients should be allowed to make their own decisions (Goldstein, 2010). As such, legalizing the use of marijuana may not be advisable because it may allow doctors to use the drug against the wish of their patients. Beneficence is an ethical principle which strongly suggests that in clinical trials, the welfare of participants should be respected. As such, it is wrong for medical researchers to use human participants in their studies. According to Elliot (2011, p. 86), “Nonmaleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome.” Based on this principle, it is ethical to use other medical options besides marijuana to avoid side effects of this drug. The principle of justice on the other hand emphasizes on fairness, equality, and entitlement (Goldstein, 2010). Based on this principle, it may not be ethically right to legalize the use of marijuana if the concerns about its impact are not adequately addressed by the medical experts. It is also possible to use fidelity principle in support of this argument. This principle upholds fairness, loyalty, and truthfulness. Before the medical experts can champion for the legalization of marijuana, they should be loyal, fair, and truthful to the public by fully disclosing the impact of marijuana when used as a medical drug. As long as the truth about this drug is not fully disclosed, it should not be legalized.
Faith Integration
Faith and religion play an important role in the social welfare of the society. Majority of the Americans are faithful of religious groups such as Christianity, Judaism, Islam, Hinduism, among others. When addressing a controversial issue such as the use of marijuana for medical purposes, it may be necessary to involve religion as a way of having a common ground. In the bible (majority of Americans are Christians) there is no clear prohibition of the use of marijuana for medicinal purposes. Any Christian who uses religion as a way of rejecting the use of marijuana is, therefore, not being sincere to self and to the American society. As such, faith should encourage responsible use of the drug for medical purposes only.
Value to Nursing
The debate about the legalization of marijuana for medical purposes is of high value to nurses in the modern society. Katherine Kolcaba’s Theory of Comfort has received massive acceptance in the modern society as a way through which nurses should approach their practice. This theory holds that it is the cardinal role of nurses to ensure that their patients are comfortable. One of the ways of ensuring that patients are comfortable is by eliminating pain, especially during and after surgical operations. Marijuana is known to be one of the leading painkillers that have been in use for a very long time. For the nurses, legalization of marijuana for medical purposes will be very important because they will be offered a number of ways of dealing with pain among their patients. The law will allow them to use extracts from cannabis to relieve their patients of the pain and sufferings that they may be going through. The nurses will also be at liberty to use the drug for various other medicinal purposes without the fear of facing prosecution. It is, therefore, in their interest that medicinal use of cannabis should be legalized in all states within the country.
Conclusion
Marijuana is one of the drugs that were used in the past to treat various ailments and to relieve pain. However, its long term impacts on the users and its abuse in the society as a stimulant made it necessary for it to be classified as an illegal drug. Recent studies have suggested that marijuana is still one of the best drugs that can be used to treat numerous ailments. As such, it has become necessary to legalize medical use of marijuana. A number of issues still need to be addressed before this drug can be legalized.
References
Boire, R. G., & Feeney, K. (2007). Medical marijuana law. Berkeley, CA: Ronin.
Caulkins, J. P., Hawken, A., Kilmer, B., & Kleiman, M. (2012). Marijuana legalization: What everyone needs to know. New York, NY: Cengage.
Dimock, M. (2010). Public Support for Legalizing Medical Marijuana: Modest Rise in Percentage Favoring General Legalization. Web.
Donovan, T., Smith, D. A., & Mooney, C. Z. (2014). State and local politics: Institutions and reform. Hoboken, NJ: Wiley.
Elliot, S. (2011). The Little Black Book of Marijuana. New York, NY: Cengage.
Gerber, R. J. (2004). Legalizing marijuana: Drug policy reform and prohibition politics. Westport, Conn: Praeger.
Goldstein, M. J. (2010). Legalizing drugs: Crime stopper or social risk. Minneapolis, MN: Twenty-First Century Books.
Minamide, E. (2007). Medical marijuana. Detroit, MI: Greenhaven Press.
Morgan, K. (2011). Legalizing marijuana. Edina, MN: ABDO Publishers Company.
Relief: Majority of Americans Support Legalizing Medical Marijuana via States. (2011). Web.
Ruschmann, P. (2004). Legalizing Marijuana. New York, NY: Infobase Publishers.
Williamson, A. (2010). The everything marijuana book: Your complete cannabis resource, including history, growing instructions, and preparation. Avon, MA: Adams Media.