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MEDICAL MARIJUANA
INFORMATIONAL BINDER
TABLE OF CONTENTS
A Federal Government Information
DOJ DEA website page for Controlled Substances Act CSA
DOJ letter to City of Eureka815 11
DOJ letter to City of Chico701 11
DOJ memo from James Cole629 ll
DOJ letter to St of Washington414 ll
DOJ letter to City of Oakland211
DOJ letter to City of Oakland12 08 10
DOJ Memo from David Ogden10 19 09
B State of California lnformation
Gaidelines for the Security and Non Diversion of Marijuana Grown for
Medical Use Guidelines
Medical Marijuana Program MMP website page
Health Safety Code Article 2 Marijuana Section 11357 11369
Health
11362 7ll362 83
Safety Code Article 25 Medical Marijuana Program Section
C Health and Medical Publications and Reports on Marijuana
Center for Medicinal Cannabis Research Report 2010
Anesthesia Journal Cannabis for Chronic Pain 2004
Journal of Pain and Symptom Management Article 2010
National Institute on Drug Abuse Marijuana Abuse
National Institute on Drug Abuse Marijuana Facts for Parent
National Institute on Drug Abuse Marijuana Facts for Teens
Science Daily Cannabis Damages Young Brains 2009
Office of National Drug Control Policy Marijuana As Medicine 2003
Eye Care America Marijuana in the Treatment of Glaucoma
Page 1 of 2

D Information from Groups in Support of Marijuana
1800 Medical Marijuana com Legal States for Medical Marijuana
Perkel com Marijuana Telling Teenagers the Truth about Smoking Pot
1800 Medical Marijuana com Benefits of Medical Marijuana
California NORMAL
Recent Research on Medical Marijuana
California NORMAL Local Medical Marijuana Cultivation Possession
Guidelines
Medical MJ org Addictive Properties of Commonly Use Drugs website
page
Medical Marijuana ProCon org
E Information from Groups in Opposition of Marijuana
Coalition for a
Drug
Free California List
California Police Chiefs Association
of City County Moratoria
Marijuana Talking Points
Bans
California Police Chiefs Association White Paper on Marijuana
Dispensaries 2009
Friends of the DEA
2009
Marijuana Dispensaries and the Federal Government
General Barry McCaffrey Ret
and Medicine
Marijuana Children The Work Place
Page 2 of 2

A Federal Government Information
DOJ DEA website page for Controlled Substances
Act CSA
DOJ letter to City of Eureka815 11
DOJ letter to City of Chico701 11
DOJ memo from James Cole629 11
DOJ letter to St of Washington414 11
DOJ letter to City of OaklandZ11
DOJ letter to City ofOal land12 OS 10
DOJ Memo from David Ogden 10 19 09

M
21 USC Codes Page 1 of 1
ed caaa
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Home
Title 21 Regulations Codified CSA 21 US Codes
Contact Us Site Map Search
Registration
RePOrting
nformatior ancf Lec al Rescrurces t d
caf1Ct1
Info
Legal Resources
Inside Diversion Control
s
t
t
ua
A
Title 21 United States Code USC
Controlled Substances Act
SubchapterI Control And Enforcement
Part A
Introductory Provisions
I
Section
Section 801 Congressional findings and declarations controlled substances
801a Congressional findings and declarations psychotropic substances
Section 802 Definitions
Section 803 Repealed Pub L95 137 Section1b Oct 18 1977 91 Stat 1169
Part B Authority to Control Standards And Schedules
Section 811 Authority and criteria for classification of substances
Section 812 Schedules of controlled substances
Section 813 Treatment of controlled substance analogues
Section 814 Removal of exemption of certain drugs
Part C Registration of Manufacturers Distributors and Dispensers of Controlled
Substances
II
411dfiltfllS OY
U
II I
Section 821 Rules and regulations
Section 822 Persons required to register
Section 823 Registration requirements
Section 824 Deniai revocation orsuspension of registration
Section 825 Labeling and packaging
Section 826 Production quotas for controlled substances
Section 827 Records and reports of registrants
Section 628 Order forms
Section 829 Prescriptions
Section 830 Regulation of listed chemicais and certain machines
Section 831 Additional requirements relating to online pharmacies and telemedicine
Part D Offenses And Penalties
I
Section 841 Prohibited acts A
Section 842 Prohibited acts B
Section 843 Prohibited acts C
http www
deadiversion usdoj gov 21 cfr 21usc index html 929 2011

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I
i
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US Department of Justice
Unr7edSlrrlesAnornep
Na daeriv Dish Ic1 ofCali wnia
Ncllnda Hnag
Iln IedSroftl Aflonmp
lldi Flaor idaul8uild uS
esn coid Go e Areu
Bor 35055
Son Frencimo Coli onda 9Jl0 J9
JIS J36d2q0
F945 JSI JJ6 73
A is zot
1
Robert S Wall
iU F
DirectorofConununityDevelopment tl I
City of Euteka t ut F 74
531 K Street
I
t
Eareka CA 955D1 1146
Dear blr Well
I write in response to your letter duted August 8 201l seeking guida tce regarding
ncdical cannabis growing facilities infl e Cir of Evreka Califomia
As the Department lias slated on many oecasions Congress tasde ermined fliat
marijuana is a controlled suhstance Congresspl ced marijuana in Schedule I of We Controlled
Substances Ac CSA and as such growing distributing and possessing marijuana in any
rApacity otlier then as part of a federally nuthorized research progTam is a viola6on of federal
law regardless of state laws pettnitting suchar tivities
The prosecution of indiviJuals and organizations involved in ihe trede of nny illega drugs
and the disruption of drug trafficking organiz itions is a core priority of the Deparhnent Tlus
core piioriry includes prosecution of 6usiuess euterprises thac wilawtully aiarkeL and sell
marijuana As stated in the Octoher 2009 Ogden Memoruidum and reitereted recently in ihe
2011 Cole Memorandum tl e Deparunent does not focus its limi ed resources on seriously il
individuals who use marijuana as pari of a medically recommended treaiment regimeu in
con pliance tvilhst te law fiowcvec individttals and orgatuzations who are in the business of
i
cultivating selling or distributing marijua ia and those who knowingly faci itnte such actjviUes
are in violation of the Convolled Substances Act and are subject to federal enforcement even if
such nclivities are permitted undcr stalc laH
Consistent with federal law Uie Depvtment maintains the authoriry to pursue criminal or
civil actions for any CSA violationswl enever tlie Department detennines that such legel action
is warranted This ineludes bul is not limited to actions to enforce tl e criminat provisions of ihe
CSA such as Title 21 Section S41 malcing it illegal to mnnufacture distributc or possess with
intent to distribut any conirolled substance including niazijuana Titte 21 Section 856 making it
unlawFul to Imowingly open lease rent muintain or usc property for the manufacturing storing
or dislri6ution oFcontrolled substances and7itle 2l Section S46 making it illegaf to conspire to
commit any of the crimes set Fortl in the CS Federal money laupdering and reJated statutes
that prohibit a variety of different types of financial activity involving the movement of drug

I
Robert S Wall
Augusl 15 20 1
Page 2
proceeds may ikewise beuilized The gove rnment may also porsue civil injunctions and the
forfaiture of drug praceeds property raceable to such proceeds and property used to facilitate
drug violations
The Departmen is concemed a6ovt die Ciry of Eurel as creation ofa licensing scheme
that permits large scele industrint mariju na culEivation processing and distribution as it
authori2es conduct cantrary ta federaf taw an3 threatens tl e Federal governmenl s eSoru to
regulate the possession manufacturing and trdfficking of controlled substances Individuals who
elect to operate any such facili6es wiU 6e doing so in violation oFfederal law OtLers who
knowingly facilitnte the actions of these individuals including propeiry owners landlords and
finnnciers should also tcnow Uiat lheir conduc t vio ates federel law if the Ciry of Eureka were to
pmceed this office tivould consider injunetive actions civil fines criminal prosecution and the
forfeiture of any property used to facilitateaiolation of Uie CSA As tlie Attomey Generat hns
repeatedly sta ed de Depazipte
of JusGce remains frimly comn itted 10 enforcing the CSA in
all states
matter
1 hope this letter assists the City of Eureka in muking informed decisions regnrding flris
Very truly yours
r1
T
Melinda Haag
United St tes Attomey
Northern Districl of California
cc
David Tyson City Manager
Mike FCnighi Assistant Cify Monager
City Attorney

Jul V1 2011 14 17 From US AiTORNEY 96 654 2874 T459 P002 003 F304
US DEPARTMENT OF NSTtCE
nSy
i UnrtedStatesAttorney
a
Eastern Drstrici of CaTfornia
a
Nenjantin 6 Wogr er
Jnifed 1alesAq rney
koben TMsui
Unitcd Stntes Courthouse
Ph nc514 554 70
501 I Svtc4 Sme IG 100 Fuz 916 554 2900
Socramento CA 95814 TTD 97fd554 2fl55
July 1 2011
Mayor Ann Schwab
City of Chico
PO Box 3420
Chico CA 9592 7
Dear Mayor Schwab
It has come to my Artention that the City of Chico is considering an ordinance whicl would
authorize permits for two medica marijuana cultivation facilities each up to 10 000 square feet
Tlvs etter isvrinen to ensure there is no conftuion regarding the US Departmem of lustice
position regerding munScipal ordinances and state Iaws that purport to estabiish proposed marijuana
cultivation or licensing programs
Congress has determined that marijuana is a eontrolled substance Conaess placed marijuana
in Schedule I of the Controlled SubstanCes Act CSA and as such growing distributing and
possessing marijuana in any capaciTy otl er than as part of a federally authorized research prram is
a violation of federal law regardless of state laws permirting such acuviries The Deparm ent of
Justice is firmly commined to enforcing the CSA in all states As stated in the October 2009
memorandum from thenTeputy Attomey General llat d Ogden and in the memorandum issued
esterday by Deputy Artorney General James Cole while the Department does not focus its limited
resowces on prosecuting seriously ili indi duals who use mazijuana as part of a medically
recommended treatment regimen in compliarice witYt state law we will enforee the CSA viSorously
ainst individvals andor anizations that parucipate in unlav ful manufacnuing and distribution
activiry involving marijuana even if such activities aze permirted under staTe law
Consistent with federal law the Depar ment maintains the authoriry to pursue crir nal or civil
actions for euy CSA violations whenever ihe Department determines that such legat action is
vvazranted This inchzdes but is not imited to actions to enforce the criminal provisions of the CSA
such as Title 21 United Scates Code Secuon 841 making it illegal to manufaccure distribute nr
possess with intent to distriUute any controlled substance including marijuana Title 31 United States
Code Section86 making it unlawful to nowingly open lease rent maintain or use property for
the manufaciwing storing or distribution of convolledsub tances and Title 21 tinited Stutes Code
1

Jul D1 2011 14 17 From US ATTORNEY 016 554 2874 i459 P003 03 P304
Secdon 8A6 mal ing it illegal to conspire to commit any of the crimes set forrh in the CSA Federal
mney aundering and reJated statutes which prohibit a variety ofdifferent types offinancial acti iry
involving the movement of drug proceeds may like vise Ue utilized The government may also pursue
ci 71 injunctions and the forfeittue of drug proceeds property traceable to such proceeds and
property used to facilitate drug violations
The Department is concemed about the proposed ordinance in the City of Chico as it would
authorize conduct contrary to federal law and threatens tl e federal govemment s effons to regulate
the possession manufacnuing and uafficking of controlled sutscances Individuals who elect to
operate industrial marijuana cultivationfcilities will be doing so in violation of feder l law Others
who knowingly facilitate such industria eultivation activities including property owners landlords
and financiers should also know tkia their conduct violates federal law
Ilope this letter assisFs you in making informed decisions regarding a proposed ordinance
which would permit the estalalishment of significant marijuana culuvation faciliries in the Ciry of
Chico
Very truly yours
Be unin B Wagner1
United States Attorney
Eastcrn District of Califomia
cc
Kamala D Harris Attorney Creneral of the State of Califomia
Mike Ramsey Burte Counry Disuict Attomcy
David Burkland Chico City Manager
Lori J Barker Chico City Attomey
Z

US Departinent ofJstice
OfFice of the Deputy Attorney General
Nfirhingron 00 X15J0
June 29 2011
MEMORANDUM FOR UNITED STAT
FROM James M Cole V
Deputy Attom
General
SUBIECT
Cuidance Regazding the Ogden Memo in Jurisdictions
Seekin to Authorize Mariivana for Medical Use
Over the last several months somc of you have requested the Department s assistance in
responding to inquiries from State and local govemments seeking guidance about the
DepartmenCs position on enforcement of the Controlled Substances Act CSA in jurisdictions
ihat have under consideration or have implemented legislation that would sanction and regulate
he commercial cultivation and distribution of marijuana purpor edly for medical use Some of
these jurisdictions have considered approving the cultivation of large quantitiea of marijuana or
broadening the regulation andta ation of the substance You may have seen letters responding
to these inquiries by several United States Attorneys Those letters are entirely consistent with
the October 2009 memorandum issued by Deputy Anomey General David Ogden to federal
prosecutors in States that have enacted laws authorizing the medical use of marijuana the
Ogden Memo
The Department of Justice is commined to the enforcement of the Controlled Substances
Act in all States Congress has determincd that marijuana is a dangerous drug and that the illegal
distribution and sale of marijuana is a serious crime that provides a significant sounce of revenue
to arge scale criminal enterprises gangs and cartels The Ogden Memorandum provides
guidance to you in deploying your resources to enforce the CSA as part of the exercise of the
broad discretion you are given ro address federal criminal matters within your disficts
A number of states have enacted some form of legislation relating to the medical use of
maryjuana Awordingly the Ogden Memo reiterated to you that prosecution of significant
trafTickers of illegal drugs including marijuana remains a core priority but advised that it is
likely not an efficient use of federal resources to focus enforcement efforts on individuals with
cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen
consis ent with applicable state law or theit caregivers The enn caregiver as used in the
memorandum mean just thaC individuals providing care to individuals with cancer or other
serious illnesses not commercial operations cultivating selling or disiributing marijuana
The DepartmenPs view of the efficient use of limited federal resources as articulated in
the Ogden Memorandum has not changed There has however been an increase in the scope of

Memorandum for United States Attorneys Page 2
Subject Guidance Regarding the Ogden Memo in Jurisdictions
Seeking to Authorize Marijuana for Medical Use
commercial cultivatioq sale distribution and use of mazijuana for purported medical puiposes
For example within the past 12 months several jurisdictions have considered or enacted
legislation to authorize multiple Iarge scale privately operated indusfial marijuana cultivation
centers Some of hese planned facilities have revenue projec ions of millions of dollazs based
on the planned cultivation of tens of thousands ofcam abis plants
The Ogden Memorandum was never intended to shield such activities from federal
enforcement action and prosewtion even where those activities purport to comply with state
law Persons who aze in the business of cultivating selling ordis ribu ing marijuana and those
who knowingly facili ate such activi ies are in violation of he Controlled Substances Act
regardless of state law Consistent with resource cons raints and the discretion you may exercise
in your dis ric such persons aze subject to federal enforcement action including poten ial
prosecution State laws or local ordinances are not a defense to civil or criminal enforcement of
federal law with respect to such conduct including enforcement of the CSA Those who engage
in transac ions imolving the proceeds of such ac ivity may also be in viola ion of federal money
laundering statu es andoher federal financial laws
The Department of Justice is tasked with enforcing existing federal criminal laws in all
sta es and enforcement of he CSA has long been and remains a core prionty
cc Lanny A Breuer
Assistant Attomey General Criminal Division
B Todd Jones
United States Attomey
District of Minnesota
Chair AGAC
Michele M Leonhart
Administrator
Drug Enforcement Administration
H Marshall Jarzett
Direc or
Executive Office for United States Attomeys
Kevin L Perkins
Assistant Director
Criminal Investiga ive Division
Federal Bureau of Investigations

US Department of Justice
k uN
UnitedStatesAttorney
Eas eDistrict of Wnshingio
Suite 340 77 omas S Foley U S Courfhouse 509 353 1767
P O Bax 1491 Fns 509 353 1766
Spokrrse Warhiagton 99210 1494
Honorable Chrisrine Gregoire
Washington State Governor
PO Box 40002
Olympia Washington 98504 0002
April 14 2011
Re
Medical Marijuana Legislativc Proposals
Deaz Honorable Govemor Gregoire
We write in response to your letter dated April 13 2011 seeking guidance from the
Attomey General and our two offices concerning the practical effect of the legslation currently
being considered by the Washington State Legislature conceming medical marijuana We
understand that the proposals being considered by theIegislature would establish a licensing
scheme for marijuana growers and dispensaries and for processors ofmarijuaoa infused foods
among other provisions We have consulted with the Attomey General and the Depury Attorney
General about the proposed legislation This letter is written to enswe there is no confusion
regarding the bepartment of Justice
view of such a licensing scheme
As the Department has stated on many occasions Congess has determined that
marijuana is a controlled substance Congress placed marijuana in Schedule I of the Controlled
Substances Act CSA and as such growing distribu6ng and possessing marijuana in any
capacity other than as part of a federally authorized research program is a violation of federal
law regazdless of state laws permitting such acrivities
The prosecution of individuals and organizations involved in the trade of any illegal drugs
and the disruption of drug trafficking organizations is a core priority of the Deparhnent This
core priority includes prosecution of business enterprises that unlawfully market and sell
marijuana Accordingly while the Department does not focus its limited resources on seriously
ill individuals who use marijuana as part of a medically recommcnded treatment regimen in
compliance with state law as stated in the October 2009 Ogden Memorandum we maintain the
authoriry to enforce the CSA vigorously against individuals and organizations that participate in
unlawful manufacturing and distribution acrivity involving marijuana even if sucb activities are
pernvtted under state law The DepartmenYs investigative and prosecutorial resources will
continue to be direcYed toward these objectives

Honorable Christine Gregoire
April 14 201
Page 2
Consistent with fcderal law the Department maintains the authority to pursue criminal or
civil actions for any CSA viola ions whcnevcr thc Department determines that such legal action
is warranted This includes but is not limited to actions to enforce thc criminal provisions of thc
CSA such as
21 USC 841 making it illegal to manufacture disvibute or
possess with intent to distribute any controllcd substance including
marijuana
21 USC 856 making it unlawful to knowingly open lease
rent maintain or use property for the manufacturing storing or
distribution of controlled substances
21 USC 860 making it unlawful to distributc or manufacture
controlled substances within 000 fect of schools collcges
playgrounds and public housing facilities and within 100 feet of
any youth centcrs public swimming pools and vidco arcadc
facilities
21 USC 843 making it unlawful to usc any communication
facility to commit felony violations of thc CSA and
21USC 846 making it illcgal to conspirc ro commit any of
the crimes set forth in the CSA
In additiontederal money laundering and related statutcs which prohibit a variety of different
typcs of financial activity involving the movement of drug procccds may likewise be utilized
Thc Govcmmcnt may also pursuc civil injunctions and the forfeiturc of drug proceeds property
traccable to such proceeds and property uscd to facilitate drug violations
The Washington legislative proposals will create a liccnsing schcmc that permits
largo scale marijuana cultivation and distribution This would authorize conduct contrary to
fcderal law and thus would undcrminc the federal govemmcn s cfforts to regulate thc
possession manufacturing and trafficking of concrolled substanccs Accordinely the
Department could consider civil and criminal legal rcmedies regarding those who sct up
marijuana growing facilities and dispcnsaries as they will be doing so in violation of federal law
Otl ers who knowingly facilitate the actions of the licensees including property owners
landlords and financiers should also know that their conduc violates federal law In addition
state cmployces who conductcd activities mandated by the Washington lcgislativc proposals
would not be immune from liability undcr the CSA Potential actions the Department cou d
consSdcr include injunctivc actions to prcvent cultivation and distribution of marijuana and other
associatcd violations of the CSA civil fines criminal prosccution and the forfciture of any

Honorable Christine Gregoire
April 14 20I I
Page 3
property used to facilitate a violation of the CSA As the Attomey General has repeatedly stated
the Department of Justice remains fumly committed to enforcing the CSA in all states
We hope this letter assists the State of Washington and potential licensees in making
informed decisions regarding the cultivation manufacture and distribution of marijuana
Very hvly yours
G
Je Durkan Michael C Om7sby
Unite States Attomey United States Attomey
Westem Disuict of Washington
Eastern District of Washington

US Department of Justice
United States Attorney
Northern District ofCalifornia
Me lnda Haag
IIYh Floor Fede Bvllding 415J 436 7200
UnUedSmles AUOmey 450 Golden Cate Avenue Box 36055
San Fsancisco CapJamla 9410J FifX 415J 436 7134
February I 2011
John A Russo Esq
Oakiand City Attorney
i Frank Ogawa Plaza 6th Floor
Oakland California 94612
Dear Mr Russo
I write in response to your letter dated January 14 2011 seeking guidance from the
Attomey General regazding the City of Oakland Medical Cannabis Cultivarion Ordinance The
US Deparhnent of 7ustice is familiaz with the City s solicitation of applications for pertnits to
operate industrial cannabis cultivation and manufacturing facilities pursuant to Oaklaud
Ordinance No 13033 Oakland Ordinance I have consulted with the Attomey General and the
Deputy Attorney Creneral about the Oakland Ordinance This letter is written to ensure there is
no confusion regazding the Department of Justice
view of such facilities
As the Department has stated on many occasions Congress has detemuned that
marijuana is a controlled substauce Congress placed marijuana in Schedule I of the Controlled
Substances Act CSA and as such growing disllibuting and possessing marijuana in any
capacity other than as part of a federally authorized reseazch program is a violation of federa
law regardless of state laws pemutting such activities
The prosecution of individuals and organizations involved in the trade of any illegal drugs
and the disruption of drugtr cking organizations is a core priority of the Department 11ris
core priority includes prosecution of business enterprises that unlaw ully market and sell
marijuana Accordingly while ihe Department does not focus its limited resources on seriously
ill individuals who use marijuana as part of a medically recouunended treatrnent regimen in
compliance with state law as stated in the October 2009 Ogden Memorandum we will enforce
the CSA vigorously against individuals and organizations that participate in unlawfiil
manufaciuring and distribution activiTy involving marijuana even if such ac6vities are permitted
under state law The DepartmenYs inves6gative and prosecutorial resources will continue to be
directed toward these objectives
Consistent with federat law the Department maintains the authority to pursue crimival or
civil actions for any CSA violations whenever the Department determines that such legal action
is warranted Tlils includes but is not limited to actions to enforce the criminal provisions of the
CSA such as Title 2 Section 841 making it IIlegal to manufacture distribute or possess with
intent to dishibute any controlled substance including marijuana Title 21 Secfion 856 making it

John A Russo
Febauary 1 2011
Page 2
unlawful to lmowingly open lease rent maintain or use property for the manufacturing storing
or distribution of controlled substances and Title 21 Section 846 making it illegal to conspire to
commit any of the crimes set forth in the CSA Federal money laundering and related statutes
which prohibit a variety of different types of financial activity involving the movement of drug
proceeds may likewise be ufllized The government may also pursue civil injuncfions and ihe
forfeiture of drug proceeds property traceable to such proceeds and property used to facIlitate
drug violations
The Department is concemed about the Oakland Ordinance s creation of a licensing
scheme that pernuts lazge scale industrial marijuana culdvation and manufacturing as it
authorizes conduct contrary to federal law and threatens the federal govemmenYs efforts to
regulate the possession manufacturing and trafFicking of controlled substances Accordingly
the DeQar ent is carefully considering civil and criminal legal remedies regazding those who
seek to set up industrial marijuana growing wazehouses in Oakland pwsuant to licenses issued by
the City of Oakland Individuals who elect to operate industrial cannabis cultivarion and
manufacturing facilities will be doing so in violation of federal law Others who knowingly
facilitate the actions of the licensees inciuding property owners landlords and financiers should
atso know that theu conduct violates federal law Potential acdons the Departrnent is
considering include injunctive actions to prevent cultivation and distribution of marijuana and
other associated violalions of the CSA civil Fmes criminal prosecution and the forfeiture of any
property used to facilitate a violation of the CSA As the Attorney General has repeatedly stated
the Department of Justice remains finnly committed to enforcing the CSA in all states
I hope this letter assists the City of Oakland and potential licensees in making informed
decisions regarding the cufrivation manufacture and distribution of marijuana
Very truly yours
Melinda Haag
United States Attorney
Northem Dishict of California
cc
Kamala D Harris Attorney General of the State of Califotnia
Nancy E OMalley Alameda County District Attorney

12 21 2010 17 00 5102084965 DA RM 213 PA6E 02l04
December 8 2010
Mayor Eiect Jean Quan
Oakland City Hall
Frank Ogawa Plaza
Oakland CA 94fi07
Dear Mayor Elect Quan
Congratulations on your election f hope this letter finds you weli I look forward to
joining together in our work towards a safe healthy and thriving Oakland in the New
Year
I am writing to you regarding akland s Ordinance amending Title 5 oE the Oakland
Municipal Code Entitled Business Licenses And Regulatipns to add Chapter581
pertaining to Medical Cannabis Cultivation Facility Permitting and amending the master
tee schedule Ordinance No 9336 as Amended to establish regulatory fees regarding
this activiiy The Alameda County District Attorney s Office has a long standing policy
of declining to issue advisory opinions as to the legality of any particular conduct To
that end this le8er is not nor should it be interpretedas an aduisory opinion on the
legality of the Ordinance ar any part contained therein
I make the point that this ce haS always taken a very reasonable approach to
enforcement of the marijuana laws in light of the Gompassionate lJse Act and the
Medical Marijuana Program As a cancer survivor myself I certainly understand the
6enefits for those in need of themdicinal use of marijuana in uariousfrms This
reasonable policy and approach should not be taken as an endorsement of the
Ordinance or as a deciaration that those engaging in conduct outside the parameters
of the law as it pertains to marijuana will be ignored
Earlier this year my 5tafF was in discussion with Council staff regarding legal concerns
the As Office had with the Ordinance if it passed At that time we were told that with
respect ta the Ordinance Council would wait untii the outcome of Proposition 19
Obviously Prop 19 failed to pass it is my understanding that Councii is now moving
forvvard with your Ordinance This letter is being written to alert you to legal concems
still held by the Alameda County District Attorney sOce regarding the Ordinance
particularly in light of recenk case law opinions regarding the Compassionate Use Act
CUA and the Medi al Marijuana Program Act MMP
The CUA and MMP define primary caregiver as the individual designated by the
person exempted under this section who has consistently assumed responsibility for the
housing health or safety of that person emphasis is mine The definition beoomes

12 21 2010 17 00 5102084965 DA RM 213 PAGE 03 04
very significant in terms of who is aliowed by California lew to cultivate and provide
marijuana to others I would point out that mos recently the California Court of
Appeals in People v Hochanadel210 176Cal App 4th 997 relying on the
Califomie Supreme Court case of People v Mentch 2008 45 Cal 4th 274 found that
operators of storefront medical manjuana dispensary were not primary caregivers
exempted from liability for certain narcotics offenses under Compassionate Use Act and
Medical Marijuana Program Act despite them being designated as such by medical
marijuana patients who purchased medical marijuana from them The Court found that
where there was no evidence of an existing established relationship providing for
housing health or safety indepanden of the administration of inedical marijuana the
dispensary operators did not qualify as caregivers under the legal definition set forth in
the law The MMP set limits on the number of plants that could be possessed or
cultivated The same section of the code but a different subsection authorizes
possession and or cultivation in amoun s for reasonable use for the patient In sfriking
down the limits language as it pertains to medicinal use or cuftivation for medicinal
use the Supreme Court did not extend its ruling to HS Sections 11359 and 11360
possession for sale and sale of marijuana outside the CUA and MMP See Peapfe v
Kelly 2010 24 Cal 4 10D8
7he Alameda County District Attorney soce makes the point that enactment of this
Ordinance does nt provide a defense over and above the defense provided by the
Campassionate Use Act Health and Safety Code section 11362 5 aka Prop 215 or the
Medical Marijuana Program Mealth and Safety Code sections 113 2J et seq to any
criminal charge In other words nofwifhstanding pronouncements by city officials or the
enactment of the Ordinance he prosecuting agency in Alameda County is not
pro iding any assurances that activities authorized by the Ordinance but not authorized
under state law or federal law are permissible Persons should not rely sofefy upon
pronouncements by city offcials or enactment of the rdinsnce as providing any legal
or equiYable defense to a criminal prosecution Nor should persons rely on
pronouncements of city officials or the Ordinance as an accurate inferpretation of the
state laws regarding marijuana cultivation possession sale etc and or the defenses
available to those charges
In California as you know culti ation of marijuana for medicinal or compassionate use
must benot for profit The law is quite specific in what can and cannot be the basis of
exchange of money from the primary caregiver and the patient as it pertains to
marijuana Potentiel difficulties might arise in assessing the appropriate amount of
taxes that can be imposed on transactions undertaken by these large scale marijuana
growing operations This concern is not only with potential difficulties in cases of tax
evasion but also persons relying on the Ordinance may 6e placed at risk of prosecution
for tax evasion due o the lack of clear guidelines in assessing when and how much tax
need be paid
One important caveat is Yhat notwithstanding the language of Section581 100 it
remains an open question whether public officers or public employees who aid and
abet or conspire to violate state or federal laws in furtherance of a city ordinance are

12 21 2010 17 00 5102084965 DA RM 213 PAGE 04
exempt from criminal liability
The District Attorney s Office will uphold and enforce the laws of this 5tate As is the
policy in this Office alleged violations of the law will be reviewed on a by case
basis
Thank you for your attention to these issues I am not providing to you an advisory
opinion on the legality of your Ordinance hat is the purview of your City Attorney
Mowever if you would like to discuss this further please don t hesitate to contact me
5incerely yaurs
Nancy EOMalley
District Attorney
Cc City Attorney John Russo

LS1epartment ofJstice
f
Oflice of the Deputy Attorne General
r np r r tc wrn
October 19 20U9
Mt 10R 1NDUi lESF LF TLDitiI 1Ft STA f1SAT CORNT YS
a
FRO vI
llavid 1 Ogdcav
leputy Attorney General
SCRJEiC7
Im esti ations and Prosccutiuns it Statcs
Authurizine thc lcdical Usc of Ntariivana
1 memorandum pro ides clarificafion andgiidance to fedcral prosecutors in Stares
tlia ha e enacted laws authorizing the medical use of mnrijuana These lnw s an in their
substan ieroci ions end in the extern uf statu regulutonucrsight both amonn he enacting
States and an ong locul jurisdictiuns ithi thosc Statcs Kather than decdoping diftcrcnt
euidclines for e ery possihle arinnt of state and local law this memorandum pro idcs uniform
uidunce to focus fed rl incestig ticros nnd prosccutions in thesc States on cure icdcral
rNurccmcnt priorities
Il cfepartmcm ul Justirc is committcd to the enfurccmcnt ofilc Controlled Substances
Zet in ull Sts Congress has determincd diat mnrijuana is a dangerous drug and the illegal
istribution ad salc ol marijuanu is serious crime andro ides a signilicant tiource ofre enue
to large sc ile criminal rntcrprises gangs and cartels One timeh example underscores thc
im ortancr nl our clCotts tu prosecute significant marijuanaualTickers marijuana distrihution in
hc l nited Statcs remains the sint le largest source of revenuefor the YIexican carids
l he1epanment is also committed to mxkin efficirnt nd rational use of its limited
incsti ati e and prosccutorial resources In general Ui ited Stdtes Attorne s arc vested witl
nlenar uthorit ilh regard to federel criminal matters aithin theirdistricts US 49 9001
Incrcising this authorittnit d Smtcs Attorncys ar invcsic b statutc xnd dclegation from
th ttornc ienrrul tiith the broadest discretion in the rserciseot such authoriri d fhis
uulhunt shauldn1 ourse br cxrrcised consistent cith Departmrnt priurities mdui linc
Ihc prascc ition ufsi nilicanttial ficl crs ufillcgal trugs includin muriivana and ihc
Jisruption oC illegal diu manuf ctu inc unhafticl ing netv orlcs eontinucs to be t corc riurit
in thrIcpartmcnt s ctfl rt against nm and dangerous drugs and thc cpanmrnt s
imestigati c and prusecuturinl resow ces should he dircctedto ards thrse objecti es s a
encrnl muucr pursuit of thcsc prinrilics should not tiicus icdcral resnurccs in ourSatcs on

Memorandum for Selected United Statcs Attorneys Page 2
Subject Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana
indi idualsHhose actions are in clear and wiambiguous compliance with existing state laws
pro iding for the medical use of mazijuana For example prosecution of individuals with cancer
or other scrious illnesses who use marijuana as part of a recommended treatment regimen
consistent with applicable state lav or those caregivers in clear and unambiguous compliance
ith existing state law who provide such individuals wth marijuana is unlikely to be an efficient
use of limited federal resources On the other hand prosecution of commercial enterprises that
unla fully market and sell marijuana for profit continues to be an enforcement priority of the
Department To be sure claims of compliance with state or local law may mask operations
inconsistent with the terms conditions or purposes of those taws and federal law enforcement
should not be deterred by such assertions when otherwise pursuing the Depattment s core
enforcement priorities
Tpically when any of the following characteristics is present the conduct vill not be in
clear and unambiguous compliance with applicable state law and may indicate illegal drug
tralficking activity of potential federal interest
unla ul possession or unla tifiul use of firearms
iolencc
sales to minors
financial and marketing activities inconsistent with the terms conditions or purposes of
state law including evidence of money laundering activity and or financial gains or
exeessive amounts of cash inconsistent with purported compliance ith state or local law
amoients of marijuana inconsistent with purported compliance with state or ocal law
illegal possession or sale of other controlled substances or
tics to other criminal enterprises
Of course no State can authorizevio ations of federal law and the list of factors above is
not intended to describeehaustively when a federal prosecution may berarranted
Accordingly in prosecutions undertl e Controlled Substances Act federal prosecutors aze not
expccted roei arge rove or otherwise establish any state law violations Indeed this
memorandum does not alter in vrv way the DepartmenYs authority to enforce federal law
including laws prohibiting the manufacture production distribution possession or use of
marijuana on federal property This guidance regarding resource allocation does not legalize
marijuana or provide a legal defense to a violation of federa law nor is it intended to create any
pri ileges benefits or rights substantive or procedural enforceable by am individual party or
imess in any administrative civil or criminal matter Nor does clear and unambiguous
compliance with state la or the absence of one or a11 of the above factors create a legal defense
to a violation of the Controlled Substanccs Act Rather this memorandum is intended soiely as a
guide to the xercise of investigative and prosecutorial discretion

Memorandum for Selected linited States Attorneys Page 3
Subject lnvestigations and Prosecutions in States Authorizing the Medical Use of Marijuana
Finally nothing herein precludcs investigation or prosecution where there is a reasonable
basis to believe that compfiance with state law is being invoked as a pretext for the production or
distribution of marijuana for purposes not authorized by state law Nor does this guidance
preclude investigation or prosecution eeen when there is clear and unambiguous compliance
with existing state lav in particular circumstances where investigation or prosecution othenvise
serves important federal interests
Your offices should continue to review marijuana cases for prosecution on a by case
basis consistent with the guidance on resource allocation and federal priorities set forth herein
the consideration of requests for federal assistance from state and loca law enforcement
authorities and the Principles of Federa Prosccution
cc All United States Attorneys
Lanny A Breuer
Assistant Attorney General
Crimina llivision
B Todd Jones
lnite States Attomey
District of Minnesota
Chair Attorney GeneraPs Advisory Committee
Michele M Leonhazt
Acting Administrator
Drug Enforcement Administration
H Marshafl Jarrett
Director
rxecuti
Office for United States Attorneys
Kc in L Perkins
Assistant Director
Criminal Investigative Division
Federal Bureau ofIm esti ation

B State of California lnformation
Guidelines for the Security and Non Diversion of
Marijuana Grown for Medical Use Guidelines
Medical Marijuana Program MMP website page
Health Safety Code Article 2 Marijuana
Section 11357 11369
Health Safety Code Article 25 Medical
Marijuana Program
Section 711362 83

EDMUND G BROWN JR
Attorney General 04
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2
DEPARTMENT OF JUSTICE
State of California
GUIDELINES FOR THE SECURITY ANDNON
DIVERSION
OF MARIJUANA GROWN FOR MEDICAL USE
August 2008
In 1996 California voters approved an initiative that exempted certain patients and their
primary caregivers from criminal liability under state law for the possession and cultivation of
marijuana In 2003 the Legislature enacted additional legislation relating to medical marijuana
One of those statutes requires the Attorney General to adopt guidelines to ensure the security and
nondiversion of marijuana grown for medical use Health Sa Code 11362 81d To
fulfill this mandate this Office is issuing the following guidelines to 1 ensure that marijuana
grown for medical purposes remains secure and does not find its way tonon patients or illicit
markets 2 help law enforcement agencies perform their duties effectively and in accordance
with California law and 3 help patients and primary caregivers understand how they may
cultivate transport possess and use medical marijuana under California law
L
SUMMARY OF APPLICABLE LAW
A
California Penal Provisions Relating to Marijuana
The possession sale cultivation or transportation of marijuana is ordinarily a crime under
California law See eg 11357 possession of marijuana is a misdemeanor 11358
cultivation of marijuana is a felony Veh Code 23222 possession of less than 1 oz of
marijuana while driving is a misdemeanor 11359 possession with intent to sell any
amount of marijuana is a felony l 1360 transporting selling or giving away marijuana
in Califomia is a felony under 285 grams is a misdemeanor 11361 selling or
distributing inarijuana to minors or using a minor Yo transport sell or give away
marijuana is a felony
B Proposition 215 The Compassionate Use Act of 1996
On November 5 1996 California voters passed Proposition 215 which decriminalized the
cultivation and use of marijuana by seriously ill individuals upon a physician
recommendation
1362 5 Proposition 215 was enacted to ensure that seriously ill
Californians have the right to obtain and use marijuuia for medical purposes where that
medical use is deemed appropriate and has been recommended by a physician who has
determined that the person
health would benefit from the use of marijuana and to
ensure that patients and their primary caregivers who obtain and use marijuana for
Unlessotk erwise noted all stat tory refereoces are to the Heal h Safety Code
1

medical purposes upon the recommendation of a physician are not subject to criminal
prosecutionorsanction ll362 5b1AB
The Act further states that Section 11357 relating to the possession of marijuana and
Section 11358 relating to the cultivation of marijuana shall not apply to a patient or to a
patienYs primary caregiver who possesses or cultivates marijuana for the personal medical
purposes of the patient upon the written or verbal recommendation or approval of a
physician 11362 5d Courts have found an implied defense to the transportation of
medical marijuana when the quantity transported and the method timing and distance of
the transportation are reasonably related to the patienYs current medical needs People
vTppet 1997 56Cal App 4th 1532 1551
C Senate Bill 420 The Medical Marijuana Program Act
On January 1 2004 Senate Bill 420 the Medical Marijuana Program Act MMP became
law 711362 83 The MMP among other things requires the California
Department of Public Health DPH to establish and maintain a program for the voluntary
registration of qualified medical marijuana patients and their primary caregivers through a
statewide identiFication card system Medical marijuana identification cards are intended
to help law enforcement officers identify and verify that cardholders are able to cultivate
possess and transport certain amounts of marijuana without being subject to arrest under
specific conditions 11362J1 e 11362 78
It is mandatory that all counties participate in the identification card program by
a providing applications upon request to individuals seeking to join the identification
card program b processing completed applications c maintaining certain records
d following state implementarion protocols and e issuing DPH identification cards to
approved applicants and designated primary caregivers 11362 71b
Participation by patients and primary caregivers in the identification card program is
voluntary However because identification cards offer the holder protection from arrest
are issued only after verification of the cardholder s status as a qualified patient or primary
caregiver and are immediately verifiable online or via telephone they represent one of the
best ways to ensure the security andnon diversion of marijuana grown for medical use
In addition to establishing the identification card program the MMP also de mes certain
terms sets possession guidelines for cardholders and recognizes a qualified right to
collective and cooperative cultivation of inedical marijuana 11362 7 11362 77
11362 775
D
Taxability of Medical Marijuana Transactions
In February 2007 the California State Board of Equalization BOE issued a Special
Notice confinning its policy of taacing medical marijuana transactions as well as its
requirement that businesses engaging in such transactions hold a Seller s Permit
http www boe ca gov news
medse11er2007 pdf According to the Notice having a
Seller s Pernut does not allow individuals to make unlawful sales but instead merely
provides a way to remit any sales and use taxes due BOE further clarified its policy in a
2

June 2007 Special Notice that addressed several frequently asked questions concerning
taxation of inedical marijuana transactionshttp www boe ca gov news
173 pdf
E
Medical Board of California
The Medical Board of California licenses investigates and disciplines Califomia
physicians Bus Pro Code 2000 et seq Although state law prohibits punishing a
physician simply for recommending marijuana for treatment of a serious medical condition
11362 5c the Medical Board can and does take disciplinary action against physicians
who fail to comply with accepted medical standards when recommending marijuana In a
May 13 2004 press release the Medical Board clarified that these accepted standards are
the same ones that a reasonable and prudent physician would follow when recommending
or approving any medication They include the following
1 Taking a history and conducting a good faith examination of the patient
2 Developing a treatment plan with objectives
3 Providing informed consent including discussion of side effects
4 Periodically reviewing the treatmenYs efficacy
5 Consultations as necessary and
6 Keeping proper records supporting the decision to recommend the use of
medical marijuana
http www mbaca gov board media releases 2004 OS 13 marijuana hhnl
Complaints about physicians should be addressed to the Medical Board1800 633 2322
orwww mbaca gov which investigates and prosecutes alleged licensing violations in
conjunction with the Attorney GeneraPs Office
F
The Federal Cantrolled Substauces Act
Adopted in 1970 the Controlled Substances Act CSA established a federa
regulatory system designed to combat recreational drug abuse by making it unlawful to
manufacture distribute dispense or possess any controlled substance 21USC 801
et seq Gonzales v Oregon 2006 546 US 243 271 273 The CSA reflects the federal
governmenYs view that marijuana is a drug with no currently accepted medical use
21USC 812 b1 Accordingly the manufacture distribution or possession of
marijuana is a federal criminal offense Id at 841 a1 844 a
The incongruity between federal and state law has given rise to understandable
confusion but no legal conflict exists merely because state law and federal law treat
marijuana differently Indeed California s medical marijuana laws have been challenged
unsuccessfully in court on the ground that they are preempted by the CSA Coainty of Scn
Diego v Sarz Diego NORML July 31 2008 Ca1 Rptr3d 2008 WL 2930117
Congress has provided that states are free to regulate in the area of controlled substances
including marijuana provided that state law does not positively conflict with the CSA 21
USC 903 Neither Proposition 215 nor the MMP conflict with the CSA because in
adopting these laws California did not legalize medical marijuana but instead exercised
the state
reserved powers to not punish certain marijuana offenses under state law when a
physician has recommended its use to treat a serious medical condition See City of
Gm den Grove v Superior Coz rt Kha 2007 157 Ca1 App 4th 355 371 373 381 382
3

In light of California s decision to remove the use and cultivation of physician
recommended marijuana from the scope of the state
drug laws this Office recommends
that state and local law enforcement officers not arrest individuals or seize marijuana
under federal law when the officer determines from the facts available that the cultivation
possession or transportation is permitted under California s medical marijuana laws
II
DEFINITIONS
A
Physician
RecommendaHon Physicians may not prescribe marijuana because
the federal Food and Drug Administration regulates prescription drugs and under the
CSA marijuana is a Schedule I drug meaning that it has no recognized medical use
Physicians may however lawfully issue a verbal or written recommendation under
California law indicating that marijuana would be a beneficial treatment for a serious
medical condition 11362 5d Conant v Walters 9th Cir 2002 309 F3d 629 632
B Primary Caregiver A primary caregiver is a person who is designated by a
qualified patient and has consistently assumed responsibility for the housing health os
safety of the patient 11362 5e Califomia courts have emphasized the consistency
element of the patient caregiver relationship Althoughaprimary caregiver who
consistently grows and supplies medicinal marijuana for a section 1 1362 5 patient is
serving a health need of the patient someone who merely maintains a source of
marijuana does not automatically become the party who has consistenUy assumed
responsibility for the housing health or safety of that purchaser People ex rel Lungren
v Per 1997 59 Ca1 App 4th 1383 1390 1400 A person may serve as primary
caregiver to more than one patient provided that the patients and caregiver all reside in
the same
city or county 11362 7d2 Primary caregivers also may receive certain
compensation for their services 11362 765 c A primary caregiver who receives
compensation for actual expenses including reasonable compensation incurred for
services provided to enable a patient to use marijuana under this article or for
payment forout of pocket expenses incuned in providing those services or both shall
not on the sole basis of that fact be subject to prosecution for possessing or transporting
marijuana
C Qualified Patient A qualified patient is a person whose physician has
recommended the use of marijuana to treat a serious illness including cancer anorexia
AIDS chronic pain spasticity glaucoma arthritis migraine or any other illness for which
marijuanaprovidesrelie 11362 5b1A
D Recommending Physician A recommending physician is a person who
1 possesses a license in good standing to practice medicine in California 2 has taken
responsibility for some aspect of the medical care treatment diagnosis counseling or
referral of a patient and 3 has complied with accepted medical standards as described
by the Medical Board of California in its May 13 2004 press release that a reasonable and
prudent physician would follow when recommending or approving medical marijuana for
the treatment of his or her patient
4

III
GUIDELINES REGARDING INDI VIDUAL QUALIFIED PATIENTS AND PRIMARY CAREGIVERS
A
State Law Compliance Guidelines
1 Physician Recommendation Patients must have a written or verbal
recommendation for medical marijuana from a licensed physician 11362 5d
2 State of California Medical Marijuana Identification Card Under the
MMP qualified patients and their primary caregivers may voluntarily apply for a
card issued by DPH identifying them as a person who is authorized to use possess
or transport marijuana grown for medical purposes To help law enforcement
officers verify the cardholder s identity each card bears a unique identification
number and a verification database is available onlinewww calmmp
gov In
addition the cards contain the name of the county health department that approved
the application a24 hour verification telephone number and an expiration date
11362 71a 11362 735 a34 11362 745
3 Proof of Qualified Patient Status Although verbalreco
nmendations aze
technically permitted under Proposition 215 patients should obtain and carry
written proof of their physician recommendations to help them avoid arrest A
state identification card is the best form of proof because it is easily verifiable and
provides immunity from arrest if certain conditions are met see sectionIII B4
below The next best forms of proof are a city or county issued patient
identification cazd or a written recommendation from a pbysician
4 Possession Guidelines
a MMP Qualified patients and primary caregivers who possess a state
issued identification card may possess 8 oz of dried marijuana and may
maintain no more than 6 mature or 12 immature plants per qualified patient
11362 7a But ifa qualified patient or primary caregiver has a
doctor s recommendation tbat this quantity does not meet the qualified
patient s medical needs the qualified patient or primary caregiver may
possess an amount of marijuana consistent with the patienYs needs
11362 77b Only the dried mature processed flowers or buds of the
female cannabis plant should be considered when determining allowable
quantities of inedical marijuana for pwposes of the MMP 11362 77d
b Local Possession Guidelines Counties and cities may adopt
regulations that allow qualified patients or primary caregivers to possess
On May 22 2008 Califomia s Second District Court of Appeal severed Health Safery Code I 1362 77
from the MMP on the ground that the statate
possession guidelines were an unconstiWtiooal amendment of
Proposition 215 which does not quantify the marijua a patient may possess See People n Kel y 2008 163
Cal AppAth 124 77 Ca1 Rptr3d 390 The Third District Court of Appeal recently reached a similar conclusioni
People v Phomphah dv July 31 2008 Cal Rptr3d 2008 WL 2931369 The Califomia Supreme Court has
gran ed review in Kelly and the Attorney General intends to seek review in Phomphakdy
5

medical marijuana in amounts that exceed the MMP s possession
guidelines 11362 77 c
c Proposition 215 Qualified patients claiming protection under
Proposition 215 may possess an amount of marijuana that is reasonably
related fo their current medical needs People v Ti ippet 1997 56
Ca1 App 4th 1532 1549
B
Enforcement Guidelines
1 Location of Use Medical marijuana may not be smoked a where
smoking is prohibited by law b at or within 1000 feet of a school recreation
center or youth center unless the medical use occurs within a residence c on a
school bus or d in a moving inotor vehicle or boat 11362 79
2 Use of Medical Marijua in the Workplace or at Correctional
Facilities The medical use of marijuana need not be accommodated in the
workplace during work hours or at anyjail correctional facility or other penal
institution 11362 785 a Ross v RagingWire Telecomms Inc 2008 42
Ca1 4th 920 933 under the Fair Employment and Housing Act an employer may
terminate an employee who tests positive for marijuana use
3 Criminal Defendants Probationers and Parolees Criminal defendants
and probationers may request court approval to use medical marijuana while they
are released on bail ar probation The court s decision and reasoning must be
stated on the record and in the minutes of the court Likewise parolees who are
eligible to use medical marijuana may request that they be allowed to continue
such use during the period of parole The written conditions of parole must reflect
whether the request was granted or denied 11362 795
4 State of California Medical Marijuana Identification Cardholders
When a person invokes the protections of Proposition 215 or the MMP and he or
she possesses a state medical marijuana identification card officers should
a Review the identi6cation card and verify its validity either by calling
the telephone number printed on the card or by accessing DPH s card
verification websitehrip www calmmp
gov and
b If the card is valid and not being used fraudulently there are no other
indicia of illegal activity weapons illicit drugs or excessive amounts of
cash and the person is within the state or local possession guidelines the
individual should be released and the marijuana should not be seized
Under the MMP no person or designated primary cazegiver in possession
of a valid state medical marijuana identification card shall be subject Yo
arrest for possession transportation delivery or culfivation of inedical
marijuana 11362 71e Furtherastate or local law enforcement
agency or officer shall not refuse to accept an identification card issued by
the department unless the state or local law enforcement agency or officer
6

has reasonable cause to believe that the information contained in the card is
false or fraudulent or the card is being used fraudulently I 1362 78
5
Non
Cardholders When a person claims protection under Proposition
215 or the MMP and only has a locally issuedie non state patient identification
card or a written or verbal recommendation from a licensed physician officers
should use their sound professional judgment to assess the validity of the person
medical use claim
a Officers need not abandon their search or investigation The standard
search and seizure rules apply to the enforcement ofmarijuana related
violations Reasonable suspicion is required for detention while probable
cause is required for search seizure and arrest
b Officers should review any written documentation for validity It may
contain the physician
name telephone number address and license
number
c If the officer reasonably believes that the medical use claim is valid
based upon the totality of the circumstances including the quantity of
marijuana packaging for sale the presence of weapons illicit drugs ar
large amounts of cash and the person is within the state or local possession
guidelines or has an amount consistent with their current medical needs the
person should be released and the marijuana should not be seized
d Alternatively if the officer has probable cause to doubt the validity of a
person
medical marijuana claim based upon the facts and circumstances
the person may be arrested and the marijuana may be seized It will then be
up to the person to establish his or her medical marijuana defense in court
e Officers are not obligated to accept a person
claim of having a verbal
physician
recommendation that cannot be readily verified with the
physician at the time of detention
6
Exceeding Possession Guidelines If a person has what appears to be valid
medical marijuana documentation but exceeds the applicable possession
guidelines identified above all marijuana may be seized
7
Return of Seized Medical Marijuana If a person whose marijuana is
seized by law enforcement successfully establishes a medical marijuana defense in
court or the case is not prosecuted he or she may file a motion for return of the
marijuana If a court grants the motion and orders the return of marijuana seized
incident to an arrest the individual or entity subject to the order must return the
property State law enforcement officers who handle controlled substances in the
course of their official duties are immune from IiabiIity under fhe CSA 21USC
885 d Once the marijuana is returned federal authorities are free to exercise
jurisdiction over it 21USC 812 c10 844 a City of Garden Grove v
Super ior Court Kha 2007 157Ca1 App 4th 355 369 386 391
7

IV
GUIDELINES REGARDING COLLECTIVES AND COOPERATIVES
Under California law medical marijuana patients and primary caregivers may associate
within the State of California in order collectively or cooperatively to cultivate marijuana for
medical purposes 11362 775 The following guidelines are meant to apply to qualified
patients and primary caregivers who come together to collectively or cooperatively cultivate
physician
recommended marijuana
A
Business Forms Any group that is collectively or cooperatively cultivating and
distributing marijuana for medical purposes should be organized and operated in a manner
that ensures the security of the crop and safeguards against diversion fornon medical
purposes The following are guidelines to help cooperatives and collectives operate within
the law and to help law enforcement determine whether they are doing so
1
Statutory Cooperatives A cooperative must file articles of incorporation
with the state and conduct its business for Uie mutual benefit of its members
Corp Code 12201 12300 No business may call iYselfacooperative or co
op unless it is properly organized and registered as such a corporation under the
Corporations or Food and Agricultural Code Id at 12311 b Cooperative
corporations are democratically controlled and are not organized to make a profit
for themselves as such or for their members as such but primarily for their
members as patrons Id at 12201 The earnings and savings of the business
must be used for the general welfare of its members or equitably distributed to
members in the form of cash properiy credits or services Ibid Cooperatives
must follow strict rules on organization articles elections and distribution of
earnings and must report individual transactions from individual members each
year See id at 12200 et seq Agricultural cooperatives are likewise nonprofit
corporate entities since they are not organized to make profit for themselves as
such or for their members as such but only for their members as producers
Food Agric Code 54033 Agricultural cooperatives shaze many
characterisUcs with consumer cooperatives See eg id at 54002 et seq
Cooperatives should not purchase marijuana from or sell tonon members
instead they should only provide a means for facilitating or coordinating
transactions between members
2 Collectives California law does not define collectives but the dictionary
defines them as a business farm etc jointly owned and operated by the members
of a group Random House Unabridged Dictio tary Randoin House Inc
OO 2006 Applying this definition a collective should be an organization that
merely facilitates the collaborative efforts of patient and caregiver members
including the allocation oFcosts and revenues As such a collective is not a
statutory entity but as a practical matter it might have to organize as some form of
business to carry out its activities The collective should not purchase marijuana
from or sell tonon members instead it should only provide a means for
facilitating or coordinating transactions between members

B
Guidelines for the Lawful Operation of a Cooperative or Collective
Collectives and cooperatives should be organized with sufficient structure to ensure
securitynon diversion of marijuana to illicit markets and compliance with all state and
local laws The following are some suggested guidelines and practices for operating
collective growing operations to help ensure lawful operation
1
Non Profit Operation Nothing in Proposition 21 S or the MMP authorizes
collectives cooperatives or individuals to profit from the sale or distribution oP
marijuana Seeeg 11362 765 a nothing in this section shali authorize
any individual or group to cultivate or distribute marijuana for profiY
2 Business Licenses Sales Tax and Seller s Permits The State Board of
Equalization has determined that medical marijuana Yransactions are subject to
sales tax regardless of whether the individual or group makes a proFit and those
engaging in transactions involving medical marijuana must obtain a Seller s
Permit Some cities and counties also require dispensing collectives and
cooperatives to obtain business licenses
3
Membership Application and Verification When a patient or primary
caregiver wishes to join a collective or cooperative the group can help prevent the
diversion of marijuana fornon medical use by having potential members complete
a written membership application The following application guidelines should be
followed to help ensure that marijuana grown for medical use is not diverted to
illicit markets
a Verify the individual s status as a gualified patient or primary caregiver
Unless he or she has a valid sfate medical marijuana identification card this
should involve personal contact with the recommending physician or his or
her agent verification of the physician
identity as well as his or her state
licensing status Verification of primary caregiver status should include
contact with the qualified patient as well as validation of the patient s
recommendation Copies should be made of the physician
recommendation or identifieation card if any
b Have the individual agree not to distribute marijuana tonon members
c Have Yhe individual agree not to use the marijuana for other than
medical purposes
d Maintain membership records on site or have them reasonably
available
e Track when members medical marijuana recommendation and or
identification cards expire and
Enforce conditions of inembership by excluding members whose
identification card or physician recommendation are invalid or have
expired or who are caught diverting marijuana fornon medical use
9

4
Collectives Should Acquire Possess and Distribute Only Lawfully
Cultivated Marijuana Collectives and cooperatives should acquire marijuana
only from their constituent members because only marijuana grown by a qualified
patient or his or her prunary caregiver may lawfully be transported by or
distributed to other members of a collective or
cooperative 11362 765
11362 775 The collective or cooperative may then allocate it to other members of
the group Nothing allows marijuana to be purchased from outside the collective or
cooperative for distribution to its members Instead the cycle should be a closed
circuit of marijuana cultivation and consumption with no purchases or sales to or
fromnon members To help prevent diversion of inedical marijuana to non
medical markets collectives and cooperatives should document each member s
contribution of labor resources or money to the enterprise They also should track
and record the source of their marijuana
5 Distribution and Sales toNon Members are Prohibited State law
allows primary caregivers to be reimbursed for certain services including
marijuana cultivation but nothing allows individuals or groups to sell or distribute
marijuana tonon members Accordingly a collective or cooperative may not
distribute medical marijuana to any person who is not a member in good standing
of the organization A dispensing collective or cooperative may credit its members
for marijuana they provide to the collective which it may then allocate to other
members 11362 765 c Members also may reimburse the collective or
cooperative for marijuana that has been allocated to them Any monetary
reimbursement that members provide to the collective or cooperative should only
be an amount necessary to cover overhead costs and operating expenses
6 Permissible Reimbursements and Allocations Marijuana grown at a
collective or cooperative for medical purposes may be
a Provided free to qualified patients and primary caregivers who are
members of the collective or cooperative
b Provided in exchange for services rendered to the entity
c Allocated based on fees that are reasonably calculated to cover
overhead costs and operating expenses or
d Any combination of the above
7
Possession and Cultivation Guidelines If a person is acting as primary
caregiver to more than one patient under section 11362 7d2 he or she may
aggregate the possession and cultivation limits for each patient For example
applying the MMP s basic possession guidelines if a caregiver is responsible for
three patients he or she may possess up to 24 oz of marijuana 8 oz per patient
and may grow 18 mature or 36 iinmature plants Similarly collectives and
cooperafives may cultivaCe and Cransport marijuana in aggregate amounts tied to its
membership numbers Any patient or primary caregiver exceeding individual
possession guidelines should have supporting records readily available when
a Operating a location for cultivation
b Transporting the group s medical marijuana and
c Operating a location for distribution to members of the collective or
cooperative
10

8 Security Collectives and cooperatives should provide adequate securily to
ensure that patients are safe and that the surrounding homes or businesses are not
negatively impacted by nuisance activity such as loitering or crime Further to
maintain security prevent fraud and deter robberies collectives and cooperatives
should keep accurate records and follow accepted cash handling practices
including regular bank runs and cash drops and maintain a general ledger of cash
transactions
C Enforcement Guidelines Depending upon the facts and circumstances
deviations from the guidelines outlined above or other indicia that marijuana is not for
medical use may give rise to probable cause for arrest and seizure The following are
additional guidelines to help identify medical marijuana collectives and cooperatives that
aze operating outside of state law
1 Storefront Dispensaries Although medical marijuana dispensaries
have been operating in Callfornia for years dispensaries as such are not
recognized under the law As noted above the only recognized group entities are
cooperatives and collectives I 1362 775 It is the opinion of this Office that a
properly organized and operated collective or cooperative that dispenses medical
marijuana through a storefront may be lawful under California law but that
dispensaries that do not substantially comply with the guidelines set forth in
sectionsIVA and B above are likely operating outside the protections of
Proposition 215 and the MMP and that the individuals operating such entities may
be subject to anest and criminal prosecution under California law For example
dispensaries that merely require patients to complete a form summarily designating
the business owner as their primary caregiver and then offering marijuanai
exchange for cash donations are likely unlawful Perori supra 59
Ca1 App 4th at p 1400 cannabis club owner was not the primary caregiver to
thousands of patients where he did not consistently assume responsibility for their
housing health or safety
2
Indicia of Unlawful Operation When investigatiog collectives or
cooperatives law enforcement oFficers should be alert for signs of mass production
or illegal sales including a excessive amounts of marijuana b excessive
amounts of cash c failure to follow local and state laws applicable to similar
businesses such as maintenance of any required licenses and payment of any
required taxes induding sales taxes d weapons e illicit drugs purchases
from or sales or distribution tonon members or g distribution outside of
California
I1

Medical Marijuana Program Page 1 of 1
hNec6ical Marijuar
Prog m
Aedical Marijuana Program MMP was estabiished to provide a voluntary medical marijuana identification card issuance and
re try program for qualified patients and their caregroers The web based registry system allows law enforcement and the public to
verify the validity of qualified patient or caregiver s card as authonzation to possess grow transport and or use Medical Marijuana in
California To facilitate the verification of authorized cardholders the verification database is available on the internet at
www calmmp
qov
In 2003 Senate Bill SB 420 Chapter 875 Statutes of 2003 was passed as an extension and clarification of Proposition 215 the
Compassionate Use Act of 1996 The Medical Marijuana Program within CDPH is administered through a patient s county of
residence Upon obtaining a recommendation from their physician for use of inedicinai marijuana patients and their primary
caregivers may apply for and be issued a Medical Marijuana Identification Card Senate Bill 420 aiso required that the MMP be fully
supported through the card application processing fees Both the state and the counties have authority to cover their costs for the
program through these appiication fees
Regulations Statutes Program Information
Senate Bill 420
Contact MMP
Compassionate Use Act
County Program Location and Hours
Health and Safety Code
Verification of Medical Marijuana ID card
Data Statistics Appeals
Patient Primary Caregiver
and Medi Cal Card Data
Forms
Participating Counties PDF New Window
Card Data by County and Fiscal Year PDF New Window
MMP Fact Sheet PDF New Window
County Implementation Schedule PDF New Window
ding
Fees
Pro9ram Revenues Expenditures and Loan Repayment PDF
New Window
Patient Advocacy Groups and Information
Americans for Safe Access
CA Norml
Marijuana Policy Projed
Office of Attorney General
Organization
Health Information and Strategic Planning
Vital Records Registration Branch
Vital Records Issuance and Preservation Branch
Public Health Policy and Research Branch
Public Health Informati s Branch
HISP Administrative Support Branch
Responsibilities
Dispensaries Cooperatives and Collectives
Patient Responsibilities
Primary Caregiver Responsibilities
Physician Responsibilities
Legal Representative Responsibilities
County Responsibilities
State Responsibilities
Last modified on928 2011 211 PM
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CA Codes hsa11357 11362 9 Page 1 of 9
HEALTH AND SAFETY CODE
SECTION 11357 11362 9
11357
a Except as authorized by law every person who possesses
any concentrated cannabis shall be punished by imprisonment in the
county jail for a period of not more than one year or by a fine of
not more than five hundred dollars 500 or by both such fine and
imprisonment or shall be punished by imprisonment in the state
prison
b Except as authorized by law every person who possesses not
more than 285 grams of marijuana other than concentrated cannabis
is guilty of an infraction punishable by a fine of not more than one
hundred dollars 100
c Except as authorized by law every person who possesses more
than 285 grams oE marijuana other than concentrated cannabis shall
be punished by imprisonment in the county jail for a period of not
more than six months or by a fine of not more than five hundred
dollars 500 or by both such fine and imprisonment
d Except as authorized by law every person 18 years of age or
over who possesses not more than 285 grams of marijuana other than
concentrated cannabis upon the grounds of or within any school
providing instruction in kindergarten or any of grades 1 through 12
during hours the school is open for classes or school related
programs is guilty of a misdemeanor and shall be punished by a fine
of not more than five hundred dollars 500 or by imprisonment in
the county jail for a period of not more than 10 days or both
e Except as authorized by law every person under the age of 18
who possesses not more than 285 grams of marijuana other than
concentrated cannabis upon the grounds of or within any school
providing instruction in kindergarten or any of grades 1 through 12
during hours the school is open for classes or school related
programs is guilty of a misdemeanor and shall be subject to the
following dispositions
1 A fine of not more than two hundred fifty dollars 250 upon
a finding that a first offense has been committed
2 A fine of not more than five hundred dollars 500 or
commitment to a juvenile hall ranch camp Eorestry camp or secure
juvenile home for a period of not more than 10 days or both upon a
finding that a second or subsequent offense has been committed
11357
a Except as authorized by law every person who possesses
any concentrated cannabis shall be punished by imprisonment in the
county jail for a period of not more than one year or by a fine of
not more than five hundred dollars 500 or by both such fine and
imprisonment or shall be punished by imprisonment pursuant to
subdivision h of Section 1170 of the Penal Code
b Except as authorized by law every person who possesses not
more than 285 grams of marijuana other than concentrated cannabis
is guilty of an infraction punishable by a fine of not more than one
hundred dollars 100
c Except as authorized by law every person who possesses more
than 285 grams of marijuana other than concentrated cannabis shall
be punished by imprisonment in a county jail for a period of not
more than six months or by a fine of not more than five hundred
dollars 500 or by both such fine and imprisonment
d Except as authorized by law every person 18 years of age or
over who possesses not more than 28 5 grams of marijuana other than
concentrated cannabis upon the grounds of or within any school
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providing instruction in kindergarten or any of grades 1 through 12
during hours the school is open for classes or school related
programs is guilty of a misdemeanor and shall be punished by a fine
o not more than five hundred dollars 500 or by imprisonment in a
county jail for a period of not more than 10 days or both
e Except as authorized by law every person under the age of 18
who possesses not more than 285 grams of marijuana other than
concentrated cannabis upon the grounds of or within any school
providing instruction in kindergarten or any of grades 1 through 12
during hours the school is open for classes or school related
programs is guilty of a misdemeanor and shall be subject to the
following dispositions
1 A fine of not more than two hundred fifty dollars 250 upon
a finding that a first offense has been committed
2 A fine of not more than five hundred dollars 500 or
commitment to a juvenile hall ranch camp forestry camp or secure
juvenile home for a period of not more than 10 days oz both upon a
finding that a second or subsequent offense has been committed
11358 Every person who plants cultivates harvests dries or
processes any marijuana or any part thereof except as otherwise
provided by law shall be punished by imprisonment in the state
prison
11358 Every person who plants cultivates harvests dries or
processes any marijuana or any part thereof except as otherwise
provided by law shall be punished by imprisonment pursuant to
subdivision h of Section 1170 of the Penal Code
11359 Every person who possesses for sale any marijuana except as
otherwise provided by law shall be punished by imprisonment in the
state prison
11359 Every person who possesses for sale any marijuana except as
otherwise provided by law shall be punished by imprisonment
pursuant to subdivision h of Section 1170 of the Penal Code
11360
a Except as otherwise provided by this section or as
authorized by law every person who transports imports into this
state sells furnishes administers or gives away or offers to
transport import into this state sell furnish administer or give
away or attempts to import into this state or transport any
marijuana shall be punished by imprisonment in the state prison for a
period of two three or four years
b Except as authorized by law every person who gives away
offers to give away transports offers to transport or attempts to
transport not more than 285 grams of marijuana other than
concentrated cannabis is guilty of a misdemeanor and shall be
piu by a fine of not more than one hundred dollars 100 In
any case in which a person is arrested for a violation of this
subdivision and does not demand to be taken before a magistrate such
person shall be released by the arresting officer upon presentation
of satis actory evidence of identity and giving his written promise
to appear in court as provided in Section 853 6 of the Penal Code
and shall not be subjected to booking
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11360
a Except as otherwise provided by this section or as
authorized by law every person who transports imports into this
state sells furnishes administers or gives away or offers to
transport import into this state sell furnish administer or give
away or attempts to import into this state or transport any
marijuana shall be punished by imprisonment pursuant to subdivision
h of Section 1170 of the Penal Code for a period of two three or
four years
b Except as authorized by law every person who gives away
offers to give away transports offers to transport or attempts to
transport not more than 285 grams of marijuana other than
concentrated cannabis is guilty of a misdemeanor and shall be
punished by a fine of not more than one hundred dollars 100 In
any case in which a person is arrested for a violation of this
subdivision and does not demand to be taken before a magistrate such
person shall be released by the arresting officer upon presentation
of satisfactory evidence of identity and giving his written promise
to appear in court as provided in Section 853 6 of the Penal Code
and shall not be subjected to booking
11361
a Every person 18 years of age or over who hires employs
or uses a minor in unlawfully transporting carrying selling
giving away preparing for sale or peddling any marijuana who
unlawfully sells or offers to se11 any marijuana to a minor or who
furnishes administers or gives or offers to furnish administer
or give any marijuana to a minor under 14 years of age or who
induces a minor to use marijuana in violation of law shall be
punished by imprisonment in the state prison for a period of three
five or seven years
b Every person 18 years of age or over who furnishes
administers or gives or offers to furnish administer or give any
marijuana to a minor 14 years of age or older shall be punished by
imprisonment in the state prison for a period of three four or five
years
11361 5
a Records of any court of this state any public or
private agency that provides services upon referral under Section
1000 2 of the Penal Code or of any state agency pertaining to the
arrest or conviction of any person for a violation of subdivision
b c d or e of Section 11357 or subdivision b of Section
11360 shall not be kept beyond two years from the date of the
conviction or from the date of the arrest if there was no
conviction except with respect to a violation of subdivision e of
Section 11357 the records shall be retained until the offender
attains the age of 18 years at which time the records shall be
destroyed as provided in this section Any court or agency having
custody of the records shall provide for the timely destruction of
the records in accordance with subdivision c The requirements of
this subdivision do not apply to records of any conviction occurring
prior to January 1 1976 or records of any arrest not followed by a
conviction occurring prior to that date
b This subdivision applies only to records of convictions and
arrests not followed by conviction occurring prior to January 1
1976 for any of the following offenses
1 Any violation of Section 11357 or a statutory predecessor
thereof
2 Unlawful possession of a device contrivance instrument or
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paraphernalia used for unlawfully smoking marijuana in violation of
Section 11364 as it existed prior to January 1 1976 or a statutory
predecessor thereof
3 Unlawful visitation or presence in a room or place in which
marijuana is being unlawfully smoked or used in violation of Section
11365 as it existed prior to January 1 1976 or a statutory
predecessor thereof
4 Unlawfully using or being under the influence of marijuana in
violation of Section 11550 as it existed prior to January 1 1976
or a statutory predecessor thereof
Any person subject to an arrest or conviction for those offenses
may apply to the Department of Justice for destruction of records
pertaining to the arrest or conviction if two or more years have
elapsed since the date of the conviction or since the date of the
arrest if not followed by a conviction The application shall be
submitted upon a form supplied by the Department of Justice and shall
be accompanied by a fee which shall be established by the
department in an amount which will defray the cost of administering
this subdivision and costs incurred by the state under subdivision
c but which shall not exceed thirty seven dollars and fifty cents
37 50 The application form may be made avai2able at every local
police or sheriff
department and from the Department of Justice and
may require that information which the department determines is
necessary for purposes of identification
The department may request but not require the applicant to
include aself
administered fingerprint upon the application If the
department is unable tosu ficiently identify the applicant for
purposes of this subdivision without the fingerprint or without
additional fingerprints it shall so notify the applicant and shall
request the applicant to submit any fingerprints which may be
required to effect identification including a complete set if
necessary or alternatively to abandon the application and request
a refund of all or a portion of the fee submitted with the
application as provided in this section If the app2icant fails or
refuses to submit fingerprints in accordance with the department s
request within a reasonable time which shall be established by the
department or if the applicant requests a refund of the fee the
department shall promptly mail a refund to the applicant at the
address specified in the application or at any other address which
may be specified by the applicant However if the department has
notified the applicant that election to abandon the application will
result in forfeiture of a specified amount which is a portion of the
fee the department may retain a portion of the fee which the
department determines will defray the actual costs of processing the
application provided the amount of the portion retained shall not
exceed ten dollars 10
Upon receipt of a sufficient app2ication the Department of
Justice shall destroy records of the department if any pertaining
to the arrest or conviction in the manner prescribed by subdivision
c and shall notify the Federal Bureau of Investigation the law
enforcement agency which arrested the applicant and if the
applicant was convicted the probation department which investigated
the applicant and the Department of Motor vehicles of the
application
c Destruction of records of arrest or conviction pursuant to
subdivision a or b shall be accomplished by permanent
obliteration of all entries or notations upon the records pertaining
to the arrest or conviction and the record shall be prepared again
so that it appears that the arrest or conviction never occurred
However where 1 the only entries upon the record pertain to the
arrest or conviction and 2 the record can be destroyed without
necessarily effecting the destruction of other records then the
document constituting the record shall be physically destroyed
d Notwithstanding subdivision a or b written transcriptions
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of oral testimony in court proceedings and published judicial
appellate reports are not subject to this section Additionally no
records shall be destroyed pursuant to subdivision a if the
defendant or a codefendant has filed a civil action against the peace
officers or law enforcement jurisdiction which made the arrest or
instituted the prosecution and if the agency which is the custodian
of those records has received a certified copy of the complaint in
the civil action until the civil action has finally been resolved
Immediately following the final resolution of the civil action
records subject to subdivision a shall be destroyed pursuant to
subdivision c if more than two years have elapsed from the date of
the conviction or arrest without conviction
11361 7 a Any record subject to destruction or permanent
obliteration pursuant to Section 11361 5 or more than two years of
age or a record of a conviction for an offense specified in
subdivision a or b of Section 11361 5 which became final more
than two years previously shall not be considered to be accurate
relevant timely or complete for any purposes by any agency or
person The provisions of this subdivision shall be applicable for
purposes of the Privacy Act of 1974 5 USC Section 552a to the
fullest extent permissible by law whenever any information or recorfl
subject to destruction or permanent obliteration under Section
11361 5 was obtained by any state agency local public agency or any
public or private agency that provides services upon referral under
Section 1000 2 of the Penal Code and is thereafter shared with or
disseminated to any agency of the federal government
b No public agency shall alter amend assess condition deny
limit postpone quali y revoke surcharge or suspend any
certificate franchise incident interest license opportunity
permit privilege right or title of any person because of an arrest
or conviction for an offense specified in subdivision a or b of
Section 11361 5 or because of the facts or events leading to such an
arrest or conviction on or after the date the records of such
arrest or conviction are required to be destroyed by subdivision a
of Section 11361 5 or two years from the date of such conviction or
arrest without conviction with respect to arrests and convictions
occurring prior to January 1 1976 As used in this subdivision
public agency includes but is not limited to any state county
city and county city public or constitutional corporation or
entity district local or regional political subdivision or any
department division bureau office board commission or other
agency thereof
c Any person arrested or convicted for an offense specified in
subdivision a or b of Section 11361 5 may two years from the
date of such a conviction or from the date of the arrest if there
was no conviction indicate in response to any question concerning
his prior criminal record that he was not arrested or convicted for
such offense
d The provisions of this section shall be applicable without
regard to whether destruction or obliteration of records has actually
been implemented pursuant to Section 12361 5
11362 As used in this article felony offense and offense
punishable as a felony refer to an offense for which the law
prescribes imprisonment in the state prison as either an alternative
or the sole penalty regardless of the sentence the particular
defendant received
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11362 As used in this article felony offense and offense
punishable as a felony refer to an offense prior to July 1 2011
for which the law prescribes imprisonment in the state prison or for
an offense on or after July 1 2011 imprisonment in either the
state prison or pursuant to subdivision h of Section 1170 of the
Penal Code as either an alternative or the sole penalty regardless
of the sentence the particular defendant received
11362 5 a This section shall be known and may be cited as the
Compassionate Use Act of 1996
b 1 The people of the State of California hereby find and
declare that the purposes of the Compassionate Use Act of 1996 are as
follows
A To ensure that seriously ill Californians have the right to
obtain and use marijuana for medical purposes where that medical use
is deemed appropriate and has been recommended by a physician who has
determined that the person
health would benefit from the use of
marijuana in the treatment of cancer anorexia AIDS chronic pain
spasticity glaucoma arthritis migraine or any other illness for
which marijuana provides relief
B To ensure that patients and their primary caregivers who
obtain and use marijuana for medical purposes upon the recommendation
of a physician are not subject to criminal prosecution or sanction
C To encourage the federal and state governments to implement a
plan to provide for the safe and affordable distribution of marijuana
to all patients in medical need of marijuana
2 Nothing in this section shall be construed to supersede
legislation prohibiting persons from engaging in conduct that
endangers others nor to condone the diversion of marijuana for
nonmedical purposes
c Notwithstanding any other provision of law no physician in
this state shall be punished or denied any right or privilege for
having recommended marijuana to a patient for medical purposes
d Section 11357 relating to the possession of marijuana and
Section 11358 relating to the cultivation of marijuana shall not
apply to a patient or to a patient s primary caregiver who
possesses or cultivates marijuana for the personal medical purposes
of the patient upon the written or oral recommendation or approval of
a physician
e For the purposes of this section primary caregiver means
the individual designated by the person exempted under this section
who has consistently assumed responsibility for the housing health
or safety of that person
11362 9 a 1 It is the intent of the Legislature that the state
commission objective scientific research by the premier research
institute of the world the University of California regarding the
efficacy and safety of administering marijuana as part of inedical
treatment If the Regents of the University of California by
appropriate resolution accept this responsibility the University of
California shall create a program to be known as the California
Marijuana Research Program
2 The program shall develop and conduct studies intended to
ascertain the general medical safety and efficacy of marijuana and
if found valuable shall develop medical guidelines for the
appropriate administration and use of marijuana
b The program may immediately solicit proposals for research
projects to be included in the marijuana studies Program
requirements to be used when evaluating responses to its solicitation
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for proposals shall include but not be limited to all of the
following
1 Proposals shall demonstrate the use of key personnel
including clinicians or scientists and support personnel who are
prepared to develop a program of research regarding marijuana s
general medical efficacy and safety
2 Proposals shall contain procedures for outreach to patients
with various medical conditions who may be suitable participants in
research on marijuana
3 Proposals shall contain provisions for a patient registry
4 Proposals shall contain provisions for an information system
that is designed to record information about possible study
participants investigators and clinicians and deposit and analyze
data that accrues as part of clinical trials
5 Proposals shall contain protocols suitable for research on
marijuana addressing patients diagnosed with the acquired
immunodeficiency syndrome AIDS or the human immunode iciency virus
HIV cancer glaucoma or seizures or muscle spasms associated with
a chronic debilitating condition The proposal may also include
research on other serious illnesses provided that resources are
available and medical inEormation justifies the research
6 Proposals shall demonstrate the use of a specimen laboratory
capable of housing plasma urine and other specimens necessary to
study the concentration of cannabinoids in various tissues as well
as housing specimens for studies of toxic effects of marijuana
7 Proposals shall demonstrate the use of a laboratory capable of
analyzing marijuana provided to the program under this section for
purity and cannabinoid content and the capacity to detect
contaminants
c In order to ensure objectivity in evaluating proposals the
program shall use a peer review process that is modeled on the
process used by the National Institutes of Health and that guards
against funding research that is biased in favor of or against
particular outcomes Peer reviewers shall be selected for their
expertise in the scientific substance and methods of the proposed
research and their lack of bias or conflict of interest regarding
the applicants or the topic of an approach taken in the proposed
research Peer reviewers shall judge research proposals on several
criteria foremost among which shall be both of the following
1 The scientific merit of the research plan including whether
the research design and experimental procedures are potentially
biased for or against a particular outcome
2 Researchers expertise in the scientific substance and methods
oE the proposed research and their lack of bias or conflict of
interest regarding the topic of and the approach taken in the
proposed research
d If the program is administered by the Regents oE the
University of California any grant research proposals approved by
the program shall also require review and approval by the research
advisory panel
e It is the intent of the Legislature that the program be
established as follows
1 The program shall be located at one or more University of
California campuses that have a core oE faculty experienced in
organizing multidisciplinary scientific endeavors and in particular
strong experience in clinical trials involving psychopharmacologic
agents The campuses at which research under the auspices of the
program is to take place shall accommodate the administrative
offices including the director of the program as well as a data
management unit and facilities for storage of specimens
2 When awarding grants under this section the program shall
utilize principles and parameters of the other well tested statewide
research programs administered by the University of California
modeled after programs administered by the National Institutes of
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Health including peer review evaluation of the scientific merit of
applications
3 The scientific and clinical operations of the program shall
occur partly at University of California campuses and partly at
other postsecondary institutions that have clinicians or scientists
with expertise to conduct the required studies Criteria for
selection of research locations shall include the elements listed in
subdivision b and additionally shall give particular weight to
the organizational plan leadership qualities of the program
director and plans to involve investigators and patient populations
from multiple sites
4 The funds received by the program shall be allocated to
various research studies in accordance with a scientific plan
developed by the Scientific Advisory Council As the first wave of
studies is completed it is anticipated that the program will receive
requests for funding of additional studies These requests shall be
reviewed by the Scientific Advisory Council
5 The size scope and number of studies funded shall be
commensurate with the amount of appropriated and available program
funding
f All personnel involved in implementing approved proposals
shall be authorized as required by Section 11604
g Studies conducted pursuant to this section shall include the
greatest amount oE new scientific research possible on the medical
uses of and medical hazards associated with marijuana The program
shall consult with the Research Advisory Panel analogous agencies in
other states and appropriate federal agencies in an attempt to avoid
duplicative research and the wasting of research dollars
h The program shall make every effort to recruit qualified
patients and qualified physicians from throughout the state
i The marijuana studies shall employ state of the art research
methodologies
j The program shall ensure that all marijuana used in the
studies is of the appropriate medical quality and shall be obtained
from the National Institute on Drug Abuse or any other federal agency
designated to supply marijuana for authorized research If these
federal agencies fail to provide a supply of adequate quality and
quantity within six months of the effective date of this section the
Attorney General shall provide an adequate supply pursuant to
Section 11478
k The program may review approve or incorporate studies and
research by independent groups presenting scientifically valid
protocols for medical research regardless of whether the areas of
study are being researched by the committee
1 1 To enhance understanding of the efficacy and adverse
effects of marijuana as a pharmacological agent the program shall
conduct focused controlled clinical trials on the usefulness of
marijuana in patients diagnosed with AIDS or HIV cancer glaucoma
or seizures or muscle spasms associated with a chronic debilitating
condition The program may add research on other serious illnesses
provided that resources are available and medical information
justifies the research The studies shall focus on comparisons of
both the efficacy and saEety of inethods of administering the drug to
patients including inhalational tinctural and oral evaluate
possible uses of marijuana as a primary or adjunctive treatment and
develop further information on optimal dosage timing mode of
administration and variations in the effects of different
cannabinoids and varieties of marijuana
2 The program shall examine the safety of marijuana in patients
with various medical disorders including marijuana s interaction
with other drugs relative safety of inhalation versus oral forms
and the effects on mental function in medically ill persons
3 The program shall be limited to providing for objective
scientific research to ascertain the efficacy and safety of marijuana
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as part of inedical treatment and should not be construed as
encouraging or sanctioning the social or recreational use oE
marijuana
m 1 Subject to paragraph 2 the program shall prior to any
approving proposals seek to obtain research protocol guidelines from
the National Institutes of Health and shall if the National
Institutes of Health issues research protocol guidelines comply with
those guidelines
2 If after a reasonable period of time of not less than six
months and not more than a year has elapsed from the date the program
seeks to obtain guidelines pursuant to paragraph 1 no guidelines
have been approved the program may proceed using the research
protocol guidelines it develops
n In order to maximize the scope and size of the marijuana
studies the program may do any of the following
1 Solicit apply for and accept funds from foundations private
individuals and all other funding sources that can be used to
expand the scope or timeframe of the marijuana studies that are
authorized under this section The program shall not expend more than
5 percent of its General Fund allocation in efforts to obtain money
from outside sources
2 include within the scope of the marijuana studies other
marijuana research projects that are independently funded and that
meet the requirements set forth in subdivisions a to c
inclusive In no case shall the program accept any funds that are
offered with any conditions other than that the funds be used to
study the efficacy and safety of marijuana as part oE medical
treatment Any donor shall be advised that funds given for purposes
of this section will be used to study both the possible benefits and
detriments of marijuana and that he or she will have no control over
the use of these funds
o 1 Within six months of the effective date of this section
the program shall report to the Legislature the Governor and the
Attorney General on the progress of the marijuana studies
2 Thereafter the program shall issue a report to the
Legislature every six months detailing the progress of the studies
The interim reports required under this paragraph shall include but
not be limited to data on all of the following
A The names and number of diseases or conditions under study
B The number of patients enrolled in each study by disease
C Any scientifically valid preliminary findings
p If the Regents of the University of California implement this
section the President of the University of California shall appoint
a multidisciplinary Scienti ic Advisory Council not to exceed 15
members to provide policy guidance in the creation and
implementation of the program Members shall be chosen on the basis
of scientific expertise Members of the council shall serve on a
voluntary basis with reimbursement for expenses incurred in the
course of their participation The members shall be reimbursed for
travel and other necessary expenses incurred in their performance of
the duties o the council
q No more than 10 percent of the total funds appropriated may be
used for all aspects of the administration of this section
r This section shall be implemented only to the extent that
funding for its purposes is appropriated by the Legislature in the
annual Budget Act
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HEALTH AND SAFETY CODE
SECTION 711362 83
11362 7 For purposes of this article the following definitions
shall apply
a Attending physician means an individual who possesses a
license in good standing to practice medicine or osteopathy issued by
the Medical Board of California or the Osteopathic Medical Board of
California and who has taken responsibility for an aspect of the
medical care treatment diagnosis counseling or referral of a
patient and who has conducted a medical examination of that patient
before recording in the patient s medical record the physician
assessment o whether the patient has a serious medical condition and
whether the medical use of marijuana is appropriate
b Department means the State Department of Aealth Services
c Person with an identification card means an individual who
is a qualified patient who has applied for and received a valid
identification card pursuant to this article
d Primary caregiver means the individual designated by a
qualified patient or by a person with an identification card who has
consistently assumed responsibility for the housing health or
safety of that patient or person and may include any of the
following
1 In any case in which a qualified patient or person with an
identification card receives medical care or supportive services or
both from a clinic licensed pursuant to Chapter1commencing with
Section 1200 of Division 2 a health care facility licensed pursuant
to Chapter2commencing with Section 1250 of Division 2 a
residential care facility for persons with chroniclife
threatening
illness licensed pursuant to Chapter 301 commencing with Section
1568 01 of Division 2 a residential care facility for the elderly
licensed pursuant to Chapter 32 commencing with Section 1569 of
Division 2 a hospice or a home health agency licensed pursuant to
Chapter8commencing with Section 1725 of Division 2 the owner or
operator or no more than three employees who are designated by the
owner or operator of the clinic facility hospice or home health
agency if designated as a primary caregiver by that qualified
patient or person with an identification card
2 An individual who has been designated as a primary caregiver
by more than one qualified patient or person with an identification
card i every qualified patient or person with an identification
card who has designated that individual as a primary caregiver
resides in the same city or county as the primary caregiver
3 An individual who has been designated as a primary caregiver
by a qualified patient or person with an identification card who
resides in a city or county other than that of the primary caregiver
if the individual has not been designated as a primary caregiver by
any other qualified patient or person with an identification card
e A primary caregiver shall be at least 18 years of age unless
the primary caregiver is the parent of a minor child who is a
quali ied patient or a person with an identification card or the
primary caregiver is a person otherwise entitled to make medical
decisions under state law pursuant to Sections 6922 7002 7050 or
7120 of the Family Code
f Qualified patient means a person who is entitled to the
protections of Section 11362 5 but who does not have an
identification card issued pursuant to this article
g Identification card means a document issued by the State
Department of Health Services that document identifies a person
authorized to engage in the medical use of marijuana and the person
designated primary caregiver if any
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h Serious medical condition means
conditions
1 Acquired immune deficiency syndrome AIDS
2 Anorexia
3 Arthritis
4 Cachexia
5 Cancer
6 Chronic pain
7 Glaucoma
all o the following medical
8 Migraine
9 Persistent muscle spasms including but not limited to
spasms associated with multiple sclerosis
10 Seizures including but not limited to seizures associated
with epilepsy
11 Severe nausea
12 Any other chronic or persistent medical symptom that either
A Substantially limits the ability of the person to conduct one
or more major life activities as defined in the Americans with
Disabilities Act of 1990 Public Law 101 336
B If not alleviated may cause serious harm to the patient s
safety or physical or mental health
i Written documentation means accurate reproductions of those
portions of a patient s medical records that have been created by the
attending physician that contain the information required by
paragraph 2 of subdivision a of Section 11362 715 and that the
patient may submit to a county health department or the county s
designee as part of an application for an identification card
11362 71 a 1 The department shall establish and maintain a
voluntary program for the issuance of identification cards to
qualified patients who satisfy the requirements of this article and
voluntarily apply to the identification card program
2 The department shall establish and maintain a 24 hour
toll free telephone number that will enable state and ocal law
enforcement officers to have immediate access to information
necessary to verify the validity of an identification card issued by
the department until a cost effective Internet Web based system can
be developed for this purpose
b Every county health department or the county s designee
shall do all of the following
1 Provide applications upon request to individuals seeking to
join the identi ication card program
2 Receive and process completed applications in accordance with
Section 11362 72
3 Maintain records of identification card programs
4 Utilize protocols developed by the department pursuant to
paragraph 1 of subdivision d
5 Issue identification cards developed by the department to
approved applicants and designated primary caregivers
c The county board of supervisors may designate another
health related governmental or nongovernmental entity or organization
to perform the functions described in subdivision b except for an
entity or organization that cultivates or distributes marijuana
d The department shall develop all of the following
1 Protocols that shall be used by a county health department or
the county s designee to implement the responsibilities described in
subdivision b including but not limited to protocols to confirm
the accuracy of information contained in an application and to
protect the confidentiality of program records
2 Application forms that shall be issued to requesting
applicants
3 An identification card that identifies a person authorized to
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711362 83 Page 3 of 10
engage in the medical use of marijuana and an identification card
that identifies the person
designated primary caregiver if any
The two identification cards developed pursuant to this paragraph
shall be easily distinguishable rom each other
e No person or designated primary caregiver in possession of a
valid identification card shall be subject to arrest for possession
transportation delivery or cultivation of inedical marijuana in an
amount established pursuant to this article unless there is
reasonable cause to believe that the information contained in the
card is false or falsified the card has been obtained by means of
Eraud or the person is otherwise in violation of the provisions of
this article
f It shall not be necessary for a person to obtain an
identification card in order to claim the protections of Section
11362 5
11362 715
a A person who seeks an identification card shall pay
the fee as provided in Section 11362 755 and provide all of the
following to the county health department or the county s designee on
a form developed and provided by the department
1 The name of the person and proof of his or her residency
within the county
2 Written documentation by the attending physician in the person
s medical records stating that the person has been diagnosed with a
serious medical condition and that the medical use of marijuana is
appropriate
3 The name office address office telephone number and
California medical license number of the person
attending
physician
4 The name and the duties of the primary caregiver
5 A government issued photo identification card of the person
and of the designated primary caregiver if any If the applicant is
a person under 18 years of age a certified copy of a birth
certificate shall be deemed sufficient proof of identity
b If the person applying for an identification card lacks the
capacity to make medical decisions the application may be made by
the person
legal representative including but not limited to any
of the following
1 A conservator with authority to make medical decisions
2 An attorney in fact under a durable power of attorney for
health care or surrogate decisionmaker authorized under another
advanced health care directive
3 Any other individual authorized by statutory or decisional law
to make medical decisions for the person
c The legal representative described in subdivision b may also
designate in the application an individual including himself or
herself to serve as a primary caregiver for the person provided
that the individual meets the definition of a primary caregiver
d The person or legal representative submitting the written
information and documentation described in subdivision a shall
retain a copy thereof
11362 72
a Within 30 days of receipt of an application for an
identification card a county health department or the county s
designee shall do all of the following
1 For purposes of processing the application verify that the
in ormation contained in the application is accurate If the person
is less than 18 years of age the county health department or its
designee shall also contact the parent with legal authority to make
medical decisions legal guardian or other person or entity with
legal authority to make medical decisions to verify the information
2 veriEy with the Medical Board of California or the Osteopathic
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711362 83 Page 4 of 10
Medical Board of California that the attending physician has a
license in good standing to practice medicine or osteopathy in the
state
3 Contact the attending physician by facsimile telephone or
mail to confirm that the medical records submitted by the patient are
a true and correct copy of those contained in the physician
office
records when contacted by a county health department or the county
s designee the attending physician shall confirm or deny that the
contents of the medical records are accurate
4 Take a photograph or otherwise obtain an electronically
transmissible image of the applicant and of the designated primary
caregiver if any
5 Approve or deny the application If an applicant who meets the
requirements of Section 11362 715 can establish that an
identification card is needed on an emergency basis the county or
its designee shall issue a temporary identification card that shall
be valid for 30 days from the date of issuance The county or its
designee may extend the temporary identification card for no more
than 30 days at a time so long as the applicant continues to meet
the requirements of this paragraph
b If the county health department or the county s designee
approves the application it shall within 24 hours or by the end of
the next working day of approving the application electronically
transmit the following information to the department
1 A unique user identification number of the applicant
2 The date of expiration of the identification card
3 The name and telephone number of the county health department
or the county s designee that has approved the application
c The county health department or the county s designee shall
issue an identification card to the applicant and to his or her
designated primary caregiver if any within five working days of
approving the application
d In any case involving an incomplete application the applicant
shall assume responsibility for rectifying the deficiency The
county shall have 14 days from the receipt of information from the
applicant pursuant to this subdivision to approve or deny the
application
11362 735
a An identification card issued by the county health
department shall be serially numbered and shall contain all of the
following
1 A unique user identification number of the cardholder
2 The date o expiration of the identification card
3 The name and telephone number of the county health department
or the county s designee that has approved the application
4 7a 24 hour toll free telephone number to be maintained by the
department that will enable state and local law enforcement
officers to have immediate access to information necessary to verify
the validity of the card
5 Photo identification of the cardholder
b A separate identification card shall be issued to the person
designated primary caregiver if any and shall include a photo
identification of the caregiver
11362 74
a The county health department or the county s designee
may deny an application only for any of the following reasons
1 The applicant did not provide the information required by
Section 21362 715 and upon notice of the deficiency pursuant to
subdivision d of Section 11362 72 did not provide the information
within 30 days
2 The county health department or the county s designee
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determines that the information provided was false
3 The applicant does not meet the criteria set forth in this
article
b Any person whose application has been denied pursuant to
subdivision a may not reapply for six months from the date of
denial unless otherwise authorized by the county health department or
the county s designee or by a court of competent jurisdiction
c 7ny person whose application has been denied pursuant to
svbdivision a may appeal that decision to the department The
county health department or the county s designee shall make
available a telephone munber or address to which the denied applicant
can direct an appeal
11362 745 a An identification card shall be valid for a period
of one year
b Upon annual renewal of an identification card the county
health department or its designee shall verify all new information
and may verify any other information that has not changed
c The county health department or the county s designee shall
transmit its determination of approval or denial of a renewal to the
department
11362 755
a The department shall establish application and
renewal fees for persons seeking to obtain or renew identification
cards that are sufficient to cover the expenses incurred by the
department including the startup cost the cost of reduced fees for
Medi Cal beneficiaries in accordance with subdivision b the cost
of identifying and developing a cost effective Internet web based
system and the cost of maintaining the 24 hour toll free telephone
number Each county health department or the county s designee may
charge an additional fee for all costs incurred by the county or the
county s designee for administering the program pursuant to this
article
b Upon satisfactory proof of participation and eligibility in
the Medi Cal program a Medi Cal beneficiary shall receive a 50
percent reduction in the fees established pursuant to this section
11362 76 a A person who possesses an identification card shall
1 Within seven days notify the county health department or the
county s designee of any change in the person
attending physician
or designated primary caregiver if any
2 Annually submit to the county health department or the county
s designee the following
A Updated written documentation of the person
serious medical
condition
B The name and duties of the person
designated primary
caregiver if any for the forthcoming year
b If a person who possesses an identification card fails to
comply with this section the card shall be deemed expired If an
identification card expires the identification card of any
designated primary caregiver of the person shall also expire
c If ttxe designated primary caregiver has been changed the
previous primary caregiver shall return his or her identification
card to the department or to the county health department or the
county s designee
d If the owner or operator or an employee of the owner or
operator oE a provider has been designated as a primary caregiver
pursuant to paragraph 1 of subdivision d of Section 11362 7 of
the qualified patient or person with an identification card the
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owner or operator shall notify the county health department or the
county s designee pursuant to Section 11362 715 iE a change in the
designated primary caregiver has occurred
11362 765 a Subject to the requirements of this article the
individuals specified in subdivision b shall not be subject on
that sole basis to criminal liability under Section 1135 7 11358
11359 11360 11366 11366 5 or 11570 However nothing in this
section shall authorize the individual to smoke or otherwise consume
marijuana unless otherwise authorized by this article nor shall
anything in this section authorize any individual or group to
cultivate or distribute marijuana for profit
b Subdivision a shall apply to all of the following
1 A qualified patient or a person with an identification card
who transports or processes marijuana for his or her own personal
medical use
2 A designated primary caregiver who transports processes
administers delivers or gives away marijuana for medical purposes
in amounts not exceeding those established in subdivision a of
Section 11362 77 only to the qualified patient of the primary
caregiver or to the person with an identification card who has
designated the individual as a primary caregiver
3 Any individual who provides assistance to a qualified patient
or a person with an identification card or his or her designated
primary caregiver in administering medical marijuana to the
qualified patient or person or acquiring the skills necessary to
cultivate or administer marijuana for medical purposes to the
qualified patient or person
c A primary caregiver who receives compensation for actual
expenses including reasonable compensation incurred for services
provided to an eligible qualified patient or person with an
identification card to enable that person to use marijuana under this
article or for payment for out of pocket expenses incurred in
providing those services or both shall not on the sole basis of
that fact be subject to prosecution or punishment under Section
11359 or 11360
11362 768 a This section shall apply to individuals specified in
subdivision b of Section 11362 765
b No medical marijuana cooperative collective dispensary
operator establishment or provider who possesses cultivates or
distributes medical marijuana pursuant to this article shall be
located within a 600 foot radius of a school
c The distance specified in this section shall be the horizontal
distance measured in a straight line from the property line of the
school to the closest property line of the lot on which the medical
marijuana cooperative collective dispensary operator
establishment or provider is to be located without regard to
intervening structures
d This section shall not apply to a medical marijuana
cooperative collective dispensary operator establishment or
provider that is also a licensed residential medical or elder care
facility
e This section shall apply only to a medical marijuana
cooperative collective dispensary operator establishment or
provider that is authorized by law to possess cultivate or
distribute medical marijuana and that has a storefront or mobile
retail outlet which ordinarily requires a local business license
f Nothing in this section shall prohibit a city county or city
and county from adopting ordinances or policies that further
restrict the location or establishment of a medical marijuana
cooperative collective dispensary operator establishment or
provider
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g Nothing in this section shall preempt local ordinances
adopted prior to January 1 2011 that regulate the location or
establishment of a medical marijuana cooperative collective
dispensary operator establishment or provider
h For the purposes of this section school means any public or
private school providing instruction in kindergarten or grades 1 to
12 inclusive but does not include any private school in which
education is primarily conducted in private homes
11362 77
a A qualified patient or primary caregiver may possess
no more than eight ounces of dried marijuana per qualified patient
In addition a qualified patient or primary caregiver may also
maintain no more than six mature or 12 immature marijuana plants per
qualified patient
b If a qualified patient or primary caregiver has a doctor s
recommendation that this quantity does not meet the qualified patient
s medical needs the qualified patient or primary caregiver may
possess an amount of marijuana consistent with the patient s needs
c Counties and cities may retain or enact medical marijuana
guidelines allowing qualified patients or primary caregivers to
exceed the state limits set forth in subdivision a
d Only the dried mature processed flowers of female cannabis
plant or the plant conversion shall be considered when determining
allowable quantities of marijuana under this section
e The Attorney General may recommend modifications to the
possession or cultivation limits set forth in this section These
recommendations if any shall be made to the Legislature no later
than December l 2005 and may be made only after public comment and
consultation with interested organizations including but not
limited to patients health care professionals researchers law
enforcement and local governments Any recommended modification
shall be consistent with the intent of this article and shall be
based on currently available scientific research
f A qualified patient or a person holding a valid identification
card or the designated primary caregiver of that qualified patient
or person may possess amounts of marijuana consistent with this
article
11362 775 Qualified patients persons with valid identification
cards and the designated primary caregivers of qualified patients
and persons with identification cards who associate within the State
of California in order collectively or cooperatively to cultivate
marijuana for medical purposes shall not solely on the basis of that
fact be subject to state criminal sanctions under Section 11357
11358 11359 11360 11366 11366 5 or 11570
11362 78 A state or local law enforcement agency or officer shall
not refuse to accept an identification card issued by the department
tnless the state or local law enforcement agency or officer has
reasonable cause to believe that the information contained in the
card is false or fraudulent or the card is being used fraudulently
11362 785
a Nothing in this article shall require any
accommodation of any medical use of marijuana on the property or
premises of any place of employment or during the hours of employment
or on the property or premises of any jail correctional facility
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or other type of penal institution in which prisoners reside or
persons under arrest are detained
b Notwithstanding subdivision a a person shall not be
prohibited or prevented from obtaining and submitting the written
information and documentation necessary to apply for an
identification card on the basis that the person is incarcerated in a
jail correctional facility or other penal institution in which
prisoners reside or persons under arrest are detained
c Nothing in this article shall prohibit a jail correctional
facility or other penal institution in which prisoners reside or
persons under arrest are detained from permitting a prisoner or a
person under arrest who has an identification card to use marijuana
for medical purposes under circiunstances that will not endanger the
health or safety of other prisoners or the security of the Eacility
d Nothing in this article shall require a governmental private
or any other health insurance provider or health care service plan
to be liable for any claim for reimbursement for the medical use of
marijuana
11362 79 Nothing in this article shall authorize a qualified
patient or person with an identification card to engage in the
smoking of inedical marijuana under any of the following
circumstances
a In any place where smoking is prohibited by law
b In or within 1000 feet of the grounds of a school recreation
center or youth center unless the medical use occurs within a
residence
c On a
schoolbus
d While in a motor vehicle that is being operated
e While operating a boat
11362 795
a 1 Any criminal defendant who is eligible to use
marijuana pursuant to Section 11362 5 may request that the court
confirm that he or she is allowed to use medical marijuana while he
or she is on probation or released on bail
2 The court s decision and the reasons for the decision shall be
stated on the record and an entry stating those reasons shall be
made in the minutes of the court
3 During the period of probation or release on bail if a
physician recommends that the probationer or defendant use medical
marijuana the probationer or defendant may request a modification o
the conditions of probation or bail to authorize the use of inedical
marijuana
4 The court s consideration of the modification request
authorized by this subdivision shall comply with the requirements of
this section
b 1 Any person who is to be released on parole from a jail
state prison school road camp or other state or local institution
of confinement and who is eligible to use medical marijuana pursuant
to Section 11362 5 may request that he or she be allowed to use
medical marijuana during the period he or she is released on parole
A parolee s written conditions of parole shall reflect whether or not
a request for a modification of the conditions of his or her parole
to use medical marijuana was made and whether the request was
granted or denied
2 During the period of the parole where a physician recommends
that the parolee use medical marijuana the parolee may request a
modification of the conditions of the parole to authorize the use of
medical marijuana
3 Any parolee whose request to use medical marijuana while on
parole was denied may pursue an administrative appeal of the
decision Any decision on the appeal shall be in writing and shall
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CA Codeshsc
711362 83 Page 9 of 10
reflect the reasons for the decision
4 The administrative consideration of the modification request
authorized by this subdivision shall comply with the requirements of
this section
11362 8 No professional licensing board may impose a civil penalty
or take other disciplinary action against a licensee based solely on
the fact that the licensee has performed acts that are necessary or
appropriate to carry out the licensee
role as a designated primary
caregiver to a person who is a qualified patient or who possesses a
lawful identification card issued pursuant to Section i1362 72
Iowever this section shall not apply to acts performed by a
physician relating to the discussion or recommendation of the medical
use of marijuana to a patient These discussions or recommendations
or both shall be governed by Section 11362 5
11362 81 a A person specified in subdivision b shall be
subject to the following penalties
1 For the irst offense imprisonment in the county jail for no
more than six months oraine not to exceed one thousand dollars
1000 or both
2 For a second or subsequent offense imprisonment in the county
jail for no more than one year or a fine not to exceed one thousand
dollars1000 or both
b Subdivision a applies to any of the following
i A person who fraudulently represents a medical condition or
fraudulently provides any material misinEOrmation to a physician
county health department or the county s designee or state or local
law enforcement agency or officer for the purpose of falsely
obtaining an identification card
2 A person who steals or fraudulently uses any person
identification card in order to acquire possess cultivate
transport use produce or distribute marijuana
3 A person who counterfeits tampers with or fraudulently
produces an identification card
4 A person who breaches the confidentiality requirements of this
article to information provided to or contained in the records of
the department or of a county health department or the county s
designee pertaining to an identification card program
c In addition to the penalties prescribed in subdivision a
any person described in subdivision b may be precluded from
attempting to obtain or obtaining or using an identification card
for a period of up to six months at the discretion of the court
d In addition to the requirements of this article the Attorney
General shall develop and adopt appropriate guidelines to ensure the
security and nondiversion of marijuana grown for medical use by
patients qualified under the Compassionate Use act of 1996
11362 82 If any section subdivision sentence clause phrase or
portion of this article is for any reason held invalid or
unconstitutional by any court of competent jurisdiction that portion
shall be deemed a separate distinct and independent provision and
that holding shall not affect the validity of the remaining portion
thereof
11362 93 Nothing in this article shall prevent a city or other
local governing body from adopting and enforcing laws consistent with
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this article
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C Health and Medical Publications and
Reports on Marijuana
Center for Medicinal Cannabis Research Report
2010
Anesthesia Journal Cannabis for Chronic Pain
2004
Journal of Pain and Symptom Management
Article 2010
National Institute on
Drug Abuse
Abuse
National Institute on
Drug Abuse
Facts for Parent
Marijuana
Marijuana
National Institute on
Drug Abuse Marijuana
Facts for Teens
Science Daily Cannabis Damages Young
Brains 2009
Office of National Drug Control Policy
Marijuana As Medicine 2003
Eye
Care America Marijuana
of Glaucoma
in the Treatment

I
CMCR
I Center for Medicinal Cannabis Research
N
JI N
F N
0
Universiry oF Cali fornia
ETER FORI
ANNABIS ESE C
Report to the Legislature and Governor of the Sta e ofCalifornia
presenting findings pursuant io 58847 which created the CMCR and provided state funding
Director
Igor Grant MD
University ofCalifornia San Diego
Co Directors
J Hampton Atkinson MD
Andrew Mattison Ph D
University of California San Diego
Thomas J Coates Ph D
University ofCalifornia Los Angeles
Deceased
3d
UC SanDiega Prepared February il 2010 University of California www cmccucsd edu
FFEALTH SCIENCES

Objective
In 1999 the California legislature passed and Governor Gray Davis signed 56847 which commis
sioned the University of California to establish a scientific research program to expand the public
scientific knowledge on purported therapeutic usages of marijuana
We hereby submit this report of our scientific findings pursuant to this objective
WWW CMCR UCSD EDU FEBRUAFV 11 2010

Table of Contents
ExecutiveSummary 2
Summaryof Results to Date2
OtherCMCR Activities3
Condusion 4
MissionStatement4
Scientific and Legislative Precursors of the CMCR5
Discovery ofCannabis Receptors in the Brain5
ScientificReports5
LegislativeOrigins5
CMCRReview Process6
GMCR Vision for Cannabis Therepeutics Research 7
Stagel Smoked Cannabis7
Stage 11Non Smoked Preparations7
Stage lll Molecules To Target Endocannabinoid System7
Overview of Research Program8
Studies in Pain and Other Neurologic Conditions8
Synopsis of CMCR Published Clinical Study Results10
The Effect of Cannabis on Neuropathic Pain inHIV Related Peripheral
Neu ropa thy
10
Placebo Controlled Double Blind Trial of Medicinal Cannabis in Painful HIV
Neuropathy
10
4 Double BlindPlacebo Controlled CrossoverTrial of the Antinociceptive Effects
ofSmoked Marijuana on Subjects with Neuropathic Pain 11
4nalgesic Efficacy ofSmaked Cannabis 11
Short Term Effects of Cannabis Therapy on Spasticiry in Multiple Sclerosis 12
Uaporization asaSmokeless DeliverySystem 11
Recently Completed And Ongoing Studies13
Sleep and Medicinal Cannabis 13
Impact ofRepeated Cannabis Treatments on
DrivingAbilities 13
Efficacyoflnhaled Cannabis in Diabetic Painful Peripheral Neuropathy 13
The Analgesic Effect of Vaporized Cannabis on Neuropathic Pain 13
CompletedPre Clinical Studies14
Mechanisms ofCannabinoid Analgesia 14
annabinoids in Fear Extinction 14
Effects of Cannabis Therapy on Endogenous Cannabinoids 14
Effec s ofMedicinal Cannabis on CD4lmmuniry in AIDS
I S
DiscontinuedStudies15
Summary And Future Directions16
CMCRRoster17
CMCRSupported Publications18
Resultsof CMCR Studies 18
PublishedAbstracts 18
OtherCMCRions 19
Supported Publica
CENTER FOR MEDIUNAL CANNABIS RESEARCH UNNER9TV OF CALIFOflNIA

Research should continue into the physiological effects of synthetic and
plant derived cannabinoids and the natural function of cannabinoids found
in the body
InstitureofMedicine 1999
The question of whether marijuana has any legitimate medical purpose
should be determined by sound science and medicine
Asa Hutchinson Former DEA Administrator 2001
The scientific community the medical community in particular is divided
on the real therapeutic effectiveness of marijuana Some are quick to say
that opening the door to medical marijuana would be a step toward outright
legalization of the substance But none of that should matter to physi
cians or scientists It is not a question of defending general public policy on
marijuana or even all illegal drugs It is not a question of sending a symbolic
message about drugs It is not a question of being afraid that young people
will use marijuana if it is approved as a medicine The question and the only
question for physicians as professionals is whether to what extent and in
what circumstances marijuana serves a therapeutic purpose
Canadian Senate Special Committee On Illegal Drugs Cannabis Summary Report 2002
Although the indications for some conditionseg HIV wasting and
chemotherapy induced nausea and vomiting have been well documented
less information is available about other potential medical uses Additional
research is needed to clarify marijuana s therapeutic properties and deter
mine standard and optimal doses and routes of delivery
American College of Physicians 2008
The Center for Medicinal Cannabis Research is currently conducting
scientific studies to determine the efficacy of marijuana in treating various
ailments Until that research is concluded however most of what the public
hears from marijuana activists is little more than a compilation of anecdotes
John Wa ters Former Director of the White House Office of National Drug Control Policy 2002
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i

Executive Summary
The Genter for Medicinal Cannabis Research CMCR at the University of California was created in 2000
to conduct clinical andpre clinical studies of cannabinoids including smoked marijuana to provide
evidence one way or the other to answer the question Does marijuana have therapeutic value To
accomplish this objective the CMCR issued calls for applications from researchers at leading California
institutions developed a close working relationship with state and federal agencies to gain regulatory
approvals estabtished panels ofnationally recognized experts to rigorously review the merit of appli
cations and funded carefully designed studies that have now been published in high impact scientific
journals making significant contributions to the available literature on cannabis and the cannabinoids
Summary of Results to Date
In total the CMCR has approved fifteen clinical studies including seven clinical trials of which five have
completed and two are in progress The CMCR has also approved fourpre clinical studies all of which
have completed
By design CMCR clinical studies focused on conditions identified by the Institute of Medicine for which
cannabis might have potential therapeutic effects based on current scientific knowledge Institute of
Medicine 1999 To date four CMCR funded studies have demonstrated that cannabis has analgesic
effects in pain conditions secondary to injuryeg spinal cord injury or disease eg HIV disease HIV
drug therapy of the nervous system This result is particularly important because three of these CMCR
studies utilized cannabis as an add on treatment for patients who were not receiving adequate benefit
from a wide range of standard pain relieving medications This suggests that cannabis may provide
a treatment option for those individuals who do not respond or respond inadequately to currently
available therapies The efficacy of cannabis in treaiment ref actory patients also may suggest a novel
mechanism of action not fully exploited by current therapies In addition to nerve pain CMCR has
also supported a study on muscle spasticity in Multiple Sclerosis MS Such spasticity can be painful
and disabling and some patients do not benefit optimally from existing treatments The results of the
CMCR study suggest that cannabis reduces MS spasticity at least in the short term beyond the benefit
available from usual medical care
Table 1 Clinical Studies Published or Submitted for Publication
Donald Abrams MD
UC San Francisco
Donald Abrems MD
UC San Francisco
JodyCorey BloomMD Ph D
UC San Diego
Ronald EilisMD Ph D
UC San Diego
Mark WallaceMD
UC San Diego
Barth Wilsey MD
UC Davis
Cannabis forTreatment ofHIV Related Peripheral
Neuropathy
Vaporization as a Smokeless Cannabis Delivery System
Short Term Effects of Cannabis Therepy on Spasticity in MS
Placebo controlled Double Blind Trial of Medicinal Cannabis
in Painful HIV Neuropathy
Analgesic Efficacy of Smoked Cannabis
Double BlindPla ebo Controlled Trial of Smoked Marijuana
on Neuropathic Pain
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To date six of the studies have published or are in the process of publishing results in respected medi
cal journals garnering national and international attention from other researchers media outlets
governmental agencies and the generel public see Table 1 These results have helped to bring togeth
er accomplished international experts on cannabis and cannabinoids and foster scientific dialog on the
possible utility of cannabis as a therepeutic agent
Adverse side effects experienced by participants included cough nausea dizziness sedation and
changes in cognition However these effects were typically mild and resolved rapidly after treatment
Currently approved analgesics are not without side effects and the effects observed in CMCR studies
tended to be no worse than would be expected with other potent analgesics Following the conclusion
of the two studies currently in progress CMCR will have exhausted its available funding for clinical work
though the CMCR will continue to maintain a sample bank and to consult with researchers and policy
makers as needed
The majority of CMCR studies that have been discontinued were cancer studies that experienced diffi
culty in recruiting participants Many severely ill individuals were reluctant to volunteer for a rigorous
research protocol where the experimental treatment addressed disease symptomsie nausea pain
but did not affect tumor growth directly Other factors such as requirement that patients have stable
pain scores over a period of time leading into the study prohibition from driving for che duration of
the study and difficulty in providing cannabis for home administration may also have played a role in
the lack of success in recruiting this population A further impediment to participation in CMCR stud
ies particularly in cancer patients was the inability of CMCR Co continue to provide study drug beyond
the study period to patients who find active treatment beneficial Additionally some individuals
already were using cannabis to treat pain or other symptoms and so had less incentive to participate in
research
The CMCR portfolio also included basic science studies in animals and in human cellspre clinical
research This research was supported because it had the potential to provide insights into therepeutic
use of cannabinoids in human disease One study provided evidence by way of iecordings of nerve cell
activity and in awake animals of analgesic effects of cannabis like compounds on head and facial pain
suggesting that clinical trials of cannabis might be warranted in patients with headache or other facial
pain Another study reported that cannabis did not interfere with the function of blood celis involved
with immunity an important finding considering potential therapeutic use of cannabis compounds will
be in persons with chronic illnesses
Other CMCR Activities
In addition to the research
CMCR has also functioned as a catalyst for discussion and examination of
the potential development of cannabis as medicine In July 2002 CMCR sponsored a workshop Future
Directions in Cannabinoid Therapeutics featuring presentations by intellectual and scientific leaders
in the field of cannabinoid science from around the world CMCR hosted a second meeting in summer
2004 to address recent progress in science that would be likely to lead to clinical trials of new cannabi
noid compounds Future Directions in Cannabinoid Therapeutics II From the Bench to the Clinic
brought together the major stakeholders in the development of cannabinoid therepeutics in order
to survey laboratory compounds that are most promising for testing in human trials and to confront
potential stumbling blocks to testing and development ofthese compounds A special issue of the
journal Neuropharmacology 2005 was dedicated to publishing the research presented at this meeting
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Executive Summc ry cont l
CMCR researchers have also published two literature reviews on the neuropsycholo9ical effects of
cannabis use in order to better understand the potential hazards of cannabis use in short and long term
treatment settings Grant et al 2003 Gonzalez et al 2002 see reference list
Conclusion
As a result of the vision and foresight of the California State Legislature Medical Marijuana Research Act
SB847 the CMCR has successfully conducted the first clinical trials of smoked cannabis in the United
States in more than 20 years As a result of this program of systematic research we now have reason
able evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or
diseases of the nervous system and possibly for painful muscle spasticity due to multiple sclerosis
Obviously more research will be necessary to elucidate the mechanisms of action and the full therapeu
tic potential of cannabinoid compounds Meanwhile the knowledge and new findings from the CMCR
provide a strong science based context in which policy makers and the public can discuss the place of
these compounds in medical care
Mission Statement
The Center for Medicinal Cannabis Research CMCR will conduct high quality scientific studies intend
ed to ascertain the general medical safety and efficacy of cannabis products and examine alternative
forms of cannabis administration The Center will be seen as a model resource for health policy plan
ning by virtue of its close collaboration with federal state and academic entities
4 CENTEP FOR MEDICINAI CANNABIS RESEARCH UNIVEPSITY OF CAUFOFNIA

Scientific and Legislative Precursors of the CMCR
Discovery of Cannabis Receptors in the Brain
During the late 1980 s and early 1990 s a series of significant scientific breakthroughs revealed anin built
system of cannabinoid receptors and cannabinoid signaling molecules in the human brain Cannabinoid
receptors are located throughout the central nervous system and peripherel tissues and are implicated
in nervous system excitability movement analgesia neuroprotection and feeding behaviors including
newborn suckling
Scientific Reports
Following this period of scientific discovery and expanded understanding ofthe physiological basis of
cannabinoid action there was renewed interest in potential therapeutic applications of cannabinoid
chemicals The National Institutes of Health Ad Hoc Group of Experts and the Institute of Medicine follow
ing thorough review ofthe existing scientific literature identified medical conditions warranting further
research regarding the possible therapeutic effects of marijuana Medical evidence for likely therapeutic
benefit was identified in the areas of appetite stimulation neurological and movement disorders analge
sia and nausea and vomiting
1997 National Institutes of Health Workshop on the Medical Utility of Marijuana
1999 Institute of Medicine Report Marijuana and Medicine Assessing the Science Base
Available through the CMCR websire athttp
Ocmccucsd edu geninfo marijuana htm
Legislative Origins
7he triggering event which led to the creation of the CMCR was the passage by the people of California
in 1996 of Proposition 215 the Compassionate Use Act which approved the medical use of marijuana
although at that time the exact role the substance should play in patient care remained ambigu
ous Following that in 1999 the Legislature of California passed Senate Bill SB 847 authored by then
Assemblyman later Senator John Vasconcellos after extensive negotiations with then Attorney General
Dan Lungren providing he bipartisan legitimacy that enabled this bill to obtain the required two thirds
vote in each house of the California legislature 56847 proposed subject to the approval of the Board
of Regents of the University of California to create a three year program overseeing objective hi9h
quality medical research that would enhance understanding of the efficacy and adverse effects of
marijuana as a pharmacological agent stressing that the projed should not be construed as encour
aging or sanctioning the social or recreational use of marijuana In August 2000 the Center for Medici
nal Cannabis Research was established at the University of California to carry out this mission In 2003
after CMCR had demonstrated its ability to carry out the proposed progrem of research SB295 was
approved to remove the3year program limitation included in the founding legislation
1996 California voters pass the Compassionate Use Act of 1996
1999 California State Legislature passes the Medical Marijuana Resea ch Act of 1999 5B647
2000 Center for Medicinal Cannabis Research is established as a state funded research center at the University of
California to solicit review and support clinical and limited preclinical research
2000 CMCR issued its first call for proposals
2003 5B295 is passedre authorizing the CMCR to continue indefinitely
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CMCR Review Process
In order to evaluate the scientific validity ofthe proposals submitted the CMCR engaged
senior scientists from around the nation to serve as a Scientific Review Board SRB Studies
recommended for funding by the Scientific Review Board were then submitted for review to
the Research Advisory Panel of California RAP C the Office of Public Health and Science of
the federal Department of Health and Human Services DHHS the Food and Drug Administra
tion FDA the National Institute on Drug Abuse NIDA and the Drug Enforcement Adminis
tration DEA Upon final approval from each of the above agencies studies were authorized
to order cannabis cigarettes from NIDA and io begin recruiting patients This process is
described in Figures 1 and 2
Figure L CMCR Scientific Review
Application reviewed intetnally
Appiication assigned 3 SRB
reviewersfordetailedcritique
Applicationsenttofull5R8
SRBmemberssubmitcritiquestoCMCN
to cirwlare ta entire SRB
ielephone meeting of entire SRB
Each protocol is reviewed and scored evisions
Necessary modifications including
budget are diswssed
CMCR Director communicates review to
Investigaton
Results
Recommended
Invite Investigator
revisions
Deferred
Suggest major
for next
round
NOiRecommended
proposal Declined
Figure 2 CMCR Regulatory Approval Process
p SFBApproval
Review
qevisions
Stattof
Calilorrtia
RAPC DHHS NIDA
Review pevisions RevisedAppwved Pevisions
i
ProPOSals
Neview DNHS
Review FDA
FDA
INDN
DEAHQ
DEALOCaI
DEA
Inspectian
Review
Appwval
Order Pmdact
Begln Studie5
fi
CENTER fOR MEDIUNAL CANNABIS FESEARCH UNNERSITV OF CALIFORNIA

CMCR Vision for Cannabis Therapeutics Research
CMCR envisions its role in the investigation of cannabis and cannabinoid compounds in three main
research domains involving smoked cannabisnon smoked preparations and eventually new pharmaceu
tical drug candidates formulated to act directly on the endocannabinoid system
Stage 1 Smoked Cannabis
Develop state and federal review process and solicit proposals for initial studies
Conductwell designed rigorously controlled clinical trials of smoked cannabis Until alternative
delivery systems and new molecules are available smoked cannabis offers the most efficient delivery
of cannabinoids for clinical trials
Cannabis cigarettes are provided by the National Institute on Drug Abuse NIDA
Work Accomplished
CMCR has developed the scientific and administretive infrastructure to support application review
selection and implementation of studies and has developed a rigorous process of peer review of scien
tific proposals by independent Scientific Review Board CMCR has also established a relationship with
state and federal agencies RAPC DEA FDA DHHS NIDA to facilitate regulatory approval
The CMCR first solicited applications in fall 2000 and has funded fifteen clinical and fourpre clinical
studies throughout California The CMCR has issued five calls for proposals most recently in summer
2006
Stage IINon Smoked Preparations
Explore the safety and effectiveness ofnon smoked forms of inedicinal cannabis
Expand trials to include alternative non smoked delivery of cannabis preparations
Alternative delivery may include vaporization patches suppositories and alternative oral forms
Work Accomplished
In the area ofnon smoked routes of cannabis administretion Dr Donald Abrams study Vaporization
asaSmokeless Cannabis Delivery System has been completed and the results published in the Jour
nal of Clinica Pharmacology Therapeutics This study found that vaporization was a safe and effective
mode of delivery Two CMCR clinical trials are now in progress utilizing vaporization
Stage 111 Molecules To Target Endocannabinoid System
Stage III represents long term goals for cannabinoid research If the MCR were to continue the long
term research objectives would be to
Collaborate with laboratories around the world who are working on specific molecules both natural
and synthetic to activate modulate or deactivate the body sin built cannabinoid system
Perform Phase I II and III clinical trials on new molecules targeting the endocannabinoid system
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Overview of Research Program
Studies in Pain and Other Neurologic Conditions
Chronicpain
on a daily or almost daily basis for six months or longer is one of the
most prevalent and disabling conditions in California and in the US generelly Whereas many
types of pain are caused by stimulation of specialized pain receptors on nerve endings due to
injury of tissues neuropathic pain is produced either by direct damage to the central brain
spinal cord or peripheral nervous system itself or by abnormal functioning of these systems
Infections diabetes physical trauma strokes and many other diseases can injure the nervous
system with resulting pain which persists even though pain receptors themselves are not
directly activated It is therefore not surprising that neuropathic pain is widespread affect
ing510 of the US population Only a few classes of inedications are approved for use as
analgesics in these conditions opioids anticonvulsants antidepressants and many patienis
obtain only partial relief even when using combinations of all available therapies Among the
most difficult to treat neuropathic pain conditions are those secondary to HIV diabetes and to
physical trauma to the nervous system Because these neuropathic disorders are so prevalent
and treatment alternatives are so limited the CMCR focused on these conditions
A distinguishing scientific feature of this program of pain research made possible only by the
coordinating function of the CMCR is the commonality of ineasures and methods across the
research studies This allows for the distinctive advantage of comparability of results across
studies Additionally when possible we studied treatment of the same type of pain condition
eg HIV neuropathy in more than one geographic site Finding comparable results at two or
more sites studying the same disease is scientifically important since this suggests that the
results are generally valid rather than being due to chance or the specific characteristics of a
single sample of patients or of a particular team of researchers
This research used the gold standard design for assessment of therapeutic effects the
rendomized clinical trial In this approach participants are assigned by chance like flipping a
coin to an experimental treatment in this case cannabis or to a placebo an inactive treat
ment The placebo in all of our studies was a marijuana cannabis cigarette made with
cannabis from which the active ingredients for exampledelta 9te
rahydrocannabinol
THQ had been removed The cigarette therefore had the appearance and the aroma of a
marijuana cigarette but without the crucial chemical ingredients hypothesized to be thera
peutically active Randomization ensures factors which might skew the results like age dura
tion or intensity of pain are equally present in both the experimental and placebo condition
Placebo is essential since the expectation of pain relief from any treatment is a powerful anal
gesic itself All of our protocols used measures of pain recommended by expert consensus as
standard in the field For studies of smoked cannabis the researchers used a standard timed
method of inhalation research using vaporized cannabis used similar state of the art technol
ogy Researchers measured blood concentrations of the primary active ingredient of cannabis
THC allowing estimates of relationships between dose concentration and magnitude of
pain relief
To date the CMCR has completed four studies in the treatment of neuropathic pain Two
studies have focused on neuropathic pain resulting from HIV infection or the drugs used to
treat HIV one has focused on neuropathic pain of varying causes and one has used an experi
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mental model of neuropathic pain tested in healthy volunteers The results from these four
studies have been convergent with all four demonstrating a significant decrease in pain after
cannabis administration The magnitude of effect in these studies expressed as the number of
patients needed to treat to produce one positive outcome was comparable to current thera
pies Two additional studies involving neuropathic pain are underway
Multiple sclerosis MS is one of the most common chronic and disabling diseases of the
nervous system Caused by loss of the insulating sheath surrounding nerve fibers the dizease
usually begins in young adulthood Although it may initially wax and wane in intensity and be
of mild severity it often steadily progresses causing fatigue loss of balance muscle weakness
and muscle spasticity Affecting up to70 of people with the disease muscle spasms lead to
pain inability to walk and difficulties with self care causing most of the everyday life disabil
ity from this disease There is as yet no cure for M5 Treatments for muscle spasticity are only
partially effective and have side effects which are not easily tolerated making the search for
new therapies of high importance Given this background the CMCR identified MS spasticity
as an additional target for therapeutic research As with all CMCR studies the research used
the most rigorous scientific approach to testing therapies a randomized clinical trial supple
mented by modern measurement of muscle spasticity everyday function life quality and side
effects Results to date have found a significant improvement in both an objective measure
of spasticity and pain intensity in patients whose standard therepy had provided inadequate
relief
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Synopsis of CMCR Published Clinical
Study Results
The Effect of Cannabis on Neuropathic Pain inHIV Related
Peripheral Neuropathy
Donald 1 Abrams MD University ofCalifornia San Francisco
The primary objective of this study was to evaluate the efficacy of smoked cannabis when used as an
analgesic in persons with neuropathic pain fromHIV associated distal sensory polyneuropathy DSPN
In a double blind randomizedfive day clinical trial patients received either smoked cannabis or place
bo cannabis cigarettes Patients continued on any concurrent analgesic medicationseg gabapentin
amitriptyline narcotics NSAIDs which they were prescribed priorto the trial the dose and amount of
the medications were recorded daily
The full results of this study appear in the journal Neurology Abrams et al 2007 see reference list
In brief 55 patients were randomized and 50 completed the entire trial Smoked cannabis reduced
daily pain by34 compared to17 with placebo The study concluded that a significantly greater
proportion of patients who smoked cannabis 52 had a greater than 30 reduction in pain intensity
compared to only 24 in the placebo group This result is clinically important since the threshold of a
30o reduction in pain intensity is associated with meaningful improvement in quality of life in other
research on pain outcomes
Cannabis appeared to bewell tolerated and there were no safety concerns raised By design all patients
had smoking experience with cannabis There were more side effects in those receiving cannabis than
placebo with the most frequent being sedation anxiety and diuiness but these were all rated as mild
Placebo Controlled Double Blind Trial of Medicinal Cannabis in
Painful HIV Neuropathy
Ronald J EllisMD Ph D University ofCalifornia San Diego
The primary objective of this study also was to evaluate the efficacy of smoked cannabis when used as
an analgesic in persons withHIV associated painful neuropathy In a double blind randomized clinical
trial of the short term adjunctive treatment of neuropathic pain inHIV associated distai sensory poly
neuropathy participants received either smoked cannabis or placebo cannabis cigarettes A structured
dose escalation titration protocol was used to find an individualized effective safe andwell tolerated
dose for each subject Participants continued on their usual analgesic medications throughout the trial
with the dose and amount of these medications being recorded daily
The full results of this study were published in thejournal Neuropsychopharmacology Ellis et al 2006
see reference list In brief 34 eligible subjects enrolled and 28 completed both cannabis and placebo
ireatments Among completers pain relief was significantly greater with cannabis than placebo The
proportion of subjects achieving at least 30 pain relief was again significantly greater with cannabis
46 compared to placebo 18 It was concluded thai smoked cannabis was generallywell tolereted
and effective when added to concomitant analgesic therapy in patients with medicalfy refractory pain
due toHIV associated neuropathy Once again these results appeared to be relevant to everyday clinical
practice because the magnitude of pain relief is associated with that which improves life quality and
also because the benefit was above and beyond that conferred by the patients usual analgesics
As in the study described above side effects were more frequent with cannabis than with placebo with
the most common being sleepiness or sedation fatigue and difficulty with concentration These were
mild for the most part and did not raise safety concerns
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A Double Blind Placebo Controlled Crossover Trial of the
Antinociceptive Effects of Smoked Marijuana on Subjects with
Neuropathic Pain
Bar h WilseyMD University of Californio Davis
This study
objective was to examine the efficacy of two doses of smoked cannabis on pain in persons
with neuropathic pain of different originseg physical trauma co nerve bundles spinal cord injury
multiple sclerosis diabetes In a double blind randomized clinical trial participants received either low
dose high dose or placebo cannabis cigarettes As customary in CMCR trials participants were allowed
to continue their usual regimen of pain medicationseg codeine morphine and others
The full results of this study have been published in the Journal of Pain Wilsey et al 2008 see refer
ence list Thirty eight patients underwent a standardized procedure for smoking either high dose7h
low dose35 or placebo cannabis of these 32 completed all three smoking sessions The study
demonstrated an analgesic response to smoking cannabis with no significant difference between the
low and the high dose cigarettes The study concluded that both low and high cannabis doses were effi
cacious in reducing neuropathic pain of diverse causes
Disagreeable or unpleasant side effects were significantly more likely with high dose cigarettes
compared to low dose or placebo whereas there was no difference in these effects between low dose
and placebo sessions There was no indication of mood changeseg sadness anxiety fearfulness
Analgesic Efficacy of Smoked Cannabis
Mark Wallace MD University ofCalifornia San Diego
This study used an experimental model of neuropathic pain to determine whether pain induced by the
injection into the skin of capsaicin a compound which is the hot ingredient in chili peppers could be
alleviated by smoked cannabis Another aim of the study was to examine the effects of dose of canna
bis and the time course of pain relief In a rendomized double blinded placebo controlled trial volun
teers smoked low medium and high dose cannabis2 48THC by weight or placebo cigarettes
The full results ofthis study were published in he journal Anesthesiology Wallace et al 2007 see refer
ence list Nineteen healthy volunteers were enrolled and 15 completed all four smoking sessions In brief
five minutes after cannabis exposure there was no effect on capsaicin induced pain at any dose By 45
minutes after cannabis exposure there was a significant decrease in capsaicin induced pain with the medi
um dose4and a significant increase in pain with the high dose8There was no significant effect
seen with low dose2h There was a significant inverse relationship between pain perception and plasma
THC In summary this study suggested that there may beatherapeutic window or optimal dose for
smoked cannabis low doses were not effective medium doses decreased pain and higher doses actually
increased pain These results suggest the mechanism
of cannabinoid analgesia are complex in some
ways likenon opioid pain relieverseg aspirin ibuprofen and in others like opioidseg morphine
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Synopsis ofCVICR Published Clinic nl Sh idy Results cont
Short Term Effects of Cannabis Therapy on Spasticity in
Multiple Sclerosis
JodyCorey BloomMD University ofCalifornia San Diego
This objective of this study was to determine the potential for smoked cannabis to ameliorate
marked muscle spasticity chronic painful contraction of muscles a severe and disabling symptom
of multiple sclerosis In a placebo controlled rendomized clinical trial spasticity and global func
tioning was examined before and after treatment with smoked cannabis Patients were allowed to
continue their usual treatments for spasticity and pain while participating in the research
The full results ofthis study are being submitted for publication lnitial results were presented at
the meeting of the American College of Neuropsychopharmacology in 2007 Thirty patients with
multiple sclerosis were enrolled Compared to placebo cigarettes cannabis was found to signifi
cantly reduce both an objective measure of spasticity and pain intensity This study concluded
that smoked cannabis was superior to placebo in reducing spasticity and pain in patients with
multiple sclerosis and provided some benefit beyond currently prescribed treatments
Vaporization asaSmokeless Cannabis Delivery System
Donald Abrams MD University ofCalifornia San Francisco
The aim of this study was to evaluate the use of a vaporization system the Volcano
VAPORMED Inhalatoren Tuttlingen Germany asasmokeless delivery system for inhaled
cannabis Because of concerns regarding the practicality and palatability of using cannabis
cigarettes as a siandard treatment there has been an interest in developing alternative deliv
ery systems Participants were randomly assigned to receive low medium or high dose17
34 or68tetrahydrocannabinop cannabis cigarettes delivered by smoking or by the vapor
ization system on six study days
The full results of this study have been published in thejournal Clinical Pharmacology Thera
peutics Abrams et al 2007 see reference list Eighteen healthy volunteers were recruited to
participate in the research The analysis indicated that the blood levels of vaporized cannabis
are similar to those of smoked cannabis over a six hour period However blood concentrations
of THC at 30 and 60 minutes after inhalation were significantly higher in vaporized cannabis as
compared to smoked cannabis In addition carbon monoxide levels were significantly reduced
with vaporization compared with smoked cannabis Fourteen participants preferred vaporiza
tion 2 preferred smoking and 2 reported no preference In summary vaporization of cannabis
was found to be a safe mode of delivery and participants had a preference for vaporization
over smoking as a delivery system in this trial
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Recently Completed And Ongoing Studies
Sleep and Medicinal Cannabis
Sean Drummond Ph D UniversityofCalifornia San Diego
The primary objective of this study was to determine the effects of cannabis on insomnia and poor
sleep quality which are experienced by up of90 ofHIV infected individuals Participants in this study
were individuals enrolled in the UCSD randomized trial comparing cannabis and placebo as an analge
sic in painfulHIV associated neuropathy see Dr Ellis above
The results of this study suggest that cannabis administration during the day does not affect objective
or subjective measures of sleep approximately 78 hours after the last use of cannabis
Impact of Repeated Cannabis Treatments on Driving Abilities
Thomas Marcotte Ph D UniversiryofCa ifornia San Diego
The principal aim of this study was to examine whether routine administration of cannabis in the medi
cal treatment ofHIV related neuropathy and spasticity associated with multiple sclerosis results in
significant impairment in driving abilities Participants in this study were individuals enrolled in the
randomized clinical trials of cannabis for painful HIV neuropathy and for spasticity in multiple sclerosis
conducted at UCSD see Dr Ellis and Dr Corey Bloom above
The results of this study are in preparetion Subjects were tested using a computerized driving simulator
commonly used to demonstrate the effects of alcohol on driving ability The driving simulator presents
different driving conditions and circumstances and was done at four points before cannabis and at
one three and 18 hours after the final dose in the therapeutic trials These data will provide insights
regarding the real life impact of using cannabis as medicine
Efficacy of Inhaled Cannabis in Diabetic Painful Peripheral
Neuropathy
Mark WallaceMD Universiry ofCalifornia San Diego
The primary objective of this ongoing study is to evaluate the efficacy of smoked cannabis when
used as an analgesic in painful neuropathy due to diabetes In a double blind randomized placebo
controlled trial participants will inhale low medium or high dose vaporized cannabis or placebo
Concurrent testing with experimentally induced pain will help identify the potential mechanisms of
therapeutic effects
This study is actively recruiting its intended sample of 20 participants No preliminary results are avail
able at this time
The Analgesic Effect of Vaporized Cannabis on Neuropathic Pain
Barth WilseyMD UniversiryofCalifornia Davis
The primary aim of this study is to evaluate the analgesic effects of vaporized cannabis in patients with
neuropathic pain of different origins In a rendomized clinical trial the effects of placebo and of low and
medium 17 o and35 dose cannabis on clinical pain and on experimentally induced pain will be
assessed As noted above use of experimentally induced pain may help identify mechanism of actions
This study is beginning to recruit participants No preliminary results are available at this time
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CompletedPre Clinical Studies
In addition to testing the possible benefits of inedicinal cannabis the CMCR supported a small number
of laboratory and animal studies which might lead to either developing new treatments in humans or
better understanding the mechanisms of therapeutic actions
Mechanisms of Cannabinoid Analgesia
Howard Fields MD Ph D University ofCalifornia San Francisco
The aim of this study was to determine whether cannabinoids might be a useful class of inedication for
migraine and other headaches or facial pain conditions
The full results of this study were published in thejournal Pain Papanastassiou et al 2003 see reference
list A cannabis like drug WIN55 212 given to rats under anesthesia showed reduced activityof individual
nerve cells transmitting pain whereas giving anotherdrug which blocked cannabis receptors on these nerve
endings reversed this effect Moreover the analgesic effect of the cannabis like drug was evident in tests of
facial pain heat in awake rats This study therefore provided direct scientific evidence at the level of both
individual nerve cells and in awake animals of analgesic effects of cannabis like compounds on head and
facial pain Randomized clinical trials in humans might be conducted to determine ifcannabis could treat
facial pain or headache
Cannabinoids in Fear Extinction
Mark Barad MD Ph D University ofCalifomia Los Angeles
The aim of this study was to determine if a cannabis like agent could suppressfear inducing memories or
images that might be the basis for some psychiatric conditions such asPost Traumatic Stress Disorder PTSD
andotheranxietydisorders Therapeuticeffectswerethoughtpossiblebecauseearlierresearchsuggested
that specializedin built cannabinoid receptors in the brain are necessary for suppression of normal fears
Tests using three different synthetic cannabis like compounds showed no significant differences in
behavior between mice treated with study drugs and untreated mice treined to fear specific locations
This study suggests that acutely enhancing the brain s internal cannabinoid system does not extinguish
specific fears of place memory in animals
Effects of Cannabis Therapy on Endogenous Cannabinoids
DanielePiomelli Pharm D Ph D UniversiryofCalifornia Irvine
7he aim of this study was to determine the short and longer term effects of THC on the naturalin built
system of nervous system chemical trensmitters called endocannabinoids which help regulate move
ment cognition pain and other physiological processes Amplification or interference with activity of
this system could influence outcomes of cannabinoid treatment
These experiments contributed preliminary data to work that was later published in the journal Neuropsy
chopharmacology Giuffrida et al 2004 see reference list A synthetic cannabis like compound had no
effects on the levels of anandamide an endocannabinoid in blood or in brain tissue from regions involved
in memory motivation movement and wakefulness Chronic but not acute treatment caused a marked
increase in anandamide levels in the brain hippocampus a region crucially involved in learning and memory
This study provides evidence indicating that exposure to cannabis like drugs can alter endocannabinoid
signaling in the brain Alterations in this important signaling system might be involved in mediating the
actions of cannabis in humans
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Effects of Medicinal Cannabis on CD4 Immunity in AIDS
Rachel5chrier Ph D University ofCalifornia San Diego
The aim of this study was to determine if cannabis might suppress the immune system in individuals
with HIV This is an important question since already fregile immunity is characteristic of AIDS and other
serious illness where cannabis might be used
Results of the study are being prepared for publication Briefly immune system cells CD4 white blood
cells obtained from 15 individuals with AIDS participating in another study were exposed to three
concentrations of THC in tests of their functional competence There was no evidence of acute impair
ment of immune function at concentrations achievable in living humans These results parallel other
research showing that short term cannabis administration does not diminish the circulating number of
this white blood cell essential for immunity
Discontinued Studies
Five clinicaf studies were discontinued before completion because they could not accrue a sufficient
number of participants The scientific and safety design of two studies one studying the combination
of cannabis and opioidseg morphine for cancer pain relief and one on relief of muscle spasticity in
multiple sclerosis required either a nine day hospitalization or 16 weeks without driving an automobile
Understandably chronically ill patients were reluctant to bere
hospitalized for research or to surrender
driving privileges for an extended period
Two other cancer studies faced different real Itfe obstades to recruitment One study on cannabis for
severe nausea and vomiting due to chemotherepy could not identify a sufficient number of patients
with sufficiently severe nausea lt appeared that currentanti nausea treatments are often highly effec
tive Alternative or adjunctive therapy may be required only by a minority of patients Another project
on cannabis for advanced cancer pain unresponsive to all other analgesics found chat local hospice
agencies were willing to refer potential participants These patients however were often already smok
ing cannabis for pain control One study of cannabis for use at home for neuropathic pain did not elicit
sufficient interest despite outreach to the community through advertisements and focus groups
Although the outcomes of these studies is disappointing valua6le lessons were learned in terms of
design of future studies and selection of appropriate populations for study
WWW CMCF UCSD EDU FEBRUARY il 2010I5

Summary And Future Directions
Results of CMCR studies support the likelihood that cannabis may represent a possible adjunctive
avenue of treatment for certain difficult to treat conditions like neuropathic pain and spasticity In
establishing the University of California CMCR the California Legislature enabled the creation of what is
now arguably a world class resource both forstate of the art clinical trials on medicinal cannabis and its
derivatives and for developing knowledge on the potential and limitations of cannabinoid therapeutics
for selecced indications By facilitating high caliber clinical trials whose results are published in leading
peer reviewed scientific journals the CMCR is providing physicians and policy makers with solid scien
tific data to inform both medical research and policy decisions As a seasoned and unique resource the
CMCR iswell positioned to inform public health and policy decision makers
Worldwide the merit of new therapies is rigorously evaluated by a series of clinical trials termed Phase
I Phase II Phase III and Phase IV In Phase I usually involving 20 50 participants several possible doses
of a drug are tested safety is assessed and hints of therapeutic value are revealed Drug development
then proceeds to Phase II trials which may recruit up to several hundred individuals to more accurately
gauge the efficacy of treatment along with determining short term side effects and risks Results from
Phase II trials with smoked cannabis in neuropathic pain form the basis of the CMCR s efforts to date In
the next step Phase III trials involving hundreds to several thousand patients are designed to provide
definitive assessment of the efficacy of new treatment for specific conditions usually by comparing he
newer therapy to the best standard treatment available while also adding to a better understanding
of benefit risk relationships Finally Phase IV trials conducted after a treatment is licensed or approved
for general medical use gather additional information on benefits risks and optimal use of the therepy
The expertise developed at CMCR iswell suited to contribute to each of these phases of cannabinoid
research
Were support for the CMCR to continue research might focus on 1 larger placebo controlled stud
ies to generate definitive data on therepeutic meritie Phase III trials 2 to head comparisons
with other current therapies in Phase II or III studies or 3 expanded studies evaluating cannabis as an
adjunc to existing treatment with opioids andnon steroidalanti inflamma ory drugsie Phase II and
III research determining if cannabinoids have an opioid sparing effect that is if they might allow use
of lower doses of opioids without sacrificing pain relief Other Phase II and III studies might move from
the question of efficacy to overall effectiveness that is evaluating 1 alternative delivery systemseg
vaporization that reduce the harmful effects of smoking 2 models oftake home treatment that more
accurately mimic the way drugs are prescribed and 3 long term studies to assess emergent toxici
ties stability of treatment effects and possible development of tolerance to treatment over time This
research might extend into formal Phase IV trials
Studies also might be conducted onnewly developed synthetic agents which enhance antagonize
or otherwise modulate the cannabinoid system comparing their efficacy to cannabis as a botanical
product In any event the fundamental nature of the endocannabinoid system evident by its partici
pation in essential functions like movement pain moods and other behaviors suggests concinuing
clinical research on cannabis might yield important contributions to health care
16 CENTEF FOfl MEDIUNAL CANNABIS RESEAftCH 11NIVER5ITY OF CALIFORNIA

CMCR Roster
James Anthony Ph DMSc
William Breitbart MD
Alan Budney Ph D
Don Cherek Ph D
Steven Childers Ph D
Reena Deutsch Ph D
Wiltiam L Dewey Ph D
Judith Feinberg MD
Richa d Foltin Ph D
Richard Gracely Ph D
Margaret Haney Ph D
Miles Herkenham Ph D
Karl Kieburtz MDMPH
Robert A Parker Sc D
Frank Porreca Ph D
Judith Rabkin Ph DMPH
Srinivasa Raja MD
Richard Rauck MD
Wilfred Van Gorp Ph D
Leslie Weiner MD
Sandra P Welch Ph D
Tanya Wolfson MA
Scientific Review Board
Johns Hopkins University
Memorial Sloan Kettering Cancer Center
University of Vermont
University of Texas Health Sciences Center
Wake Forest University
University of California San Diego
Virginia Commonwealth University
University of Cincinnati Holmes Hospital
Columbia University
NIDCR National Institutes of Health
Columbia University
National Institute of Mental Health
University of Rochester
Harvard University
University of Arizona
Columbia University
Johns Hopkins University
Wake Forest University
Columbia University
University of Southern California
Virginia Commonwealth University
University of California San Diego
National Advisory Council
1 Richard Crout MD Crout Consulting
Samuel A Deadwyler Ph D
Dale Gieringer Ph D
Lester Grinspoon MD
Janet Joy Ph D
Lewis Judd MD
Wake Forest University
California NOFML
Professor Emeritus Harvard Medical School
Institute of Medicine
University of California San Diego
AlexandrosMakriyannis Ph D UniversityofConnecticut
T Philip Malan MD Ph D
Billy Martin Ph D
CharlesOBrienMD Ph D
John Phair MD
June Machover Reinisch Ph D
Roger A RoffmanDSW
Donald P Tashkin MD
Robert Temple MD
Scott Thorpe lD
John Vasconcellos
Tom Vischi
Deceased
Acknowledgement
University of Arizona
Virginia Commonwealth University
University of Pennsylvania
Northwestern University Medical School
R2 Science Communications Inc
University of Washington
University of California Los Angeles
Food and Drug Administration
Special Assistant Attorney General State of California
Retired California State Senare
Retired Department Health and Human Services
CMCR particularly wishes to acknowledge the contributions of Tom Marcotte Ph D as Center
Manager Shondra Neumayer RN and Heather Bentley CCRA as Project Managers and Ben
Gouaux as a Research Associate
WWW CMCR UCSD EDU FEBRUARV 11 2010 17

CMCR Supported Publications
Results of CMCR Studies
Abrams Dl lay CA Shade S6 Vizoso H Reda H Press S Kelly ME Rowbotham MC Petersen KL Cannabiz in painful
HIV associated sensory neuropathy A randomized placebo controlled trial Neurology 2007 68 515 521
Abrams DI Vizoso HP Shade SB Jay C Kelly ME Benowitz NL Vaporization as a Smokeless Cannabis Delivery
System A Pilot Study Clin Pharmacol Thei 2007 825 572 578
Ellis R Toperoff W Vaida F van den Brande G Gonzales J Gouaux B Bentley H Atkinson 1H Smoked Medicinal
Cannabis for Neuropathic Pain in HIV A Randomized Crossover Clinical Trial Neuropsychopharmacology 2008
343 672 680
Giuffrida A Leweke FM Gerth CW Schreiber D Koethe D Faulhaber 1 Klosterkotter J PiomelliD2004 Cerebrospi
nal anandamide levels are elevated in acute schizophrenia and are inversely correlated with psychotic symptoms
Neuropsychopharmacology 29 2108 2114
Papanastassiou AM Fields HL Meng ID 2004 Local application of the cannabinoid receptor agonist WIN S5
212 to spinal trigeminal nucleus caudalis differentially affects nociceptive andnon noci eptive neurons Pain
107 3 267 75
Wallace M Schu teis G Atkinson 1H Wolfson T Lazzaretto D Bentley H Gouaux B Abramson I Dose dependent
Effects of Smoked Cannabis on Capsaicin induced Pain and Hyperalgesia in Healthy Volunteers Anesthesiology
107 51 785 796 November 2007
Wilsey B Marcotte T Tsodikov A Millman J Bentley H Gouaux B Fishman 5 April 2008 A Randomized Placebo
Controlled Crossover Trial of Cannabis Cigarettes in Neuropatbic PainJoumal ofPain96506 521
Published Abstracts
Abrams D Jay C Vizoso H Shade S Reda H Press 5 Kelley ME Rowbotham M Petersen K Smoked Canna
bis Therepy for HIV Related Painful Peripheral Neuropathy Results of a Randomized Placebo Controlled Clinical
Trial 2nd Annual Meeting ofthe International Association for Cannabis as Medicine 2005
Abrams Dl Jay C Petersen K Shade S Vizoso H Reda H Benowitz N Rowbotham M The Effects of Smoked Canna
6is in Painful Peripheral Neuropathy and Cancer Pain Refractory to Opioids Proceedings ofthe International Asso
ciation of Cannabis as Medicine Cologne 2003p28
Abrams D Vizoso H Shade S Jay C Kelley ME Benowitz N Vaporization as a Smokeless Cannabis Delivery System
A Pilot Study 2nd Annual Meeting ofthe International Association for Cannabis as Medicine 2005
Corey Bloom J Wolfson T Gamst A Jin 5 Marcotte T Bentley H Gouaux 6 Short Term Effects of Medicinal Canna
bis on Spasticity in Multiple Sclerosis Poster presented at the 60th Annual Meeting of the American Academy ot
Neurology Chicago IL 2008
Jay C Shade S Vizoso H Reda H Petersen K Rowbotham M Abrams D The Effect of Smoked Marijuana on Chronic
Neuropathic and Experimentally Induced Pain in HIV Neuropathy Results of an Open Label Pilot Study Proceed
ings 11th Conference on fletroviruses and OpportunisticIfections abstract 496p243 2004
Lopez C Toperoff W van den Brande G Tapert 5 Atkinson JH Drummond SPA Increased Sleep Disturbances in
Patients withHIV Related Neuropathy 2005 Annual Meeting ofthe Associated Professional Sleep Societies
Marcotte T Rosenthal T Corey Bloom 1 Roberts E Lampinen 5 Allen W The Impact of Cognitive Deficits and
Spasticity on Driving Simulator Performance in Multiple Sclerosis Proceedings of the Third International Driving
Symposium on Human Factors in Driver Assessment Training and Vehicle Design 2005
Schrier R Soto P Hamlat C Durand D Ceci K Ellis R 2004 3 Effects of in Vitro Cannabinoids onTcell Responses
of HIV Infected Patients Poster presented at the 70th Sociery on Neuroimmune Pharmarology Conference Santa
Fe NM
IB
CENTEF FOR MEDICINAL CANNABIS RESEARCH UNIVERSITY OF CALIFORNIA

OtherCMCR Supported Publications
t Darmani NA Izzo AA Degenhardt B Valenti M Scaglione G Capasso R Sorrentini I Di Marzo V 2005
Involvement of the cannabimimetic compoundNpalmitoyl
ethanolamine in inflammatory and neuro
pathic conditions Review of the available pre clinical data and first human studies Neuropharmacology
48 1154 1163
t Fattore L Spano S Cossu G Deiana 5 Fadda P Fratta W 2005 Cannabinoid C81 antagonist SR 147716A
attenuates reinstatement of heroinself
administration in heroin abstinent rats Neuropha macology 48
1097 1104
t Fride E Ponde D Breuer A Hanus L 2005 Peripheral but not centrel effects of cannabidiol derivatives
Mediation by C61 and unidentified receptors Neurophaimacology 48 11V1129
t Fu J Oveisi F Gaetani S Lin E Piomelli D2005
Oleoylethanolamide an endogenous PPAR alpha agonist
lowers body weight and hyperlipidemia in obese rats Neuropharmacology 48 1147 1153
t Grant I 2005 Foreword by Igor Grant MD Director Center for Medicinal Cannabis Research CMCR
Neuropharmacology 48 7067
Grant I Cahn BR 2005 Cannabis and Endocannabinoid modulators Therapeutic Promises and Challenges
Clinical Neuroscience Research524185 799
Grant I Gonzalez R Carey C Natarejan L Wolfson T 2003 Non acute residual neurocognitive effects of
cannabis use Ameta analysis study lournal of the International Neuropsychological Society 9 679 689
Gonzalez R Carey C Grant I Nonacute Residuaq Neuropsychological Effects of Cannabis Use A Qualitative
Analysis and Systemic Review 1 Clin Pharmacol 2002 42485 575
t Hillard U Jarrahian A 2005 Accumulation of anandamide Evidence for cellular diversity Neuropharmacol
agy 486 1072 1078
Ilan A Gevins A Role K Vizoso H Abrams D The Cognitive Neuropysiological Effects of Medicinal Mari
juana in HIV Patients with Peripheral Neuropathy 2nd Annual Meeting of the International Association for
Cannabis as Medicine 2005
tLupicaCR RiegelAC 2005
Endocannabinoidreleasefrommidbraindopamineneurons
apotentialsubstrate
for cannabinoid receptor antagonist treatment of addiction Neuropharmacology 48 17OS 1116
tMakriyannisA
MechoulamR PiomelliD 2005
Therapeuticopportunitiesthroughmodulationoftheendo
cannabinoid system Neuropharmacology 486 7068 1071
t Pacher P Batkai S Kunos G 2005 Blood pressure regulation by endocannabinoids and their receptors
Neuropharmacolagy 48 7130 1738
t Pertwee RG Thomas A Stevenson LA Maor Y Mechoulam R 2005 Evidence that7hydroxy 4dimethyl
heptyl
cannabidiol activates a non CBI CB2non TRPVI target in the mouse vas deferens Neurophar
macology 48 1139 7146
t Salim K Schneider U Burstein S Hoy L Karst M 2005 Pain measurements and side effect profile of the novel
cannabinoid ajulemit acid Neuiopharmacology 48 7164 1171
t Ueda N Tsuboi K Lambert DM 2005 A secondNacylethanolamine hydrolase in mammalian tissues
Neuropharmacology 48 1079 1085
t Zhuang SY Bridges D Grigore ko E McCloud 5 Boon A Hampson R Deadwyler SA 2005 Cannabinoids
produce neuroprotection by reducing intracellular calcium release from ryanodine sensitive stores Neurop
harmacology 48 1086 1096
tConrents ofCMCF special issueothejournal Neuropharmacology
W WWCMCR UCS EDU FEHRUARY 11 1010 19

Y
UCSanDiego
HEALTH SCIENCES
UniversiryofCalifornia
www cmcr ucsd edu

Anaest esia 2004 59 pages 440 452
Initial experiences with medicinal extracts of cannabis
for chronic pain Results from 34 N of 1 studies
William Notcutt Mario Price Roy Miller Samantha Newport Cheryl Philiips
Susan Simmons and Cathy Sansom
1 Cons dmnt Annestlietist 2 Seriior Phnmm ist 3 Specinlist Registrnr Annestlresin 4 ResenrcH Assistnnt
i Registered Nuvse Depnrtroent of Anaesd esiq Jnnies Pnget NospirnlLaeueslofr Rond Crea Yam oufh Norfolk
NR 31
6LA UK
Summary
Three Cannabis Based Medicinal Extracts CBMEs for sublingual use became available in 2000
Aotal of 34 N of 1 studies were undertaken using his novel herapy for patients with chronic
mairily neuropathic pain and associaced symptonu ro explore efficacy olerability safery and
dosages Three CBMEs 49 Tetrahydrocannabinol THC Cannabidiol CBD and a 1 1 mix
ture of them both were given over a 12 week penod After an initial open label period the
CBMEs were used in a randomised double blind placebo controlled crossover rial Extracts
which contained THC proved most eH ecdve in symptom concroi Regimeas for the use of the
subfingual spray emerged and a wide range of dosing requirements was observed Side effec s were
commoq reflecting a leaming curve for both patient and study eam These were generally
acceptable and Gtde different to those seen when other psycho accive agents are used for chronic
paia These ini ial experiences with CBME open the way ro more detailed and extensive smdies
Keywords
neuropathic
CnnnnGis Def n 9re
rahyArocnnnnbinoL CannaGidiol Multiple sderosia
Pnin chmnic
Conespondenre YVilliaii Notcutr
Email willinni no au tajpagetnl suk
Arrepted i Ocro6er 2003
Cannabis has been used for five millennia for he 1 The absence of reliable and standardised
reatment of many conditions including pain inftamma preparations
tion neuralgia migraine and dysmenorrhoea It has also Marerials obtained om mntrolled sources having
been used as an anticonvulsant msde relaxant and Eor reliable standardised tomposition and prepared to
restlessness and aiixiery in cerminal illness 12j However pharmaceuuca standards have not previously been
1971 it was
by deemed to be of liccle medical use and available
was removed from he formulary UK The synthe ic
cannabinoid nabdone was subsequendy in roduced for 2 Difi ieulries with deGvery methods
the treacmen of chemotherapy induced intractable Smoking is an efficienc method of pa ient titration and
nausea
and vomiting delivery bu modem medicine does not accept the
More recendy basic science research has revealed che inhalation of carcinogenic smoke om buxning dried
Endocannabinoid system 2 thereby providing a ration plant matenal as a method of delivenng a therapeutic
ale for clinical research Concunently there has been an agenc Not only are there health nsks 4SJ but under
explosion of anecdotal evidence Gom patients of the taking quality clinical research using this approach is
therapeutic efTects of cannabis
almost impossible
A few single dose clinical studies on the ure oE cannabis As an oIly substance cannabis is difficult m nebulise
for were
pain conducred in the 1970s but the condusions and as such is imtable to the laryra and trachea
drawn are debatable 3 Very litde has been undertaken Equipment for heating cannabis m produce a vapour for
since because of four major obstacles
inhalation is available recreationally
o zoon eiackweuamn9 m

Anaesthesia 2004 59 pages 440 452 W Not utt et al
Cannabrs based medicinal extracts
Whilst the oral route is oen used recreadonally the Yharmaceuticals We chose to investigate a 1 1 mixmre
onset of ef ec is slow over
one and a half hours of THC and CBD for chronic pain and ro compare it
absorption is very variable and there is a significan first with placebo THC alone and CBD alone Two recently
pass eH ect This makes accurate and rapid ticration compleced CBME smdies 14 15 were run in parallel
difficult for a
patient
with chronic pain although this with this study as pazt of the initial development program
may become a practical
route for the pa ient
who is The primary objective of this study was to identify the
stabilised and who a
requires
constant intake oE cacmabi thezapeutic windows of three CBMEs The secondary
noid Rectal administration has also been suggesced objectives were o study the effects of three CBMEs of
as a
possibility but ptobably corifers no advantages over the varying constituent composition on patients suffering
oral route
with chronic reErac ory pain or defects of neurological
The subGngual
rouce was first descdbed by Marshall in function to study safety and rolerabiliry parameters for
1897 t It provides the possibility of acceptable rapid these CBMEs and to determine the approaches ro more
absorption for titration combined with the absence of a exrensive and de aIled studies
first pass effec No clinical smdies had previously been
ndertaken on this rouce of administration
Methods
3 PoGtical and legal difficulties The smdy was approved by the Local Research Ethics
It is only recendy that the issues of the recreational and Committee and by the Medicines Control Agency and
the medicinal use of cannabis have been disentangled in was conducced underaDoctors and llentisa Exemp
the minds of the public the medical profession
and senior tions DDX Gcence lluring the ime of the smdy the
politicians267 CBMEs remained classified as Schedule 1 drugs This
required that the patients and the invesdgating team be
ects Gcensed by he CIK Home Off ce in London Each
of acu e psycho active other prychologi panent gave written informed consen a the start of the
effects2891Oj that have been smdy The stud underwent independen external audic
4 Side ef
The possibility
cal and physical side
observed with recrea ional cannabis se have discouraged
cli tical study
The smdy cannabinoids
The caruiabinoids were derived direcdy Erom standardised
Single chemical or plant extract
cloned plants and were prepared to medicinalsandards
It has been suggested that the presence of cannabidiol Each extract contained 95 of the specified cannabi
CBll amelioraces the psycho acdve eflects of 09 noid s the remainder being a mixture oE other plant
tetrahydrocannabinol THC ll Patients have self chemicals minor cannabinoids terpenes and Ravonoids
reporred chat they prefer milder forms of cannabis that The materials were prepared as a sublingual spray and
have a significan
CBD con suggests each ac uadon delivered 25 mg of THC 25 mg CBD
that pa ients prefer plant cannabis to dronabinol an oral or 25 mg THC 25 mg CBD THC CBD or
synthetic form of THC when used for the control of matching placebo in Ot ml The first six patients recei
nausea and vomiting associated wi h chemotherapy ved che spray as an aerosol delivery system excipients
712 Similarly patien s
who had used cannabis for their tetraf3uoroe hane 80a ethanol 20Sbsequent pa chronic pain prior
to
trying nabilone a syn hetic used a pump ac ion spray excipients ethanol 50
analogue of THC prefened the formez 13 propylene glycol 50
There may be sevetal reasons for this difference CBD
blocks the mecabolism of THC m 11 hydro cy THC Patien selection
which is more
psycho ac ive than THC and may produce Patients were either recruited om he local Pain ielief
dysphoria 2 Alcernatively it may simply be that patiencs CGnic or direcdy referred by ge eral practitioners or
find dtiation easier with smoked cannabis It is unknown hospital consultants Several volunceered direcdy with he
whether any other ingredients of plant cannabis contrib agreement of their general practitioners
ute ro this effect
The patien s were all over 18 years old with chronic
It was decided to investigate he poten ial benefits of stable pain poorly responsive to other modalities of
whole planc
extracts ra her than pure THC alone control Painoher symptoms and medicarion use had o
Pharmaceutical grade Cannabis Based Medicinal Extracts be stable over the 4 weeks preceding che start of the
CBMEs derived from cloned plants yielding standard study Patients were required co abstain om ddving
ised quan ities of cannabinoids for sublingual use during the study and also
contracepcion
required m ensure adequace
in 2000 om GW
became available for clinical sudy
o zooa eia kweurmny m

I
I
I
W Not utt et al
Cannabs based medional exVacts
Anaes hesia 2004 59 pages 440 452
Patients with significan cardiovascular disease oral Ti IC CBll or placebo At he start of each week
disease or any oher serious sys emic disorders titration under supervision was under aken as on the first
were
exduded Patients with any history of schizophrenia day of the open label period Each CBME was Chen given
other
psychoses oher significant psychiatric disorder or
again in random order over the next 4 weeks Therefore
any problem with drug or alcohol misuse
dependency each patient received each CBME and placebo for nvo
were also excluded 0 llepression secondary co their separate1week penods
chroriic pain was not an exdusion facror Randomisation was undenaken externally and che
Patiena with a
past history of sigruficant recreational tchedule supplied to GW Pharmaceuticals Un 66nding
cannabis use or who were continuing ro use the drug in occurred at completion of each patient s study
this manner ere excluded Padents who had current or
previous expenence of using cannabinoids as a medicine Cannabinoid escape medication
illicit plant cannabis or nabilone were included Seven Gequent urers of illicic cannabis for eympmm
The racionale for recruiting patients who were non control prior o the smdy wereofered the THC CBll
naYve ro cannabis was
mixture as escape medicanon dunng che crossover period
The CBME preparations the delivery sysrem and he This was o ensure that they did not retum ro their use of
sublingual roure were new and untried in patients There illicit cannabis when receiving inefIective medicanon
was no information on Gkely dose rann e
These panents would have knowledge of the benefits Patient assessment
eflects and side effeces of cannabinoids They would At he fint visit a full medical hisrory was obtained
therefore be appropriarely prepared and able co recognise including an assessment of che pain and associated symp
these ef ects early
toms the past management and the current dmg therapy
Some qualitadve comparison with their preceding The previous use of cannabis recreational and medicinal
cannabinoid use and effect migh be achievable
determining equency type effec iveness and side As more
experience grew cannabinoid patients was explored Futther relevant informaboo was obtained
were recruited om local medical records and the patient s general
practicionrr A physical examinanon was undertaken
The study design Fig 1 Basic haematology urea electrolyces and Gver function
An IV of 1 methodology was used Two weeks of tests were pedormed and repeared a the end of the smdy
baseline assessments were followed by a 4h supervised Depression was assessed with che Beck llepression
titration wich open label 1HC CBD CBME use was Invenrory BDI wtilch was applied at each visic Thu was
connnued at home for a 2week run in penod A supplemented by the General Health Quescionnaire 28
schedule of assessments was undertaken before and after GHQ28 a three poinrs during the study Fig 1 16
each penod Throughout the study patients kept a daily Up to five significant pain or other symproms were
diary of their worst two symproms each measured with a
no ninated by the panent and the severiry of each was
standard 10 cm visual analogue scale VAS and also of assessed at each visit using a standard VAS The patients
their sleep and any side experienced
were familiansed ith he assessmenc procedures and the
If ehe patien s showed some benefit in one or more of daily dianes to be completed at home The seventy of he
cheir assessments chey muld proceed
to che8week two worst symptoms was measured in the mottung at
randoaused double blind placebo controlled crossover midday and in the evening on a dady basis The
part of he study Each week for the first 4 weeks hey remai ung index symptoms were used to broaden the
randomly received a difE THC CBll assessment of individual clinical efEectiveness Duration of
IWEEk
Superv sN smB
BBSB Lne
Run ln
crosco roaumeen
cros onoa eisen
aiweek emm aea
penomoi
TXC
ceo
zx zea
u J rncceo
0 2 9
waceeo
5 6
1 I
aeax aneom sae
pe oasm
TXC
eeo
NCwo
waceea
9 B 9 10 11 1Y
nme sneaw 1 1 1 1
1
IGH028 t I I
I
Figure i Thesrucmre of che smdy
442
moa eiack veucei n g m

Anaesthesa 2004 59 pages 440 452 W Notcutt et al Cannaba based medional extracts
Results
sleep houcs and quality of sleep Good Fair Poor were benefies seen the occunence ofside effeca etc Similady
recorded for each night Appetite
bowel fonctioq a comparison of he efFectiveness of the three CBMEs and
bladder fimction and activity levels were also monitored placebo was under aken
Yacients were Eully briefed on the possible psycho Where clinical benefit could be shown for individual
active side effects and the likely seven mos common pacients hey were ot ered the opportunity to con inue
were iden ifiedi the diary These were presenred
in the into a long rerm safety extension study CBME SAFEX
form of he
question Throughouc the day have you Ic had been a requiremen of the Local 2esearch Ethics
experienced any of the following please tick Dry Commitree for the patients to be able ro continue
mouth Time disrortion Dizziness Panic aixiety attacks trea ment unless cGnical pharmaceutical or regulatory
Drowsiness High Strange feeling Hallucinations requiremen s deemed otherwise
Patiena were also asked ro record any other side efCects
or new
sympmms that they expedenced whether or not
they felt this was associa ed wich he medication Vo
attempt was made o investigare tolerance dependency or Patients
other longer term psychiattic ef ects
A total of 34 patiencs ere studied Demographic details
The use of concoautanc medication was monirored underlying diagnosis main problem symproms and
Patients were asked not m change heir re ular medica previous medicinal use of cannabis are shown in Table l
tion withouc prior discussion wi The high number of female padents ref3ected he
maintenance oE a constant
pharmacological background prevalence of multiple sclerosis The patients have been
was considered impor an Non
grouped for analysis Fig 2
for was
breakthrough pai allowed and documented Only seven pacients used THC CBD as rescue
However by definicion most
patients were getting very medication during the crossover part of the study Group
litde benefit from their previously prescribed medication CRM Therefore data from these panenrs have only
been included for the assessment of the run in periods
Cannabinoid administration The first two patients had inadequate daca fmm the
The patien s underwent4h dosing sessions a the hospital baseGne period
Fig 1 whenever a new CBME was incroduced Initially Out of the toal oE 34 24 patients complered he
one
spray was given every 15 min This interval had been crossover penod without cannabinoid rescue medication
determined om studies of the use of the spray in
healthy Group NoRM Fig 2 They provide the comparadve
voluneeers Thisiterval was changed
to 30 min afrer the information on effects and side effects
fiat six
pa ients
had been smdied One patient who experienced a vasovagal episode
Throughout these itrations vital signs
and side wntinued single blind without the THC periods for the
were monitored ac
regular intervals Tesrs of psychomotor remainder of the crossover period Therefore only data on
and cognitive func pedormed before the start and dosage used are induded Table 2
after 3hTrail Making Tests A B17 Adulc Memory Two patients were withdrawn from the study Table 2
and Informacion Processing Battery AMIPB 18 One failed ro mlerare he 1HC CBD at the lowesc
had received between nvo
dose during he run in and che other could not cope with
At the end oE 4 h patients
and four sprays two and eight sprays for the first six the smdy requirements
pauencs depending on their response etFects and side
efi ec s The patienrs were then discharged home with a Dose titration sessions
rela ive if in a clinically satisfacrory state They were given The inicial rate oE citration was roo rapid for cwo of che
a supply oF the test CBME During the initial2week first six patiena who developed dysphoria and light
mn in
penod patients were contacred daily for 7 days or headedness Both recovered Eully over che following 2 h
longer as necessary A all imes a member of he ream Subsequently the in erval between sprays was changed
was available for con ac in an
emergency ro answer from 15 to 30 min This gave the patiencs adequate
etc
questions opportunity o tenninare heir itration safely if they
stareed to experience side efEects
Data analysis
The rests of psychomotor and mgnitive function Trail
1his smdy was primarily observational and each patient s Tests and AMIPB yielded unexpectedly equivocal
data were evaluated individually The use of placebo and results requiring a more detailed analysis than planned
blinding was ro provide greater rigour w the observa There were ofren improvements in performance aer
tional da Data om the individual N of 1sudies have CBME 19 Therefore the resulcs will be presented
been aggregated o give
an indica ion of the scale oE he separately
C 2004 Blackwell Pubhshing Lttl
3

W Notcutt et al
Canna6is based medicinai eztracts Anaesthesa 2004 59 pages 440 52
Table 1
Pa iene details
Site of pain Site of pain Prev Rescue Global
No Sex A9e Dia9nosis
Years symptom 51 symptom 52 cann use CBME outcome
1 M 51 MS 12 Lum6ar pain Leg spasms 3 CRM 2
2 M 43 Spinal cord tethering IamineROmy 13 Low lumbar pain Posterior leg pain L 3 CRM 3
3 F 58 MS 6 Thigh pain L spasms Hip pain L 2 CRM 3
4 M 55 Low back sciatica post laminectomy 36 Lum6ar pain Posterior le9 pain B 3 CRM 2
5 F 53 MS 71 Whole le9 pain Ne k arm L pain Z CRM Z
6 F 52 MS 15 Knee pain B Head facelpain 1 CRM 0
7 F 33 Disc degeneration laminotomy z 2 35 Posterior thigh R Low back pain 0 NoRM 1
8 F 44 M5 post cystecfomy ileostomy 78 Urethral pain Pelvic floor pain 1 NoRM 3
9 F 51 MS 7 Thigh L lower legs pain Chest tightness
N None
10 F 50 MS 15 Leg pain R Right leg spasm 1 None X
11 F 53 Spinal fusion 18 Posterior leg pain B Low back pain 2 NoRM 3
12 F 55 MS 10 Lower le9 pain Lumbar pain 0 NoRM 0
13 F 32 Degenerative Dis pos laminotomy 6 Leg B pain Back pain 0 NoRM 2
14 M 64 Paraplegia AV malformation of mrd 10 Leg pain B foot R 4abbing pain 1 NoRM 2
15 F 46 MS 13 Legpain Sa ro ilia pain 0 None 3
16 M 4 MS 10 Leg spasms Bladder urgency
1 NoRM 3
17 F 41 MS 23 Leg spasms Hip pain R 1 NoRM 2
18 M 50 6rachial Plexus Avulsion injury 14 Arm R aching pain Arm shooting pains 0 NoRM 1
79 M 48 Femoral Plexopathy from phenol inj 7 Lumbar pain Leg scmtum L pain 2 NoRM 2
20 F 30 LamineROmy L15 x 2 9 Wmbar pain Leg L pain 0 NoRM 1
21 F 46 MS 3 ftetro orbital pain 8 Arm R pain 1 NoRM 3
22 M 53 MS 4 Legs spaAicity Leg B pain 1 NoRM i
23 M 48 4
Myopathy
Leg B pain Upper arms 3 NoRM 2
24 F 35 CRP51 post ankle trauma 9 Ankle R aching pain Ankle R stab6ing pain 0 NoRM 1
ZS F Z6 CRP51 4 Neck arm ache Neck scapula N NoRM 1
shooting pain
26 F 41 20
Polyarthralgia
Spinal pain Knee pain B 2 NoRM 0
27 F 26 Disc degeneration post discectomy 5 Lumbar pain Posterior leg pain L 0 NoRM 1
28 F 47 MS 7 Neck thorax pain Arm pain R 0 NoRM 2
29 F 56 Raditulopathy cervical fusion 11 Arms CS Inter 0 NoRM 2
30 F M Diffuse systemic Atrophy 11 Jaw pain
Tremor in limbs 2 NoRM 2
31 F 50 MS 10 Neck pain Lower leg pain B 0 NoRM 2
32 F 66 MS 3 Leg pain B Hand pain B 0 NoRM 0
33 M 62 Massive Trauma Left Arm 26 Lateral forearm pain L Wrist allodynia L 1 NoRM 1
34 M 38 Stiff Man Syndrome 75 Hands wrisis pain Buttocks hips pain 3 CRM 2
MS Multiple Sdemsis CRPS Complex Re9ional Pain Syndrome ft ftight L Left B Bilateral
Previous medicinal cannabis use 3 frequent 2 sometimes 1 occasional 0 none N nabilone
Resme CBME CRM Resme CBME group NoRM No Rescue CBME group None athers
Glo6al Outmme3Subrtantial 2 Moderate 1 Some 0 No Benefit X Didn t omplete
xe ne
2 Patlantv
Sixreen of the 34 patients had a decrease in VAS of
greater than 50 for either S1 or S2Of hese 10 patients
zev um had a greater than 50 reduction in VAS for both S1
LBMEfteaweMeElntlon CRMgmup
NoCBMENeatu
MeClcaEOn NeftMgaup
tPeEen kt5
and Sz
Of he 34 padents 32 recorded the VAS of 1 and 52 at
rar c midday on each day of the baseline and run in penods
2 weeks each The results have been aggregaced Fig 4
and the median and inrerquartile range presented
za na
Figure 2 The progress of che 34 paciena ehrough che smdy Crossover period symptom control
Uuring the crossover period the cumulative S1 scores for
Run in pedod symptom control
24 patients in group NokZM measured three times The wo main sympmms S1 S2
were measured VAS median inrerquartile range were placebo SA2873
ac che start and at completion of the2week run in period CBD 545 3674 THC 463 lJ4606 and
for all 34 patients The scores were aggregared and the THC CBD 4A2658 p 001 overall cest for
median and interquartile ranges are shown Fig 3 significance Fnedman THC CBll and THC were
n
r Zp04 Blaceweli Publrshing ttl

Anaesthesa 2004 59 pa9es 440 152 W Notwtt e al Cannabis based medional extracts
Table 2 Uecails of the patienu who either failed ro complece che stady or for whom che
andomizanon mde was broken
PatientlD
Reason
N9
Very frail from M5 Could not tolerate the lowest dose of the spray during the open label period and hecame too sedated
She was withdrawn at this point
N70 Travel to the study entre was too distressing for her 3 weeks into the rossover part of the study she was withdrawn
The randomization was broken There had heen no evidence of benefit during the crossover period
k75
She experienced a vasova9al episode during titration with THC Her vital signs had been checked 10 min previously and
refleaed the pre dosing resulu She recovered uneventfully and was able to retum home about 2 h latec 7he THC periods
of the crossover period were omitted and she continued single 61ind
19 He be ame very depressed and distressed towards fheed ot the crossover period having had no benefit for 5 weeks
following initial success Breaking the randomization code it was discovered tfiat only the 7HC CeD period had been beneficial
He continued the last Z weeks single hlind whi
induded the semnd THC CBD period Later we leamed that he was on the
verge of divorcing his wife who had a psychiatric disorder coincidental to the study
W32
She had an episode of abdominal pain and vomiting in week 2 of the crossover period Randomization was 6roken A diagnosis
of gastroenteritis was made A break from the medi aiion was allowed and she then continued single hlind
Q
N 9 Sl
a10
N 8 Q S2 c 8
7
6
oi 5
c 4 cm
a 3 Q 4
c 2
c
1
a 2
0
Baseline
Run in
0
F T C P
Figure 3 Change in med an inmrquarcile range VAS for CBME
sympmm St 5 recorded at the start baseline and a com
pletion of he2week mn in penod for 34 patiencs wich open
label THC
m
N
ia
e
CBU
6
Sl
O S2
Figure 5 Crossover period aggregated symprom Sl and S2
VAS measured 3 cimes day mediannerquar ile ange for
che four pairs oE weeks For each CBME and placebo F
THC CBD T THQ C CBD P Placebo
51
261750 50331688 408133543 and 428
SZ
233 51 respectively p 001 overall est for
N s
significance Friedman THC and THC CBll were
5
significandy better tha placebo p 001 and
o
p OA54 Wilmxort with Bonferroni correction
a
2
Of these 24 paden s nine had a deaease in VAS of
more than 50 for either 51 or S2 when using one of he
o hree active preparations compazed with placebo All
Baseline
Rumin
ne experienced this with THC and or THC CBD
hese three patients also achievcd his reduction with
Figure 4 Change in median VAS recorded in che daily dianes at Of
noon for symptom Sl S2 incerquartile range during CBll
2 weeks base line period and 2 weeks open label THC CBD
Paciencs 3 co 34
EfFectiveness of inedication in comparison
with mn in THC CBD
both significandy betrer chan placebo p 05 and At the weekly visit the patients were asked ro compare
p 01 Wilcoxon with Banferroni correction Fig 5 their current test medication with che THC CBD
Similarly the S2 scores median interquartile range received during the initia run in penod of the smdy
for placebo CBll THC and THC CBll were 495 Fourteen of 24 patienes in group NoRNI found he
445
moa eiaaweureom g ce

W Notcutt et al
Cannabis 6ased medional extracts
Anaez hesia 2004 59 pages 440 52
c
Range
er 75
t Median
o 25
Range
W100 W 100 f
J
N a F 80 0
o
Z
LL
O
60
0 40
qp
o o
20
0
Base Line
CBME PERIOD
A
Run In
Z
LL 20
O
z o p
60
o
op
o
Range
o75
t Median i
o25o i
Range
F T C P
CBME PERIOD
Figure 7 Percentage of mghu when sleep was of good
Figure 6 Percenrage of nigh c when sleep was of good quahq for 24 pa ien s Group NoAM comparing the 14 days of
qualiry Eor 32 patiena 3 ro 34 rompanng the 14 day each CBME used during the crossover penods median incer
baseline and run in
penods medianin erquartile range range 9uaaile range range
o
THC CBD nine patiena and or the THC eight
9
pa ients as or
equal
more effective Cor symptom control a 8
Four of these patients also Eound CBD as effective as the 7
onginal medication No patient found che placebo as E 6
effective as the odginal medication
i a 5
y 4
QuaGty of sleep N 3
percentage oE nights thae each padent described as
y 2
good quality sleep were compazed
Eor che baseline and
o
the iun in periods The res les Erom 32 of 34 patiena are
presented median IQR range The median IQEZ rose F T C P
om 134 35J 0 to 535 714 25 Fig 6
CBME
Similarly the percen ageof good ni hts was calcula
ted for he 24
patien s of group NoRM for the Figwe 8 Uuration oEslerp in hours mean SU for 24 panena
crossover
part of he study comparing the hree diflerent CBMEs Group NoRM wmparing he 14 days oF each CBME used
during he crossover periods F THC CBD T THQ
and placebo median QR range Fig 7 The median C CBU P Placebo
IQR Eor THC CBll was 554 78 345 for THC
was 429 572 357 for CBD was 369 47 9 286
and for placebo 170 35J 36 p 001 overall sleep dura ion in hours for THC CBll THC CBD and
eest for significance Friedman THC CBll THC placebo were 68 13 6J 13 64 14 and 63l6
and CBU were all significandy better than placebo respecuvely Pig S
P 001 p 001 and p 05 respectively
Wilcoxon with Bonfeaoni correction
General Health Questionnaire 28 GHQ28
The GHQ28 assesses he patient s health in general over
Duradon of sleep che preceding few weeks It has four mmponents
The duration of sleep for each of the 24 patients in group Somatic Symptoms Aivciety Ineomrtia Social Dys
NoKM for each of the CBMEs and placebo during the Funcdon Severe llepression and it is recognised that
crossover
part of the study was calculated The mean SD these are not independent of each other The lower the
6
2004 BlackwellPUbbshing Ltl

Anaesthesia 2004 59 pages 440 452 W Notcutt et al Cannabis based med mal extracts
Table 3 Median valoes inrerquart
range range of the four elements the rotal smre and the caseness of the GHQ28 and of che
BDI at the start the end of the mn in and a the end of the study
Generel Health Questionnaire GHQ28
Somatic Anziety So ial Severe Total
Period Symptoms Insomnia Dysfunction Uepression Maximum 84 Caseness BDI
easeline 85 1345 192 9 1155 181 913575 181 3 121 20 36 44 23 69 11 13 175 Z5 0 16 267 9J 423
End of Run In 5 64 10 5 8290 785 11 1 650 10 18 26 13 36 8p 2 61 90 7 16 25 430
End of Study 6p5 14 17 784 130 795 170 15650 120 24 5315165 412 4105 140 B Q0 4J5 420
score the healtMer the pauent
The median scores
interquartile range rangeJ for the 24 patients in group
V 30
NoRM measured ac
the start at the end oE the run in o 25
period and ac the end of the smdy are shown Table 3 20
The Caseness derived from the patienc s score is an
15
indication of psychological psychiatric disturbance
m 5
Depression
Q
For the 24 pa ients in N
group IVoRM the median IQR of
FF F T C P
he BDI score measured at the start at the end of the run in
period and at comple ion of he study are shown Table 3 Figwe 9 Box and whisker ploc of the medianin erquattile
Four een patients changed the severity of their depression range range number oEsprays day used by 25 patien s Group
between the start and he end of the study Seven NoRM pacienc 15 The lasc 4 days of ehe mn in penod
pa ients
and the last 4 days of each of che pairs of weeks of each CBME
moderate mild three patiena moderate 9 aurtimal
ere averaged FF RuniHQCBU F THC CBD
two
patients severe moderate one patient severe a T THC C CBD P Placebo
mild one patient minimal mild BDI score Minimal
09 Mild 10 16 Moderate 17 29 Severe 30 63
commonest side efEec
occurred during the run in
Daily intake o CBME period and the 2 weeks of use of each CBME and
At the start of he run in period each of the padents placebo during crossover are shown Fig 10 Unfortu
titrated themselves to their optimum dose over a period of narely data on the incidence of the designared side effects
several days The amount was pardy determined by he eg dry mouth drowsiness dunng the baseline period
onse of side efIects and partly the in
improvement was subs antially incomplece due to an enor in data
symproms lluring he crossover pedod he patients collec ion and is not presented
reached heir optimum dose more quickly
Drowsiness and euphoda dysphoria high were com
The wo
patients who used six or more sprays as a mon in the East 2 weeks of the run in period while patients
single dose found ic difficulc ro retain sublingually because ried co find an appropriate dose and were more equent
of saGvation This caused some of he CBME m be wi h CBMEscon aining THC Dizziness followed a sunilar
swallowed cheoretically altering the absorp ion proEile pattem but was less of a problem Episodes of panic and
Across the 34 patients there was a range
of use of between acuciety were infrequent They were commonest during che
one and eight sprays as a single dose
run in period and noc exclusive ro those who were
For 25 patients Group NoRM patient 15 the cannabinoid ntive Time disrortion was infrequent but
average daily in days ofhe run occuned with CBMEs contauilng THC Halluciriadon was
in and each pair of CBME treatment weeks during he recorded by only one patient and was not repotced as severe
crossover
period was calculaced median IQR range The most common rymptom hat patients complained of
Fig 9 TFus assumed a level of stabiliry in the dose used was a dry mouth Fig 10 However most patients were
towards the end of each week
taking other mediwtions which could contribute to chis
indicated by the high occurrence when using placebo
y
35
Side effects Some padents experienced a stinging sensation on use
In cheir daily diaries the patients recorded episodes of the of the spray particularly wich the ial formulation
seven specified side effects For 24 patients Group Many did not like the taste No subling al mucosal
PIoRM the number of on
days which the hree changes were observed
2004 Blackwell Publrshing Lttl

W Notcutt ei al
Cannabiz based medicmal extracts
Anaesthes
2004 59 pagez 440 452
PREVALENCE OF COMMONESTSIDE EFFECTS
25
20
wt5 17 deyS Figure 10 Prevalence of daily
814
episodes oE dry mouch drowsiness and
dey5
dysphoria euphoda high during
o
mn in 14 days and crossover periods
Z 7 7 days None No episodes
5
7 days Epfsodes on S1 of days
814 days Episodes on 50 of
O
days FF Run In THC CBU
FF F T C P FF F T C P FF F T C P
F THC CBD T THC
Dry Mouth Drowsiness DysphorialEuphoria c Csv P Ptacebo
None
Patient 15 had a vasovagal episode during
a dosing prefereoce5
session It occurred 1 h aer he third spray when using
THC for the first ime as revealed on immediare The 28 paciena who obtained benefi were asked which
unblinding Table 2 The reaction was probably due CBME they had prefened Eleven preEerred THC
to a combination of prolonged sittmg and excessive CBD 14 found THC and THC CBD equally satisFac
IVo other cardiovascular side effec
were obser tory two preferred THC and one found THC and CBD
dosing
ved for any patients
equally satisfactory
A change in neural func ion was observed in two At the end of each individual study the senior clinician
patients xho had had previous spinal surgery One had a made a clinical asseesment of the overall benefi for each
retum of an absent ankle reftex pauent 11 The second patient to decide on progression to the safety extension
patient 2 discovered that touch sensation reappeared in smdy This subjective assessmen included he concrol of
a previously anaesthe ic fifth lumbar dermatome He also symptoms Sl and S2 and other identif ed symp oms
found chat his abiliry
to mai ain an erection sleep mood and GHQ28 Table 1
was
dramatically improved leading to the acciden al preg
nancy o his partner and bir h of a daughter
Distussion
No other side effects relared ro the use of CBME
emerged dunng che smdy
This was the first clinicalsudy ofboh the use of CBMEs
The patients were weighed at the beginning and the and of their delivery via the sublingual rou e The
end oF he study in normal clothing The median change objectives were ro ob ain an initial indica ion of the
in weight or 27 of 34 patients interquartile range efEicacy safety and tolerability We had no firm know
range was OS kg 2 m 06 kg56 to 4 kg Of the ledge of the exrent of the therapeutic ef ect he Gkely
remainin seven two patien s eeraunated the study early dose range ehe frequenty and pattem of administration
and data the incidence of and threshold for side eflects or he
one
pacient
was paraplegic and unweighable
were unrecorded on four
tolerabiliry of the CBME spray
Full blood count urea and electrolytes and Gverfl ncdon
ests remained within noxmal limits for 33 patients One Designing the study
patienc had transien changes
in alanine transaminase and In designing he study si c major fac ors were taken into
alkaline phosphatase wMch may have been related mhe consideration
use ofery hromycin for a vaginal abscess 1 Chronic pain is ahe
erogeneous problem with mul During the 3 months of the study other events and vadable pathophysiological mechanisms coexisting in
occurred which were unassociated with CBME but the paden and varying over ime llifI eren mechanisms
would be Gkely to have an effect on outcomes significant Eor pain genesis probably ecist wi hin a single clinical
marical disharmony two husband made redundant diagnostic group leading to the eed for difCerent
one wife undergoing chemocherapy one pregnancy treatment strate es 20 21
and misdiagnosis of a major geneuc abnoxmaliry one 2 There has been a pressure o use cannabinoids in
flare up of MS one other two The randomization pa ients for whom all other therapy has failed These
was broken for two patiena and boh continued single are usually the most difficult and complex padena to
blind Table 2
smdy
J 200a Blackwell Pubirshing Lid

Anaesthesa 2004 59 pages 440 452 W Notcutt et al Cannabis based medional eatracts
3 The efEec of cannabinoids on pain is Gkely to be ae padents to individually customise heir usage to difl erent
vadable sites in he nervous
system ranging om the endpoints
neurone to
pedpheral
he cerebral mrtex
Comparisons of results across groups of patien s canno
4 Previous and current therapy is usually hererogeneous reach the same level of sta istical significance as with
5 DifEerences benveen healthy volunceers and patients in homogeneous parallel group studies Therefore the
side ef ec profde were anncipaced analyses undertaken are anatempt to summarise some
6 Differences in cherapeucic dose effect and inside effect
of the data om the 34 individual studies Furthermore
profde benveen patients were expected
morphine and many ocher psycho active drugs because of he failure of past symptom controL The
For multiple sclerosis MS the ae iology of the pain attention from the study ream futther compGcaces the
may be central neuropathic somatic muscle spasm evalua ion It was no surprising that all but one patient
and spasticity visceral muscle spasm eg bladder could show some benefit at the end of che run in period
mechanical spinal mechanical immobility Therefore the daca only allows for generaliza ions to be
or even
as see wi
h he patients were desperate o participare in the study
unrelated ro MS The pain may be markedly aggravared drawq hereby providing information for individual
by psycho social factors such as depression immobility clinical practice and for he design of fumre and more
einployment loss burden on the family and variable focussedsudies
progression of the disease To these must be added the The progress of patients inasceady state in the
effecrs of a vadety of other problems including defects subsequent extension study will complement he inor
of vision co ordination strength sensation bladder mation given here paper in prepara ion Future smdies
contml and sexual function
night give tighter indications of cl e Gkely success of
There were three specific reasons for on
focussing CBMEs in neating the specific sympcoms of specific
patien s with MS Firs ly there is ex ensive anecdotal diseases although we are still far from being able to
evidence of he benefi s of illicit cannabis Eor symprom predict accurarely he outcome of most therapy in chronic
mntrol in his disease Secondly there is a perception that pain
cannabinoids should be used for reating neuropaehic The 1week periods of the crossover patt were too
paiq although there is no strong evidence to support this short However periods of 2 weeks or more would have
opinion
We herefore saw no reason to exclude othea extended this study unacceptably Alcematively we could
with a
vanety of other incraceable pain problems All have eliminaced one or more CBMEs However as we
patients exhibited multiple pains of neuro
nociceptive had no hard evidence on the optimum CBME we
pathic and or unceetain pa
hophysiology Two patients compromised We did not include washout periods as
nominated a
symp om hat was no specifically painful cannabinoids have a long half life in the body even
tremor bladder urgency Third it was expedien
ro though their clinical effect may only last a Eew hours
focus on this group o obcain agreement to ini iate studies
of CBMEs However choosing the mos intraccable Dosing
problems for the clinical crial of a new drug for pain is far tllchough healchy volunteers in the Phase 1 smdies could
from ideal tolerare titraeion at 15 min incervals our patiena proved
With all hese diff culties we decided that a classical differen This vindicated our use at the beginning of
or crossover
parallel group study was inappropriace 22 thesudy of patients who had previous experience oF
We
op ed to use anN oE 1 approach which has been medicinal cannabis use
descdbed as a developei sool and has been recommen 1 general patienrs initially itrated o the linut of
ded for scudying new therapy in chronic pain 23 24 and rolerability drowsiness dysphoria rather than benefi
cannabinoids 7 The method has already been used by The tescs of psychomo or and cognitive function served
others for the scudy of the medicinal use of cannabinoids mairily as a reassurance for discharging he patien s home
in individuals 25 26 19 The wide range of dosage parallels tha seen wi h
The pacienrs are smdied as individuals but with the morphine and many other psycho active drugs
gour of double blind placebo controlled As the smdy progressed the ins mctions for home
crossover
echniques Each individual patient scudy stands by itself usage of the CBMEs evolved Because of our concems
and indeed is much closer co
everyday clinical practice over safety we instructed pa ienes ro initially use as a
than is he classical parallel
trial of a new pharmacolo single dose 30 SO less chan they had received during
treatment It
gical
allows both for the hererogeneity of the citration sessioa They were allowed to use ehe CBME
patients and their varied responses The cap ure of daca up m 6 times per day as required Over the days the
can be individualised allowing a variety of endpoines panents dosage and pattem ofuse was customised ro their
Variable dosing patterns are acceptable enabling the need from their response For example some might
8 2004 Blackwell PubLShing Ltl
9

W No cutt et al
Anaesthesia 2004 59 pages 440 452
Cannabis based medinnal extracts
and con
were mos prevalent during the run in period as patien s
prefer a higher dose at night With expenence
fidznce the
patients quickly moved ro heir optimum learnt eo titrare themselves to an appropriare level
dosing schedule IZealistically the weekly periods oF che study were too
short to allow time for the patients ro fully customise their
Pain and other symptoms
No az empt has been made to analyse
use and their side ef ect managemen
effects of the Drowsiness and dizziness induced by the CBMEs were
CBME on speci6c pain sympmms
The VAS scores do common but manageable for all but one pacient
not difCerenciate between improvements due co direct Table 2 It was used o positive advantage at night time
eEfects on neuralpa hways efEects on sleep and mood and to improve sleep as wi h mcyclic antidepressants
the benefi oE the supporuve environment of the study morphine etc
Equally some padents found the smdy tiring eedious and Dysphoria and mild euphoria were common during the
uscrating whilst others experienced domestic upheavals mn in period Some patienrs were pleased to experience a
ec
feeling of relasation and well being especially if they had
ihe overall ttends seen with the use of THC and had a bad day wi h pain Soaie found he distancing effect
THC CBD were encouraging We anticipated that beneficial However no patient wanted to exchange the
CBD would have litde effect by itself in his study but it disabling efCect of chronic pain for that of immobility
may have other cherapeu ic roles par iculady
in inRam from being dysphorideuphoric
mamry pain 14 27J At the sart of the srudy and before che dose titracion
All eigh patients with residual pain associated with che sessions the padents were briefed about the possibility of
failure of spinal surgery obtained benefit and tis is panic attacks We had no iri ormation about their
an
exciting prospect for Eurther smdy in this notoriously incidence or at what point they might appear No severe
dif icult group
to reat
panic attacks occurred although some bewme amcious at
the onset of dysphoria It may be chat these are pnmarily
Sleep and mood
a feacure of uncontrolled dosing particularly in he novice
The CBME seemed ro have litde effect on he recorded
recreational user
number of hours of sleep However che change in quality A dry mouth was a coaunon oral problem However
om poor or fair to good was unexpectedly high many panencs were using oher drugs which could
The quality of sleep is a subjective global
assessmen and contribuce to this effect No specific oral lesions were
includes duration depth and disturbance It is more seen although they have occuaed in patiena m other
important Eor the pauent
than duration alone Others studies GW Pharmaceucicals
have analysed nocturia 15 and shown a reduction in its Cannabis is known ro etimula
appetite
However
equency wich the use of THC The efLeca oE CBMEs only one patient showed a substantial increase in weigh
he The loss of Sb kg by ano her probably ref3ec ed
on sleep may prove
o be one ofthe major benefits oE
use of cannabinoids in chronic pain and MS substandal marital disharmony
The GHQ28 indicated that the useoCBME had had a
broad efIect even though i was only applied
on three
preferenees
occasions across the study The changes in the Caseness
of the GHQ28 and in che BDI show valuable improve The irtitial open label Utration with THC CBD proved
men in mood o be a guide to the optimum dose of THC Although
CBD and placebo had limited efFect panena did not
Side efI ects
titrare themselves much fur her than they had wi h the
eflects of cannabinoids are the original THC CBD Prior o the smdy we had expected
The psycho active side
main focus of objection ro this group of drugs
We o find that heTHC CBD mixture would be opumal
specifically targetted he common acute side etFeccs by that we would see more side eEfects with THC and that
recording their daily
occurrence Whilst we did not CBD alone would be almost ineffective Whilsc chere was
measure intensity
or duration directly the daily a preference for THQCBD the differences were not as
occur
rence gives an indicatio of prevalence Fig 10
marked as we antidpated The lack of effect of CBD by
Pa ients were ee ro record any other perceived effects itself may just reHect either the narrow range of pain
However except for the oral effects of the spray itself no problems smdied and or the need for a subscancially
other side effects emerged
higher dose of CBD
In conclusion chis study has been a fiat step in gaining
In general the side effects were manageable tolerable
and similar ro those seen cfinically with most other confidence in the use of CBMEs THC and THC CBD
prycho ac ive drugs used in pain management They were effec
ive in relieving pain and improving sleep in a
450
i004 BlackweU Pubhshing Ld

W Notcutt et aL Cannabis based medional extracts
Anaesthesia 2004 59 pages 440 52
small grouP of pa ien s As expenence was gained
in che dosing the spray proved eary and convenient for he 1510Lhem
pa ients ro use They were able to medicate in public JYJ Watson S Brnson J eds Mnrijunnn nnd MeAi ine
Assusing tlie Srienre Bnse Washing on UQ Insnture of
without at www nap edu books
030907155
Side eEEec s were not substantially diH eren m those seen
hcrnl
wi h most oher psycho active drugs used in pain g Mi deman M Lewis R Madure M Sherwood J Muller J
managemenL
Tnggering myocardial infa cion by nanjuana Cirndn ion
Stodying CBMEs in pauents with a wider variety of 2001 103 2805 9
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clinical expenence are the next steps The uses
potential PsycHintry 2001 178 116 22
in a variety oE other non pain areas neuro protection 10 Rey JM Tennanc CC Cannabis and mencal healch
dicorial Bnnsh Med nl ounm12002 325 1783 4
psychiatric disease Wmour therapy inf3ammation AIDS E
etc are exciting prospects for he future ow that we ll Zuardi A Shirakawa I Finkelfarb E Kamiol I Action of
have some confidence and m
experience the se oE hese Cannabidiol on he amciery and ocher effeca produced
by THC in normal subjec
Pryrhoplinrrcm ology 1982 76
materials
245 50
12 Vinaguerra V Moore T Brennan E Inhala ion manjuana
Aeknowledgements
as an anti eme ic for cancer chemotherapy ti ew YorkJam al
of Medirine 1988 10 525 7
The smdy was desigtted by members of he team Ttis has
3 Noccucc WG Price M Chapman G CGnical ezpenence
been supported in planning in adrtunistration liceasing with nabilone For chronic pain PlinmmceuticalSienres 1997
etc and m evalua by GW Pharmaceuticals who 3I1 551
provided the cannabis exnacts free of charge The fiat 14 Wade DT Robson P House H Makela P Aram J
year of the was
smdy financed om local funds with A preliminary concrolled scudy ro dreenrune whecher whole
support
om the MS Society Subsequendy
i was plant cannabis ex racts can miprove mttac able neurogemc
necessary to ob ongoing fimding for research stafI rymp oms Cliniml Rehabdimtion 2003 17 18 26
15 Brady CM UasGup
R Wiseman OJ Dalmn CM Berkley
from GW Pharma euCicals
KJ Fowler CJ The effea of cannabis based medicinal
Dr Malcolm Adams Dean School of Health PoLcy
exttact on lower urinary raa dysfunaion in advanred mul
and Practice University of Eas AngGa Norwich advised
sdemvs preliminary resul
Abs racts of Associadon of
on he N of 1 methodology the res6 o
psychological gtish Neurologisu Aucumn Mee ing Newcasde Universiry
use the analysis of results and provided the randomisation meecing at Uurham 12 14 Sepcember 2001 Joumnl of
schedule Ms Kerry Jeavons Medical Student helped Newology Neurosurgery nnd Psychiatry 002 72 133 42
wi h analysis of he Side ect Data 16 Rabins PV Brooks BR Emotronaldsmrbance in mulciple
Finally the managemen and many other members of sderosis pauenes validiry of che General Healeh Quescion
the staf oE he James Paget Hospi al have provided naire GH Psycliologiml Medi ine 1981 Il 425 7
to
support he 17 Reican iM Validity of he Trail Making Tesc as an indi
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canon of orgamc bain damage Percepnmi nnd Nlo or Skills
1958 6 271 i
R2fef2 ICe5 18 Coughlan AK Tlre Adu6 Neniop anA Lfommtion Proressing
Bnttery AMIPB Test Mnruml Leeds AK Coughlan
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of MnnJunnn Oxfocd
9 Nomutt W Pnce M Miller R Newporc S Sansom C
Oxford University Press 2000
Simmons S Medicinal cannabis ex aas in chroni pain
2 Morgan DR rdTiempeutic Uses of Cnnnnbis London 5 Cognitive Eunc ion and blood cannabinoid levels
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Abstracu of Mee ing of the Incernational Assoaadon of
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clinical and experimental neuropach
pain the chnical
5 Iversen L Comparing cannabis wi h obacco Ari hmetic
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eds Progress in Pnin Resemdi nnd Mnnagemenl Vol 21
6 House of Lords Selea Comrttittee Cannabis The scientific
Neumpa hic PainPa
hophysiology and Trea menc Seatde
and medical evidence Hmae of LorAs Sele Conimittee on ASP Press 2000
Snence nridTe Hriology Nintli Reporthepwww parliame c
9 20a4 Blackwell Publrshing lttl
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23 Guyatt GH Keller JL Jeaschke A Rosenbloocn U Adathi 7997 52 483 6
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QSZ
d 2004 8iacewell Publrshmg td

Iol 39 No 2 FeMuary 20I0
Jourrc l oJPin ad Synep6om Man gemen 167
Original Article
Multicenter Double Blind Randomized
Placebo Controlled Parallel Group Study
of the Efficacy Safery and Tolerability
of THC CBD Extract and THC Extract in
Patients with Intractable Cancer Related Pain
Jeremy R Johnson MB ChB Mary Burnell Nugent MB BChir
Dominique Lossignol vIB ChB MRCG DRCOG
Elena Doina Ganae Motan MD Richard Potts BSt Hons MICR and
Marie T Fallon vIB ChB MD FRCP E FRCP Glasg
Swent Hospice RJ Shrewsbury Shro shi e nd Sl Luke s HasQ ceMBN Turnthapel
Plymou6h Unated Kangdom Associ tio rz Hospitalaere De BrusseGsDL Cenlre des Tu rrzeuTS de
lULB BrusteLs Belgaum EmngeacyDe irmenlEDGM Hospit l Sf Ioan cel Nou Sute oa
Rom ania GWPh rma Ltd RPj Ely Cambrfdgeshire and Edirzburgh Can er Researth Centre
MTFUruversity of Edinburgh Edanburgh Ueeted Kingdom
Abstract
Thzs study comp red the effic cy of atetr hydroc nnabinol cnrwbid oL THQCBD extract
a nanopioid analgesic endocannabinoid systene modul tm and a THC extratt withpl cebo
in relievang pain inptients with dvantedcncer In total 177 patientsuth cancer pain
who experiencedin dequ tenlgesia despite chronit opioid dasing entered truo week
multacen ter double bli tdrndomizedpl cebo
contT011edpar llel group lnal Patients were
rndo raized to THC CBD extr ct n 60 THC extr ct n 58 orpl cebo n 59
The prim ry nalysis of change jrom baseline in mean pain Numeric l Rating Scale NRS
scare ws statistic lly signifac ntly in favor ojTHC CBD comp red euith placebo
improvement of137 vs 069 vhereas the THC group shomed nonsignific nt
change101 vs 0 69 Twice s many patiencstking THC CBD showed a reduction of
more thn 30 from baseline pain NRS score mhen comp red with placebo 23 43o vs
12 21a The assoei ted oddsrtio wasst tistic lly sign cny whereas the number of
THC groxcp responders ws similar to pl cebo 12 23 vs 12 21 and did not reach
tistical signific nce There ms no ch nge from base ine in meda n dose ofoioid
bckground medic tion ar me n number ajdoses ojbre kthrough meditalian cross
teatment groups Nosi group difjerences mere jound in the NRS sleeyi quality or
navse scores or the pain control assessment However the resu ts from the European
7his study was sponsored by correspondence to Marie T Fallon MD St Co
study medicauon was supplied by GW Pharma lumba s Hospice Chair of Palliative Medicine Edin
Ltd and it also funded all sites imolved in the study burgh Cancer Reseazch Centre Crewe Road
by means of per patient payments based on recruit Edinburgh EH4 2XR Cni ed Kingdom Email
ment GW Pharma Ltd has funded J R Johnson marie
fallonQedacuk
primary author toaend two conferences to pres
ent the results of this study
Atcepted forpub icatian Ju ne 22 2009
GW Phartna Ltd All
Address
O 2010 US Cancer Pain Relief Commi tee 4885 3924 IOjS see fYunt matter
Published by Elsevier Inc 411 rights reserved Aoi
1016
jpainsmiman 2009 06 008

168 fohvasoit et aG o1 39 No 2 Febru ry 2010
Organisation jor Rese rch nd Tre tment ojCancer Quality aJLifeCncer Questionn ire
shorued a morsening innusea and vmaiting with THQCBD compared ruith placebo
P 02 mhere s TNC had no difference P 10 Most drug rel ted adverse evenGs
weremild Yrwderate in seaerity This study shows tht THC CBD extract is efficaciou s fm
reliej ofpin in patierets with dvancedcncer pain not fully relieoed by strong opioids
f Pain Symptom Manage2010 39 167 179 O 2010 US Cancer Pain Relief Committee
Published lry Elseuier Inc Ali nghts reseived
Key Words
Canterpin tetrahydrocann binol tannabidiol Sativex
InCroduction
and behaviocal activity support the similadty
Cancer pain is a common problem and of the endogenous CB anandamide to
THC Both are partial agonists at the CBI re
70 90 of patients with advanced cancer ceptoc CBD in contrast binds weakly to CB
experience significant pain Opioids remain
and CB but does show phaRnacological po
he keystone for the tteatment of moderate
to severe cancer pain however some patienrs ten12 as a neuval antagonist at each recep
experience inadequace pain relief with opioids
and standard adjuvant analgesics despite dose
tor chat is is silent at such receptors but
an reverse both agonist and inverse agonist
side ellects responses CBD also has shown po3erful anti
adjusvnents and unacceptable
23 inFlammatory immunomodulatory and ana
are common
a
Cannabis contains 60 or more cannabinoids
oxidant properUes in vitro It is a TRPVl
anilloid receptor agonist in its own right
CBs The main ones include delta 9tetrahy
drocannabinol THC and cannabidiol hile modulating anandamide by inhibiting
both its reuptake and hydrolysis Addidon
CBD4 There is evidence that both THC
ally CBD increases adenosine A2A receptor
and CBD show promise in relieving cancer
related pain Sativex THC CBD
an endo signalin
by inhibition of the adenosine trans
porter Both THC and CBD have shown anal
cannabinoid system modulator is produced by
gesic efficaty in animal models In this
GW Pharma Ltd United Kingdom it is de
rived from strains ofCnnabis sativ L
study both a THC CBD extract and a THG
planrs
only extract were compared against placebo
developed to produce high and reproducible
to ascertain if the indusion of CBD provided
yields of principal CBs THC and CBD with
a different efficacy or safety profile
minor amounts of other GBs and terpenes in
Campbell et al published a litelature re
a solution containing ethanol propylene gly etv of ine randomized controlled trials
col and peppermint oil flavoring The named
CBs cons iute at least 90o of the rotal CB
performed using CBs any route of administra
con
tion in patients with acute chronic nonmalig
tent of the extracts
nant or cancer pain Five studies that were
CBs act
primarily through specific CB recep
tors CB receprors are predominandy distrib described i four reports comprised 128
patients with cancer pain62 All of the ui
uted in the cenval nervous system and CB2
s conducted in padents with cancer pain
receptors are located primarily in the periph
ery including the immune system The ere placebo tonu trials Four of the tri
prin
als found CB as effecrive as codeine but with
cipal pharmacological effects of THG include
analgesia
muscle rela cation antiemesis dose limiting side effects Thus CBs have dem
appe
tite sdmulation and psychoactivity CBD has onstrated efficacy comparable to selected
shown anticonwlsant muscle relaxant anxio
opioids
THC CBD is the first endocannabinoid sys
lytic neuroprotective antioxidant and anti
temmod
latortoundergoclinicaldevelopment
psychotic activiry and has been also shown to
for pain It has been approved in Canada for the
reduce the anxiety and psychoactive effeccs of
THC Preliminary rests of relief of neuropathic pain
pharmacology
in muluple sderosis

Uol 39 No 2 Febru ry 2010
THQCBD for Tre tmenl of Cncer Re1 led Pain 169
and persistent background cancerrelared pain for assessment randomizauon and dose intro
The formulation is an oromucosa spray
that al duction to one of the three treatrnent arms
lows fle ble individualized dosing Patients THC CBD exvact THC extract or placebo
self titra
their overall dose and pattern of dos Fig 1 in a 1 treatment allocation rauo
ing according to their response to and toler Patients were reviewed after710 days Visit
ance of the medicine with administration of 2 and at the end of study 14 20 days or
approximarely 812 sprays day that is withdrawal Visit 3 During the medica ion
22 32 mg day THC and 20 30mg day CBD dosing period the patients condnued to mm
This study assessed the analgesic efficacy of plete the daily smdy diaries with the aforemen
THC CBD and THC ext acts compared with
tioned information and the number of doses
that of placebo in the management of patients of study medication taken The relevan regu
with at least severe
moderately cancervrelated latory authorides and research ethics commit
pain despite appropriate pharmacological tees approved the study
management
The study medication was delivered using
a pump action oromucosal spray Each 100
L actuation of the pump containing the
THQCBD extract delivered a dose containing
Methods
27 mg THC and 25 mg CBD Each 00L ac
This ttvo two day baseline and two mation of the pump containing the THC ex
week veatment multicenter double blind tract delivered a dose containing 27 mg
randomized placebo controlled parallel CHC and each actuauon of placebo delivered
group study evaluared the efficacy
of only excipients plus mlorants The mascimum
THC CBD extract and THC extract in the anal permitted dose of all study medication was
gesic management of padents with moderate eight actuations in any three hour period and
to severe cancerrelated pain There was 48 actuations in any 24hour period
a
nvo day baseline period Adult male or Patients self titrated to their opdmal dose
female patienrs who had been using strong over the seven days of Week 1 based on effi
opioids for at least one week to relieve pain as cacy tolerability and the maximum permitted
sociated with incurable malignancy
and who dose Pauents could increase the total number
gave written informed consent were screened of splays each day by a maximum of 50 until
for study entry Eligible patients recorded they either had satisfactory relief of their symp
a
pain severity
score of 4 or above on a010 toms or developed unwanted effeccs such as
Numerical Rating Scale NRS on both days intoxication high The total number of
of the two day baseline period
Patients were
sprays was spread over the day with a minimum
exduded if they had cancers affecting the of 15 minutes benveen any nvo sprays f un
oral cavity radiotherapy to the floor of the wanted effects developed on a new number
or cardiovascular dis of sprays the patient would not take any fur
mouth major psychiatric
orders epilepsy renal or hepatic impairment ther sprays for three to four hours The pauent
or if they were pregnant lactating or not using would then go back to taking their further
adequare contraception Patients who had re sprays at a similar level to the previous day
ceived therapies expected to confound the Oce the patient had found he maximum
smdy outcome epidural analgesia within 48
number of sprays per day that they rolerated
hours of screening pallia ive radio chemo well or the number that provided good symp
or hormonal therapy within cwo weeks of tom relief they continued with approacimately
screening
or CBswi days of random the same number of sprays per day for the
ization were also excluded Patients taking remainder of the study
levodopa sildenafil or fentany or patients The coprimary endpoints were the change
with a
hypersensitivity ro CBs were excluded from baseline in NRS pain score and use of
on safety grounds PaUents completed a study breakthrough analgesia The NRS a widely
diary recording pain score three dmes daily used and validated measure of pain severity
and background medication and all addiuonal is capable of showing clinically and stadstically
breakthrough analgesia on each day during significant changes in pain disorders The
the baseline period Patients hen returned IVRS question indicate your level of pain

170 Johnsaa et aL Yal 39 No 2 February 2010
Screened n 192
2day baseline period
Randomized n 177
2week treatment penod
THC CBD THC extract Placebo
n60 n58 n59
Withdrawn12 Withdrawn13 Withdravm n8
Adverse event W Adverse event 7 Ativerse event 3
ConseMwiihdrawal Consentwtthtlrawel 2 Cansentwithdravrel 2
ONer 1 Sponsor tlecision 1 Olher 3
Prorocol vlotation 1
Other 2
Completedn48 Completed n 45 Completed n 51
ITT population n 177
Safety population n 177
Fig 1 Study design Consolidated Standards of Reporung Trials CONSORT diagram ITT inten to ireat
was answered by patients three times daily in represents the pain intensity The Total BPI
the morning on waking atlnchtime and in for Question 9 is the unweighted sum of the
the evening before retiring using the anchors seven assessmencs and represents the effect
0 no
pain and 10 very bad pain Pa of pain The EORTC QL C30 cancer ques
were allowed to use their breakthrough analge tionnaire consisrs of 30 quesuons that cover
sia as
required and this was recorded daily in global health status functional scales eg
the diary Patients maintained background physical functioning and symptoms eg
medication for the duration of the smdy The fatigue
secondary endpoints included the use of opi
Adverse events AEs and use oE concomi
oid background medication pa ient assess tant medications were reported by patients at
ments of sleep quality nausea memory study visits throughout the trial Predefined
concentration and appetite over the previous categories for determining the intensity and
24 hours
using diary ARSsihe Brief Pain the relationship to study medicauon were
Inventory Short Form BPI SF and The Euro used The expert dinical judgment from the
pean Organisation for Research and Treat imestigating study physicians was used in de
ment of Cancer EORTC Quality of Life termining intensity and causal relationship of
Questionnaire QLQC30 Version 3 were AEs and serious AEs
completed by patients at Visit 1 and at the The smdy was powered assuming an underly
end of the SIUflY 24 25 e BPI ing treatment difference of 1 point on an NRS
nine quesuons eight have a single response and a standard deviation SD of 16 esti
and Question 9 is subdivided into seven parts mated from previous studies with 80 power
The Total BPI Questions 36 is the and nvo sided 5 significance After allow
un
weighted sum of the four pain scores and ing for 15 dropouts 58 subjecrs per groop

al 39 No 2 February 2010
THC CBD for Tiealmeat of Cancer
Related Pain 171
were
required For the two coprimary efficacy
jgul
variables NRS pain score and use f break p total of 192 patients were screened over 25
through medication the Hochberg method
months leading to 177 patients randomized to
was used to test the globa hypothesis for a treat
treatment Fig 1 at 28 European centers The
ment effect on
pain The null hypothesis was to mean SD duration of cancer in these pa
be rejected if either coprimary variable pro
uenrs was 35 years 28 327 32 427
duced two sided P 025 or both produced
and 45 525 years respectively in the
P 05 The daily pain NRS score was the THQCBD THC and placebo groups respec
mean of the three daily assessments The tively The mean age gender distribution
change in mean NRS pain score from baseline Previous cannabis use primary disease sites
all days in run in period to the end of treat and pain classification were similar among
ment last three days on reatment was ana the three treaUnent groups Table 1 The
lyzed using analysis of covariance ANCOVA most common type of cancer pain was of
with baseline pain as a covariare and gr
ouped mixed pathophysiology followed by bone and
smdy center and treavnent as factors The neuropachic pain Table 1 At baseline the
proporuons of responders patients with mean dai y dose of opioid backgroond medica
30 improvement from baseline to end of
uon in the whole study population was 271 mg
study NRS pain score wece compared between
of oral norphine equivalencs The median oral
treatments Use of breakthrough medication
morphine equivalent dose was slighdy lower in
number of days of use during last three days
the THQCBD group at baseline compared
on treaunent was analyzed using logistic re
with the THC and placebo groups Table 2
gression with a cumulative logit modeL In addi
For all three tteatment groups the predomi
don the change from baseline in mean
nant primary reason for discontinuing the
number of doses of escape
medicauon was an
study was AEs Fig 1
alyzed using ANCOVA
Tab e 1
Pafi enDe
Demographics
THGCBD THC Placebo Total
Gender rz
Male 38 55 SO 52 32 64 95 54
Female 27 45 28 48 27 46 82 46
Ethnic origin n
Gaucasian 59 98 57 98 58 98 I74 98
Other 12J 2 12 32
Previous cannabis usen 610 610 7l2 19 11
Age years
mean SD 94 Q2 1 613 125 601 123 60 2 Q2 3
Uuration of cancer years mean SU 28 83 32 43 45 58 35 4
BMI mean SD 281 42 235 52 241 43 236 46
Primary canrer sires n
Breazt 14 20 S74 9l5 Y9 Q6
Prostate 610 S14 10 t7 24 Q4
Lung 712 916 47 20 11
Pain dassifica ion n
Mixed 31 52 28 48 30 51 89 50
Bo e 16 27 24 41 25 42 65 37
Neuropa hic
11 QB I1 l9 17 29 89 22
Vaceral 14 28 12 21 71 79 37 21
Somafic incident 7I1 9 610 18 10
Baseline morphine equivalents
Median mg B0 12U 0 120 120
Range 06000 01280 06000 06000
Mean Sll 258 4 789 47 188 2 234 49 367 0 886 38 2712 698
is Srcl quartile 30 180 50 213 240 240
BMI body mass index
Onl morphine equivalen
data are sourred mm ReCs 43 4i

172 Johrzson ell Yal 39 No 2 February 2010
Opioid
Table 2
Change in Dose of Opioid Background Medication Oral Morphine Equivalents and Strong Opioid
Breakthrough Medica4on
Characteristics THQCBD THC Placebo All
Opioid background medication change From baseline co last 3 days on study medication pauents with data available excluding
3 pa ients receiving intra hecal opioids
e ITC population 60 Q00 58 100 58 98 176 99
Median 0 0 0 0
Range 627 to 300 27 to 1088 1200 to 400 1200 to 1088
Mean f5D 35 108 44 269 152 00 414 201 27 64 160
QI QS 0 QO 0 QO
Opioid background medicntionca egorized change Crom baseline in ornl morphine equiwlents per day
Increasen90 612 6lY 47 16 LO
No changen
41 79 40 77 43 SO 144 78
Decreasen 510 612 713 18 I1
Smng opioid break hrough medication categorized thange from baseline in number oE doses taken
N90 ITTpopulation 22 37 18 Sl 19 32 59 83
Increasen90 49 422 737 13 22
No changea 12 56 l0 56 12 63 84 58
Dn 836 422 0 12 20
17Cincen m tteaqSD standard deviatlon
The mean SD number of sprays
taken pet a reduction in pain which was in favor of
day which had srabilized by the end of the first THQCBD extract055 pointsPOA24 but
week Days 17 ending the titrauon phase not for the THC ex ract 024 points
were THG CBD extiact 575514 THC ex
P0204 Sensiuvity analyses of the change
tract 834 517 and placebo 961 467 from baseline in the mean NRS scores con
Fig 2 Ove all for the endre treatment pe curred with the primary analysis
riod the mean SD number of sprays
used
In thronic pain trials it is recommended
daily in the placebo group 10 88581 was that the percentages of pauenrs obtaining re
higher than those in the THQCBD 926 dUCtions in pain intensity of at least 30 on
53 and THC groups 547546 a pain NRS responders should be docu
mented A reduction in pain NRS of approx
Effic cy imately 30 o is considered to represeni
The mean SD baseline NRS pain scores a clinically important
difference2 the in
were similar
among creatment groups and tent to treat responder analysis approximately
within grouped centers THQCBD extract
twice as many patients in the THC CBD group
568 124 range 233 825 THC exva ct
had a reduction from baseline NRS of at least
577133 range 287933 placebo 605 30 compared with the placebo and THC
132 range 35956 The adjusted mean groups THC CBD 23 43 vs THC 12
reduction in NRS ANCOVA for THC CBD 23 placebo 12 21 The odds ratio
THC and placebo groups at the end of the for the comparison of responders benveen
veatment were 137 Ol and 069 THCCBD and placebo was 281 9 confi
points respecuvely The adjusted mean treao dence interval CI 122 650 P 006
ment difference from placebo was statistically and benveen THC and placebo was 110
significant
for a reduction in pain with the 95 C1 044273P028 Fig 3
THC CBD extract 067 pointsP014 but The number of days on which any break
not the THC extract 032 pointsP0245 through medication was used was similar
The ANCOVA did not have normally distrilr among all treatment groups with no signifi
uted residuals but the nonparametric analysis cant differences observed in this clinical trial
gave a similar result The median changes of brief duration THQCBD vs placebo
from baseline for THC CBD THC and pla P070 There was a reduction observed in
cebo groups were136100 and060 re
the mean number of daily doses of all break
spectively
The median difference from through medication THC CBD extract
placebo
was statistically significant
for 019 THC extract014 platebo015

Yo 39 No 2 February 2010
THQCBD far Trea menl oJ Cancer RefnledPi 173
w ts
l r
i
o i 1
i
z
nio T
f
t
A r 1
1 1 1 1
8
1 1
y
f
o s r THC CBD
01
Ey
zC 2
af 0
9L 1 2 3 6 5 fi 8 9 10 11 12 13 1A
Stutly Trealment Oay
1
Place6o
THC
Fig 2 Exposure to study medica ion mean number of sprays per day SE
standard error
by the end of the smdy period but the of patients in the THC CBD group eight pa
difference i change from baseline benveen uents reduced breakthrough doses con
treatment groups was not statistically significant versely the highest proportion of increases in
More specifically there was no change from dose was in the placebo group seven pa
baseline to the last three
days of treatment in tients which was staustically significandy
the median oral morphine equivalent dose of greater than those in the THC CBD group
opioid background medications in 124 78 P004
paaenrs for whom the data were available Most of the NRS diary symptom scores and
Doses were increased for 16 patients 10 investigatorvassessed pain control showed no
and reduced for 18 11 these changes significant treavnent differences benveen the
were evenly distributed across the three treat
three groups Table 3 A statisucally signifi
ment groups Table 2 During the baseline cant difference in improvement with placebo
period or last three days on treatment strong was observed in the diary NRS concentradon
opioid breakthrough medicauon was recorded and memory scores whereas the placebo
by 59 patients 33 of these 34 58o group showed a mean improvement from
showed no change in the number of doses baseline in concentradon score035 and
taken when comparing baseline with last three the THQCBD group showed a deteriorado
days of treatment 13 22 increased the
033P02 as did the THC group029
number of doses and 12 20 reduced the P03 The memory score showed no
number of doses taken A greater proportion change in the placebo group 01 but a dete
rioration in the THC CBD group 063
P045 and in the THC group 066
P053 Similarly the appetite diary NRS
60
N
score showed a mean improvement from base
a so line in the placebo group and there was
rn zm zz smiv aaa
i ap ecao a slight reduction in appetite score in both
t d
THC CBD and THC groups 059 vs 024
a m
J
30 ace P 016 and 059 vs 06 P 056 re
d Zo spectively Table 3
a
ssm asi
The QL C30 showed as expected few dif
10
0
ferences among treatment groups in the nvo
o
week follow p Of the 16 items assessed the
ioi 3oi SO Io 45Fa1m 95 HCCao war oo only statistically significant observations were
ResponseLevel
reductions in cognitive funcuon smre when
Fig 3 Pain0 Numerical Rating
Scale smres re
cOmPared wi h Placebo THC CBD ex rat
sponder analysis ITT anal sis Odds ratio 95 533 vs 368 P 02 THC extract
CI THQCBD vs
placebo Fisher
ezact test 677 vs 368 P OAl and a
worsening of

l74 Jahnson el G lol 39 1Uo 2 FeGruary 2010
Tble 3
Primazy and Secondary Endpoints Showing Baseline Score Change from Baseline Treatment Difference and
Stafis4cal Significance of the Difference inChang e From Baseline for1IC TT IC and Plac
Comparison with Piacebo
Satistital
Treaunenl Changr Trea ment Significanre
Endpoin Group Baseline From Baseline Dillerence Pvalue
Mean pain severity NRS smre THQCBD 568 137 067 014
oprimary IHC 57 101 082 0245
Placebo 605 Ob7
Brcakthrough medication no of THQCBD OR 096 0697
days used mprimary THC OR 120 0555
Placebo
Breakthro gh
daily
medication mean THQCBD 091 019 04 0688
dose THC I10 014 01 0899
Placebo 080 015
Nean sleep quality KRS score THQCBD 433 057 031 0346
THC 46 024 OA2 095
Placebo 417 026
Mean nausea NRS score THQCBD 244 026 049 0110
THC 204 024 046 0126
Placebo 198 OY2
Ytean memory NRS store THCCBD 302 063 065 045
THC 298 066 0fi2 053
Placebo 290 01
Neammcentration URS smre THQCBD 359 033 068 021
THC 353 029 064 028
Placebo 397 035
Nean appetite NRS score THQCBD 483 024 083 016
THC 458 06 066 056
Placebo 498 059
Pain convol assessment THQCBD 50 1 OR 10 0488
proportion wi paimmtro0ed THC 54 2 OR 176 0400
Placebo 36 170
7ean BPISF mtal pain in last 24 THQCBD 20 88 017 104 U619
hours THC 21 29 320 407 048
Placebo 23 48 087
Mean BP1SF total inter erence by THQCBD 46 63 353 484 0325
pain
in last 24 hours THC 39 89 450 58I 0275
Placebo 51 05 131
Nean QLQL30 global health THQGBD 29 74 723 247 0443
status THC 27 05 560 084 0793
Placebo 25 29 477
Mean QL C30 physical IHC CBD 40 84 692 423 0108
fimctioning THC 35 56 894 125 0631
Plarebo 34 14 269
C30 role functioning
THQCBD 29
J1ean QLQ
02 OA2 31 Q415
THC 28 65 012 921 0434
Plare6o 25 00 333
Mean QLQ C30 emotional THGCBD 24 44 70 673 064
Functioning THC 22 41 619 522 0174
Placebo 25 37 098
Mean QLQC30 mgnitive THQCBD 50 57 588 901 022
46 008
fimctioning THC 5632 67 I0
Mean QLQC30 social functioning
Mean QLQ
Placebo 50 85 3fi8
THC CBD 29A2 319 161 0679
THC 29 89 966 808 038
Placebo 25J1 158
C30 fatigue
THGCeD 71 55 392 271 0422
Mean QLQ C30
THC 70 69 136 015 0965
Plarebo 64 56 131
nausea and CHQCBD 25 57 513 856 OA20
vomiting THC 22 18 341 02 U997
Pla ebo 2175 343
lean QLQL30 pain THCGBD 88 62 15 64 634 0107
THC 79 60 15 71 641 0103
Placebo SL64 930
ConGnue

Yol 39 No 2 Febru ry 2010
THC CBD for Treatmen of CncervRel tedPin 175
Table 3
Continued
Comp arison with Plac
Sta istical
Trea ment Change Trea men Significance
Endpoint Group Bazeline From Baseline Difference Pvalue
Mean QL iC30 dyspnea THQCBD 40 23 109 080 0846
THC 43 27 421 49 0282
Placebo 84 46 028
Mean QL C30 insomnia THCCBD 5230 615 105 0883
THC 51 15 041 469 0347
Mean QLQ C30 appetire loss
Mean QLQC30 consupation
Mean QLQC80 diarrhea
Placebo 51 41 510
THC CBD 60 34 869 088 0857
THC 54 60 19 lb2 0743
Placebo 59 82 281
THC CBD 50 00 574 797 077
THG 38 33 311 535 0233
Placebo 40 68 23
THC CBD 13 22 215 157 0615
THC 862 056 15 0713
Placebo 12 99 058
Mean QLQC30 finantial THQCBD 58 05 558 170 0714
diculties THC 59 20 893 505 0276
In Cawr oF active vea ment
In fawr oI pla ebo
Placebo 57 06 388
nausea and score
vomiting in the THC retention mmorvrelated pain worsened nau
although ot in the THC only group when sea weakness tumor hemorrhage and somno
mmpared with placebo THC CBD 513 vs
lence were experienced by five padents in the
343 P 02 THC341 vs 343 THC CBD group all of which were unrelated
P 10 A trend toward was
improvement to study medication Three events were moderv
seen in both acrive treatment in the
groups are in severity and four evenrs were severe Five
QL C30 pain assessment score THC CBD subjects who received THC experienced the
extract 15 64 vs 930P011 THC ex
nonfatal SAEs of inetastases to brain gastric
tract15 71 vs 930 P010 and in the ulcer hemorrhage syncope bronchopneumo
constipadon
score THQCBD574 vs
nia hyperglycemia confusion oral candidia
23 P 08 THC311 vs 23 P023 sis somnolence tremor and disorientauon
All events were unrelated to study medicauon
Safely and with the exception of a single episode of
Toler bility
The active compounds were generally well syncope which was probably related to THC
Two events were moderate in severity and
tolerated and no safety
concerns were identi
eight events were severe No patients from
fied dudng this study Treaunenarelated AEs
he placebo group reported a nonfatal SAE
were
reported by 106 60 patients Com
mon treatment related AEs three or more pa
tients were similar to those seen in other
TI IC CBD clinical trials somnolence dizzi
SClISStOri
ness and nausea mosdy
of mild or moderate Unrelieved cancer pain can result in signifi
severity Table4s233 3s The incidence of
cant distress and disability The results of
death in this advanced cancer
populadon was this study show hat the THC CBD extract is
similar across treatment groups eight an efficacious adjunctive treatment for can
THQCBD eight THC seve placebo and cervrelated pain in patiencs who are not achiev
all were considered because of progression of ing an adequate analgesic response to opioids
underlying disease None of the cases from This study involved pauents with advanced
the 10 patients who reported nonfatal serious cancer who had a mean diseasedration of
AEs SAEs raised any
concerns
regarding more than three years and moderate to severe
the safety of CBs The nonFatal SAEs of urinary levels of pain at entry 4 on an NRS pain

776 Johnson el a1 Yoi 39 No 2 Febru ry 2010
Table 4
At baseline the mean daily use of opioid
Most Common 1YeavnenaRelated Adverse
background medication was relatively high
Events
Reported by TMree or More Patients
271 mg of oral mocphine equivalents The
THC
cha ge in number of daily doses of break
Destription o THQCBD ez act Placebo
Eei no rzo n through medication between baseline and
end of study showed a slight trend toward re
Somnolenre 8ts S4 6lo
Dizziness 7 12 7 12 3 5
duction and no relevant differences benveen
Co son a7 l2 2 treatment groups Only a small number of pa
tvausea 6t0 47 a7 tienrs recorded taking svong opioid break
vomidng 35 a7 23
Naised gamma GT 23 59 12 through medicadon in their daily diades
Hyper aema o 0 35 during the baseline period or last three days
Hypocension S5 0 0
on vearment Of these most showed consis
Camma CT gamma gluumyl tans erase
Cn CIOSIng paLtC I1S the changes that did oc
cur showed a trend toward a decrease in the
scale despite ongoing opioid trea menc ARer number oFdoses taken in the THC CBD group
two weeks of receiving study medication ad and an increase in the placebo group There
junctive
to all other treatmencs the THC was a large range in the dose of background
extract grotip showed a staustically significant oral mocphine equivalent veatmenc These
reducdon in pain severity when compared findings may be a reflecuon of different treat
with placebo with a reduction in mean pain ment models used in the participadng coun
NRS scores from baseline of 137 points tries and illusvates the need to indude
226o The pain NRS data were not norv
a more specific eligibility criteria of minimum
mallydis ributed hence parametric
and non
opioid treatment in fut re studies Less varia
were
parametric analyses conducted This had tion in the existing treavnent regimens would
no influence on the significance of the results enhance the interpretauon of the efficacy re
The heterogeneity
in the distribution of the sult but would make recruivnent to the study
pain scores many large negaUVe and large more challenging
posiuve results combined with consensus Ao statistically significant differences in pa
based recommendations highlight the im tient assessed sleep quality or nausea NRS
portance of the responder analysis These rer scores or invesdgator assessed pain control
ommendations are primarily based on the assessment were noted benveen the smdy
results of an
analysis of relationships benveen medications and placebo There was a signifi
changes in pain intensity and paUent reports cant imprwement in the BPI SF total score
of overall improvement
in 10 clinical trials of for THC but not for THQCBD Studies of
chronic pain with patients of diverse diagno longer duration in other indications have
ses in which a
clinically relevant response regularly shown that the quality of sleep in
was defined as a reduction of pain of at least the THQCBD group needs to be im
30 Crom baseline to end of study proved262zs3 4o The differences benveen
In this current study population 43o of pa treatment groups in the memory concentea
tients
taki g
the THC CBD extract achieved uon and appetite NRS diary scores are pardy
a 30 or
greater improvement in their pain attributable to an apparent improvement in
score
equated to a mean improvement of the placebo group
271 boxes approximately nvice the number The QL C30 showed few differences be
of patients who achieved this response in the nveen study medications and placebo Consid
THC and placebo groups
The results of the ering the follow up duration and the patient
responder analysis and the mean change population this is unsurprising There were
from baseline must be interpreted remember marginal improvements in QLQC30 pain
ing that the study medications were adjuncdve scores but significantly reduced cognitive func
to
existing treaunents includingsrong opi Uon scores with the THC CBD and THC
oids for the duradon of the triaL Larger veat groups compared with those of the placebo
ment differences from placebo may be noted group The stadstically significant worsening
in a
smdy of lon er durauon as evident in in the QLQ C30 nausea and vomiung score
other conditions 2 24 seen with the THC CBD extract tompared

PoL
39 Na 2 Februa ry 2010
THC CBD ftrr Treat rrzerel of Cscer Rel ted Pin 177
with placebo was not seen in the diary scores THC extract alone This finding is supported
for nausea and is confounded by a median by evidence of additional synergy benveen
change of 0 benveen the groups making inter THC and CBD CBD may enhance the analge
pretation of this result difficult Similarly the sic potenual of THC by means of potent in
changes in appetite reported in the patient verse agonism at CB2 receprors which may
diaries were not seen in he QL C30
produceanu
inflammatory effects along with
The few staustically significant results of the its ability to inhibit immune cell migration
secondary endpoi ts should be interpreted Additionally CBD may modulate the potential
with caution because of the multiple analyses unwanted effects of THC by means of antago
performed on the questionnaire and the nism at CB receptors which potenually
over
lap in content between some of the NRS scales would provide a better safety profile for the
and questionnaire items However there is THC CBD medicauon in chronic use
a consistent impairment of cogniuve function
In conclusion THC CBD extract a nonop
reported by pauenrs in this smdy Although ioid analgesic endocannabinoid system modu
the dinical significance of this finding is lator has been shown ro be a use ul adjuncdve
uncleay it warrants further care ul assessment treatment for relief of pain in patients with
in long term studies It is accepted that there advanced cancer who experience inadequate
will be limitations and potenual
inaccuracies analgesia despite chronic opioid therapy The
of patient completed diary data and future reductions in pain scores were neither because
studies will look to refine this method of data oF a change in opioid background medications
completion
nor because of an inerease in use of break
The AEs seen in this study
were similar to through medication Therefore we can con
those seen in other clinical CIlHI5 2627 33 38 Of clude that the observed reduction in pain
theAEsleadingtopermanentcessationofstudy scores is attributable to the posiuve analgesic
medicauon 17 12o and3respectively for effects of THQCBD extract These results are
THC CBD extrnct THC extract and placebo
approximately half were considered to be re
lated to study treatment None of the 33 re
ported SAEs raised concerns regarding
treatment
safety The incidence of death ACknowlC
was
very encouraging and merit further smdy
pfYtCYIfS
comparable among treatment groups and The authors thank all the patients and their
therewerenotreacmenUrelaleddeaths Despite families who parricipated in this trial Additiorn
some
uncertainty in the total morphine equiva ally the authors acknowledge GW Pharma Ltd
lent dose received by pauenrs the safety profile for sponsoring the trial and the following
addsevidencethatthiswasapopulauonwithad invesdgatorsandtheirresearchstafFfortheirparv
vanced disease 13 of patients died during the dcipation Dr D Brooks Royal ChesterField
study because of their underlying disease
Hospital Chesrerfield UK Dc D Feuer S Bar
The THC CBD and the THC medications tholomew s Hospital London UK Dc R Gaunt
were well tolerated Patients were
fully utrated Rowden Surgery Chippenham UK Dr A Gri
at one week and maintained stable dosing gorescu Institutul Oncologic ProE Alex Tres
throughout the treatment period that is there tioreanu Sos Bucuresu Romania Dc K
was no observed tendency to increase dose GruffyddJones The Box Surgery Corsham
with time This corresponded to a reduction UK Dr E Hall St Helena Hospice Colchester
in pain NRS score over the same period The UK DcJ Hardy The Royal Marsden NHS Trust
clinical response ro pai with THQCBD Sutton UK Dr C Higgs Dorothy House Foun
extract oromucosal spray has not demon daUOnfl adford Upon Avon UK Dv P Hos
strated tolerance in several clinical trials of lon kins Mount Vemon Hospiral Northwood UK
ger duration
Dc S Kelly Marie Curie Cenve Belfast UK
There is evidence of synergy benveen THC Dr M Leng Roxburgh House Grampian Uni
and morphine in pain and THC may modu versity Hospitals NHS Trust Aberdeen UK Dr
late endogenous opioid rone However in D McKeirh Townhead SurgeryIvine UK Dr
this sudy the THC CBD tombinadon showed D Mosoiu Fiospice Casa Spetantei Brasov
a more
promising efficacy profile than the Romania Dc C Nitipir Diagnostic
and

y8 Johnson et aL 01 39 No 2 February 2010
Treatment Centre Foundation Dr Vic or 9 Pernvee RG Neuropharmacology and therapeu
Babes 281 Bucharest Romania Dt W Notcutt uc pocential of cannabinoids Addict Biol 2000 5
James Paget Hospital Norfolk UK Dc L Parker
Beehive Surgery Bath UK Dc J Riley Royal
Marsden Hospital Palliative Care Unit London the
UK Dc A S Thomson Atherstone Surgery
Atherstone UK Dc L Trotman Michael Sobell
House Mount Vernon Hospital Northwood
37 46
10 Russo EB Guy GWAale of nvo cannabinoids
herapeuuc rationale for combining tetrahydro
annabinol and cannabinol Med Hypotheses 2006
66 234 246
11 Fride E Mechoulam R Pharmacological activity
of the cannabinoid receptor agonist anandamide
UK Dr L Vata District Hospital Dr Alexandru a brain consutuent Eur J Phannacol 1993231
Simionescu Onmlogy Department Hune 313 314
doara Romania Dc C Volovat Center of Medi
12 Thomas A Baillie GL Phillips AM et aL Canna
cal Oncology Lasi Romania Dc A Wijnberg bidiol displays unexpectedly high potency as an an
Cornhill igeiY Birmingham UK and Dc A tagonist of CB 1 and CB 2 receptor agonists in
Wilcock Hayward House HospiceNo Ungham vitro Br Phamiacol 2007 150 613 623
City Hospi al Nottingham UK Finally the I3 Matfait Ahl Gallily R Sumariwatla PF e al The
authors acknowledge V Lane Maclagan Health nonpsychoactive cannabis constituent cannabidiol
care Ltd forherassistance in producing
the fitst s an oral anti arthdtic therapeudc in murine colia
gen inducedar hri is Proc Na t Acad Sci USA 2000
draft of this manuscri t The authors are
p grateful
97 9561 9566
to Peter Clark statis ician at GW PharmaLd for
14 Hampson AJ Grimaldi M eUcetrod J Wink D
actin as
g
statisucal ediror for this article
Cannabidiol and delta9tetrahydrocannabinol
are neuroprotectivean oxidants Proc Nad Acad
Sci USA 1998 95 8268 8273
CI riCCS
L Glare P Choice of opioids
and he WHO ladder lecular
In Davis M Glare P Hardy J eds Opioids in ogues
cancer
pain Oxford UK Ozford University Press 2005
221 234
2 Sco ush Intercollegiate
Guidelines Network 16
Con rol of pain in patients
with cancer A National
tio
cannabidiol
Clinical Guideline Edinburgh Scodand SIGN 44
15 Bisogno T Hanus L De Petrorellis L et al Mo
targets for cannabidiol and its synthetic ana
effect on vanilloid VRl receptors and on he
cellular uptake and enrymatic hydrolysis of ananda
mide Br Pharmacol 2001 134 845 852
Carrier EJ Auchampach JA Hillard C Inhibi
of an equilibrative nucleoside tansporter by
a mechanism of cannabinoid immuno
2000179
suppression Proc Nad Acad Sci USA 2006 103
7895 7900
3 Cleeland CS Conin R Ha field AK et al Pain
and its treatment in
outpa ients
with metastadc
17 Pettwee RG Cannabinoid phartnacology he
cam
cec N Engl J
Med 1994 330 592 596 TS 66 years Br J Pharmacol 2006 147 Suppl 1
I63 171
4 House of Lords Select Committee on Stience
18 Pertwee RQ Cannabinoid receptors and pain
and Technology
Canrmbis Ihe scientific and
pog Neurobiol 2001 63 569 611
medical evidence 9th Report Session 1997 98
London UK House of Lords 1998 Aailable 19 Campbell FA Tamer MR Carroll D et aL Are
from
htp www
padiamencche stationery office cannabinoids an effecuve and safe treatment op ion
co uk pa Idl fJ9798 ldselect Idsctech
15101 in the management of pain A qualitauve systemic
htm Accessed January 4 2008 review BMJ 2001 323 16
5 GW Pharma Ltd Product monograph Sativez 20 Jochimsen PR Lawton RL VerSteeg K Noyes R
Ottawa Canada Health Canada 2007 Available from Effect of benzopyranoperidine a delta 9 THC con
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cpe001321164c6d
cm0014e88ee7a4
net gener on pain Clin Pharmacol Ther 197824
cable rogers comdpdonline
searchRequest
do 223 Accessed March 4 2008
21 Staque M Gan C Machin D Effec of a nivo
6 Noyes R Brunk SF Baram DA et aL Malgesic gen analog of cevahydrocannabinol on cancer pain
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macol 1975 15 139 143
22 McCormack HM Horne DJ Sheather S Clini
7 Noyes R Brunk SF Avery DA et aL The analge cal applicanons of visual analogue scales a critical
sic properties of delta 9tevahydro cannabinol and review Psychol Med1988 18 1007 1019
codeine Clin Pharmacol Ther 1975 18 84 89 23 Farrar T Young JPJr LaMoreaux L et al Clin
8 Perlwee RG Pharmacology of cannabinoid CB ical importance of changes in chronic pain intensity
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THC CBD for Tie lmenl of CancerRelated Paen 179
24 Cleeland CS Ladinsky JL Serlin RC et al Mul 35 Wade DT Makela PM House H ec aI Long
udimensional measuremen of cancer com
pain term use of a canrmbis based medicine in the treat
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Symptom Manage 1988 323 27 sderosis Mult Scler 2006 12 639 645
25 Aaronson NK Ahmedzai 5 Bergman B et aL 36 Bames MP Sativez clinical efficacy and tolera
The for Research and Treat
European Organisation bility in the treatment of symptoms of muldple scle
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ivex cannabis based medkine Chem Biodivers
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I
i
Treatment Research
Trends and Statistics
T Home Research Renort Series Marijuana Abuse
I
Research Report Series
Marijuana Abuse
How Does Marijuana Use Affect
Your Brain and Body
Effects on the Brain
As THC enters the brain it causes the user to feel euphoric orhigh by
acting
on the brain sreard system which is made up of regions that
govern the response to pleasurable things like sex and chocolate
as well as
I
to most drugs of abuse THC activates the reward system in the same way
that nearly all drugs of abuse do by stimuIating
chemical dopamine
brain cells to release the
i
ng with euphoria relaxation is another frequently reported effect in
iman studies Other effects which vary dramatically among different
users include heightened sensory perceptioneg brighter colors
laughter altered perception of time and increased appetite After a while
the euphoria subsides and the user may feel sleepy or depressed
Occasionally marijuana use may produce anxiety fear distrust or panic
i
r i i
i i r r
Ii
I
j
i
I
i
i
t
t
Marijuana use impairs a person
ability to form new memories see
Marijuana Memorv and the Hi ocampus and to shift focus THC also
disrupts coordination and balance by binding to receptors in the cerebellum
and basal ganglia parts of the brain that regulate balance posture
coordination and reaction time Therefore learning doing complicated
tasks participating in athletics and driving
are also affected
available
Marijuana users who have taken large doses of the drug may experience an
M
This report is also
for download
Mariivana Abuse
PDF format 41 M8j
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i
2

acute psychosis which includes hallucinations delusions and a loss of the
NIDA
Pnse of personal identity Although the specific causes of these symptoms
nain unknown they appear to occur more frequently when a high dose of
cannabis is consumed in food or drink rather than smoked Such short term
psychotic reactions to high concentrations of THC are distinct from longer
lasting schizophrenia like disorders that have been associated with the use
of cannabis in wlnerable individuals See Is There a Link Between
Marijuana Use and Mental Illness
DRUG
7NIDA NIH
Order this pubiication
Our understanding of marijuana s long term brain effects is limited
Research findings on how chronic cannabis use affects brain structure for
example have been inconsistent It may be that the effects are too subtle for
reliable detection by current techniques A similar challenge arises in
studies of the effects of chronic marijuana use on brain function Although
imaging studies functional MRI flVIRI in chronic users do show some
consistent alterations the relation of these changes to cognitive functioning
is less ctear This uncertainty may stem from confounding factors such as
other drug use residual drug effects which can occur for at least 24 hours
in chronic users or withdrawal symptoms inlong term chronic users
rijuana Memary and the Hippo campus
Memory impairment from marijuana use occurs because THC alters how
information is processed in the hippocampus a brain area responsible for
memory formation
Distribution of cannabinoid receptors in the rat brain Brain image reveals
highle els shown in orange and yellow of cannabinoid receptors in many
areas including the cortex hippocampus cerebellum and nucleus
mbens ventral striatum
Most of theeidence supporting this assertion comes from animal studies
3

i
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i
For example rats exposed to THC in utero soon after birth or during
2olescence show notable problems with specificlearning memory tasks
r in life Moreover cognitive impairment in adult rats is associated with
structural and functional changes in the hippocampus from THC exposure
during adolescence
As people age they lose neurons in the hippocampus which decreases their
ability to learn new information Chronic THC eacposure may hasten age
related loss of hippocampal neurons In one study rats exposed to THC
every day for 8 months approximately 3o percent of theirlife span
showed a level of nerve cell loss at ii to i2 months of age that equaled that
of unexposed animals twice their age
An enduring question in the field is whether individuals who quit
marijuana even afterlong term heavy use can recover some of their
cognitive abilities One study reports that the ability oflong term heavy
marijuana users to recall words from a list was still impaired i week after
they quit using but returned to normal by 4 weeks However another study
fouttd that marijuana s effects on the brain can build up and deteriorate
cr tical life skills over time Such effects may be worse in those with other
rtal disorders or simply by virtue of the normal aging process
Effects on General Physical Health
Within a few minutes after inhaling marijuana smoke an individual s heart
rate speeds up the bronchial passages relax and become enlarged and
blood vessels in the eyes expand making the eyes look red The heart rate
normally o to 8o beats per minute may increase by 2o to 5o beats per
minute or may even double in some cases Taking other drugs with
marijuana can amplify this effect
Limited evidence suggests that a person
risk of heart attack during the
first hour after smoking marijuana is four times his or her usual risk This
observation could be partly explained by marijuana raising blood pressure
in some cases and heart rate and reducing the blood s capacity to carry
oarygen Such possibilities need to be examined more closely particularly
since current marijuana users include adults from the baby boomer
generation who may have other cardiovascular risks that may increase
their wlnerability
j
i
4

Consequences ofMarijua Abuse
qcute present during intoxicarion
Impairs short term memory
Impairs attention judgment and other cognitive functions
Impairs coordination and balance
Increases heart rate
Psychotic episodes
Persistent lasting langer than intoxication but may not be
permanent
Impairs memory and learning skills
Sleep impairment
Long term cumulative effects of chronic abuse
Can ead to addiction
Increases risk of chronic cough bronchitis
Increases risk of schizophrenia in wlnerable individuals
May increase risk of anxiety depression and amotivational
syndrome
These are often reportedco occurring symptoms disorders with
chronic marijuana use However research has not yet determined
whether marijuana is causal orjust associated with these mental
problems
The smoke of marijuana like that of tobacco consists of a toxicmi cture of
gases and particulates many of which are known to be harmful to the lungs
Someone who smokes marijuana regularly may have many of the same
respiratory problems that tobacco smokers do such as daily cough and
phlegm production more frequent acute chest illnesses and a greater risk
of lung infections Even infrequent marijuana use can cause burning and
stinging of the mouth and throat often accompanied by a heavy cough One
study found that extra sick days used by frequent marijuana smokers were
often because of respiratory illnesses Polen et al i993
1 addition marijuana has the potential to promote cancer of the lungs and
other parts of the respiratory tract because it contains irritants and
s

carcinogens up to o percent more than tobacco smoke It also induces
hah levels of an enzyme that converts certain hydrocarbons into their
er causing form which could accelerate the changes that ultimately
produce malignant cells And since marijuana smokers generally inhale
more deeply and hold their breath longer than tobacco smokers the lungs
are exposed longer to carcinogenic smoke However while several lines of
evidence have suggested that marijuana use may lead to lung cancer the
supporting evidence is inconclusive Hashibe et al 2006 The presence of
an unidentified active ingredient in cannabis smoke having protective
properties if corroborated and properly characterized could help explain
the inconsistencies and modest findings
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A significant body of research demonstrates negative effects of THC on the
function of various immune cells both in vitro in cells and in vivo with test
animals However no studies to date connect marijuana s suspected
immune system suppression with greater incidence of infections or immune
disorders in humans One short3week study found marijuana smoking
to be associated with a few statistically significant negative effects on the
immune function of AIDS patients a second small study of college students
also suggested the possibility of marijuana having adverse effects on
immune system functioning Thus the combined evidence from animal
studies plus the limited human data available seem to warrant additional
research on the impact of marijuana on the immune system See The
Science of Medical Marijuana
NIDA Home Site Man Search FAQs Accessibilitv Pn FOIA NIH Emplovment Archives
6

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A Letterto Parents
Marijuana is the illegal drug most often used in this country
Since 1991 lifetime marijuana use has almost doubled among
8th and lOth grade students and increased by a third among
high school seniors Our research shows that accompanying this
upward pattern of use is a significant erosion in antidrug percep
tions and knowledge among young people today As the number
of young people who use marijuana has increased the number
who view the drug as harmful has decreased Among high
school seniors surveyed in 2001 current marijuana use has
increased by about 62 percent since 1991 The proportion of
those seniors who believe regular use of marijuana is harmful
has dropped by about 27 percent since 1991
These changes in perception and knowledge may be due to
a decrease in antidrug messages in the media an increase in pro
drug messages through the pop culture and a lack of awareness
among parents about this resurgence in druguse most thinking
perhaps that this threat to their children had diminished
Because many parents of this generation of teenagers used
marijuana when they were in college they often find it difficult
to talk about marijuana use with their children and to set strict
ground rules against drug use But marijuana use today starts at
a youngerage and more potent forms of the drug are available
to these young children Parents need to recognize that marijuana
use is a serious threat and they need to tell their children not
a
to use it
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We at the National Institute on Drug Abuse NIDA are
pleased to offer these two short booklets Marijuana Facts for
Teens and Marijuana Facts Parents Need to Know far parents
and their children to review the scientific facts about marijuana
While it is best to talk about drugs when children are young it
is never too late to talk about the dangers of drug use
Talking to our children bout drug abuse is not always
easy but it is very important I hope these booklets can help
f14
ffy
Glen R Hanson Ph DDS
Acting Director
National Institute on
Drug Abuse
1

Contents
1 A Letter to Parents
5
What is marijuana
6
What are the current slang terms for marijuana
7
How is marijuana used
7 How many people smoke marijuana
8
How can I tell if my child has been using marijuana
10 Why do young people use marijuana
11
Does using marijuana lead to other drugs
12 What are the effects of marijuana
13 What happens after a person smokes marijuana
13 How long does marijuana stay in the user
body
13 Can a user have a bad reaction
14
How is marijuana harmful
14 How does marijuana affect driving
16 What are the long term effects of marijuana
19 What about pregnancy
19
What happens if a nursing mother uses marijuana
21
How does marijuana affect the brain
22 Can the drug cause mental illness
22
Do marijuana users lose their motivation
22
Can a person become addicted to marijuana
0
Z4 Are there treatments to help marijuana users
25 Can marijuana be used as medicine G
z
Z6 How can I prevent my child from getting
involved wi marijuana
a
Z7 Talking to your children about marijuana W
Z8
Resources
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QWhat is marijuana Are there different hinds
AMarijuana is a green brown or gray mixture of dried
shredded leaves stems seeds and flowers of the hemp plant
Cannabis sativa Before the 1960s many Americans had never
heard of marijuana but today it is the most often used illegal
drug in this country
Cannabis is a term that refers to marijuana and other drugs
made from the same plant Strong forms of cannabis include sinse
millasin seh me yah hashish hash for short and hash oil
All forms of cannabis aremind altering psychoactive drugs
they all contain THCdelta 9tetrahydrocannabinol the main
active chemical in marijuana They also contain more than 400
other chemicals
Marijuana s effect on the user depends on the strength or
potency of the THC it contains THC potency has increased since
the 1970s and continues to increase still The strength of the drug
is measured by the average amount of THC in test samples con
fiscated by law enforcement agencies For the year 2001
Most ordinary marijuana contained on average
5 percent THC
Sinsemilla made from just the buds and flowering tops of
female plants contained on average 9 percent THC with
a range as high as 25 percent
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Hashish the sticky resin from the female plant s flowers
had an average of 9 percent THC with a range as high
as 19 percent
Hash oil a tar like liquid distilled from hashish had an
average of 19 percent THC with a range as high as
27 percent
QWhat are the current slang terms for marijuana
AThere are many different names for marijuana Slang terms
for drugs change quickly and they vary from one part of the
country to another They may even differ across sections of a
large city
Terms from years ago such as pot herb grass weed Mary
Jane and reefer are still used You might also hear the names
Aunt Mary skunk boom gangster kif or ganja
There are also street names for different strains or brands
of marijuana such as Texas tea Maui wowie and Chronic
A recent book of American slang lists more than 200 terms for
various kinds of marijuana

QHow is fnarijuana used
AMost users roll loose marijuana into a cigarette called a
joint or a nail or smoke it in a pipe Onewell known type of
water pipe is the bong Some users mix marijuana into foods
or use it to brew a tea Another method is to slice open a cigar
and replace the tobacco with marijuana making what s called
a blunt When the blunt is smoked with a 40 oz bottle of malt
liquor it is calledaB40
Lately marijuana cigarettes or blunts often include crack
cocaine a combination known by various street names such as
primos or woolies Joints and blunts often are dipped in PCP
and are called happy sticks wicky sticks love boat or tical
QHow many people smohe inarijuana At what
age do children generally start
A recent government survey tells us
Marijuana is the most frequently used illegal drug in the
United States Over 83 million Americans over the age
of 12 have tried marijuana at least once
Over 12 million had used the drug in the month before
the survey
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The Monitoring the Future Survey which is conducted
yearly includes students from 8th lOth and 12th grades
In 2001 the survey showed that 20 percent of8th graders have
tried marijuana at least once and by lOth grade 20 percent are
current users that is used within the past month Among
12th graders nearly 50 percent have tried marijuana hash at
least once and about 22 percent were current users
Other researchers have found that use of marijuana and
other drugs usually peaks in the late teens and early twenties
then declines in later years
QHow can I tell if my child has been using
marijuana
AThere are some signs you might be able to see If someone is
high on marijuana he or she might
seem dizzy and have trouble walking
seem silly and giggly for no reason
have very red bloodshot eyes and
have a hard time remembering things that just happened
When the early effects fade the user can become very sleepy
Parents should be aware of changes in their child s behavior
although this may be difficult with teenagers Parents should
look for withdrawal depression fatigue carelessness with
grooming hostility and deteriorating relationships with family

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members and friends In addition changes in academic perfor
mance increased absenteeism or truancy lost interest in sports or
other favorite activities and changes in eating or sleeping habits
could be related to drug use However these signs may also indi
cate problems other than use of drugs
In addition parents should beavare of
signs of drugs and drug paraphernalia including pipes
and rolling papers
odor on clothes and in the bedroom
use of incense and other deodorizers
use of eye drops and
clothing posters jewelry etc promoting drug use
QWhy do young people usetia lijuaiia
AChildren and young teens start using marijuana for many rea
sons Curiosity and the desire to fit into a social group are common
reasons Certainly youngsters who have already begun to smoke
cigarettes and or use alcohol are at increased risk for marijuana use
Also our research suggests that the use of alcohol and drugs
by other family members plays a strong role in whether children
start using drugs Parents grandparents and older brothers and
sisters in the home are models for children to follow

Some young people who take drugs do not get along with
their parents Some have a network of friends who use drugs
and urge them to do the same peer pressure All aspects of a
child s environment home school neighborhood help to
determine whether the child will try drugs
Children who become more heavily involved with marijuana
can become dependent making it difficult for them to quit
Others mention psychological coping as a reason for their use
to deal withar iety anger depression boredom and so farth
But marijuana use is not an effective method for coping with
life s problems and staying high can be a way of simply not deal
ing with the problems and challenges of growing up
Researchers have found that children and teens both male
and female who are physically and sexually abused are at greater
risk than other young people of using marijuana and other drugs
and of beginning drug use at an early age
QDoes using marijuana lead to other drugs
ALong term studies of high school students and their patterns
of drug use show that very few young people use other drugs
without first trying marijuana alcohol or tobacco Though few
young people use cocaine for example the risk of doing so is
much greater for youth who have tried marijuana than for those
who have never tried it While research has not fully explained
this association growing evidence suggests a combination of bio
logical social and psychological factors are involved
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Researchers are examining the possibility that long term
marijuana use may create changes in the brain that make a
person more at risk of becoming addicted to other drugs such
as alcohol or cocaine While many young people who use
marijuana do not go on to use other drugs further research is
needed to determine who will be at greatest risk
QWhat are the effects of marijuana
AThe effects of marijuana on each person depend on the
type of cannabis and how much THC it contains
way the drug is taken by smoking or eating
experience and expectations of the user
setting where the drug is used and
whether drinking or other drug use is also going on
Some people feel nothing at all when they first try
marijuana Others may feel high intoxicated and or euphoric
It is common for marijuana users to become engrossed with
ordinary sights sounds or tastes and trivial events may seem
extremely interesting or funny Time seems to pass very slowly
so minutes feel like hours Sometimes the drug causes users to
feel thirsty and very hungry an effect called the munchies

QWhat happeris after a person smohes riarijuana
AWithin a few minutes of inhaling marijuana smoke the
user will likely feel along with intoxication a dry mouth rapid
heartbeat some loss of coordination and poor sense of balance
and slower reaction time Blood vessels in the eye expand so the
user
eyes look red
For some people marijuana raises blood pressure slightly
and can double the normal heart rate This effect can be greater
when other drugs are mixed with marijuana but users do not
always know when that happens
As the immediate effects fade usually after 2 to 3 hours
the user may become sleepy
QHow long does marijuana stay in the user
body
ATHC in marijuana is readily absorbed by fatry tissues in vari
ous organs Generally traces metabolites of THC can be detected
by standard urine testing methods several days after a smoking
session However in heavy chronic users traces can sometimes
be detected for weeks after they have stopped using marijuana
QCan a user have a bad reaction
AYes Some users especially someone new to the drug or in
a strange setting may suffer acute arixiety and have paranoid
thoughts This is mare likely to happen with high doses of THC
These scary feelings will fade as the drug s effects wear off
In rare cases a user who has taken a very high dose of the
0
drug can have severe psychotic symptoms and need emergency
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medical treatment
Other kinds of bad reactions can occur when marijuana
is mixed with other drugs
such as PCP or cocaine
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QHow is marijuana harmful
AMarijuana can be harmful in a number of ways through both
immediate effects and damage to health over time
Marijuana hinders the user
short term memory memory for
recent events and he or she may have trouble handling complex
tasks With the use of more potent varieties of marijuana even
simple tasks can be difficult
Because of the drug s effects on perceptions and reaction time
users could be involved in auto crashes Drug users also may
become involved in risky sexual behaviars which could lead to
the spread of HN the virus that causes AIDS
Under the influence of marijuana students may find it hard
to study and learn Young athletes could find their performance
is off timing movements and coordination are all affected
by THC
Some of the more long range effects of marijuana use are
described later in this boohlet
QHow does mariJuana affect driving
AMarijuana affects many skills required for safe driving alert
ness the ability to concentrate coordination and reaction time
Marijuana use can make it difficult to judge distances and react
to
signals and sounds on the road

Fact Marijuana has
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There are data showing that marijuana can play a role in
crashes When users combine marijuana with alcohol as they
often do the hazards of driving can be more severe than with
either drug alone
A study of patients in a shock trauma unit who had been
in traffic accidents revealed that 15 percent of those who had
been driving a car or motorcycle had been smoking marijuana
and another 17 percent had both THC and alcohol in their blood
In one study conducted in Memphis TN researchers found
that of 150 reckless drivers who were tested for drugs at the
arrest scene 33 percent tested positive for marijuana and 12
percent tested positive for both marijuana and cocaine Data also
show that while smoking marijuana people show the same lack
of coordination on standard drunk driver tests as do people
who have had too much to drink
QWhat are the long tenn effects of marijuana
AWhile all of the long term effects of marijuana use are not
yet known there are studies showing serious health concerns
For example a group of scientists in California examined the
health status of 450 daily smokers of marijuana but not tobacco
They found that the marijuana smokers had more sick days and
more doctor visits for respiratory problems and other rypes of
illness than did a similar group who did not smoke either substance
Findings so far show that the regular use of marijuana or
THC may play a role in cancer and problems in the respiratory
and immune systems

Cancer
It is hard to find out whether marijuana alone causes cancer
because many people who smoke marijuana also smoke cigarettes
and use other drugs Marijuana smoke contains some of the same
cancer causing compounds as tobacco sometimes in higher con
centrations Studies show that someone who smokes five joints
per day may be taking in as many cancer causing chemicals as
someone who smokes a full pack of cigarettes every day
Tobacco smoke and marijuana smoke may work together to
change the tissues lining the respiratory tract Marijuana smoking
could contribute to early development of head and neck cancer
in some people
Immune system
Our immune system protects the body from many agents that
cause disease It is not certain whether marijuana damages the
immune system of people But both animal and human studies
have shown that marijuana impairs the ability ofTcells in the
lungs immune defense system to fight off some infections
Lungs and airways
People who smoke marijuana regularly may develop many
of the same breathing problems that tobacco smokers have
such as daily cough and phlegm production more frequent
chest colds a heightened risk of lung infections and a greater
tendency toward obstructed airways Cancer of the respiratory
tract and lungs may also be promoted by marijuana smoke
since it contains irritants and carcinogens Marijuana smokers
usually inhale more deeply and hold their breath longer which
increases the lungs exposure to carcinogenic smoke Thus puff
for puff smoking marijuana may increase the risk of cancer
more than smoking tobacco does
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Q What about pregtiancy Will smohirig marijuana
hurt the baby
ADoctors advise pregnant women not to use any drugs because
they might harm the growing fetus One animal study has
linked marijuana use to loss of the fetus very early in pregnancy
Some scientific studies have found that babies born to
women who used marijuana during their pregnancy display
altered responses to visual stimulation increased tremors and
a high pitched cry which may indicate problems with nervous
system development During pre and early school years
marijuana exposed children have been reparted to have more
behavioral problems and difficulties with sustained attention
and memory than nonexposed children
Researchers are not certain whether any effects of marijuana
during pregnancy persist as the child grows up however
because some parts of the brain continue to develop into
adolescence it is also possible that certain kinds of problems
will become more evident as the child matures
QWhat happens if a nursing mother uses marijuana
A When a nursing mother uses marijuana some of the THC
is passed to the baby in her breast milk This is a matter for
concern since the THC in the mother s milk is much more con
centrated than that in the mother s blood One study has shown
that the use of marijuana by a mother during the first month of
o
breastfeeding can impair the infant s motor development control
of muscle movement
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QHow does niarijuana affect the rain
ATHC affects the nerve cells in the part of the brain where
memories are formed This makes it hard for the user to recall
recent events such as what happened a few minutes ago It
is hard to learn while high a working short term memory is
required for learning and performing tasks that call for more
than one or two steps
Among a group oflong time heavy marijuana users in Costa
Rica researchers found that the people had great trouble when
asked to recall a short list of words a standard test of inemory
People in that study group also found it very hard to focus their
attention on the tests given to them
As people age they narmally lose nerve cells in a region of
the brain that is important for remembering events Chronic
exposure to THC may hasten the age related loss of these nerve
cells In one study researchers found that rats exposed to
THC every day for 8 months about 13 of their lifespan
showed a loss of brain cells comparable to rats that were twice
their age It is not known whether a similar effect occurs in
humans Researchers are still learning about the many ways that
marijuana could affect the brain
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QCan the drug cause mental illness
AScientists do not yet know how the use of marijuana relates
to mental illness Among the difficulties in this kind of research
are determining whether drug use precedes or follows mental
health problems whether one causes the other and or whether
both are due to other factors such as genetics or environmental
conditions High doses of marijuana can induce psychosis
disturbed perceptions and thoughts and marijuana use can
worsen psychotic symptoms in people who have schizophrenia
There is also evidence of increased rates of depression ar iety
and suicidal thinking in chronic marijuana users However
it is not yet clear whether marijuana is being used in an attempt
toself medicate an already present but otherwise untreated
mental health problem or whether marijuana use leads to men
tal disorders or both
QDo marijuana users lose their rnotivation
ASome frequent long term marijuana users show signs of
a lack of motivation amotivational syndrome Their problems
include not caring about what happens in their lives no desire to
work regularly fatigue and a lack of concem about how they look
As a result of these symptoms some users tend to perform poorly
in school or at work Scientists are still studying these problems

QCan a person become addicted to marijuana
AYes While not everyone who uses marijuana becomes
addicted when a user begins to seek out and take the drug
compulsively that person is said to be dependent on the drug
or addicted to it In 1999 over 220 000 people entering drug
treatment programs reported marijuana as their primary drug
of abuse showing they needed help to stop using
Some heavy users of marijuana show signs of dependence
because when they do not use the drug they develop withdrawal
symptoms Some subjects in an experiment on marijuana with
drawal had symptoms such as restlessness loss of appetite trouble
sleeping weight loss and shaky hands
According to one study marijuana use by teenagers who have
prior serious antisocial problems can quickly lead to dependence
on the drug That study also found that for troubled teenagers
using tobacco alcohol and marijuana progression from their
first use of marijuana to regular use was about as rapid as their
progression to regular tobacco use and more rapid than the
progression to regular use of alcohol
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QWliat is tolerance for marijuana
ATolerance means that the user needs increasingly larger
doses of the drug to get the same desired results that he or she
previously got from smaller amounts Some frequent heavy
users of marijuana may develop tolerance for it
QAre there treatments to heip marijuana users
AUp until a few years ago it was hard to find treatment pro
grams specifically for marijuana users Treatments for marijuana
dependence were much the same as therapies for other drug abuse
problems These include behaviaral therapies such as cognitive
behavioral therapy multisystemic therapy individual and group
counseling and regular attendance at meetings of support
groups such as Narcotics Anonymous
Recently researchers have been testing different ways to
attract marijuana users to treatment and help them abstain from
drug use There are currently no medications for treating
marijuana dependence Treatment programs focus on counseling
and group support systems From these studies drug treatment
professionals are learning what characteristics of users are predic
tors of success in treatment and which approaches to treatment
can be most helpful
Further progress in treatment to help marijuana users includes
a number of programs set up to help adolescents in particular

Some of these programs are in university research centers where
most of the young clients report marijuana as their drug of choice
Others are in independent adolescent treatment facilities Family
physicians are also a good source for information and help in
dealing with adolescents marijuana problems
QCan marijuana be used as medicine
AThere has been much debate in the media about the possible
medical use of marijuana Under US law since 1970 marijuana
has been a Schedule I controlled substance This means that the
drug at least in its smoked form has no commonly accepted
medical use
In considering possible medical uses of marijuana it is
important to distinguish between whole marijuana and pure
THC or other specific chemicals derived from cannabis Whole
marijuana contains hundreds of chemicals some of which may
be harmful to health
THC manufactured into a pill that is taken by mouth not
smoked can be used for treating the nausea and vomiting that
go along with certain cancer treatments and is available by
presctiption Another chemical related to THC nabilone has
also been approved by the Food and Drug Administration for
treating cancer patients who suffer nausea The oral THC is also
used to help AIDS patients eat more to keep up their weight
Scientists are studying whether marijuana THC and related
chemicals in marijuana called cannabinoids may have other
medical uses According to scientists more research needs to be
done on marijuana s side effects and potential benefits before it
can be recommended for medical use
o
z
25
c3

i
I
26
0
z
w
a
a
QHow can I prevefit my child from getting involved
with marijuana
AThere is no magic bullet for preventing teenage drug use
But parents can be influential by talking to their children about
the dangers of using marijuana and other drugs and remain
actively engaged in their children s lives Even after teenage chil
dren enter high school parents can stay involved in schoolwork
recreation and social activities with their children s friends
Research shows that appropriate parental monitoring can reduce
future drug use even among those adolescents who may be prone
to marijuana use such as those who are rebellious cannot con
trol their emotions and experience internal distress To address
the issue of drug abuse in your area it is impartant to get involved
in drug abuse prevention programs in your community or your
child s school Find out what prevention programs you and your
children can participate in together
II
Fq
M
bS

Talking to your children
about marijuana
As this booklet has shown marijuana can pose a particular
threat to the health andwell being of children and adolescents at
a critical point in theirlives when they are growing learning
maturing and laying the foundation for their adult years As a
parent your children look to you for help and guidance in
working out problems and in making decisions including the
decision not to use drugs As a role model your decision to not
use marijuana and other illegal drugs will reinforce your mes
sage to your children
There are numerous resources many right in your own
community where you can obtain information so that you can
talk to your children about drugs To find these resources you
can consult your local library school or communiry service
organization
The National Clearinghouse for Alcohol and Drug Information
NCADI offers an extensive collection of publications videotapes
and educational materials to help parents talk to their children
about drug nse For more information on marijuana and other
drugs contact National Clearinghouse for Alcohol and Drug
Information PO Box 2345 Rockville MD 208471800
729 6686 TDD number1800 487 4889 and or visit
NIDA s Web site athttp
wwwdrugabuse gov
vz
3W
c
27

x
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aca
6
28
Selected Resources and References
National Institute on Drug Abuse NIDA
N1DA s mission is to lead the Nation in bringing he power oE science to bear on
drug abuse and addiction It does so by supparting over 85 of the world s
research on drug abuse and ensuring the effective dissemination and use of this
research to improve drug abuse and addiction prevention treatment and policy
For general inquiries contact NIDAs public inEormacion office at 301 443 1124
or visit the NIDA Web si e atwww drugabuse gov andwww marijuana inEo org
NIDA publications are available through the National Clearinghouse on Alcohol
and Drug Information
National Clearinghouse on Alcohol and Drug Information NCADI
NCADl provides access to educational publica ions from N1DA and other Federal
agencies Staff provides assis ance in English and Spanish and has TDD capability
Call1800 729 6686 or visit the NCADI Web site atwww healdi org
Center for Substance Abuse Prevention CSAP
CSAP a part of the Substance Abuse and Mental Health Services Administration
provides national leadership in the development of policies programs and services
to prevent the onset of illegal drug alcohol and obacco use CSAP publications are
available through the NCADI
Cenrer for Substance Abuse 7reatment CSAT
CSAl a part oI the Substance Abuse and Mental Health Services Administration
supports treatinent services research dissemination and adoption and operates
the National Treatment Referral Hodine1800 662 HELP CSAT publications
are available through the NCADI
Feel free to reprint this publication in any quantiry you wish

Be a gvod listener
Give clear nous ir sages abo t
drugs and alcaho
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Help your child deal with peer
pressure usgs
x
Get to hnw your chiid s friends
tnd parents k
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Supervise teen activities
Maintain an open and honest
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Fact Marijuana e most frequently
usil ga rug in the Un td tates
F early 50 of12th graders have
tied marijuana at east one
r
fact Marijuana smokingafct the
bain and eads to impaired short term
mer ory perception judgrner
mr skills
US DEPARTMENT OF HEALTH AND HUMAN SERVECES
NIHPublication No 02 4036
Printed 1995 Revised November 199 2002
Reprinted April 2001

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I
Contents
What is marijuana 2
How is marijuana used 4
How long does marijuana stay
in the use
body 5
How many teens smoke marijuana 5
Why do young people use marijuana 5
What happens if you smoke marijuana 6
What are the short term effects of marijuana use 8
Does marijuana afFect school sports
or other activities 9
What are the long term effects of marijuana use 9
Does marijuana lead to the use of other drugs 10
How can you tel if someone has been using marijuana 11
Is marijuana sometimes used as a medicine 11
How does marijuana affect driving 12
If a woman is pregnant and smokes marijuana
will it hurt the baby 12
What does marijuana do to the brain 14
Can people become addicted to marijuana 14
What if a person wants to quit using the drug 16

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Marijuana is a green brown or gray mixture of dried shredded
leaves stems seeds and flowers of the hemp plant You may
4x
v
hear marijuana called by street names such as pot herb weed
grass boom Mary Jane gangster or chronic There are more
than 200 slang terms for marijuana
Sinsemillasin seh me yah its a Spanish word
hashish hash for short and hash oil are stronger forms
of marijuana
All forms of marijuana are mind aLtering In other
words they change how the brain works They all contain THC
delta 9tetrahydrocannabinol the main active chemical in
marijuana They also contain more than 400 other chemicals
Marijuana s effects on the user depend on its strength or
potency which is related to the amount of THC it contains
The THC content of marijuana has been increasing since
the 1970s
6
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cool at all and I
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tr to pressure it
on other people
from the videotape
Marijuana What Can
Parents Do
Q How is mar jua
i

Q How Iong does marijuana stay
in the user
body
A
THC in marijuana is strongly absorbed by fatty tissues in
various organs Generally traces metabolites of THC can
be detected by standard urine testing methods several days
after a smoking session However in heavy chronic users
traces can sometimes be detected for weeks after they have
stopped using marijuana
A u i u
A
Contrary to poputar belief most teenagers do not use marijuana
Among students surveyed in a yearly nationa survey only about
one in five 10th graders report they are current marijuana users
that is used marijuana within the past month Fewer than
one in four high school seniors is a current marijuana user
ns u
A
There are many reasons why some children and young teens
start smoking marijuana Many young people smoke marijuana
because they see their brothers sisters friends or even older
family members using it
Others may think its cool to use marijuana because
they hear songs about it and see it on TV and in movies
Some teens may fee they need marijuana and other drugs
to help them escape from problems at home at school or
with friends
5

No matter how many shirts and caps you see printed
with the marijuana leaf or how many groups sing about it
remember this You dan t have to use marijuana just because
yau think everybody eLse is doing it
R e u uo
A
The efFects ofthe drug on each person depend on many
factors induding
how strong the marijuana is how much THC it has
what the user expects to happen
where the place the drug is used
how it is taken and
whether the user is drinking alcohol or using
other drugs
Some people fee nothing at all when they smoke
marijuana Others may feet relaxed or high Sometimes
marijuana makes users feel thirsty and very hungry
an effect called the munchies
Some users can get bad effects from marijuana
They may suffer sudden fee ings of anxiety and have paranoid
thoughts This is more likely to happen when a more potent
variety of marijuana is used
6

I
i
I
11
f
A
x
a
F

A Er o ds s
a
A
The short term efFects of marijuana indude
problems with memory and Learning
distorted perception sights sounds time touch
trouble with thinking and problemsolving
loss of motor coordination and
increased heart rate
i
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8

These efFects are even greater when other drugs are mixed
with the marijuana and users do not always know what
drugs are given to them
1 u
A
It can Marijuana afFects memory judgment and perception
The drug can make you mess up in school in sports or dubs
or with your friends If you re high on marijuana you are more
likely to make stupid mistakes that could embarrass or even
hurt you If you use marijuana a lot you couLd start to lose
interest in how you look and how you re gettingaong at
school or work
Athletes could find their performance is ofF timing
movements and coordination are all affected by THC Also
since marijuana can afFect judgment and decisionmaking
its use can Lead to risky sexual behavior resulting in expo
sure to sexually transmitted diseases like HIV the virus that
causes AIDS
A
u
u
A
findings so far show that regular use of marijuana or THC
may play a role in some kinds of cancer and in problems
with the respiratory and immune systems
Cancer It s hard to know for sure whether regular marijuana
use causes cancer But it is known that marijuana contains
9

some of the same and sometimes even more of the cancer
causing chemicals found in tobacco smoke Studies show that
someone who smokes five joints per day may be taking in as
many cancer causing chemicais as someone who smokes a full
pack of cigarettes every day
Lungs and airways People who smoke marijuana often
develop the same kinds of breathing problems that cigarette
smokers have coughing and wheezing They tend to have
more chest colds than nonusers They are also at greater
risk of getting ung infections like pneumonia
Immune system THC may increase the risk of developing
infections by inhibiting normaL disease preventing reactions
1 u
i
A
It could Long term studies of high schoo students and
their patterns of drug use show that very few young people
use other illegal drugs without first trying marijuana Using
marijuana puts children and teens in contact with people
who are users and sellers of otF er drugs So there is more of
a risk that a
marijuana user will be exposed to and urged to
try more drugs
While most young people who use marijuana do not
go on to use other drugs further research is needed to pre
dict who will be at greatest risk
o

dESf
A H iH C
9
A
If someone is high on marijuana he or she might
seem dizzy and have trouble walking
seem silly and giggly for no reason
have very red bloodshot eyes and
have a hard time remembering things that just happened
When the early effects fade over a few hours the user
can become very sleepy
a
u u
u
A
There has been much talk about the possible medical use of
marijuana Under US law since 1970 marijuana has been a
Schedule I contro led substance This means that the drug at
least in its smoked form has no commonly accepted medical use
THC the active chemicalin marijuana is manufactured
into a pill available by prescription that can be used to treat
the nausea and vomiting that occur with certain cancer treat
ments and to help AIDS patients eat more to keep up their
weight According to scientists more research needs to be
done on marijuana s side effects and potential benefits
before it is used medically with any regularity

Q How does marijuana affect driving
A
Marijuana has serious harmful effects on the skills required to
drive safely alertness the abi ity to concentrate coordination
and the ability to react quickly Marijuana use can make it
difFicult to judge distances and react to signals and sounds
on the road
Marijuana may play a role in car accidents In one
study conducted in Memphis TN researchers found that of
150 reckless drivers who were tested for drugs at the arrest
scene 33 percent tested positive for marijuana and 12 per
cent tested positive for both marijuana and cocaine Data
have also shown that while smoking marijuana people show
the same lack of coordination on standard drunk driver tests
as do people who have had too much to drink
u
u
u
A
Doctors advise pregnant women not to use any drugs because
they could harm the growing fetus One animal study has linked
marijuana use to oss of the fetus very early in pregnancy
Other studies have shown increased behavioral prob
lems during infancy and preschool years in children born to
mothers who use marijuana In school these children are
more likely to have problems with decisionmaking memory
and the ability to remain attentive
z

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Researchers are not certain whether health problems
that may be caused by early exposure to marijuana will
remain as the child grows into adulthood However since
some parts of the brain continue to develop into adolescence
it is also possib e that certain kinds of problems may appear
as the child matures
e s u e e n c c
A
Some studies show that when peopte have smoked large
amounts of marijuana for years the drug takes its toll on
mental functions Heavy or daily use of marijuana affects
the parts of the brain that control memory attention and
learning A working short term memory is needed to earn
and perform tasks that call for more than one or two steps
Smoking marijuana causes some changes in the brain
that are like those caused by cocaine heroin and alcohol
Some researchers believe that these changes may put a per
son more at risk of becoming addicted to other drugs such
as cocaine or heroin Scientists are still learning about the
many ways that marijuana could affect the brain
x
A
Yes Long term marijuana use can lead to addiction in some
people That is they cannot control their urges to seek out
and use marijuana even though it negatively affects their
family relationships school performance and recreational
4

u
u
i i r r
I
activities According to one study marijuana abuse by
teenagers who have prior antisocial problems can quickly lead
to addiction In addition some frequent heavy marijuana
users develop tolerance to its efFects This means they need
Larger and larger amounts of marijuana to get the same
desired effects as they used to get from smaller amounts
R
r
er
t
A
In 1999 over 220 000 people entering drug treatment pro
grams reported marijuana as their primary drug of abuse
However up until a few years ago it was hard to find treat
ment programs specifically for marijuana users
5

Now researchers are testing different ways to he p
marijuana users abstain from drug use There are currently
no medications for treating marijuana addiction Treatment
programs focus on counseling and group support systems
There are also a number of programs designed especially
to help teenagers who are abusers Family doctors are also
a good source for information and help in dealing with
ado escent marijuana problems
I6

USDRMENT 3 D BUMAN xY3CES
NIH Publieation No 3 03
s
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a
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Page 1 of 2
a
Yc ur source for the Eatest research news
Web address
httpwwwsciencedaily com releases 2009 12
091217115834 htm
Cannabis Damages Young Brains More Than
Originally Thought Study Finds
ScienceDaily Dea 20 2009 Canadian teenagers are among the
largest consumers of cannabis warldwide The damaging effects of
this illicit drug on young brains are worse than originally thought
according to new research by Dr Gabriella Gobbi a psychiatric
researcher from the Research Institute of the McGill University
Health Centre The new study published in Neurobiology ofDisease
suggests that daily consumption of cannabis in teens can cause
depression and anxiety and have an irreversible long term effect on
the brain
We wanted to know what happens in the brains of teenagers when
they use cannabis and whether they are more susceptible to its
neurological effects than adults explained Dr Gobbi who is also a
Daily consumption ofcannabis in teens can
professor at MeGill University Her study points to an apparent action cause depression and anxiety and have an
of cannabis on two important compounds in the brain serotonin and rreversible long term effect on the brain
n
inephrine which are involved in the regulation of neurological
Credit iStockphoto Rasmus Rasmussen
functions such as mood control and anxiety
Teenagers who are exposed to cannabis have decreased serotonin transmission which leads to mood disorders as well
as increased norepinephrine transmission which leads to greater long term susceptibility to stress Dr Gobbi stated
Previous epidemiological studies have shown how cannabis consumption can affect behaviour in some teenagers Our
study is one of the first to focus on the neurobiological mechanisms at the root of this influence of cannabis on
depression and anxiety in adolescents confirn ed Dr Gobbi It is also the first study to demonstrate that cannabis
consumption causes more serious damage during adolescence than adulthood
Dr Gabriella Gobbi is a researcher at the neuroscience axis of the Research Institute of the McGill University Health
Centre and also a psychiatrist and associate professor at the Department of Psychiatry McGill University
This study was funded by a grant from The Canadian Psychiatric Research Foundation CPRF
This article wasco authored by Dr Francis Rodriguez Bambico Ms Nhu Tram Nguyen and Mr Noam Katz from
fromIR MUHC and the Neurobiological Psychiatry Unit Department of Psychiatry McGill UniversiTy
Recommend this story on Facebook TwUter
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wwwsciencedaily com releases 2009 1
2091 2 1 7 1 15834 htm 912 2011

Page 2 of 2
Story Source
The above story is reprinted with editorial adaptations by ScienceDaily staffl from materials provided by
McGill Universih Health Centre via EurekAlert a service of AAAS
Need to cite this story in your essay paper or report Use one of the following formats
r APA
MLA
McGill University Health Centre 2009 December 20 Cannabis damages young brains more than originally thought
study finds ScienceDaily Retrieved September 12 2011 fromhttp
wwwsciencedaily com
releases 2009 12 091 2 17 1 1 5834 htm
Note If no author is given the source is cited instead
Disclaimer This article is not intended to provide medical advice dingnosis or treatment Views expressed here do not
necessarily reflect those ofScienceDaily or its staff
http www
sciencedaily com releases 2009
091217ll 5834
htm 912 2011

Medical Marijuana Page 1 of 6
Medical Mariivana
raLic
MARIJUANA AS MEDICINE
NTRODUCT ON
New England Governors Summit on Drug Use
October 8 2003
Andrea G Barthwell MD FASAM
Deputy Director Office of Demand Reduction
Office of National Drug Control Policy
The hoax of using a smoked weed as medicine is the Trojan Horse of the new millennium The claim that
marijuana can be used as medicine is proving to be one of the worst scams drug legalizers have perpetrated
on the American people In reality smoked marijuana is far too complex unstable and harmful a substance
to be approved as a medicine
l ery instance claimed by legalizers as a use for smoked marijuana there exist far better legitimate
scientifically approved medications Any argument supporting a smoked material as a medicine is dubious
ridiculous even The purpose of proposals to use marijuana as medicine is simple make marijuana and
other illicif substances more available to individuals and communities in our country
The tangle of consequences of state or local referenda to make marijuana available for personal use creates
more difficult policy questions and greater public health concerns than the proposed laws would address
Before joining the Bush Adminisfration as Deputy Director for Demand Reduction in the White House Office
of National Drug Control Policy ONDCPJ 1 served as Medica Director of lnterventrons anot for profit drug
treatment system in lllinois At lnterventions l ran the largest and oldest adolescent treatmenf sysfem in that
state Children entering treatmenf routinely reported that they heard that pot is medicine
and therefore believed it to be good for them Claims that marijuana is medicine reduce the efficacy of
prevention efforts
Fortunately modern medical science is close to developing a safe delivery system for the constituent parts
of marijuana Marijuana legalizers will no longer be able to exploit the sick and dying as part of their attempts
to subvert the medical system undermine the legal system make a laughingstock of policy and expose our
children fo dangerous poisons
SCIENCE SHOULD DETERM NE THE PRACTICE OF MEDICINE
7
ical marijuana is a broadly used butill defined term Federal law does not recognize marijuana as a
rn cine Marijuana is listed in Schedule I of the Federal Controlled Substances Act CSA which reflects
the fact that marijuana has no currently accepted medical use in treatment in the United States Schedule I
is the most restrictive schedule in the CSA Smoked marijuana delivers harmful and unspecified substances
http neoa org index php view article catid 33Apublic id 18 3Amedical marijuana tmpl compone 912 2011

Medical Marijuana Page 2 of 6
to the body cannot be expected to provide a precisely defined drug effect and has a high potential for
abuse In short smoked marijuana is unsafe for use
even under medical supervision
Nevertheless voters in several states have passed referenda making marijuana available for a variety of
r cal conditions The resulting laws are in conflict with the CSA and with the Federal Food Drug and
Cwmetic Act
Science not public opinion must drive the practice of inedicine Political measures aimed at endorsing
marijuana as medicine undercut efforts to ensure that approved medications have undergone rigorous
scientific scrutiny and the Food and Drug Administration FDA approval process Scientists are engaged in
research to determine whether there are indeed potential medical uses for constituents of marijuana The
purpose of such research is not to develop marijuana as a licensed drug but to investigate rapid onset
delivery systems that do not require inhaling the acrid and potentially carcinogenic smoke of a burning weed
WILLOW TREE BARK AND OTHER CRUDE REMEDlES
In the 19th century marijuana was thought to be useful as an analgesic muscle relaxant anticonvulsant
and appetite stimulant It was provided in the form of tinctures extracts and elixirs Snake oilsa esmen
extolled the virtues of marijuana for asthma bronchitis migraine headaches depression gonorrhea uterine
hemorrhage and dysmenorrhea Treatment responses were unpredictable or nonexistent These marijuana
laced products were subsequently discarded as science developed disease and symptom specific
medicafions
Every American is familiar with aspirin and some know that it was rst found in willow bark from which the
therapeutic agent acetylsalicylic acid was eventually synthesized Surely no physician today would
recommend chewing willow bark much less smoking a piece of tree to cure a headache Likewise no
ler imate physician would prescribe smoked opium to relieve the pain of cancer when manysemi synthetic
a
ynthetic opioids are currently in use for pain Moreover there is no clamor from legitimate medical
organizations to get a smoked weed on the medications formulary
Marijuana legalizers want to set the clock of modern medicine back to a time before the passage of the Pure
Food and Drug Act in 1907 when Americans were exposed to a host ofpatent medicine cure alls
everything from vegefable folk remedies to dangerous mixtures with morphine The major component of
most cures was alcohol which probably explains why people reported that they felt better Claimed
benefifs were erratic and irreproducible The case is the same with marijuana As Dr Mark Krauss of the
Connecticut Society of Addiction Medicine will explain marijuana cannot be equated with credible
medications The Institute of Medicine IOM in its 1999 report commissioned by ONDCP stated
Scientific data indicate the potential therapeutic value of cannabinoid drugs primarily
THC for pain relief control of nausea and vomiting and appetite stimulation smoked
marijuana however is a crude delivery system that also delivers harmfu
substances
In the 1970s and subsequent years anecdotal claims surfaced that marijuana relieved a number of inedical
conditions These claims were investigated in a number of studies supported by the National Institutes of
Health NIH The National Cancer Institute NCI in collaborafion with the National Institute on Drug Abuse
NIDA initiated clrnical trials on a synthetic orally administered form ofdelta 9tetrahydrocannabinol THC
the primary psychoactive ingredient in marijuana In 1985 the FDA approved synthetic THC marketed
under the trade name Marinol0 for nausea associated with cancer chemotherapy
F approval means that the product was subjected to rigorous clinical trials that established its medical
value profiled its side effects and contraindications established appropriate standards for dosing and
detailed pertinent drug interactions As outlined by the Institute of Medicine
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I83 Amedical marijuana hnpl compone 912
20l 1

Medical Marijuana Page 3 of 6
Under the Federal Food Drug and Cosmetic FDC Act the FDA approves new
drugs for entry into the marketplace after their safety and efficacy are established
through controlled clinical trials FDA approval of a drug is the culmination of a long
research intensive process of drug development which often takes well over a
decade 2
Institute of Medicine Mariivana and Medicine Assessinq the Science Base
Executive Summary visited Oct 5 2003
http books napedu
marimed eshtml
Z Institute of Medicine Mariivana and Medicine Assessinp the Science Base Chapter
5 visited Oct 5 2003http books nap edu
marimed ch5 html
For each symptom or disease that marijuana legalizers suggest can be treated with smoked marijuana there
is a variety of existing scientifically proven options available to the clinician Among these is Marinol0
Claims that smoking marijuana is more effective than taking Marinol0 remain unproven Interestingly
enough the only property that Marinol0 acks is the capacity 10 create a euphoric mood or high
DRUG USE THRIVES ON MYTHS AND LIES
Legalizers argue that government is oppressive and unjust because elecfed representatives and government
officials will not let a few people who are at the end of their lives smoke a plant material in lieu of expert
medical care utilizing prescribed medications This is not in fact the problem The real problem exists where
wealthy advocates for drug legalization misleadwell intentioned and compassionate voters into passing local
referenda to allow the use of a smoked weed as medicine These efforts subvert the integrity of the scientific
process upon which 21 st century medicine is based
L to Maryland fo see how big and how soon the problems emerge from efforts to construe marrjuana as
medicine On October 1 2003 a Maryland law took effect allowing anyone convicted of possessing
marijuana to argue for a maximum penalty ofa100 fine if the drug was used for medical purposes The ink
was barely dry on the bill before defense attorneys were preparing arguments to defend any marijuana using
criminal who would claim that he or she had a legitimate quasi legitimate or imagined symptom or disease
As The Washinvton Post reported
Defense lawyers would constantly test the law s reach and would be neglecting their
clients if they did not try to find out what physical emotional or psychological pain
causes them to use the drug Sometimes people areself medicating withouf even
realizing it
Self medication hypotheses also support the normalization ofnon dependent drug use 4
In addition to sending the wrong message about drug use these laws will allow attorneys to argue that any
use ofmarijuana can be construed medical Ifany use can be deemed medical and medical marijuana
use carries a maximum fine of only 100 marijuana laws are not worth enforcing at all they say
ENVIRONMENTAL FACTORS
As Dr Berthas Madras of Harvard Medical School has stafed The environment is a major influence on
w
her a youth will experiment with drugs or develop an aversion to them The big fhreat in fhe
ei ronment of drug use today is the active campaign to blur the distinctionbe ween illegal and legal drugs
and corrupt the judgment of the American people
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Medical Marijuana Page 4 of 6
Simply stated alcohol tobacco and the illegal drugs including marijuana are not medicines 5 But by
characterizing the use ofillegal drugs as quasi legal sanctioned medicinal use legalizers destabilize the
societal norm that drug use is dangerous and drug use is wrong Such attempts to blur the line between the
use of an addictive illegal drug and the use of a medicine undercut the goals of stopping initiation of drug
G
and preventing addiction
3 Tim Craig Maryland Starts To Allow Marijuana Court Plea The Washinpton Post October 1 2003 at
801
4 Robert M Dupont Biolonv and the Environment A Rethinkinq of Demand Reduction visited
October 5 2003http www
ourdrugfreekids org article 46 htm
5 Id
The key to the environment of addiction is a strong focus on the individual who makes the decision to use or
not to use drugs Risk factors as described by Dr Madras can reduce an individual s capacity to make
reasonable responsible decisions However they do not mitigate personal responsibility for such decisions
Individuals are more likely to avoid drug use if they see clear warnings and know they are responsible for
their behaviors The distinction between illegal and legal drugs is important It warns would be users of illegal
drugs that the use of particular drugs is so dangerous that it is prohibited by criminal law
To the extent that the environment is tolerant or even encouraging of the use of addicting drugs the rates
of use rise Rates of the problems resulting from that use also rise To the extent that the environment
rejects in meaningful ways the use of addicting substances the levels of drug use and resultant problems
decline 6
N ROBIOLOGICAL REWARD PATHWAYS
Dr Madras has shown that over the pasf decade science has made remarkable progress in clarifying the
biological changes elicited by drugs The study of brain biology is important because it shows that the human
brain is permanently vulnerable to the siren call of addicting substances Vulnerability to drugs is hardwired
into the brain and is deepened by repeated use of addicting drugs
The best hope for reducing drug use is in the software the brain s operating instructions for deciding to use
or not to use addicting drugs 7 Thirty years of prevention research have shown that prevention works best in
an environment where the rules are clear the rules are known and the rules are enforced
6 Id
Id
As Dr Billy Martin of Virginia Commonwealth University will tell you science is moving at a rapid pace
There have been major breakthroughs over the last 15 years in understanding the cannabinoid receptor
system Scientists agree fhat the best scienti
course for developing new medications to address a range of
diseases and symptoms lies in our ability to alter this biological system Regardless of what individuals think
marijuana does for them medically medical marijuana will become obso ete very quickly based upon fhe
advances brought about by a process of scientific research The advances on cannabinoids administered by
inhalers for example are encouraging
Wt ARE NOT AFRA D OF ANY COMPOUND
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Medical Marijuana Page 5 of 6
As an American physician with more than 20 years of experience 1 have practiced medicine in the most
advanced medical system in the world Americans today receive care in the world s safest most effective
system of inedical practice built on a process of scientific research testing and oversight that is unequaled
F onents of using a smoked plant as a medicine would have you believe that modern medicine is afraid of
ma ijuana and we are motivated by this fear in our response of outrage and incredulousness at attempts to
turn fantasy into reality Medical science does not fear any compound even those with a potential for abuse
lf a substance has a proven capacity to serve a medical purpose then it will be accepted Only if compounds
from marijuana pass the same tests of research and scrutiny that any other medication must undergo will
they become part of the modern medical arsenal These tests are described as
Phase I studies which test the product for its adverse effects on a small number of
healthy volunteers
Phase ll studies which probe the drug s effectiveness in patients who have the
disease or condition the product is intended to treat and
Phase lll studies which seek to determine the drug s safety effectiveness and
dosage In these trials hundreds or thousands of patients are randomly assigned
freatment either with the tested drug or a control substance most frequently a
placebo
The results of Phase III trials are submitfed to the FDA for review by a team of
chemists physicians epidemiologists and other specialists This group s crucial task
which is frequently shared with an advisory panel of outside experts is to judge
whether the trials have demonstrated that the producYs health benefits outweigh its
risks Only products that pass this test may be approved for marketing
These are the tests marijuana has yet to pass Medical science is at risk if we do not defend the proven
process by which medicines are brought fo the market
GRAVE DANGER POSED BYFRAUDS IN WHITE COATS DISTORTING THE TRUTH
Pockets ofwell funded individuals and organizations pursuing a political agenda are behind the efforts to
legalize drugs and are using the pain and suffering of patients to gain the attention of people in many
communities across the country Many of the organizations supporting this effort have in fact been trying to
legalize marijuana and other drugs for over 20 years
It is a well known and established fact that the same people who want to legalize marijuana and other drugs
outright are behrnd fhe medical marijuana movement 9 This is their wedge issue These wealthy
businessmen and aging hippies who are caught up in halcyon memories of smoking weed in dorm rooms
during the 60s and 70s are pursuing the same goal decades later
8 FDA and the Druq Development Process How the AqencV Ensures that Druqs are Safe and Effective
visited Oct 5 2003http www fda gov opacom factsheets
justthefacts 17drgdev html
9 See eq Jim McDonough They Just Said No The Washinpton Times Nov 26 2002 reprinted at
http www myfloridacom
government
governorinifiatives drugcontrol editorials
washingtonhtml
Dr Kraus will discuss the medical issues complications and contraindications surroundingso cal ed
medica use of this plant In every instance claimed by legalizers as a use for the smoked weed far better
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Medical Marijuana Page 6 of 6
legitimate and safe alternatives are available Marijuana advocates also claim that the smoked weed is
superior to the constifuent part that has been shown to be responsible for the effects on the brain
Marijuana is composed of over 480 different chemicals Our medical system relies on proven scienfific
r 3rch science that is extremely difficult to deliver with a smoked plant containing a variable mixture of
bw ogically active compounds Dr Martin will tell you the problems associated with the study of a plant
material in which no agreement exists on the standardized material
Dr Martin will also explain that those who are inclined to support proposals to use marijuana as medicine do
so without considering the scientific and medical evidence This evidence is necessary before any credible
scientist or physician can recommend the use of marijuana as a medicine because a strong justification is
needed when one wants to deliver a medicafion as a plant Dr Martin willaso provide us with the data that
shows that while some who inhale the smoke of marijuana do fee better none get better
The rhetorical arguments for marijuana as a medicine are not enough to legitimize it Similarly a few wealthy
individuals putting on white coats and declaring that marijuana is medicine cannot substitute for the FDA
process of approving drugs Marijuana must be subjected to the same efficacy and safety standards It is the
opinion of the world s finest scientists and physicians however that because marijuana cannot withstand the
rigors of science it will never be added to medical treatment formularies Cannabinoid derivatives on the
other hand offer tremendous promise for more specific cannabinoid medications
Many legalizers andwell meaning individuals who support the use of this weed for medicine call for its
availability on the basis of compassion Dr Kraus is a compassionate physician But Dr Kraus will not allow
his patients to be persuaded that smoking a plant is a reasonable alternative to conventional medicines that
have been deemed to be safe and effective
MP iicine is at its most compassionate when the patient knows that she is getting the best that modern
s ce can provide to ease suffering and cure the cause of that suffering In cases where a cure cannot be
offered management of disease to prevent progression and preserve function is a highly desired oufcome
Marijuana has none of these attributes of inedicine and offers none of these benefits Marijuana is not
medicine
http neoaorg index php view article catid 33Apublic id 183Amedical marijuana tmpl compone 912 2011

From Saved by Windows Internet Explorer 8
ent Saturday May 01 2010 10 33 AM
ubject
Marijuana in the Treatment of Glaucoma
Donate
Ga er1
The Foundation af the Ameriean Academy of phthalmology
Eyecare Americasea o
I I i i I
Marijuana in the Treatment of Glaucoma
Marijuana is a mixture of the dried flowering leaves and tops from the plant
cannabis sativa and it contains over 400 chemicafs A medical use of
marijuana has been to lower intraocular pressure IOP in patients with primary
open angle glaucoma POAG
CONCLUSIONS
Based on reviews by the National Eye Institute NEI and the Institute of Medicine and on available scientifc evidence the Task
Force on Complementary Therapies believes that no scientifc evidence has been found that demonstrates increased benefits
andlor diminished risks of marijuana use to treat glaucoma compared with the wide variety of pharmaceutical agents now
available
BENEFITS
Initial studies in the 1970s reported that smoked marijuana resulted in lower IOP hours after administration TheNEI sponsored
studies demonstrated that some derivatives of marijuana did result in lowering of IOP when administered orally intravenously
or by smoking but not when topically applied to the eye The duration of the pressure lowering effect is reported to be in the
range of 3 to 4 hours Benefts also include euphoria as an acute effect
RISKS
Potentially serious side effects associated with smoking marijuana include an increased heart rate and a decrease in blood
pressure Studies ofsingle
administration marijuana use have shown a lowering of blood pressure concurrent wilh the lowering
of IOP This raises concerns that there may be compromised blood flow to the optic nerve but no data have been published on
the long term systemic and ocular effects from the use of marijuana by patients with glaucoma
1

D Information from Groups in Support of
Marij uana
1800 Medical Marijuana com Legal States for
Medical Marijuana
Perkel com Marijuana Telling Teenagers the
Truth about Smoking Pot
1800 Medical Marijuana com
Marijuana
Benefits of Medical
California NORMAL Recent Research on
Medical Marijuana
California NORMAL
Cultivation
Medical
Local Medical Marijuana
Possession Guidelines
MJ org Addictive Properties of
Commonly Use Drugs website page
Medical Marijuana ProCon org

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Fourteen states have enacted laws that legalized medical marijuana
State
Year How Passed ID Card Possession Limit
Passed IYes Vote Fee
Alaska 1998 Bailot Measure 8
z5 20 1 oz usable 6 plants
3 mature 3 immature
2 CdI1fOI ni8 1996 Proposition 215
66 33 8 oz usable 18 plants
6 mature 12 immature
3 Colorado 2000 Bailot Amendment g0 2 oz usable 6 plants
20 54
3 mature 3 immature
a Hawaii 2000 Senate 8tll 862 32 25 3 oz usable 7 plants
s House is iz
Senate
s Maine 1999 Ballot Question 2
o
3 mature 4 immature
125 oz usable 6 piants 3
http
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Legai States for Medical Marijuana Page 2 of 2
90 Off Services mo e 100
s Michigan 2008 Proposal163
25
25 oz usable 12 plants
Montana 2004 Initiative 148 62 50 1 oz usable 6 plants
a Nevada 2000
Ballot Question 9
ss io
g 50 1 oz usable 7 plants
3 mature 4 immature
9 NeW Jersey 2010 Senate Bill 119 48 g0 2 oz usable
14 House 25 13
Senate
io New Mexico 2007 Senate Bill 523 36 0 6 oz usable 16 plants
r 31 House 323
Senate
When you join
our collective
OI egon 1998 6allot Measure 67
you ll receive a 10 55
discount on all our services
4 mature 12 immature
100 24 oz usable 24 plants
20 6 mature 18 immature
and merchandise as well as 2 Rhode 2006 Senate Bill 0710 52 75 10 25 oz usable 12 plants
our medical marijuana
Island
o tiouse 33
Senate
i3 Vermont 2004 Senate Bill76 227 50 2 oz usable 9 plants
HB sas sz 5s
2 mature 7 immature
a Washington 1998 Initiative 692 59 24 oz usable 15 plants
Information taken from
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Marijuana Telling Teenagers the Truth about Smoking Pot Page 1 of 11
r
Marijuana
Telling Teenagers the Truth
about Smoking Pot
a
Lying to Teens about Marijuana does more harm than good
I think iYs wrong for society to lie to teenagers about smoking marijuana I find it frustrating
when I hear ads from places like Partnership for a Drug Free America running
commercials against Pot that just aren t true I don t like it when people warn teens about
using Marijuana and Cocaine when Pot is almost harmless and Cocaine is a dangerous 1
drug When people lie to teens about Marijuana then teens assume they are lying about
other drugs too and I think they are more likely to do drugs they shouldn t do So I think iYs
time to come clean and tell the truth If teens are going to do drugs they should have truthful and accurate
information So I have decided to tell it like it is Best decisions are made when the real facts are presented
For those parents who are reading this in horror I am not trying to get kids to smoke Pot What I am doing here
is trying to tell them the truth and tell you the truth about a widely misunderstood substance This is an
opportunity for everyone to have a better understanding of reality If you can t handle reality stop reading this
web page There are plenty of other web sites that will tell you what you want to hear This is not one of them
How bad is Marijuana Really
As compared to most drugs Pot is the least dangerous Pot is not an addictive drug For those who claim it is
anything is theoretically addictive and there are some people who can become addicted to spring water So to
put it in perspective Pot is less addictive than coffee I have become addicted to coffee myself and have
broken the habit You get mild headaches for a few days I have never had any symptoms for withdrawal from
Pot
Pot will cause some short term memory loss IYs harder to remember a 10 digit phone
number Beer causes the same memory loss as Pot The effect is temporary and wears off
completely Pot has no long term affects on the brain I have been smoking Pot for the last 25
years and I still test as a genius on IQ tests My mental abilities have increased over the
years
Pot will give you the Munchies You may eat more than you would normally If you are on a diet you should
factor this in when deciding to smoke Pot It could cause you to gain weight
Pot is a sexual stimulant It removes a persons inhibitions You are more likely to agree to have sex when you
are stoned You are also more likely to not use birth control while stoned Sometimes people get others stoned
to try to get them to have sex when they normally wouldn t If you are getting stoned with members of the
opposite sex be aware of this and realize that it can have this effect on you
If anyone asks if you smoke Pot Just say No
Ne r drive while doing any drugs or alcohol or many prescription drugs for that matter Alcohol causes you to
wreck your car Pot has a much lesser effect on driving than alcohol but it has some effect You are more
likely to pull out in front of someone or run a red light than lose control of the vehicle Pot might also cause you
to get lost Don t drive while stoned
http www perkel com politics issues pot hhn 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 2 of 11
Smoking Pot increases your risk of cancer But most people smoke very little Pot If you use Pot moderately
you don t have anything to worry about Moderate means a joint every few days
Pot will give you dry mouth Have something to drink when smoking Pot
The most dangerous thing about Pot is getting caught with it You can go to jail People get very weird about
Pot and you can get in a lot of trouble over it So if anyone asks if you ve been smoking Pot Just Say No
aN uvzM
Benefits of Marijuana
Marijuana is the safest of all drugs It is far safer to smoke a joint than to have a beer Pot is the
drug of choice for people who want to get high but be responsible in getting high There are
people who do no drugs at all and thaYs fine But for those of you who want to get high and be
responsible Pot is a very good choice
Marijuana make most people more relaxed It relieves the clutter and tension after a hard days
work or school It mellows you out and makes you more relaxed It heightens the imagination
and improves creativity If you have a problem with anger Pot is usually a good drug to reduce
it
Marijuana has other medical benefits It helps reduce problems with glaucoma If you have cancer it reduces
nausea from chemotherapy I had a close friend who died of cancer His doctor prescribed Pot even though it
wasn t legal I gave him some and it allowed him to eat food again This was three weeks before he died I
think the Pot gave him another week of quality life
M
ana is also safer more effective and has less side effects than many prescription antidepressants
Shortly after mv divorce when I learned that I got a judgement for more that 100 of everything I owned my
doctor put me on Pamalor a common antidepressant Pamalor turned me into a zombie and made me
practically impotent I merely existed and felt nothing had no motivation couldn t accomplish anything and
became basically useless After two weeks of that I got off it Getting stoned and laid a couple time a week had
a much better result I was alert motivated effective sharp got better sleep happy and alive Not all
antidepressants have this same effect However these drugs are overperscribed and in many cases I think
that an occasional joint is a better alternative to antidepressant drugs
Marijuana is especially good for those with high stress lifestyles The brain has a tendency to lock on to a
problem and your mind gets into a mental loop where you can t stop thinking about work or some other
problem Pot can help you break the cycle and see the problem from a different perspective or allow your mind
to move on and rest allowing you to enjoy life so that you can recover and have a fresh perspective for the next
day
a
x
Marijuana can make you Smarter
Marijuana enhances certain mental abilities Although it cuts into short term memory it reallocates
mental resources allowing you to become more imaginative and to come up with new solutions to
problems that you wouldn t normally think of when you re not stoned Much of my creative writing
starts from things I though of while smoking Pot For example my web page on Teen Ciqarette
Sr inc is a very effective web page that has resulted in thousands of kids decided to not
smoKe cigarettes I wrote most of it while I was stoned And I came up with the concepts as to
why it would work as a result of smoking Pot My smoking Pot has resulted in a decrease in teem
smoking
http www perkel com politics issues pot htm 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 3 of 11
When used correctly and responsibly Pot can actually
increase your ability to find new and innovative solutions
to problems
Thc e are hundreds of web sites targeted at discouraging kids from smoking cigarettes and they all have the
same message Smoking causes Cancer and will kill you There s nothing wrong with that message andIm
sure that it reaches a lot of teens However a huge number of teens still smoke and iYs not because they
haven t got the cancer message Traditional thinking results in repeating the message more times The idea
being is that if these kids actually understood the health issue they would quit smoking This kind of reasoning
is an example of what is known as thinking inside the box
Marijuana helps you think outside the box This concept of thinking out of the box is an ability sought after
by corporations who want to hire people with new an innovative ideas and actually invent a better mousetrap
However by having drug testing policies the corporations are actually excluding the very people who they seek
to hire I believe that if some of these corporate policy makers were to smoke some Pot themselves they
would realize that Pot when used responsibly actually enhances a persons ability to make strategic decisions
Going back to myanti smoking page and thinking outside the box I want to
now describe the mental processes behind developing this web page while
smoking Pot While I was stoned I wondered why anyone would want to start
smoking cigarettes Although cancer and addiction were reason enough for me
to not smoke obviously there were a lot of people who are not like me If
everyone thought like I do no one would smoke I considered the idea that
perhaps there were people who didn t know about cancer and addiction and
quickly dismissed that It seem pretty obvious that everyone has got that
me sage Therefore I reasoned that to continue to repeat the same argument
isi ing to gain ground among those who have already rejected it It was
logical that in order to gain ground I needed to come up with other reasons to
not smoke than those that everyone already knows
People who think in the box would conclude that cancer and death are the
strongest arguments and that if that doesn t work then other issues wouldn t be
important But what these in the box thinkers don t realize is that they are
coloring things from their perspective They are for the most partnon smokers
who have bought the cancer and death argument and wrongly assumes that everyone else thinks like they do
But smokers see things differently Most smokers don t even know why they started smoking because they
can t remember a rational process that caused them to decide to start to smoke ThaYs because most people
smoke because of instinctive forces which are more powerful in humans than we would like to admit People
are herd animals and the instinct to be part of the herd is more powerful than reasoning And those who
advertise tobacco product know this all too well
My approach on myanti smoking web page was to address the social and lifestyle issues
involved in smoking To expose how the tobacco companies are manipulating your mind and
taking advantage of you My web page creates mental defenses in the mind of the reader so
that in the future when the reader is being seduced by tobacco that their brains are
programmed to recognize the seduction and to branch to a mental process that causes outrage
that they are being manipulated and results in them not deciding to smoke In addition I made
strong argument about the smokers lifestyle that add many new strong arguments as to why to
no noke in addition to cancer and death The problem with cancer and death is that those are
loi
arm arguments and many young peopie don t respond to it My additional arguments are
short term effects that will start immediately and are more relevant to young people
Am I saying that my web page is better than the addiction cancer and death web pages No I think those
reach most people But my Pot inspired web page reaches a significant number of additional teens that the
http www perkel com politics issues pot htm 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 4 of 11
cancer and death pages don t reach My point in this and I hope you as the reader have understood it is that
Fot inspires this kind of analytical thinking that results in being able to think outside the box and to come up
with new approaches to problem solving that compliment traditional solutions I hope that I have made it clear
by example that Pot when used correctly and responsibly has a mind enhancing effect But I want to stress to
al a read this that any drug legal or not prescription or not from coffee to LSD should only be used
correctly and responsibly
w
rs
Marijuana can make you Dumber
Pot affects everyone differently Just because Pot has some beneficial effects on me doesn t
mean that it will do the same for you Everyone is different and drugs affect different people in
different ways Obviously if you have tried Marijuana and it had a bad effect on you don t
continue to use it
Marijuana use has been associated with turning teens into mental zombies who lose all
M
motivation They claim that it makes it so that all you want to do is lay around and get high that
you will become like Cheech n Chong There is a real correlation with lazy dopers and Pot but
Im not sure if the Pot makes you a lazy doper or if you are a lazy doper type first and are
therefore attracted to Pot Some people experience fear and paranoia while high on Pot Some people get
headaches Marijuana does compromise certain mental abilities on a short term basis You don t want to
smoke a joint before taking a test Therefore if Pot is messing up your life or you don t have the self control to
use it moderately and appropriately don t use Pot
s
a
Orug Abuse is a Bad Idea
Marijuana is a drug to be used not abused Just because Pot isn t addictive doesn t mean that
you should get stoned every day It doesn t mean that iYs totally safe It doesn t mean that you
should go out and start smoking Pot And just because it makes me more mentally effective
under some circumstances doesn t mean that iYs going to have the same effect on you There
are a lot of people who experiences the opposite effect and if your one of those Pot isn t for you
Pot affects different people in different ways and if Pot is having a detrimental effect on you you
should not smoke it
M
Handhixak
Drugs of all kinds have varying degrees of danger You have to be mature and responsible when
experimenting with any drug You should never do a drug that you don t know what the effects are And drugs
should be used in moderation and under the right circumstances You should never do any drug while driving a
car especially alcohol If you are a teenager one beer can make you wreck your car
Many drugs out there are highly addictive The most addictive druq that kills more people than anv other
druq is Tobacco This drug is to be avoided at all costs The addiction to Tobacco is much harder to break if
you get hooked at a young age Besides cancer and death Tobacco will totally change your lifestyle Your
whole life will revolve around scheduling when and where you ll be able to smoke next
LSD is not an addictive drug but it is very mind altering It can be viewed as having similar characteristics as
Pot by much more powerful Mushrooms Mescaline and Peyote are also in thenon addictive psychedelic
class of drugs They are similar to the neurotransmitters in the brain and are more mind altering than any other
dr
The experience can have a profound effect on you and should be used only with extreme caution
Once you become addicted you can t just quit You
become a slave to the drug Your life revolves around
http www perkel com polities issues pot htm 928 2011

Marijixana Telling Teenagers the Truth about Smoking Pot Page 5 of 11
getting it This includes cigarettes
Cocaine and Crack are extremely addictive So is Methamphedamine These drugs are very dangerous in that
they are stimulants and require larger doses to produce the same effects Heroine and Morphine are opiates
ar re also very addictive Valium and Alcohol are depressants and are also addictive Addiction to
de assants take a lot longer that addiction to stimulants and opiates Cocaine and Heroine can hook you from
the first dose Even coffee is addictiveIve had to break that habit a few times myself
I personally avoid all addictive drugs except Alcohol I like to drink some Beer and Wine but I
don t like to get drunk Other people have a different reaction to Alcohol than I do and enjoy
getting drunk Those who enjoy it are more likely to become alcoholic than those who don t
Addiction makes you a slave to the drug and controls your life I never met an addict that was
glad they got addicted If the people who are hooked wish they weren t what would you want to
start
Teens usually have a stronger tendency to follow the crowd than adults do You may find
yourself in a situation where everyone else is doing a drug that you don t want to do You find
yourself tempted because you don t want to go to the trouble to not go along What you may not realize is that
iYs kool to say that you just don t want to do whatever everyone else is doing and not make a big deal out of it
Usually the others will just say OK and iYs no big deal In other words you really can Just say No If you don t
want to do a drug don t do it If someone gets pushy about it tell them to fuck off
IYs your Life Be Responsible
Most people will bullshit you about the truth about drugs I have been honest about it here In
fa n being honest at great personal risk because there are a lot of people out there who
wo persecute me personally for saying the thingsIm saying here But whatIm saying is the
truth andIm standing by itIm sure that the government particularly the moralists would like to
classify this page as harmful to minors under their new censorship laws would like to see me
shut down and probably jailed This page not harmful to minors iYs helpful to minors Telling
minors lies about drugs is harmful to minors
What I want to make clear to you who read this is that people make choices in their lives that
affect who they are and who they will become If you make the right choices you are more likely to have a
better life than if you make the wrong choices Although you can make all the right choices and still be killed in
a car accident because someone else ran a red light But if you are smart about what you do then the odds are
in your favor
The most important thing a Teenager needs to learn is
how to say NO and mean it
These choices are yours alone and iYs your responsibility to make good choices and make your
life meaningful You may have had a hard beginning and you may have to work hard climbing up
the ladder of life to become successful But ultimately you become who you decide to become
and you can choose to be better than what you are raised to be The choices you make are
ultimately yours and you have to be responsible and take your choices seriously If you smoke
cigarettes you will become a smoker If you get pregnant you will become a parent If you get
hOr on Meth you will become a drug addict Its your choice and if you choose to fuck up
yc fe iYs your fault But if you want to become great then you can be great even if you come
from unfortunate conditions And the difference between those who become great and those who
don t is that great people take control of their lives take responsibility for their decisions and through pure
force of will looking into the future and through self discipline lift themselves up and achieve greatness And
every one of you who read this can do the same thing
http www perkel com politics issues pot htm 928 20ll

Marijuana Telling Teenagers the Truth about Smoking Pot Page 6 of 11
It s your life f you screw it up you ve screwed it up It s
your fault
Thc was this kid bom to a single mother His father died in a car accident a few months before
he
s born The lived in a trailer in a small hick town in the south His mother went to nursin
P
9 rauri
school and left him to his grandmother for a few iniOiooA
years Then his mother married a drunk and had
another kid The father wouid often get drunk and get violent The younger brother grew up and
became a Cocaine addict But this kid decided that he was going to rise above his upbringing as
a poor southern white trash stepson of a drunk and make something of himself He worked hard
and got good grades in school and in 1962 his class went on a trip to Washington where he
shook hands with President Kennedy At that moment that poor kid from Arkansas decided that
some day he was going to be President of the United States and he went out and did it If this
kid could become President surely you can decide to grow up and not get hooked on drugs IYs your life and
you can be what you want to be
r
n
i Why Marijuana should be Legal
Legalizing Marijuana would be a benefit to society We as a nation would be improved by it
There are several reasons I make this claim Although Pot has iYs problems iYs benefits for
a
outweigh iYs consequences
If Pot were legal many people would switch from alcohol to Pot I think that a lot of Alcohol
abuse come from the fact that it is the only legal drug and therefore is overused Alcohol is highly
addictive physically and psychologically destructive and is a severe drag on society I think that
if Pt were legal that many people would switch to Pot and be much better off I think one side
ef of legalizing Pot would be a major reduction in the abuse of Alcohol and that the number of
traffic deaths would drop dramatically
The only reason Pot isn t legal is because there are a lot
of people making money because its not legal
Another reason is to save the huge cost in tax dollars wasted in prohibiting Pot and enforcing
drug laws that have no benefit to society If Pot were legal you immediately eliminate the illegal
Pot market and get rid of crime associated with Pot money You could also release from jail all
those convicted from Pot related offenses and cut the costs of having to build new prisons to
incarcerate normal people Because of mandatory drug sentencing laws many states have to
release violent offenders to make room for Pot smokers ThaYs stupid
r
a
qL
y
Pot has many other uses Before the lumber industry lobbied Congress to make Pot illegal
Marijuana known as Hemp was the primary source of fiber for the production of paper The
United States Constitution is printed on Pot With today s technologies this fiber can be processed into
construction materials that would replace wood products saving our forests and lowering the costs of
construction while producing byproducts useful in making fuels to run cars and generate electricity Hemp is a
very hearty plant and would be a good cash crop for our nation s farmers
Who opposes legalizing Marijuana and why
There are many types of people who oppose legalizing Marijuana for a variety of reasons Many
of these groups have some very strange reasons and selfish interests Many are just ignorant of
the facts Here s some of the opposition
http www perkel com politics issues pot htm 928 2011
Lit
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FiS

Marijuana Telling Teenagers the Truth about Smoking Pot Page 7 of 11
The Uninformed
People who believe the misinformation that Pot is harmful to society
The Government Pot has been illegal for so long that no politicians have the political courage to tell the
truth about Pot The ones that do tell the truth are defeated by their opponents that paint them as a
jruggie Many of these anti drug politicians are funded by the Alcohol lobby
Religion Anything fun is sin and of the Devil Churches might lose members as people figure out that
God can t be that stupid
Moralizers The morally superior who enjoy looking down their noses at the less fortunate
and get a sadistic thrill in putting people in jail
People who do no Drugs These people who don t drink don t smoke in some cases
don t even drink coffee They just don t understand why anyone would want to smoke
anything or do any drug From their perspective the world would be better off if no one did
anything
The Alcohol Lobby Legalizing Pot would seriously cut into the sales of Beer Pot would
become the recreational drug of choice because it is safer than Beer
The Tobacco Lobby Pot has the ability in some people to help them break the addiction of nicotine
Pot smoking could actually reduce the number of tobacco addicts
x
People before Lawyers
aw Enforcement There are a lot of people who make a living fighting Pot who would have to go get a
real job if Pot were legalized Police departments get a lot of funding to fight Marijuana and those funds
could be returned to the taxpayer if Pot were made legal Cops would have to chase robbers rapists and
murderers
Government Agencies Using unconstitutional civil forfeiture laws the government has been able to use
the presence of Pot to steal billions of dollars of private property from the People Drug laws have been
an excuse to circumvent our constitutional right and justify wire tap laws the erosion of protection from
illegal searches key recovery encryption and domestic spying If you take a politically unpopular position
like this oneIm taking now the government can plant drugs on you and put you away
Pot Dealers If Pot were legalized then people making money off of selling Pot illegally wouid be out of
business Pot prices would drop to 10 a bale Crime relating to illegal Pot money would vanish
Wood Industry Hemp would become the primary source of fiber for paper products as
well as a new source for building materials We wouldn t have to cut down every big tree in
the world
Private Prisons If Pot were legalized the private prison industry would be hurt They
would no longer jail Pot smokers It could free up space for violent criminals
Trial Lawyers Normal people caught with a joint spend billions each year on lawyers to
get them off of criminal charges after getting caught with a joint Lawyers get rich off of the
Vlarijuana laws If Marijuana were legal this money could be spent sending your kids to college
Mental Hospitals There s a big industry treating people for problems they don t have If you have
insurance you re crazy until the insurance coverage runs out If you smoke Pot then you have mental
problems If Pot were legal some of these people would have to get real jobs We should start treating
http www perkel com polirics issues pot htm 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 8 of 11
people who are addicted to 12 step programs
Republicans Pot helps you see reality the way it really is IYs harder to con a Pot smoker on political
issues Once you get stoned iYs harder to want to hate Liberals Queers Blacks Pregnant Teens Draft
Dodgers President Clinton Feminists Lesbians Pot Smokers and other people the Republicans want
you to hate When you re stoned iYs harder to like Newt Gingrich John Ashcroft the KKK the Christian
Coalition Jerry Falwell Pat Buchanan Reverend Sun Myung Moon People who beat Gay s to Death
People who blow up Abortion Clinics and the morally superior in general
Political Cowards Politicians like to pose with police as somebody who is against
drugs promising to lock up all the pot smokers and throw away the key These people
need an artificial issue to be against so they don t have to face real issues like how to
protect the public from crooked lawyers and crooked judges Political cowards cross all
party lines when it comes to pot and includes President Clinton
Others These groups could also be hurt by legalizing Pot Car body shops would get less r
alcoho related wrecks to fix Hospitals would get less alcohol related business as would
alcohol treatment centers and funeral homes It could hurt cemeteries and tombstone
makers as well
tmportant Peopfe for Legalizing Marijuana
There have been several people who have come out in favor of legalizing marijuana in the last
year or so These people have shown courage in the face of this artificial drug hysteria
r
3overnor Jesse Ventura of Minnesota Governor Ventura the first governor elected by the Reform Party is the famousex
w
wrestler Navy Seal who is known for telling it like it is
cs
a
Governor Gary Johnson of New Mexico The Republican governor has come out in FF
favor of legalizing pot This is an especially brave move for a Republican as the 1
Republican Party has been especially abusive of Marijuana users
Hugh Downs ABC News 20co anchor and respected journalist for more than 60 years retired On
his last show he was asked if he had any opinions of his own that he d like to express He responded the
marijuana should be legalized
Oppressing Pot Smokers is the Real Crime
The time has come where We the People have to stand up to the government and tell them that
we are no longer going to put up with the jailing and oppression of pot smokers and this artificial
war on drugs They teach you that there are three branches of government by in fact there are
four branches The fourth branch of aovernment is the ueople The time has come for
reasonable people to rise up against the government and to force them to justify the reason for
oppressing pot smokers and drug addicts People in America have been to complacent for to
long and the time has come to stand up and get in their faces and demand satisfaction
x 5
Myths about Marijuana
The most common myth is that Marijuana Leads to Harder Drugs Critics say the medical
http www perkel com politics issues pot htm 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 9 of 11
marijuana movement promotes drug abuse and criminal behavior by ushering young people into
what one judge has called the kindergarten of the drug industry They call Pot the gateway drug and say
that once you do Pot that you will need to move on to harder drugs like LSD Heroine and Cocaine to get the
same thrill Sounds good but it just isn t so
Marijuana does not lead to harder drugs
Actually if there is anything that s a gateway drug iYs nicotine Tobacco is the first drug that kids use IYs
illegal for kids and unlike Pot iYs addictive Once a kid is hooked on nicotine they have joined the ranks of
drug addicts As an addict already its easier for them to move on to other addictive drugs like Alcohol
Cocaine Crack Meth and Heroine
Marijuana on the other hand is the choice of the responsible drug user A person who wants to
get high on something that isn t addictive and doesn t have any long term health effects for the
moderate user would likely choose to smoke Pot This is the drug of choice for those who don
want to be on the path of drug addiction
t s
Another common myth is there is no official proof to back the contention that marijuana
can help ease symptoms of AIDS cancer multiple sclerosis and other serious
diseases But the reason there is no proof is that the government is actively avoiding the
funding of inedical research inYo medical uses of Marijuana because they are afraid that they
will indeed discover what doctors already know and it would undermine the laws criminalizing Marijuana and
lead to legalization If you want to read something amusing read the study from National Institute of Health
Here s pages and pages documenting the results of doing nothing to research the medical benefits of smoking
PotIve never seen such a long paper documenting what the government hasn t investigated or tested If the
government weren t afraid of legalizing Pot they would Yest it The fact that the government won t do medical
testc on Pot proves that they don t want to know the truth
WhaYs more outrageous is the claims that the government makes about Marijuana when they
refuse to make any medical or scientific tests They claim that smoked Marijuana damages the
brain heart lungs and immune system but they don t know that There have been some tests
done indicating that Marijuana can cause lung cancer even more so than cigarettes But those
test don t take into account that the usage isn t 100th as much as cigarette smokers If the
government wants to make medical ciaims about Pot they should test it and look at the scientific
data I challenge the government to do the research and then we ll talk about reality
t
Twisting Logic
I find it amazing how the anti pot organizations twist logic to try to justify their positions that pot is a dangerous
drug And these people wonder why teenagers don t take their message seriously Teens just aren t that
stupid And when you try to pull stupid logic tricks on teens they resent it and ignore you If they are going to
accuse us of being brain damaged the sure aren t setting a very good example of what normal is supposed
to be Here some examples of tortured logic
90a of drug addicts smoked Marijuana first Therefore smoking Marijuana leads to harder
drugs
Wow This is really brilliant Based on that reasoning 99 of drug addicts attended church
efore becoming a drug addict Therefore going to church leads to harder drugs What else
did over 90 of drug addicts do first Over 90 of drug addicts smoked a cigarette most
still do They drank alcohol most still do How about watched television voted for a
Democrat had a pet had sex owned a bicycle chewed gum participated in sports
celebrated Halloween had a religious experience took something that didn t belong to
http www perkel com politics issues pot htm 928 2011

Marijuana Telling Teenagers the Truth about Smoking Pot Page 0 of 11
them voted for a Republican told a lie wondered if they might be homosexual or ate too
much white sugar Using the same reasoning all these activities must also lead to harder drugs
There are over 400 chemicals in the marijuana plant
There are over 400 chemicals in every plant There are over 700 chemicals added to American
cigarettes
When a user begins to feel that he or she needs to take the drug to feel well that person is said
to be dependent or addicted to the drug
I supposeIm addicted to aspirin When I get a headache I need aspirin to feel well
Everything that feels good is addictive and there s a 12 step program out there for every
one of them And if you don t believe it you re in DENIAL Since they know that Pot isn t
addictive they try to redefine the word addiction and try to make Pot fit the new definition
The fact that the need to twist the definition indicates that they know that Pot doesn t fit the
traditional definition of addiction
r r i
Drug addiction occurs when the drug affects the body in a way that causes the body to
become dependent on the drug and causes a negative reaction when the drug is removed
Marijuana LSD and magic mushrooms are examples ofnon addictive drugs Cocaine Heroine
Methamphedamine Alcohol Tobacco and Caffeine are examples of addictive drugs Telling lies about
what drugs are addictive is not going to help solve the drug problem
Marijuana Related Links
Medical Organizations Endorsinq Marijuana
Marijuana Policy Project
Cannabis Freedom Fund
What Teens should know about Smoking Cigarettes
Marijuana Special Report New Scientist
Mary Jane s Garden
Anti Marijuana Web Sites
Read Both Sides of the Issue
Marijuana Facts for Teens
Marijuana Anonymous
White House statements on MariLana Policy
r
A Ring of Cannabis Marijuana and Hemp Related Sites
fPrevious Sitel fRandom Site Next Site
Home Join The Rinq WebRin CID
OOa
Shoopinq EMail Home
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Marijuana Telling Teenagers the Truth about Smoking Pot Page 11 of 11
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Benefits of Medical Marijuana Page 1 of 2
Wedoesday 10 February 2010 01 19
Benefits of Medical Marijuana
Written by1800 Medical Marijuana
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Every day it becomes more difficult to deny the benefits of inedical marijuana
Ask anyone who s used it for pain management relating to alife altering illness
Cancer AIDS Glaucoma Multiple Sclerosis and Crohn s disease among others
and they ll tell you how its changed their lives
How smoking or ingesting a natural herb has made managing their pain and side effects a revelation That when
compared to any variety of chemically enhanced pharmaceutical offerings the little white pills simply don t measure
up
Take side effects for instance Most prescription drugs come with a multi page rider of possible bad things that might
happen with regular use liver damage is almost synonymous with long term use Compare that to marijuana which
studies show have almost no permanent damage with long term use and many patients choose not to smoke Baked
goods butters oils and other natural means make marijuana the easiest medicine to swallow
And medical marijuana doesn t only benefit debilitating illnesses It has also been found to ease the discomfort
surrounding arthritis chronic pain and nausea Many women report success when using marijuana to treat menstrual
cramps and menopausal women have found great success in using marijuana to battle hot flashes mood swings and
chills Currently there are studies being done which indicate that medical marijuana might have a positive effect on
depression and other anxiety related disorders
The bunch of stoners stereotype has followed responsible marijuana users around for far too long Like any other
beneflcial drug marijuana can be abused Unlike every other beneficial prescription drug out there it is vir ually
impossible to overdose on marijuana Classifying marijuana as a dangerous drug in the first place is a little like
outlawing black cohosh or ginseng or any of the other herbs routinely used in different cultures for healing and pain
management It is an alternative medical course as legitimate as chiropractic medicine and often used hand in hand
to great results Chiropractic philosophy lines up perfectly with that of inedical marijuana your body and nature has
the power to heal
Ultimately thaYs the number one beneft marijuana has to offer it is an herb grown from the earth It is not processed
or refined or chemically enhanced It does not contain an endless list of unpronounceable ingredients designed to
carefully manipulate the symptoms of your illness Marijuana is a natural medicine whose potential applications have
not yet begun to scratch the surface
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Recent Research on Medical Marijuana NORML Page 1 of 4
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Emerging Clinical Applications For Cannabis
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7hanprutic Usas of Medical MadJuana
et es Svndrome
the ongoing political debate regarding the legality of inedical
marijuana dinical investigations of the therapeutic use of cannabinoids are
now more prevalent than at any time in history
For example in February 2010 investigators at the Universitv of California
Center for Medicinal Cannabis Research publicly announced the findin s of a
series of randomized placebo controlled clinical trials on the medical utility
of inhaled cannabis The studies which utilized theso called gold standard
FDA clinical trial design concluded that marijuana ought to beafirst line
for patients with neuropathy and other serious illnesses
Among the studies conducted by the Center four assessed smoked
4orua 7estina
marijuana s ability to alleviate neuropathic pain a notoriously difficult to
rooean Drua Laws
treat type of nerve pain associated with cancer diabetes HIV AIDS spinal
RML Freedom of
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cord injury and many other debilitating conditions Each of the trials found
information rteauests
that cannabis consistently reduced patients pain levels to a degree that was
Survevs
Polls
as good or better than currently available medications
OIn The Media
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Another studY conducted by the Center s investigators assessed the use of
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WOmen S Allidrtce marijuana as a treatmen for patients suffering from multiple sclerosis That
COntaCt OffiCidls study determined that smoked cannabis was superior to placebo in reducing ge5t 420
spasticity and pain in patients with MS and provided some benefit beyond
EvaluOtionS
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ut Marijudna currently prescribed treatments 42 Medical Marijana
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Around the globe similarly controlled trials are also taking place
MediCal USe
g16 484 1200
review by researchers in Germany reports that since 2005 there have been
32oe awatons info
OIndustridl U5e
37 controlled studies assessing the safety and efficacy of marijuana and its
Leqal ISSUeS
naturally occurring compounds in a total of2563 subjects By contrast
most FDA approved drugs go through far fewer trials involving far fewer TrinitV Uraent
Find A awyer subjects Care
Open daily 9am
Contdct Us While much of the renewed interest in cannabinoid therapeutics is a result of gPm 365 days 10200
PbOUt NORML the discovery of the endocannabinoid requlatorv svstem which we describe Trinity PKWY
NORML FoUfldation in detail later in this booklet some of this increased attention is also due to www niniCY ucpm
the growing body of testimonials from medical cannabis patients and their
TShi1 ts G@dr Physicians Nevertheless despite this influx of anecdotal reports much of ToVOtaC OffiClal
the modern investigation
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of inedical cannabis remains limited o preclinical
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animal studies of individual cannabinoids eg THC or cannabidiol and or
Discover the 2012
BU5ine55 synthetic cannabinoid agonistseg dronabinol or WIN 55 212 rather
Suppol t2r5 than clinical trial investigations involving whole plant material Because of Toyotap Camry
the US government s strong public policy stance against any use of Reliable Durable
cannabis the bulk of this modern cannabinoid research is predictably taking Learn More
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As clinical research into the therapeutic value of cannabinoids has
TreatmEnt
prolifera ed there are now an estimated 20 oublished oapers in the premier Napa Valley
scientific literature analyzing marijuana and its constituents so too has Alcohol Rehab Sober
investigators unders anding of cannabis remarkable capability to combat
Recovery for over 40
disease Whereas researchers in the 1970s 80s and 90s primarily assessed
years
cannabis ability to temporarily alleviate various disease symptoms such
oufrvsRehab com
as the nausea associated with cancer chemotherapy scientists today are
exploring the potential role of cannabinoids to modifv disease
Medieal 420 M7
Of particular interest scientists are investigating cannabinoids capacity to
moderate autoimmune disorders such as multiple sclerosis rheumatoid
arthritis and inflammatorv bowel disease as well as their role in the
treatment of neurological disorders such as Alzheimer s disease and
amvotrophic lateral sclerosisaka Lou Gehrig s disease In fact in 2009
the American Medical Association AMA resolved for the first time in the
organization s history that marijuana s status as a federal Schedule I
controlled substance be reviewed with the goal of facilitating the conduct of
clinical research and development of cannabinoid basetl medicines
Investigators are also studying the anti cancer activities of cannabis as a
body of preclinical and clinical data concludes that cannabinoids can
reduce the spread of specific cancer cells via apoptosis programmed cell
death and by the inhibition of angiogenesis the formation of new blood
vessels Arguably these latter findings represent far broader and more
significant applica ions for cannabinoid therapeutics than researchers could
have imagined some thirty or even twenty years ago
THE SAFETY PROFILE OF MEDICAL CANNABIS
Evaluation
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Cannabinoids have a remarkable safety record particularly when compared World s Larges Drug Policy
to other therapeutically active substances Most significantly the
Reform Conference One Month
Awdy
consumption of marijuana regardless of quantity or potency cannot oim os oc zoii
induce a fatal overdose According to a 1995 review prepared for the World
Health Organization There are no remrded cases of overdose fatalities
Aweses
attributed to cannabis and the estimated lethal dose for humans
extrapolated from animal studies is so high that it cannot be achieved by
U52f5
In 2008 investigators at McGill Universi y Health Centre and McGill
University in Montreal and the University of 8ritish Columbia in Vancouver
reviewed 23 clinical investigations of inedical cannabinoid drugs typically
oral THC or liquid cannabis extracts and eight observational studies
conducted between 1966 and 2007 Investigators did not find a higher
incidence rate of serious adverse events associated with medical cannabinoid
use compared to non controls over these four decades
sce9 Reap d
wnat we sow
Fn 3o sep zoii
A Pot Pardon Plea Prisoner
Seeks Presidential Pardon For
Offenseear Senrence For Firs
ved za 5eU mii
Feds 7o Legal Medical
Marijuana Patients You Don t
Ha e second nmendmen
Riqncs Pe od
Wed 28 Sep Z011
New Vork City Police
Commissioner Calls On Officers
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10 32011

Recent Research on Medical Marijuana NORML Page 3 of 4
NORML on That said cannabis should not necessarily be viewed asaharmless
110Nti11 Facebook substance Its active constituents may produce a variety of physiological and
To Curb Manjuana Arrests
Tue 2 Sep 2011
euphoric effects As a resul there may be some populations that are
Like
susceptible to increased risks from the use of cannabis such as adolescents
oreonant or nursinq mothers and pa ients who have a family history of
3a5 b41 people like mental illness Patients with heoatitis C decreased lung function such as impact on driving
noRM
aanyne
Stpne
chronic obstructive pulmonarv disease or who have a history of heart
disease or stroke may also be at a greater risk of experiencing adverse side
effects from marijuana As with any medication patients should consult
thoroughly with their physician before deciding whether the medical use of
cannabis is safe and appropriate
HOW TO USE THIS REPORT
Learn the truth about poYs
State DUID Laws
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As states continue to approve legislation enabling he physician supervised
use of inedical marijuana more patients with varying disease types are
Nearly 200 Studies Support
NOaM on Facebook exploring the use of therapeutic cannabis Many of these patients and their Medical Cannabist Read
physicians are now discussing this issue for the first time
Them
and are seeking
guidance on whether the therapeutic use of cannabis may or may not be
advisable This report seeks to provide this guidance by summarizing the
most recently published scien ific research 2000 2010 on the therapeutic
use of cannabis and cannabinoids for 19 dinical indications
Here
Alzheimer s disease
Amvotrophic lateral sclerosis
ChroniC qdin
Diabetes meilitus
Dvstonia
Fibromvalqia
Gastrointestinal disorders
Gliomas other cancers
Heoatitis C
Human Immunodeficiencv Virus
HVPertension
Incontinence
MethicillimresistantSta hvloccus aureus MRSA
Multiole sclerosis
Osteoporosis
Pruritus
Rheumatoid arthritis
Sleeo aonea
Tourette s svndrome
In some of these cases modern science is now affirming longtime anecdo al
reports of inedical cannabis userseg the use of cannabis to alleviate Gi
disorders In other cases this research is highlighting entirely new potential
clinical utilities for cannabinoidseg the use of cannabinoids o modify the
progression of tliabetes
The conditions profiled in this report were chosen because patients
frequently inquire about the therapeutic use of cannabis to treat these
disorders In addition many of the indications included in this report may be
moderated by cannabis therapy In several cases preclinical data and
clinical data indicate that cannabinoids may halt the progression of these
diseases in a more efficacious manner than available pharmaceuticals
For patients and their physicians this report can serve as a primer for those
who are considering using or recommending medical cannabis For others
this report can serve as an introduction to the broad range of emerging
clinical applications for cannabis and its various compounds
Paul Armentano
Deputy Director
NORML NORML Foundation
Washington DC
January 7 2011
The author would like to acknowledge Drs Dale Gierinqer Dustin Sulak
Gregory Carter Steven Karch and Mitch Earlevwine as well as Bernard
Ellis MPH former NORML interns ohn Lucy Christopher Rasmussen and
http www norml org index cfm Group ID 7002
1032011

Recent Research on Medical Marijuana
NORML Page 4 of 4
Rita Bowles for providing research assistance for this report The NORML
Foundation would also like to acknowledge Dale Gieringer Paul Kuhn and
Richard Wolfe for their financial contributions toward the publication of this
report
Important and timely publications such as his are only made possible
when concerned citizens become involved with NORML For more information
on joining NORML or making a donation please visit
htto www norml orq ioinTax deduc ible donations in support of NORML s
public education campaigns should be made payable to the NORML
Foundation
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Local Medical Marijuana Cultivation Possession Guidelines Under California State Law SB 420 Califor Page 1 of 6
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Join California NoRML and Local Medical Marijuana Cultivatian Possession Guidelines Under
hel us continue our work California State Law SB 420
Updated817 2011
Exolanation of 5B420 Cultivation Guidelines
Search Site
Anderson Humboldt Sacramento Countv
Arcata Imoerial Beach San Bemardino Countv
Berkelev Kern Countv Citv of San Carlos
Biaas Lake Countv Citv of San Dieoo
Search Butte Lakeoort San Francisco
Frequently Asked
Questions
Chico Lassen Citv of San Mateo
Corninq Live Oak Santa Cruz
Dunsmuir Mendocino Shasta Lake
EI Dorado Nevada Sonoma
Eureka Oakland South Lake Tahoe
Ft Braaa Paradise Tehama
Benefits of Legal zation Fresno Reddina Trinitv
M11edical Marijuana Gridlev Rocklin Tulare
Collectives Coops
Delivery Services
Physician Locator
Starting Collectives
List Your
Collective
Patient Guidelines
Local Guidelines
Economic Benefits
Businesses and
Organizations
Legal Tnformation
Legal Referrals
Roseville
Localities NOT listed above adhere to CA state default quidelines which are
6 mature OR 12 immature plan s and 8 oz of dried processed marijuana
For guidelines on collectives cooperatives and aggegate grows for multiple
patients see Local California Disoensarv Requlations
NOTE On May 22 2008 the Second District of Califomia Court ofAOOeals ruled that the
state limits on medical marijuana possession and cultivation established under SB 420 are
unconstitutional The court s reasoning would seem to apply only when the SB 420 numbers
are used to limit patients rights but has been interp eted otherwise 6y police who would
prefer to ignore them On January 2i 201Q the Califomia Suoreme Court in essence
affirmed the rulino
Califo nia NORML strongly advises Prop 215 patients to continue following the SB 420
CA Marijuana Laws
guidelines six mature or 12 immature plants and 8 ounces of processed marijuana except
Legislative Ne vs
Economics
CA Prisoner Arrest
Da
Federal Medical
Marijuana Cases
CAMP data
Health Info
Student Youth Usage
Studies
where local guidelines speci y more The Supreme Court s recent Kelly decision has been
widely misinterpreted to imply that the limits no longer apply and that patients can
therefore grow as much as they want In fact the Court s decision lets the police arrest
anyone who exceeds the guidelines The only thing it disallows is for the guidelines to be
used as a basis fo conviction inciminaltials
So unless you don t mind being arrested and dragged into court for a felony trial where you
will have to show that the amount ofmarijuana you had was consistent with your medical
needs the best rule of thumb is to follow the guidelines The Kelly decision simplyre affirms
the original intent of 58 4Z0 which was to establish reasonable guidelines forarest not
automatic limits for guilt
Drug Testing
Below is the latest information CaNORML has about local guidelines check with your local
P1J and Driving government entities for updates and please let us know if this page needs to be updated
Pain Patients Localities NOT listed below adhere to CA state default guidelines of 6 mature OR 12
Vaporizers
immature plants and 8 oz of dried processed marijuana
Historical Info
About Us
California Chapters
Anderson
On February 18 2011 an ordinance took effect in Anderson that prohibits cultivation either
inside a dwelling or in an outdoor garden limits the growing harvesting and processing of
medical marijuana to a50 square foot outbuilding that is built to city state and federal
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Coming Events
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codes is protected by an audible alarm system and contains electrical plumbing and
ventilation A suit was filed agains the Anderson ordinance on April 15 Z011
Arcata
City Council passed an ordinance 11 08 allowing no more than 50 square feet forcul ivation
In addition dispensaries will be prohibited from using more than 25 of their property for
cultivation and patients must grow in their own homes which must be mainly residential
space Those with special needs may request more grow space
Berkeley
Measure J7 passed by the voters in 2008 repealed Berkeley s plant and possession limits
Outdoor gardens that are observable are limited to 10 plants
Biggs
Citv code requires marijuana be grown inafully enclosed and secure structure
Butte Co
UPDATE June 22 2011 Butte Countv Citizens fo Comoassionate Use have submitted
12 308 signatures on a referendum petifion to suspend Butte county s cont oversial medical
marijuana ordinance Theodinance is now officially suspended for 30 days pending
validation of the signatures If as seems likely at least 7 600 are valid theodinance will
remain suspended until it can be voted on in the Novemeber election Read more
On May 25 2011 Butte County supervisors passed an ordinance setting permit fees for
aggregate grows at 285 regardless of the size and acreage waived for six plants The
ordinance takes effect June 23
Limits are
On lots less than 05 acres no cultivation allowed
On lots between0515 acres 6 mature plants or 12 total plants with a 15 foot setback
Between 15 and 20 acres up to 12 mature or 24 total plants and 100 foot setback
Between 20 and 80 acres up to 24 mature or 48 total plants and Z50 foot setback
Between 80 and 160 acres up to 36 mature or 72 total plants and 500 foot setback
Over 160 acres up to 99 mature plants and 700 foot setback
No outdoor growing would be allowed within thirty 30 feet of any occupied residential
structure located on a separate legal parcel and no growing at all within 1000 feet of a
school etc Any gardens over 6 plants must register with the Depar ment of Development
and pay fees
California NORML is interested in hearing from potential plaintiffs who would like to challenge
the ordinance Write IeqalCa canorml ora
Chico
Chapter 19 77 of Chico municipal code allows outdoor residential cultiva ion of 50 square
feet per parcel regardless of the number of patients Plants must be enclosed screened
and 5 feet from the property line Indoor cultivation under SO square feet and IZ00 watts
can take place only with a permit stating outdoor is not possible and the building owner
approves States all marijuana grown must be for personal use only
Corning
The city of Corning prohibi s cultivation outdoors or in a residential structure Gardens must
be loca ed in a secure detached structure in the rear yard only removed ten feet from the
property line artd with a six foot solid fence and with a mechanical ventilation system and
security system approved by a Building Official or the Police Dept
Dunsmuir
On May 19 2011 the city of Dunsmuir enacted an ordinance Chapter 17 34 of city code
that disallows outdoor cultivation and requires anyone growing for more than one person to
submit an affidavit to the city manager A maximum of 100 square feet may be grown per
patient not to exceed three patients per parcel Patients must live on the property and
growing must take place in a garage
EI Dorado Co
Sheriff DA policy Indoors 10 flowering plants 10 vegging 1 mother Outdoors 20
sarters or 10 mature plants 1 2 Ib processed marijuana depending on season of year
Eureka
On May 3 2011 Eureka city council approved an ordinance that allows personal cultivation
within 50 square feet in area and 10 feet in height or up to 100 feet with an Exemption
Request only in a residence Processing area cannot exceed 20 square feet Also regulates
dispensaries delivery services and labs
Ft Bragg
Cultivation Ordinance allows up to S00 sq feet indoors
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Local Medical Marijuana Cultivation Possession Guidelines Under California State Law SB 420 Califor Page 3 of 6
Join Today
Fresno county On Abm lJS on CaNORML F H A k 0
July 12 2011 Presno County unanimously passed an ordinance to ban dispensaries and Oeon CaNORML Store oin or mau
sharply restrict cultivation It requiresaMedical MJ Cultivation Business License for anyone
seeking to grow in the county Cul ivation can only occur only in a secure locked enclosed
structure in industrial zoning districts if1000 feet from any school park recreation area
aports facility adult business church etc maximum of plants is 99
Activists in Fresno are working towards filing a referendum against their ordinanceAtend
the alona with Sabrina Fendick Debby Goldsberrv Melissa Sanchez and Kyndra Miller
Amone interes ed in ioining the efiort can contact Shannon at sluce47C oqmail rom or 559
486 6010
Gridley
The city of Gridley has banned outdoor cultivation
Humboldt Co
County guidelines allow patients 100 square feet and 3 Ibs w no plant number limit City of
Fortuna and CHP enforce SB 420 limits 6 mature 12 immature plants 12 Ib Also see
Eureka above
Imperial Beach
On July 7 2011 with a 4 to 1 vote the Imperial Beach City Council approved an ordinance
banning collective cultivation of inedical marijuana within city limits including in the private
homes of qualifed patients Read more
Kem County
On August 9 2011 Kern County Board of Supervisors passed an ordinance to limit collective
membership to 3 members and outlaw outdoor cultivation and edibles In addi ion a second
emergency ordinance taking effect immediately disallows more than 12 plants per parcel
Read more
Kern Citizens for Patients Rights is organizing a referendum petition to repeal the county s
repressive ordinances Similar peticion drives have succeeded in overturning or suspending
anti MMJ ordinances in San Diego and Butte County
Interested supporters are invited to contact Kem Citizens for Patient Rights Heather Epps
heooslCa msn com 661 327 3337 or Craig Beresh craiqbereshCa sbcqlobal net or Bakersfield
VORML
Lake Co
On August 23 2011 at 130 PM Lake County Board of Supervisors will consider a cultivation
ordinance As it is written permitted gardens on plots 5 acres or larger can have 36 mature
or 72 total plants Personal gardens on plots one acre or less can have 6 mature and 12
immature plants per patient not to exceed 36 total plants Outdoor gardens would be
prohibited near schools and other youth oriented sites Indoor gardens at residences would
be limited to 100 square feet and 1200 watts greenhouses and sheds would have no square
footage limits
The meeting will take place at
LAKE COUNTY COURTHOUSE
255 NORTH FORBES STREET
LAKEPORT CA 95453
htto www co lake caus
Government Boards
of Sunervisors BOS Aaen
Lakeport
Cultivation Ordinance
Lassen County
On November 23 2010 Lassen County Ordinance No 575 which prohibits dispensaries and
outdoor cultivation was passed by the Lassen County eoard of Supervisors
Live Oak Sutter County
July 20 2011 The city of Live Oak in Sutter County is considering banning outdoor
cultivation after holding a public meeting about citizen complaints
Mendocino Co
On March 23 2010 the county enacted an ordinance that would allow gardens of up to 99
plants with proper licensing Otherwise it allows 25 plants per parcel More at Mendocino
Medical Mariivana Advisorv Board site
Nevada Co
Cultivation 6 mature female plants or 75 square feet of plant canopy previously 10 plants
not to yield more than 2 Ibs Possession 2 Ibs processed marijuana consistent with
patient s recommendation
nie c rsrea c u
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Local Medical Marijuana Cultivation Possession Guidelines Under California State Law SB 420 Califor Page 4 of 6
Oakland
Indoors 72 plants in maximum 32 sq ft growing area Outdoors 20 plants no area limit
Weight limit 3 Ibs dried marijuana per patient Collective gardens limited to 3 patients
Dispensaries serving four or more patien s are allowed max 6 mature and 12 immature
plants and 12 pound per patient See Oakland Municipal Code 5 81 101
Paradise
On July 8 2011 the Paradise planning commission approved a draft medical mariivana
ordinance that would limit personal cultivation to 50 square feet within a residential zoning
district and require permits for indoor gardens Collective cultivation could take place in
industrial zones with a permit A requirement that residential gardens be fenced and locked
has been added
Redding
An ordinance passed in 2010 restricts medical marijuana gardens to a maximum of 100
square feet of canopy or 10 of home or garden area Also see Local Ordinances Attack
Patients Riqh to Grow
Rocklin
In January 2011 the city of Rotklin passed ordinance 970 Section 1 Chapter 17 81 of
Rocklin Municipal Code which limits cultivation to 50 square feet and ten feet in height per
residence only within an enclosed structure Marijuana cultivation lighting cannot exceed
1200 watts and the authorized grower must reside in he residence where the marijuana
cultivation occurs Other building and fre codes issues of privacy noise odor etc must be
observed With documentation of a second patient living on the premises up to 100 square
feet can be grown Penalty for violation is 500 day
Roseville
July Z0 2011 Roseville is holding a meeting about medical marijuana cultivation and is
considering enacting an outdoor ban starting in October CaINORML has written to public
ocials there at the request of local patients asking them if they must ban outdoor growing
to adopt language stating Outdoor growing is prohibited where sight or odor presents a
nuisance to neighbors leaving it up to the grower to use a charcoal greenhouse filter
cover aromatic crops like lavender or other measures to address odor
Sacramento County
On August 10 2011 Sacramento County supervisors will hear a revised ordinance that could
regulate dispensaries and ban edibles and outdoor cultivation limit indoor cultivation to 12
mature plants force registration of all patient gardens require permits and excessive costs
for patients Read more
San Bernardino County
County code82 02 070 outlaws outdoor cultivation in unincorporated areas of San
Bernardino it must occur indoors in a secure locked and fully enclosed structure that
includes solid walls and a ceiling roof or top
City of San Carlos
San Carlos collective requlation ordinance says a patient may grow medical marijuana for
consumption at their residence It adds All cultivated marijuana must be secured in
structures consisting of at least four walls and a roof and 6e held secure to the satisfaction
of the police chief
City of San Diego
Citv Municioal Code allows up to 1 Ib of marijuana 24 plants in 64 square feet indoors no
outdoors growing allowed except in enclosed greenhouses
San Francisco
Patients allowed up to 24 plants or 25 square feet of canopy dispensary gardens capped at
99 plants in 100 square feet Possession limit 8 oz dried cannabis per patient See p 44 of
the ordinance
San Francisco has enaded regulations on edibles
City of San Mateo
San Mateo s city collective ordinance says
Marijuana cultivated and possessed at a private residence must not 6e visible from
adjacent public areas or neighboringpoperties and must be secured within structures
consisting of at least four walls and a roof with standa
locks
Santa Cruz
S00 sq ft canopy and up to 99 plan s is allowable under county guidelines
bone fide caregiver
for a patient or a
Sebastopol
In January 2011 Sebastopol city council enacted an ordinance allowing patients and
caregivers fo grow up to 30 plants within 100 square feet at their homes Under the
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Local Medical Marijuana Cultivation Possession Guidelines Under Califomia State Law SB 420 I Califor Page 5 of 6
ordinance patients and caregivers can possess up to 3 Ibs at the garden site It also allows
two secured 750 square foot gardens for dispensing collectives and two more for non
dispensing patients and caregivers
Shasta Lake
In December 2010 city council adopted an ordinance that allows growing only in residential
or mixed used zoning districts while it would be banned in commercial and industrial
districts The ordinance allows for growing up to 100 square feet inside a garage or adjacent
building but not inside the home
Outdoor growing is limited to 25 square feet on a half acre parcel 60 square feet on a parcel
between half acre and one acre and 240 square feet on parcels larger than one acre
Outdoor grows must also be enclosed in a6foot high non climbable fence with a locking
gate Chain link fences are not allowed according to the ordinance
Sonoma Co
Guidelines permit 3 Ibs for possession maximum 100 square feet cultivation area with 30
plants or fewer approved Sept 2006
South Lake Tahoe
On May 17 2011 the City of South Lake Tahoe unanimously passed an ordinance to
require that medical marijuana be cultivated in appropriately secured enclosed and
ventilated structures in permitted residential structures only in compliance with the
maximum dimensions permissible for the cultivation of inedical marijuana within 10 of the
total residence square footage Fines for violations start at S00 day and escalate to S00
with repeat offenses
Enforcement of the ordinance would not take effect until after Dec 19 The city plans to hold
two or three workshops to educate growers and property managers on the provisions of the
ordinance
Tehama Co
Tehama County Board of Supervisors has adopted an ordinance that declares it a public
nuisance for anyone cultivate over 12 mature or 24 immature plants on parcels of less than
20 acres The Tehama ordinance bans any cultivation whatsoever within 1000 ft of a school
and requires every landlord to register any Prop 215 garden with the city The ordinance
allows hardship exemptions to a requirement that gardens be 100 from property lines
California NORML has joined a lawsuit against the Tehama ordinance see Local Ordinances
Attack Patients Riaht to Grow
Trinity Co
On March 17 2011 Trinity supervisors voted to extend their moratorium on aggregrate
grows on rural residential parcels through Feb 2 2012 The moratorium limits any large
scale operations to nonresidential parcels only that are greater than 30 acres It also sets a
maximum garden size of2500 square feet for such operations and a 500 foot property line
setback
The temporary moratorium also limits the size of inedical marijuana gardens that may be
grown for personal use within residential areas to 50 square feet on an acre or less 100
square feet on one to fve acres and 250 square feet on parcels greater than five acres It
includes residency requirements calling for individuals upon request to furnish proof that
the property in use is their primary residence An ongoing process is aking place with public
hearings by the Trinity Planning Department
Tulare Co
Chapter 11 of Tulare County code requires marijuana be grown within a secure locked and
fully enclosed structure whose exterior is compatible with the exterior appearance of
structures already constructed or under construction within the immediate area and has an
alarm system and exterior lighting Collectives may grow up to 99 plants within proper
zoning otherwise up to 24 plants at 6 mature or 12 immature plants per patient for only 2
patients Patients may smoke only entirely within a private residence or on the premises of
a private residence but out of public view Violations are crimi al misdemeanors
State Guidelines Under 56 420 Health Safetv Code 11362 71
HSC 11362 77a A qualified patient or primary caregiver may possess no more than eigh
ounces of dried marijuana per qualified patient In addition a qualifed patient or primary
caregiver may also maintain no more than six mature or 12 immature marijuana plants per
qualified patient
HSC 11362 77 b If a qualified patient or primary caregiver has a doctor s
recommendation that this quantity does not meet the qualified patient s medical needs the
qualified patient or primary caregiver may possess an amount of marijuana consistent with
the patienYs needs
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2011

Local Medical Marijuana Cultivation Possession Guidelines Under California State Law SB 420 I Califor Page 6 of 6
HSC 11362 77 c Counties and cities may retain or enact medical marijuana guidelines
allowing qualifed patients or primary caregivers to exceed the state limits set forth in
subdivision a
HSC 11362 77 d Only the dried mature processed flowers of female cannabis plant or the
plant conversion shall be consideretl when determining allowable quantities of marijuana
under this section
5B 420 Enforcement Guidelines
State law SB 420 Health Safety Code 11362 7 which took effect on an 1 2004
protects Prop 215 patients from arrest provided they cultivate no more than 6 mature or 12
immature plants and possess no more than 8 ounces of dried marijuanaHSC
11362 77 al
Counties and cities are authorized to establish higher but not lower limits if they wish
HSC 11362 77c Listed above are those localities that have adopted limits above the
state limit
Patients who need more marijuana can be exempted from these limits if they obtain a
physician
statement specifying that they need moreHSC
11362 77 bl While police are often reluctant to recognize such exemptions they are
helpful in court
Despite supposed protections of 5B 420 and Prop 215 patients may still be arrested if law
enforcement suspects they are outside the law for example by being involved in illegal
sales or distribution or growing plants with excessive yields
In general the state Attorney General has given local authorities discretion in how they
enforce Prop 215 as explained in a letter to local law enforcementocials
http canorml org prop
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MedicalMJ org Medical Marijuana News and Facts Page 1 of 28
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NORML
said Deputy Health programs in several states States cities moving to allow medical use by those in need model for
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For more information on medical
Ca inabis PlAlXjek pledged
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What aze some of the pros and cons between smoked andnon smoked medical marijuana Medical Marij Page 1 of 2
Medical IVfarijuana
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What are some of the pros and cons between smoked and non smoked medical marijuana
PAaalcal Marijuana Home
Featured Resoumes
Soultl marijuana be a
medical option
Genera Reference not clearly pro or con
Method I Description ProS CO05
Top 10 Pros antl Cons 1 Smoking Full Plant Reliet from symptoms is usually Mari7uana smokers have been shown
Ditl Vou Know Buming the Flowering tops obtained in less than a minute to suffer an increased incidence of
and sometimes the because ihe smoke enters the
Historical Timeline
bronchitis and respiratory intections
leaves and inhaling it into bloodsiream direcity from lhe lungs There coultl be a greater risk of
Comments
the lungs
cancer of the throat and respiratory
Pros Gons by Catagory U2C1
CORE QUESTION
Metlical Value
Diseases
Condinons
Results will often fade after an hour
2
No smoxeo Jary
Smoking Plant Relief from symptoms is usually Smoking anything can cause severe
Particles obtained in less ihan a minute medical problems although less of
Public PoliCy
Palients manipulate the because the smoke enters ihe the harmful materials are consumed
RiSks flowered lops and bloodstream directly from the lungs in this method
us covemmen2 and
sometimes leaves of the
nneaicai Marijuana plant to make a produd Resutts will often fade aker an hour
Access to Metlical
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i6 Legal Metlical Marijuana
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States antl DC
hash and others It is
6 Siateswit Pending then burned in a pipe or
Legislalion ro Legalize
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Fon npprovea Druqs point where d produces a use less product in ihis method than smoking others say it uses more
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nnar jana
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Metlical Marijuana Infogrephic of the pianPs bloodsream directly From the lungs The vaporizer needed for this is oo
Opinion Polls Surveys cannabinoitls and is relief from symptoms is usually expensive for some patients Prices
90 Physlcians Views on mostly free of obtained in less than a minute range from about S30 up to huntlreds
Medical Marijuana
contaminanis without the harmfW toxins in Ihe o dollars for high tech versions The
smoke
marijuana plant materiai must be
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Detecting Cannabis Use
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Major Court Cases antl 4 Oil The primary beneft of this method is The extraction method uses highty
Relatetl Docs Cannabis 8owered tops to convert leaf or inferiorca nabis Flammable gases such as butane
and leaves are fltered into buds into a form that is safer to inhale and can be dangerous as well as too
tearn more
its oils by a method using or consume without ihe tars and complicated for some people
Soume eiograpnies butane gas Some other plant malerials inhaled when
rssary patients may create a smoking The oil some say is messy and
es nrcnive weaker oil using
a difficult to work with
supercrifical carbon Inhalation methods smoking or
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dioxide extraction The oil vaporization usually take effect in Non inhaling eating or drinking it
ptltlitional Resource5
can then be inhaled using less ihan a minute often takes390 minutes for ihe full
a
pipe or vaporizer
effects to be realized
Get Ireo email uptlates
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279 Online Translate Become a Fan U
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What are some of the pros and cons between smoked andnon smoked medical marijuana Medical Marij Page 2 of 2
OK
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conditions applled directly
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This method can be expensive to
purchase or produce technicians
say they produce less ihan a gram of
oil from each ounce of leaf and
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each ounceof bud
5 Tincture This method is usetl mostly by pain This method often takes 2030
Cannabis flowered tops patienls who say ihe tinctures dull minutes for the full effects to be
and leaves are soaked in the pain without the sirong realized
an alcohol solution psychoactive eHects of other
iransferring the THC and methods because ihe tinctures are Many conditions do not find adequate
other cannabinoids to the generally weaker m polency relief trom this product as it is too
liquid The tinclure is then
weak o produce some of the desired
used in various ways
effects
adtled to foods and
liquids applied to the skin
The alcohol consumetl in this method
or lhe patient consumes
is undesirable to some
directly by drinking a small
quantity or placing a tew
drops under the tongue
sublingual
6 Butter This method can create a product This method oNen takes 30 90
Cannabis flowered tops that tlelivers long results lasting minules for the fuii effects to be
and Ieaves are simmered several hours realized
in butler or vegetable oil
for several hours Patients can modulate the results 6y Proper doses are diffcWt to
transferring the THC and eating smaller or larger portions and determine and patients oflen don t
other cannabinoids to the can carry their medicine with them in realize until loo late that iheir portion
butter The solid plant public without being noticed is too strong or too weak
material is then discarded
The butter now a dark Pain patients ciaim this method Eating too much can cause vomiting
shade of green is then relieves their symptoms the longest and loss of consciousness
used in baking such items
as brownies and cakes or
added to such foods as
spaghetti sauce or soup
The oily base of the butter
is needed for the
cannabinoids to properly
adhere
and many patienls use this method
mostly m the evenings to assist with
sleep
Prepared by Medical Marijuana ProCon org Specials thanks to Dale Gieringer of California NORML and Jay
Cavanaugh PhD of the Amencan Alliance For Medical Cannabis for their input
Raprmbng Poi cy roei lo Gt ProCa org Fovtsn PraCOn org Matla 8 Pess I Dcla ier Prmacy Pollcv
sProConorg z50ifc i3 nonpronf
73JVb5L reNd Smte200cntz don ca CFl9040t
Te13t0 451 3596
http
medicalmarijuana procon org view answers php questionID 000225
926 2011

E Information from Groups in Opposition
of Marijuana
Coalition for a
Drug
City County Moratoria
Free California List of
Bans
California Police Chiefs Association
Talking Points
California Police Chiefs Association
on Marijuana Dispensaries 2009
Marijuana
White Paper
Friends of the DEA
Marijuana Dispensaries and
the Federal Government 2009
GeneraI Barry McCaffrey Ret Marijuana
Children The Work Place and Medicine

S1oP F
V 0
O
u
DRUG
p
A
FREE
I
C A L I F O R N 1 A
yHWdrugfreecali omia org
youth parents schools law enforcement health care media businesses govemment
non profts community groups religious entities freternai and service organizations
United to Protect our Youfh
California City and County Listing of Illegal Store Front Ordinances
Effective Date Aug 03 2010
Cities With Moratoria 81
Adelanto Moraga South Lake Tahoe
Alameda Morgan Hill Tafr
Alturas National City Tahoe City
Anderson Needles Tehama
Barstow Nevada City Temple City
Baldwin Park Newport Beach Vacaville
Bell Gardens Oceanside Ventura
Calimesa Orange West Sacramento
Camarillo Orinda Westlake Village
Canyon Lake Pacific Grove Winters
Carpinteria Perris Woodland
Chula Vista Pomona Yreka
El Centro Rancho Cordova Yucca Valley
Ferndale
Rancho Palos Verdes
Fillmore
Redwood City
Fountain Valley Richmond Counties With Moratoria
Galt Rio Vista 10
Guadalupe
Rosamond Colusa
Half Moon Bay Rosemead Glen
Hemet Sacramento Lake
Hughson San Bruno Lassen
Huntington Park San Juan Bautista Nevada
Imperial San Luis Obispo
Placer
Imperial
Ione San Ramon San Diego
La Canada Flintridge Sand City San Miguel
Laguna Niguel Santa Clara Tulare
Lancaster
Santa Clarita
Livingston
Lodi
Loma Linda
Mayv ood
Menifee
Montague
Beach San Marino San Bernardino
Santa Ynez
Scotts Valley
Shasta Lake
Signal Hill
Soledad
South Gate

T1oN e
p
O
U
DRUG
O
9
D
FREE I
CALIFORNIA
Cities WiYh Bans
Agoura Hills Covina Indian Wells
Anaheim Antioch Cypress Indio
Apple Valley Davis Inglewood
Arcadia Desert Hot Springs Irwindale
Arroyo Grande Dublin King City
Atascadero El Cajon Laguna Hills
Auburn El Cerrito La Mirada
Azusa El Monte La Palma
Banning Emeryville La Quinta
Beaumont Encinitas La Verne
Bellflower Escalon Laguna Beach
Beverly Hills Escondido Lake Elsinore
Big Bear Lake Fairfield Lake Forest
Biggs Firebaugh Larkspur
Bishop Folsom La Mesa
Blythe Fontana Lawndale
Brentwood Fortuna Lemon Grove
Buellon Fowler Lemoore
Buena Park Fremont Live Oak
Calabasas Fresno Livermore
Capitola Fullerton Lincoln
Carlsbad Garden Grove Lodi
Cathedral City Gardena Lomita
Ceres Gilroy Lompoc
Chico Glendale Los Altos
Chino Glendora Los Banos
Chino Hills GoleYa Manhattan Beach
Chowchilla Grand Terrace Marina
Claremont Gridley Manteca
Clearlake Grover Beach Merced
Cloverdale Hawaiian Gardens Millbrae
Clovis Hawthorne Milpitas
Colma Healdsburg Mission Viejo
Concord Hercules Modesto
Corning Hennosa Beach Monrovia
Corona Hesperia Montague
Corte Madera Hollister Montclair
Costa Mesa Huntington Beach Montebello

S10ry
OP
u
DRUG
9
D
FREE
I
CALIFORNIA
Monterey San Bernardino Yucaipa
Monterey Park San Clemente Yountville
Moorpark
San Gabriel
Murrieta San Jacinto Counties with Bans 9
Newark San Juan Capistrano Amador
Norco San Leandro Contra Costa
Norwalk San Marcos El Dorado
Oakdale San Pablo Madera
Oakley San Rafael Merced
Ontario Santa Ana Placer
Orland Santa Maria Riverside
Oacnard Santee Stanislaus
Pacific Grove Sausalito Sutter
Palm Dale Seal Beach Los Angeles
Palm Desert
Palo Alto
Palos Verdes Estate
Parlier
Pasadena
Paso Robles
Patterson
Petaluma
Pico Rivera
Pinole
Pismo Beach
Pittsburg
Placentia
Pleasant Hill
PleasanYOn
Red Bluff
Redlands
Redondo Beach
Ridgecrest
Riverbank
Riverside
Rocklin
Rohnert Park
Rolling Hills Estates
Seaside
Sierra Madre
Simi Valley
Solvang
Sonoina
South E1 Monte
South San Francisco
Stanton
Suisun City
Susanville
Temecula
Torrance
Truckee
Turlock
Tuscin
Twentynine Palms
Ukiah
Union City
Upland
Victorville
Villa Park
Vista
Walnut
Yuba City

Marijuana Talking Points
1 California s police chiefs protect over 78 of Californians We take our
responsibility very very seriously
2 The legalization of marijuana will dramatically increase the public safety
challenges we face
3 Proponents would have you believe otherwise but we all know that s not true
4 The organized criminal combines who are engaged in marijuana cultivation and
distribution will not meekly go away if AB 390 passes they will become
stronger We know this based on what has happened elsewhere It is naive to
think that the major drug cartels who control cultivation in California will meekly
go away Instead they will either use fronts to apply for a Cultivator s license
or because AB 390 reduces the fine for illegal growing of marijuana to only
100 keep doing what they have been doing In either case they are not going
away
5 When the Netherlands legalizedso called marijuana cafes in the 1980 s there
were only three organized crime operations in that country Today there are
over 90 as organized criminal enterprises from all over Europe descended on the
Netherlands
6 Here in California we can expect an increase inauto burglaries robberies and
residential burglaries Again we know this because that s what happened in
Alaska when they decriminalized drugs from 1978 to 1990 During that period
there was a dramatic increase in those crimes as users committed crimes to get
money to buy marijuana It s one of the reasons Alaska abandoned this failed
experiment
7 Highway fatalities will rise if marijuana is legalized Right now driving under the
influence of drugs kills 8000 people a year Under this bill it will be possible to
buy marijuana in every liquor in the state in virtually every supermarket chain
That kind of availability will only exponentially increase highway fatalities
8 As police chiefs we feel that any law that would strengthen the hand of
organized crime increase crime and increase highway fatalities is somehow not
a very good idea
9 President Obama understands that marijuana should not be legalized Dr Sanjay
Gupta at CNN understands that marijuana should not be legalized Ourjob is to
make the Legislature understand the same
thing

WHITE PAPER ON MARIJUANA DISPENSARIES
by
CALIFORNIA POLICE CHIEFS ASSOCIATION
TASK FORCE ON MARIJUANA DISPENSARIES
O 2009 California Police Chiefs Assn
All Rights Reserved

ACKNOWLEDGMENTS
Beyond any question this White Paper is the product of a major cooperative effort among
representatives of numerous law enforcement agencies and allies who shaze in common the goal of
bringing to light the criminal nexus and attendant societal problems posed by marijuana dispensaries
that until now have been too often hidden in the shadows The critical need for this project was first
recognized by the Califomia Police Chiefs Association which put its implementation in the very
capable hands of CPCA s Executive Director Leslie McGill City of Modesto Chief of Police Roy
Wasden and City of El Cerrito Chief of Police Scott Kirkland to spearhead More than 30 people
contributed to this project as members of CPCA s Medical Marijuana Dispensary Crime Impact
Issues Task Force which has been enjoying the hospitality of Sheriff John McGinnis at regulaz
meetings held at the Sacramento County Sheriff s DepartrnenYs Headquarters Office over the past
three years about every three months The ideas for the White Paper s components came from this
group and the text is the collaborative effort of numerous persons both on and off the task force
Special mention goes to Riverside County District Attorney Rod Pacheco and Riverside County
Deputy District Attomey Jacqueline Jackson who allowed their Office s fine White Paper on
Medical Marijuana History and Current Complications to be utilized as a partial guide and granted
pemussion to include material from that document Also Attorneys Martin Mayer and Richard
Jones of the law firm of Jones
Mayer are thanked for preparing the pending legal questions and
answers on relevant legal issues that appeaz at the end of this White Paper And I thank recently
retired San Bernardino County Sheriff Gary Penrod for initially assigning me to contribute to this
important work
Identifying and thanking everyone who contributed in some way to this project would be well nigh
impossible since the cast of characters changed somewhat over the years and some unknown
individuals also helped meaningfully behind the scenes Ultimately developing a White Paper on
Marijuana Dispensaries became a rite of passage for its creators as much as a writing project At
times this daunting and sometimes unwieldy multi year project had many task force members
including the White Paper s editor wondering if a polished final product would ever really reach
fruition But at last it has If any reader is enlightened and spurred to action to any degree by the
White Paper s important and timely subject matter all of the work that went into this collaborative
project will have been well worth the effort and time expended by the many individuals who worked
harmoniously to make it possible
Some of the other persons and agencies who contributed in a meaningful way to this group venture
over the past three years and deserve acknowledgment for their helpful input and support are
George Anderson California Department of Justice
Jacob Appelsmith Office of the California Attorney General
John Avila California Narcotics Officers Association
Phebe Chu Office of San Bernardino County Counsel
Scott Collins Los Angeles County District Attorney s Office
Cathy Coyne California State Sheriffs Association
Lorrac Craig Trinity County SherifPs Department
Jim Denney Califomia State Sheriffs Association
Thomas Dewey California StaYe University Humboldt Police DeparCment
Dana Filkowski Contra Costa County District Attomey s Office
John Gaines Califomia Departrnent ofJustice Bureau of Narcotics Enforcement
Craig Gundlach Modesto Police Department
John Harlan Los Angeles County District Attorney sOffice Major Narcotics Division
O 2009 California Police Chiefs Assn I All Rights Reserved

Nate Johnson California State University Police
Mike Kanalakis Monterey County Sheriffs Office
Bob Kochly Contra Costa County Office of District Attomey
Tommy LaNier The National Marijuana Initiative HIDTA
Carol Leveroni Califomia Peace Officers Association
Kevin McCar hy Los Angeles Police Department
Randy Mendoza Arcata Police Department
Mike Nivens California Highway Patrol
Rick Oules Office of the United States Attorney
Mark Pazin Merced County Sheriffs Department
Michael Regan El Cerrito Police Department
Melissa Reisinger California Police Chiefs Association
Kimberly Rios California DeparUnent of Justice Conference Planning Unit
Kent Shaw California Department ofJustice Bureau of Nazcotics Enforcement
Crystal Spencer California Department of Justice Conference Planning Unit
Sam Spiegel Folsom Police Department
Valerie Taylor ONDCP
Thomas Toller California District Attomeys Association
Martin Vranicaz Jr California District Attorneys Association
Apri122 2009
Dennis Tilton Editor
O 2009 California Police Chiefs Assn II All Rights Reserved

TABLE OF CONTENTS
Paees
ACKNOWLEDGMENTS
ii
EXECUTIVE SUMMARY
ivvi
WHITE PAPER ON MARIJUANA DISPENSARIES
INTRODUCTION1
FEDERAL LAWI2
CALIFORNIA LAW26
LAWS IN OTHER STATES 6
STOREFRONT MARIJUANA DISPENSARIES AND COOPERATNES 67
HOW EXISTING DISPENSARIES OPERATE 78
ADVERSE SECONDARY EFFECTS OF MARINANA DISPENSARIES
AND SIMILARLY OPERATING COOPERATIVES 8
ANCILLARY CRIMES810
OTHER ADVERSE SECONDARY IMPACTS IN THE IMMEDIATE VICINITY OF
DISPENSARIES11
SECONDARY ADVERSE IMPACTS IN THE COMMUNITY AT LARGE 11 14
ULTIMATE CONCLUSIONS REGARDING ADVERSE SECONDARY EFFECTS14
POSSIBLE LOCAL GOVERNMENTAL RESPONSES TO MARINANA DISPENSARIES 14 17
LIABILITY ISSUES18 19
A SAMPLING OF EXPERIENCES WITH MARIJUANA DISPENSARIES 19 30
PENDING LEGAL QUESTIONS 31 39
CONCLUSIONS 40
ENDNOTES 41 44
NON LEGAL REFERENCES 45 49
O 2009 California Police Chiefs Assn iii All Rights Reserved

WHITE PAPER ON MARIJUANA DISPENSARIES
by
CALIFORNIA POLICE CHIEFS ASSOCIATION
TASK FORCE ON MARIJUANA DISPENSARIES
EXECUTIVE SUMMARY
INTRODUCTION
Proposition 215 an initiative authorizing the limited possession cultivation and use of marijuana by
patients and their care providers for certain medicinal purposes recommended by a physician without
subjecting such persons to criminal punishment was passed by California voters in 1996 This was
supplemented by the California State Legislature
enactment in 2003 of the Medical Marijuana
Program Act SB 420 that became effective in 2004 The language of Proposition 215 was codified
in Califomia as the Compassionate Use Act which added section 11362 5 to the California Health
Safety Code Much later the language of Senate Bi11420 became the Medical Marijuana Program
Act MMPA and was added to the California Health SaFety Code as section 11362 7 et seq
Among other requirements it purports to direct all California counties to set up and administer a
voluntary identification card system for medical marijuana users and their caregivers Some
counties have already complied with the mandatory provisions of the MMPA and others have
challenged provisions of the Act or are awaiting outcomes of other counties legal challenges to it
before taking affirmative steps to follow all of its dictates And with respect to marijuana
dispensaries the reaction of counties and municipalities to these nascent businesses has been
decidedly mixed Some have issued pernuts for such enterprises Others have refused to do so
within theirjurisdictions Still others have conditioned permitting such operations on the condition
that Chey noY violate any state or federal law or have reversed course after initially allowing such
activities within their geographical barders by either limiting or refusing to allow any further
dispensaries to open in their community This White Paper explores these matters the apparent
conflicts between federal and California law and the scope of both direct and indirect adverse
impacts of marijuana dispensaries in local communities It also recounts several examples that could
be emulated of what some govemmental officials and law enforcement agencies have already
instituted in their jurisdictions to limit the proliferation of marijuana dispensaries and to mirigate
their negative consequences
FEDERAL LAW
Except for very limited and authorized research purposes federal law through the Controlled
Substances Act absolutely prohibits the use of marijuana for any legal purpose and classifies it as a
banned Schedule I drug It cannot be legally prescribed as medicine by a physician And the
federal regulation supersedes any state regulation so that under federal law California medical
marijuana statutes do not provide a legal defense for cultivaYing or possessing marijuana even with
a physician
recommendation for medical use
OO 2009 California Police Chiefs Assn IV All Rights Reserved

CALIFORNIA LAW
Although California law generally prohibits the cultivation possession transportation sa1e or other
transfer of marijuana from one person to another since late 1996 after passage of an initiative
Proposition 215 later codified as the Compassionate Use Act it has provided a limited affirmative
defense to criminal prosecution for those who cultivate possess or use limited amounts of marijuana
for medicinal purposes as qualified patients with a physician
recommendation or their designated
primary caregiver or cooperative Notwithstanding these limited exceptions to criminal culpability
California law is notably silent on any such available defense for a storefront marijuana dispensary
and California Attomey General Edmund G Brown Jr has recenUy issued guidelines that generally
find marijuana dispensaries to be unprotected and illegaldrug trafficking enterprises except in the
rare instance that one can qualify as a true cooperative under California law A primary caregiver
must consistently and regularly assume responsibility for the housing health or safety of an
authorized medical marijuana user and nowhere does California law authorize cultivating or
providing marijuana medical ornon medical for profit
California s Medical Marijuana Program Act Senate Bi11420 provides further guidelines for
mandated county programs for the issuance of identification cards to authorized medical marijuana
users on a voluntary basis for the chief purpose of giving them a means of certification to show law
enfarcement officers if such persons are investigated for an offense involving marijuana This
system is currently under challenge by the Counties of San Bernardino and San Diego and Sheriff
Gary Penrod pending a decision on review by theUS Supreme Court as is California s right to
permit any legal use of marijuana in light of federal law that totally prohibits any personal
cultivation possession sale transportation or use of this substance whatsoever whether for medical
ornon medical purposes
PROBLEMS POSED BY MARIJUANA DISPENSARIES
Marijuana dispensaries are commonly large money making enterprises that will sell marijuana to
most anyone who produces a physician
written recommendation for its medical use These
recoinmendations can be had by paying unscrupulous physicians a fee and claiming to have most
any malady even headaches While the dispensaries will claim to receive only donations no
marijuana will change hands without an exchange of money These operations have been tied to
organized criminal gangs foster large grow operations and are oftenmulti million dollar profit
centers
Because they are repositories of valuable marijuana crops and large amounts of cash several
operators of dispensaries have been attacked and murdered by armed robbers both at their storefronts
and homes and such places have been regularly burglarized Drug dealing sales to minors
loitering heavy vehicle and foot traffic in retail areas increased noise and robberies of customers
just outside dispensaries are also common ancillary byproducts of their operations To repel store
invasions fireanns are often kept on hand inside dispensaries and firearms are used to hold up their
proprietors These dispensaries are either linked to large marijuana grow operations or encourage
home grows by buying marijuana to dispense And just as destructive fires and unhealthful mold in
residential neighborhoods are often the result of large indoor home grows designed to supply
dispensaries money laundering also naturally results from dispensaries likely unlawful operations
OO 2009 California Police Chiefs Assn v All Rights Reserved

LOCAL GOVERNMENTAL RESPONSES
Local govemmental bodies can impose a moratorium on the licensing of marijuana dispensaries
while investigating this issue can ban this type of activity because it violates federal law can use
zoning to control the dispersion of dispensaries and the attendant problems that accompany them in
unwanted areas and can condition their operation on not violating any federal or state law which is
akin to banning them since their primary activities will always violate federal law as it now exists
and almost surely California law as well
LIABILITY
While highly unlikely local public officials including county supervisors and city council members
could potentially be charged and prosecuted for aiding and abetting criminal acts by authorizing and
licensing marijuana dispensaries if they do not qualify as cooperatives under California law which
would be a rare occurrence Civil liability could also result
ENFORCEMENT OF MARIJUANA LAWS
While the Drug Enforcement Administration has been very active in raiding large scale marijuana
dispensaries in California in the recent past and arresting and prosecuting their principals under
federal law in selective cases the new US Attorney General Eric Holder Jr has very recently
announced a major change of federal position in the enforcement of federal drug laws with respect to
marijuana dispensaries It is to target for prosecution only marijuana dispensaries that are exposed
as fronts for drug trafficking It remains to be seen what standards and definitions will be used to
determine what indicia will constitute a drug trafficking operation suitable to trigger investigation
and enforcement under the new federal administration
Some counties like law enforcement agencies in the County of San Diego and County of Riverside
have been aggressive in confronting and prosecuting the operators of marijuana dispensaries under
state law Likewise certain cities and counties have resisted granting marijuana dispensaries
business licenses have denied applications or have imposed moratoria on such enterprises Here
too the future is uncertain and permissible legal action with respect to marijuana dispensaries may
depend on future court decisions not yet handed down
Largely because the majority of their citizens have been sympathetic and projected a favorable
attitude toward medical marijuana patients and have been tolerant of the cultivation and use of
marijuana other local public officials in California cities and counties especially in Northern
California have takenahands off attitude with respect to prosecuting marijuana dispensary
operators or attempting to close down such operations But because of the life safety hazards
caused by ensuing fires that have often erupted in resultant home grow operations and the violent
acts that have often shadowed dispensaries some attitudes have changed and a few political entities
have reversed course after having previously licensed dispensaries and authorized liberal permissible
amounts of marijuana for possession by medical marijuana patients in their jurisdictions These
patienfs have most often turned out to be young adults who are not sick at all but have secured a
physician
written recommendation for marijuana use by simply paying the required fee demanded
for this document without even first undergoing a physical examination Too often medical
marijuana has been used as a smokescreen for those who want to legalize it and profit off it and
storefront dispensaries established as cover for selling an illegal substance for a lucrative return
OO 2009 California Police Chiefs Assn VI All Rights Reserved

WHITE PAPER ON MARIJUANA DISPENSARIES
by
CALIFORNIA POLICE CHIEFS ASSOCIATION
Editor Dennis TiltonMAEdMALitMCJJD
Adjunct Professor of Criminal Justice Political Science Public Administration Upper Iowa University
Sheriffls Legal Counsel Retired San Bernardino County Sheriffls Department
INTRODUCTION
In November of 1996 California voters passed Proposition 215 The initiative set out to make
marijuana available to people with certain illnesses The initiative was later supplemented by the
Medical Marijuana Program Act Across the state counties and municipalities have varied in their
responses to medical marijuana Some have allowed businesses to open and provide medical
marijuana Others have disallowed all such establishments within their borders Several once issued
business licenses allowing medical marijuana stores to operate but no longer do so This paper
discusses the legality of both medical marijuana and the businesses that make it available and more
specifically the problems associated with medical marijuana and marijuana dispensaries under
whatever name they operate
FEDERAL LAW
Federal law clearly and unequivocally states that all marijuana related acrivities aze illegal
Consequently all people engaged in such activities are subject to federal prosecution The United
States Supreme Court has ruled that this federal regulation supersedes any state
regulation of
marijuana even California s Gonzales v Raich 2005 125 SCt 2195 2215 The Supremacy
Clause unambiguously provides that if there is any conflict between federal law and state law
federal law shall prevail Gonzales v Raich sa pra Even more recenUy the 9 Circuit Court of
Appeals found that there is no fundamental right under the United States Constitution to even use
medical marijuana Raich v Gonzales 9th Cir 2007 500 F3d 850 866
In Goi zales v Ruich the High Court declared that despite the attempts of several states to partially
legalize marijuana it continues to be wholly illegal since it is dassified as a Schedule I drug under
federal law As such there aze no exceptions to its illegality 21 USC secs 812 c 841 a1
Over the past thirty years there have been several attempts to have marijuana reclassified to a
different schedule which would permit medical use of the drug All of these attempts have failed
See Gonzules v Raich 2005 125 SCt 2195 fn 23 The mere categorization of marijuana as
medical by some states fails to carve out any legally recognized exception regarding the drug
Marijuana in any form is neither valid nor legal
Clearly the United States Supreme Court is the highest court in the land Its decisions aze final and
binding upon all lower courts The Court invoked the United States Supremacy Clause and the
Commerce Clause in reaching its decision The Supremacy Clause declares that all laws made in
pursuance of the Constitution shall be the supreme law of the land and shall be legally superior to
any conflicting provision of a state constitution or law The Commerce Clause states that the
O 2009 California Police Chiefs Assn 1 All Rights Reserved

Congress shall have power to regulate Commerce with foreign Nations and among the several
States and with the Indian Tribes
Gonzales v Raich addressed the concerns of two California individuals growing and using marijuana
under California s medical marijuana statute The Court explained that under the Controlled
Substances Act marijuana is a Schedule I drug and is strictly regulated Schedule I drugs are
categorized as such because of their high potential for abuse lack of any accepted medical use and
absence of any accepted safety for use in medically supervised treatment 21 USC sec 812 b1
The Court ruled that the Commerce Clause is applicable to California individuals growing and
obtaining marijuana for their own personal medical use Under the Supremacy Clause the federal
regulation of marijuana pursuant to the Commerce Clause supersedes any state
regulation
including Califomia s The Court found that the California statutes did not provide any federal
defense if a person is brought into federal court for cultivating or possessing marijuana
Accordingly there is no federal exception for the growth cultivation use or possession of mazijuana
and all such activity remains illegal California s Compassionate Use Act of 1996 and Medical
Marijuana Program Act of 2004 do not create an exception to this federal law All marijuana
activity is absolutely illegal and subject to federal regulation and prosecution This notwithstanding
on March 19 2009 US Attomey General Eric Holder Jr announced that under the new Obama
Administration theUS Department of Justice plans to target for prosecution only fhose marijuana
dispensaries that use medical marijuana dispensing as a front for dealers of illegal drugs
CALIFORNIA LAW
Generally the possession cultivation possession for sale transportation distribution fumishing
and giving away of marijuana is unlawful under Califomia state statutory law See Cal Health
Safety Code secs 11357 ll 360 But on November 5 1996 California voters adopted Proposition
215 an initiative statute authorizing the medical use of marijuana The initiative added California
Health and Safety code section 11362 5 which allows seriously ill Californians the right to obtain
and use marijuana for medical purposes where that medical use is deemed appropriate and has been
recommended by a physician The codified section is known as the Compassionate Use Act
of 1996 Additionally the State Legislature passed Senate Bi11420 in 2003 It became the Medical
Marijuana Program Act and took effect on ianuary 1 2004 This act expanded the definitions of
patienY and primary caregiver and created guidelines for identification cards It defined the
amount of marijuana that patients and primary caregivers can possess It also created a
limited affittnative defense to criminal prosecution Yor qualifying individuals that collectively gather
to cultivate medical marijuana as well as to tha crimes of narijuana possession possession for
sale transportation sale furnishing cultivation and maintenance of places for storage use or
distribution of marijuana for a person who qualifies asapatientaprimary caregiver or as a
member of a legally recognized cooperative as those terms are defined within the statutory
scheme Nevertheless there is no provision in any of these laws that authorizes or protects the
establishment ofadispensary or other storefront marijuana distribution operation
Despite their illegality in the federal context the medical marijuana laws in California are specific
The statutes craft narrow affirmative defenses for particular individuals with respect to enumerated
marijuana activity All conduct and people engaging in it that falls outside of the statutes
parameters remains illegal under Califomia law Relatively few individuals will be able to asserf the
affirmative defense in the statute To use it a person must beaqualified patient primary
caregiver or a member ofacooperative Once they are charged with a crime if a
person can prove an applicable legal status they are entitled to assert this statutory defense
OO 2009 California Police Chiefs Assn 2 All
Rights Reserved

Former Califomia Attorney General Bill Lockyer has also spoken abouf inedical marijuana and
strictly construed California law relating to it His office issued a bulletin to California law
enforcement agencies on June 9 2005 The office expressed the opinion that Gonzales v Raich did
not address the validity of the Califomia statutes and therefore had no effect on California law The
office advised law enforcement to not change their operating procedures Attorney General Lockyer
made the recommendation that law enforcement neither arrest nor prosecute individuals within the
legal scope of California s Compassionate Use Act Now the current California Attomey General
Edmund G Brown Jr has issued guidelines conceming the handling oF issues relating to
Califomia s medical marijuana laws and marijuana dispensaries The guidelines are much tougher
on storefront dispensaries generally finding them to be unprotected illegaldrug trafficking
enterprises if they do not fall within the narrow legal definition ofacooperative than on the
possession and use of marijuana upon the recommendation of a physician
When Califomia s medical marijuana laws are strictly construed it appears that the decision in
Gonzales v Ruich does affect CaliFornia law However provided that federal law does not preempt
California law in this area it does appear that the California statutes oPfer some egal protection to
individuals within the legal scope of the acts The medical marijuana laws speak to patients
primary caregivers and true collectives These people are expressly mentioned in the statutes and
if their conduct comports to the law they may have some state legal protection for specified
marijuana activity Conversely all marijuana establislunents that fall outside the letter and spirit of
the statutes including dispensaries and storefront facilities aze not legal These establishments have
no egal protection Neither the former Califomia Attorney GeneraPs opinion nor the current
California Attorney Genera s guidelines present a contrary view Nevertheless without specifically
addressing marijuana dispensaries Attorney General Brown has sent his deputies attorney general to
defend the codified Medical Marijuana Program Act against court challenges and to advance the
position that the state
regulations promulgated to enforce the provisions of the codified
Compassionate Use Act Proposition 215 including a statewide database and county identification
card systems for marijuana patients authorized by their physicians to use marijuana are all valid
1 Conduct
California HealYh and Safety Code sections 11362 765 and 11362 775 describe the conduct for
which the affirmative defense is available If a person qualifies asapatient primary caregiver
or is a member of a legally recognized cooperative he or she has an affirmative defense to
possessing a defined amount of marijuana Under the statutes no more than eight ounces of dried
marijuana can be possessed Additionally either six mature or twelve immature plants may be
possessed If a person claims patient or primary caregiver status and possesses more than this
amount of marijuana he or she can be prosecuted for drug possession The qualifying individuals
may also cultivate plant harvest dry and or process marijuana but only while still strictly
observing the permitted amount of the drug The statute may also provide a limited affirmative
defense for possessing marijuana for sale transporting it giving it away maintaining a marijuana
house knowingly providing a space where marijuana can be accessed and creating a narcotic
nuisance 16
However for anyone who cannot lay claim to the appropriate status under the statutes all instances
of marijuana possession cultivation planting harvesting drying processing possession for the
purposes of sales completed sales giving away administration transportation maintaining of
marijuana houses knowingly providing a space for marijuana activity and creating a narcotic
nuisance continue to be illegal under California law
OO 2009 California Police Chiefs Assn 3 All Rights Reserved

2 Patients and Cardholders
A dispensary obviously is not a patient or cardholderAqualified patienY is an individual with a
physician
recommendation that indicates marijuana will benefit the treatment of a qualifying
illness CalHS Code secs 11362 5b1A and 11362 7 Qualified illnesses include cancer
anorexia AIDS chronic pain spasticity glaucoma arthritis migraine or any other illness for which
marijuana provides relief A physician
recommendation that indicates medical marijuana will
benefit the treatment of an illness is required before a person can claim to be a medical marijuana
patient Accordingly such proof is also necessary before a medical marijuana affirmative defense
can be claimed
Aperson with an identification card means an individual who is a qualified patient who has
applied for and received a valid identification card issued by the State Department of Health
Services Cal HS Code secs 11362 7c and ll362 7g
3 Primary Caregivers
The only person or entity authorized to receive compensation For services provided to patients and
cardholders is a primary caregiver CaL HS Code sec 11362 77c However nothing in the law
authorizes any individual or group to cultivate or distribute marijuana for profit CalHS Code
sec 11362 7b5 a It is important to note tbat it is almost impossible for a storefront marijuana
business to gain true primary caregiver status Businesses that call themselves cooperatives but
function like storefront dispensaries suffer this same fate In People v Mower the court was very
clear that the defendant had to prove he was a primary caregiver in order to raise the medical
marijuana affirn ative defense Mr Mower was prosecuted for supplying two people with
marijuana He claimed he was their primary caregiver under the medical marijuana statutes
claim required him to prove he consistently had assumed responsibility for either one s housing
health or safety before he could assert the defense Emphasis added
The key to being a primary caregiver is not simply that marijuana is provided for a patient s health
the responsibility for the health must be consistent it must be independent of inerely providing
marijuana for a qualified person and such a primary caregiver patient relationship must begin before
or contemporaneously with the time of assumption of responsibility for assisting the individual with
marijuana People v Mentch 2008 45 Cal 4th 274 283 Any relationship a storefront marijuana
business has with a patient is much more likely to be transitory than consistent and to be wholly
lacking in providing for a patienYs health needs beyond just supplying him or her with marijuana
Aprimary caregiver is an individual or facility that has consistently assumed responsibility for
the housing health or safety of a patienY over tune CaLHS Code sec 11362 5e
Consistency is the key to meeting this definition A patient can elect to patronize any dispensary
that he or she chooses The patient can visit different dispensaries on a single day or any subsequent
day The statutory definition includes some clinics health care facilities residential care facilities
and hospices But in lighi of the holding in People v Mentch szrpra to qualify as a primary
caregiver more aid to a person
health must occur beyond merely dispensing marijuana to a given
customer
Additionally if more than one patient designates the same person as the primary caregiver all
individuals must reside in the same city or county And in most circumstances the primary
caregiver must be at least 18 yeazs of age
OO 2009 California Police Chiefs Assn 4 All Rights Reserved
This

The courts have found that the act of signing a piece of paper declaring that someone is a primary
caregiver does not necessarily make that person one See People ex rel Lungren v Peron 1997 59
Ca1 AppAth 1383 1390 One maintaining a source of marijuana supply from which all members of
the public qualified as permitted medicinal users may or may not discretionarily elect to make
purchases does not thereby become the party who has consistently assumed responsibility for the
housing health or safety of that purchaser as section 11362 5e requires
The California Legislature had the opportunity to legalize the existence of dispensaries when setting
forth what types of facilities could qualify as primary caregivers Those included in the list clearly
show the Legislature
intent to restrict fhe definition to one involving a significant and long term
commitment to the patienYs health safety and welfare The only facilities which the Legislature
authorized to serve as primary caregivers are clinics health care facilities residential care
facilities home health agencies and hospices which actually provide medical care or supportive
services to qualified patients CalHS Code sec 11362 7d1 Any business that cannot prove
that its relationship with the patient meets these requirements is not a primary caregiver
Functionally the business is a drug dealer and is subject to prosecution as such
4 Cooperatives and Co1lecHves
According to the Califomia Attorney General s recently issued Guidelinesfor the Security and Non
Diversio z ofMm ijuana GroNnzfor Medical Use unless they meet stringent requirements
dispensaries also cannot reasonably claim to be cooperatives or collectives In passing the Medical
Marijuana Program Act the Legislature sought in part to enhance the access of patients and
caregivers to medical marijuana through collective cooperative cultivation programs People v
Urziceanar 2005 132Ca1 App 4th 747 881 The Act added section 11362 775 which provides
that Patients and caregivers who associate within the State of California in order collectively or
cooperatively to cultivate marijuana for medical purposes shall not solely on the basis of that fact be
subject to state criminal sanctions for the crimes of marijuana possession possession for sale
transportation sale furnishing cultivation and maintenance of places for storage use or
distribution of marijuana However there is no authorization for any individual or group to cultivate
or distribute marijuana for profit CalHS Code sec 11362 77a If a dispensary is only a
storefront distribution operation open to the general public and there is no indication that it has been
involved with growing or cultivating marijuana far the benefit of inembers as anon profit enterprise
it will not qualify as a cooperative to exempt it from criminal penalties under California s marijuana
laws
Further the common dictionary definition of collectives is that they are organizations jointly
managed by those using its facilities or services Legally recognized cooperatives generally possess
the following features control and ownership of each member is substantially equal members are
limited to those who will avail themselves of the services furnished by the association transfer of
ownership interests is prohibited or limited capital investment receives either no retum or a limited
return economic benefits pass to the members on a substantially equal basis or on the basis of their
patronage of the association members are not personally liable for obligations of the association in
the absence of a direct undertaking or authorization by them death bankruptcy or withdrawal of
one or moreme nbers does not terminate the association and the services of the association are
furnished primarily for the use of the members
normally meet this legal definition
Marijuana businesses of any kind do not
O 2009 California Police Chiefs Assn 5 All Rights Reserved

Based on the foregoing it is clear that virtually all marijuana dispensaries are not legal entetprises
under either federal or state law
LAWS IN OTHER STATES
esides California at the time of publication of this White Paper thirteen other states bave enacted
medical marijuana laws on their books whereby to some degree marijuana recommended or
prescribed by a physician to a specified patient may be legally possessed These states are Alaska
Colorado Hawaii Maine Maryland Michigan Montana Nevada New Mexico Oregon
Rhode Island Vermont and Washington And possession of marijuana under one ounce has now
been decruninalized in Massachusetts
STOREFRONT MARIJUANA DISPENSARIES AND COOPERATIVES
Since the passage of the Compassionate Use Act of 1996 many storefront marijuana businesses
have opened in California Some are referred to as dispensaries and some as cooperatives but it is
how they operate that removes them from any umbrella of legal protection These facilities operate
as if they are pharmacies Most offer different types and grades of marijuana Some offer baked
goods that contain marijuana Monetary donations are collected from the patient or primary
caregiver when marijuana or food items are received The items are not technically sold since that
would be a criminal violation of the statutes2 These facilities are able to operate because they
apply for and receive business licenses from cities and counties
Federally all existing storefront marijuana businesses are subject to search and closure since they
violate federal law Their mere existence violates federal law Consequently they have no right to
exist or operate and arguably cities and counties in Califomia have no authority to sanction them
Similarly in California there is no apparent authority for the existence of these storefront marijuana
businesses The Medical Marijuana Program Act of 2004 allows patients and primarycai to
grow and cultivate marijuana and no one else2 Although CaliFornia Health and Safety Code
section 11362 775 offers some state legal protection for true collectives and cooperatives no parallel
protection exists in the statute for any storefront business providing any narcotic
The common dictionary definition of collectives is that they aze organizations jointly managed by
those using its facilities or services Legally recognized cooperatives generally possess the
following features control and ownership of each member is substantially equal members are
limited to those who will avail themselves of the services furnished by the association transfer of
ownership interests is prohibited or limited capitalizvestment receives either no retz rn or a limited
reta rn economic benefits pass to the members on a substantially equal basis or on the basis of their
patronage of the association members are not personally liable for obligations of the association in
the absence of a direct undertaking or authorization by them death bankruptcy or withdrawal of one
or more members does not terminate the association and the services of the association are
furnished primarily for the use of the members Marijuana businesses of any kind do not meet
this legal definition
Actual medical dispensaries are commonly defined as offices in hospitals schools or other
institutions from which medical supplies preparations and treahnents are dispensed Hospitals
hospices home health care agencies and the like are specifically included in the code as primary
caregivers as long as they have consistently assumed responsibility for the housing health or
safety of a patient 28
Clearly it is doubtful that any of the storefront marijuana businesses currently
O 2009 California Police Chiefs Assn 6 All Rights Reserved

existing in California can claim that status Consequently they are not primary caregivers
and are subject to prosecution under both California and federal laws
HOW EXISTING DISPENSARIES OPERATE
Despite their clear illegality some cities do have existing and operational dispensaries Assuming
arguendo tbat they may operate it may be helpful to review the mechanics of the business The
former Green Cross dispensary in San Francisco illustrates how a typical marijuana dispensary
works
A guard or employee may check for medical marijuana cards or physician recommendations at the
entrance Many types and grades of marijuana are usually available Although employees are
neither pharmacists nor doctors sales clerks will probably make recommendations about what type
of marijuana will best relieve a given medical symptom Baked goods containing marijuana may be
available and sold although there is usually no health pertnit to sell baked goods The dispensary
will give the patient a form to sign declaring that the dispensary is their primary cazegiver a
process fraught with legal difficulties The patient then selects the marijuana desired and is tod
what the contribution will be for the product The California Health Safety Code specifically
prohibits the sale of marijuana to a patient so contributions are made to reimburse the dispensary
for its tune and care in making producY available However if a calculation is made based on the
available evidence it is clear that these contributions can easily add up to millions of dollars per
year That is a very large cash flow foranon profiY organization denying any participation in the
retail sale of narcotics Before its application to renew its business license was denied by the City of
San Francisco there were single days that Green Cross sold45 000 worth of marijuana On
Saturdays Green Cross could sell marijuana to forty three patients an hour The marijuana sold at
the dispensary was obtained from growers who brought it to the store in backpacks A medium
sized backpack would hold approximately16 000 worth of marijuana Green Cross used many
different marijuana growers
It is clear that dispensaries are running as if they are businesses not legally valid cooperatives
Additionally they claim to be the prunary caregivers of patients This is a spurious claun As
discussed above the term primary caregiver has a very specific meaning and defined legal
qualifications A primary caregiver is an individual who has consistently assumed responsibility
for the housing health or safety of a patient 30
The statutory definition includes some clinics
health care facilities residential care facilities and hospices If more than one patient designates the
same person as the primary caregiver all individuals must reside in the same city or county In most
circumstances the primary caregiver must be at least 18 years of age
It is almost impossible for a storefront marijuana business to gain true primary caregiver status A
business would have to prove that it consistently had assumed responsibility for a patienYs
housing health or safety The key to being a primary caregiver is not simply that marijuana is
provided for a patienYs health the responsibility for the patienYs health must be consistent
As seen in the Green Cross example a storefront marijuana business relationship with a patient is
most likely transitory In order to provide a qualified patient with marijuana a storefi marijuana
business must create an instant primary caregiver relationship with him The very fact that the
relationship is instant belies any consistency in their relationship and the requirement that housing
health or safety is consistently provided Courts have found that a patienYs act of signing a piece of
paper declaring that someone is a primary caregiver does not necessarily make that person one The
O 2009 California Police Chiefs Assn 7 All Rights Reserved

consistent relationship demanded by the statute is mere fiction if it can be achieved between an
individual and a business that functions like a narcotic retail store
ADVERSE SECONDARY EFFECTS OF MARIJUANA DISPENSARIES
AND SIMILIARLY OPERATING COOPERATIVES
Of great concern are the adverse secondary effects of these dispensaries and storefront cooperatives
They are many Besides flouting federal law by selling a prohibited Schedule I drug under the
Controlled Substances Act marijuana dispensaries attract or cause numerous ancillary social
problems as byproducts of their operation The most glaring of these are other criminal acts
ANCILLARY CRIMES
A ARMED ROBBERIES AND MURDERS
Throughout California many violent crimes have been committed that can be traced to the
proliferation of marijuana dispensaries These include armed robberies and murders For example
as far back as 2002 two home occupants were shot in Willits California in the course of a home
invasion robbery targeting medical marijuana And a series of four armed robberies of a
marijuana dispensary in Santa Barbara California occurred through August 10 2006 in which thirty
dollars and fifteen baggies filled with marijuana on display were taken by force and removed from
the premises in the latest holdup The owner said he failed to report the first three robberies because
medical marijuana is such a controversial issue 33
On February 25 2004 in Mendocino County two masked thugs conunitted a home invasion robbery
to steal medical marijuana They held a knife to a65 year old man s throat and though he fought
back managed to get away with large amounts of marijuana They were soon caught and one of the
men received a sentence of six years in state prison And on August 19 200518 year old
Demarco Lowrey was shot in the stomach and bled to death during a gunfight with the business
owner when he and his friends attempted a takeover robbery of a storefront marijuana business in the
City of San Leandro California The owner fought back with the hooded home invaders and a gun
battle ensued Demazco Lowery was hit by gunfire and dumped outside the emergency entrance of
Children s Hospital Oakland after the shootout He did not survive
Near Haywazd California on September 2 2005 upon leaving a marijuana dispensary a patron of
the CCA Cannabis Club had a gun put to his head as he was relieved of over 250 worth of pot
Three weeks later another break in occurred at the Garden of Eden Cannabis Club in September of
2005
Another known marijuana dispensary related murder occurred on November 19 2005
Approximately six gun andbat wielding burglars broke into Les Crane s home in Laytonville
California while yelling This is a raid Les Crane who owned two storefront marijuana
businesses was at home and shot to death He received gunshot wounds to his head arm and
abdomen Another man present at the time was beaten with a baseball bat The murderers left the
home after taking an unknown sum ofUS currency and a stash of processed marijuana
Then on January 9 2007 marijuana plant cultivator Rex Farrance was shot once in the chest and
killed in his own home after four masked intruders broke in and demanded money When the
homeowner ran to fetch a firearm he was shot dead The robbers escaped with a small amount of
OO 2009 California Police Chiefs Assn 8 All Rights Reserved

cash and handguns Investigating officers counted 109 marijuana plants in various phases of
cultivation inside the house along with two digital scales and just under 4 pounds of cultivated
marijuana
More recenUy in Colorado Ken Gorman a former gubematorial candidate and dispenser of
marijuana who had been previously robbed over twelve times at his home in Denver was found
murdered by gunshot inside his home He was a prominent proponent of inedical marijuana and the
legalization of marijuana
B BURGLARIES
In June of 2007 after two burglarizing youths in Bellflower California were caught by the
homeowner trying to steal the fruits of his indoor marijuana grow he shot one who was running
away and killed him And again in January of 2007 Claremont Councilman Corey Calaycay
went on record calling marijuana dispensaries crime magnets after a burglary occurred in one in
Claremont California
On July 17 2006 the El Cerrito City Council voted to ban all such marijuana facilities It did so
after reviewing a nineteen page report that detailed a rise in crime near these storefront dispensaries
in other cities The crimes included robberies assaults burglaries murders and attempted
murders Even though marijuana storefront businesses do not currently exist in the City of
Monterey Park Califomia it issued a moratorium on them after studying the issue in August of
20064 Afrer allowing these establishments to operate within its borders the City of West
Hollywood California passed a similar moratorium The moratorium was prompted by incidents of
armed burglary at some of the city s eight existing pot stores and complaints from neighbors about
increased pedestrian and vehicle traffic and noise
C TRAFFIC NOISE AND DRUG DEALING
Increased noise and pedestrian traffic including nonresidents in pursuit of marijuana and out of area
criminals in search of prey are commonly encountered just outside marijuana dispensaries as well
as drug related offenses in the vicinity like resales of products just obtained inside since these
marijuana centers regularly attract marijuana growers drug users and drug traffickers Sharing
just purchased marijuana outside dispensaries also regularly takes place
Rather than the seriously ill for whom medical marijuana was expressly intended perfecUy
healthy young people frequenting dispensaries are a much mare common sight Patient records
seized by law enforcement officers from dispensaries during raids in San Diego County California
in December of 2005 showed that 72 percent of patients were between 17 and 40 years old
Said one admitted marijuana trafficker The people I deal with are the same faces I was dealing
with 12 years ago but now because of Senate Bi11420 they are supposedly legit I can totally see
why cops are bummed
Reportedly a security guard sold half a pound of marijuana to an undercover officer just outside a
dispensary in Morro Bay California And the mere presence of marijuana dispensaries
encourages illegal growers to plant cultivate and transport ever more marijuana in order to supply
and sell their crops to these storefront operators in the thriving medical marijuana dispensary market
so that the national domestic marijuana yield has been estimated to be 358 billion dollars of which
a 138 billion dollar share is California grown It is a big business And although the operators of
some dispensaries will claim that they only accept monetary contributions for the products they
OO 2009 California Police Chiefs Assn 9 All Rights Reserved

dispense and do not sell marijuana a patron will not receive any marijuana until an amount of
money acceptable to the dispensary has changed hands
D ORGANIZED CRIME MONEY LAUNDERING AND FIREARMS VIOLATIONS
Increasingly reports have been surfacing about organized crime involvement in the ownership and
operation of marijuana dispensaries including Asian and other criminal street gangs and at least one
member of the Aimenian Mafia The dispensaries or pot clubs aze often used as a front by
organized crime gangs to traffic in drugs and launder money One such gang whose temtory
included San Francisco and Oakland California reportedly ran amulti million dollar business
operating ten warehouses in which vast amounts of marijuana plants were grown Besides seizing
over9000 marijuana plants during surprise raids on this criminal enterprise
storage facilities
federal officers also confiscated three firearms which seem to go hand in hand with medical
marijuana cultivation and dispensaries
Marijuana storefront businesses have allowed criminals to flourish in California In the smnmer of
2007 the City of San Diego cooperated with federal authorities and served search warrants on
several marijuana dispensary locations In addition to marijuana many weapons were recovered
including a stolen handgun and anM16 assault rifle The National Drug Intelligence Center
reports that marijuana growers are employing attned guards using explosive booby traps and
murdering people to shield their crops Street gangs of all national origins are involved in
transporting and distributing marijuana to meet the ever increasing demand for the drug Active
Asian gangs have included members of Vietnamese organized crime syndicates who have migrated
from Canada to buy homes throughout the United States to use as grow houses
Some or all of the processed harvest of marijuana plants nurtured in these homes then wind up at
storefront marijuana dispensaries owned and operated by these gangs Storefront marijuana
businesses are very dangerous enterprises that thrive on ancillary grow operations
Besides fueling marijuana dispensaries some monetary proceeds from the sale of harvested
marijuana derived from plants grown inside houses are being used by organized crime syndicates to
fund other legitimate businesses for profit and the laundering of money and to conduct illegal
business operations like prostitution extortion and drug trafficking Money from residential grow
operations is also sometimes traded by criminal gang members for firearms and used to buy drugs
personal vehicles and additional houses for more grow operations and along with the illegal
income derived froin large scale organized crime related marijuana production operations coines
widespread income tax evasion
E POISONINGS
Another social problem somewhat unique to marijuana dispensaries is poisonings both intentional and
unintentional On August 16 2006 the Los Angeles Police Department received two such reports
One involved a security guard who ate a piece of cake extended to him from an operator of a
marijuana clinic asagift and soon afterward felt dizzy and disoriented The second incident
concerned a UPS driver who experienced similar symptoms after accepting and eating a cookie given
to him by an operator of a different marijuana clinic6
OO 2009 California Police Chiefs Assn 10 All Rights Reserved

OTHER ADVERSE SECONDARY IMPACTS IN THE IMNIEDIATE VICINITY OF
DISPENSARIES
Other adverse secondary impacts from the operation of marijuana dispensaries include street dealers
lurking about dispensaries to offer a lower price for marijuana to arriving patrons marijuana smoking
in public and in front of children in the vicinity of dispensaries loitering and nuisances acquiring
marijuana and or money by means of robbery of patrons going to or leaving dispensaries an increase
in burglaries at or neaz dispensaries a loss of trade for other commercial businesses located near
dispensaries the sale at dispensaries of other illegal drugs besides marijuana an increase in traffic
accidents and driving under the influence arrests in which marijuana is implicated and the faiture of
marijuana dispensary operators to report robberies to police
SECONDARY ADVERSE IMPACTS IN THE COMMUNITY AT LARGE
A UNJUSTIFIED AND FICTTTIOUS PHYSICIAN RECOMMENDATIONS
California s legal requirement under California Health and Safety Code section 11362 5 that a
physician
recommendation is required for a patient or caregiver to possess medical marijuana has
resulted in other undesirable outcomes wholesale issuance of recommendations by unscrupulous
physicians seeking a quick buck and the proliferation of forged or fictitious physician
recommendations Some doctors link up with a marijuana dispensary and take up temporary residence
in a local hotel room where they advertise their appearance in advance and pass out medical
marijuana use recommendations to a line of patients at about 150 a pop Other individuals just
make up their own phony doctor recommendations which are seldom if ever scrutinized by
dispensary employees for authenticity Undercover DEA agents fake medical marijuana
sporting
recommendations were readily able to purchase marijuanafi om a clinic Far too ofren California s
medical marijuana law is used as a smokescreen for healthy pot users to get their desired drug and for
proprietors of marijuana dispensaries to make money off them without suffering any legal
repercussions
On March 11 2009 the Osteopathic Medical Board of California adopted the proposed decision
revoking Dr Alfonso Jimenez s Osteopathic Physician
and Surgeon s Certificate and ordering him
to pay74 323 39 in cost recovery Dr Jimenez operated multiple marijuana clinics and advertised
his services extensively on the Internet Based on information obtained from raids on marijuana
dispensaries in San Diego in May of 2006 the San Diego Police Department ran two undercover
operations on Dr Jimenez s clinic in San Diego In January of 2007 a second undercover operation
was conducted by the Laguna Beach Police Department at Dr Jimenez s clinic in Orange County
Based on the results of the undercover operations the Osteopathic Medical Board charged Dr
Jimenez with gross negligence and repeated negligent acts in the treatment of undercover operatives
posing as patients After asix day hearing the Administrative Law Judge AL issued her decision
finding that Dr Jimenez violated the standard of care by committing gross negligence and repeated
negligence in care treatment and management of patients when he among other things issued
medical marijuana recommendations to the undercover agents without conducting adequate medical
examinations failed to gain proper informed consent and failed to consult with any primary care
and or treating physicians or obtain and review prior medical records before issuing medical
marijuana recommendations The ALJ also found Dr Jimenez engaged in dishonesY behavior by
preparing false and or misleading medical records and disseminating false and misleading
advertising to the public including representing himself asaCannabis SpecialisY and Qualified
Medical Marijuana Examiner when no such formal specialty or qualification existed Absent any
O 2009 California Police Chiefs Assn 11 All Rights Reserved

equested administrative agency reconsideration or petition for court review the decision was to
become effective Apri124 2009
B PROLIFERATION OF GROW HOUSES IN RESIDENTIAL AREAS
In recent years the proliferation of grow houses in residential neighborhoods has exploded This
phenomenon is country wide and ranges from the purchase for purpose of marijuana grow operations
of small dwellings to high priced McMansions Mushrooming residential marijuana grow
operations have been detected in California Connecticut Florida Georgia New Hampshire North
Carolina Ohio South Carolina and Texas7 In 2007 alone such illegal operations were detected and
shut down by federal and state law enforcement officials in 41 houses in California 50 homes in
Florida and 1 homes in New Hampshire7 Since then the number of residences discovered to be so
impacted has increased exponentially Part of this recent influx of illicit residential grow operations is
because the THC richBC bud strain of marijuana originally produced in British Columbia can
be grown only in controlled indoor environments and the Canadian market is now reportedly
saturated with the product of competing Canadian gangs often Asian in composition or outlaw
motorcycle gangs like the Hells Angels Typically a gutted house can hold about1000 plants that
will each yield almost half a pound of smokable marijuana this collectively nets about 500 pounds of
usable marijuana per harvest with an average of three to four harvests per year With a street value
of3000 to5000 per pound for high potency marijuana and such multi
le harvests a successful
grow house can bring in between 45 million and 10 million a year 8 The high potency of
hydroponically grown marijuana can command a price as much as six times higher than commercial
grade marijuana
C LIFE SAFETY HAZARDS CREATED BY GROW HOUSES
In Humboldt County California structure fires caused by unsafe indoor marijuana grow operations
have become commonplace The city of Arcata which sports four marijuana dispensaries was the site
of a house fire in which a fan had fallen over and ignited a fire it had been tumed into a grow house
by its tenant Per Arcata Police Chief Randy Mendosa altered and makeshift no code electrical
service connections and overloaded wires used to operatehigh powered grow lights and fans are
common causes of the fires Large indoor marijuana growing operations can create such excessive
draws of electricity that PGE power pole transformers are commonly blown An average1500
square foot tract house used for growing marijuana can generate monthly electrical bills from1000
to3000 per month From an environmental standpoint the carbon footprint from greenhouse gas
emissions created by large indoor marijuana grow operations should be a major concern for every
community in terms of complying with Air Board AB 32 regulations as well as other greenhouse gas
reduction policies Typically air vents are cut into roofs water seeps into carpeting windows are
blacked out holes are cut in floors wiring isjury rigged and electrical circuits are overloaded to
operate grow lights and other apparatus When fires start they spread quickly
The May 31 2008 edition of the Los Angeles Times reported Law enforcement officials estunate that
as many as1000 of the7500 homes in this Humboldt County community are being used to cultivate
marijuana slashing into the housing stock spreading building safety problems and sowing
neighborhood discord Not surprisingly in this bastion of liberal pot possession rules that authorized
the cultivation of up to 99 plants for medicinal purpose most structural fires in the community of
Arcata have been of late associated with marijuana cultivation Chief of Police Mendosa clarified
that the actual number of marijuana grow houses in Arcata has been an ongoing subject of public
debate Mendosa added We know there are numerous grow houses in almost every neighborhood in
and around the city which has been the source of constant citizen complaints House fires caused by
OO 2009 California Police Chiefs Assn 12 All Rights Reserved

grower installed makeshifr electrical wiring or tipped electrical fans are now endemic to Humboldt
County
Chief Mendosa also observed that since marijuana has an illicit street value of up to3000 per pound
marijuana grow houses have been susceptible to violent armed home invasion robberies Large scale
marijuana grow houses have removed significant numbers of affordable houses from the residential
rental market When property owners discover their rentals are being used as grow houses the
residences are ofren lefr with major structural damage which includes air vents cut into roofs and
floors water damage to floors and walls and mold The June 9 2008 edition of the New York Tin es
shows an unidentified Arcata man tending his indoor grow the man claimed he can make25 000
every three months by selling marijuana grown in the bedroom of his rented house Claims of
ostensible medical marijuana growing pursuant to California s medical marijuana laws are being
advanced as a mostly false shield in an attempt to justify such illicit operations
Neither is fire an uncommon occurrence at grow houses elsewhere across the nation Another
occurred not long ago in Holiday Florida To compound matters further escape routes for
firefighters are often obstructed by blocked windows in grow houses electric wiring is tampered with
to steal electricity and some residences are even booby trapped to discourage and repel unwanted
intruders
D INCREASED ORGANIZED GANG ACTIVITIES
Along with marijuana dispensaries and the grow operations to support them come members of
organized criminal gangs to operate and profit from them Members of an ethnic Chinese drug gang
were discovered to have operated 50 indoor grow operations in the San Francisco Bay area while
Cuban American crime organizations have been found to be operating grow houses in Florida and
elsewhere in the South A Vietnamese drug ring was caught operating 19 grow houses in Seattle and
Puget Sound Washington In July of 2008 over 55 Asian gang members were indicted for narcotics
trafficking in marijuana and ecstasy including members of the Hop Sing Gang that had been actively
operating marijuana grow operations in Elk Grove and elsewhere in the vicinity of Sacramento
California
E EXPOSURE OF MINORS TO MARIJUANA
Minors who are exposed to marijuana at dispensaries or residences where marijuana plants are grown
may be subtly influenced to regard it as a generally legal drug and inclined to sample it In grow
houses children are exposed to dangerous fire and health conditions that are inherent in indoor grow
operations Dispensaries also sell marijuana to minors
F IMPAIRED PUBLIC HEALTH
Indoor marijuana grow operations emit a skunk like odor and foster generally unhealthy conditions
like allowing chemicals and fertilizers to be placed in the open an increased carbon dioxide level
within the grow house and the accumulation of mold 90 all of which are dangerous to any children or
adults who may be living in the residence although many grow houses are uninhabited
OO 2009 California Police Chiefs Assn 13 All Rights Reserved

G LOSS OF BUSINESS TAX REVENUE
When business suffers as a result of shoppers staying away on account oFtraffic blight crime and the
undesirability of a particular business district known to be frequented by drug users and traffickers
and organized criminal gang members a city s tax revenues necessarily drop as a direct consequence
H DECREASED QUALITY OF LIFE IN DETERIORATING NEIGHBORHOODS
BOTH BUSINESS AND RESIDENTIAL
Marijuana dispensaries bring in the criminal element and loiterers which in turn scare offpotential
business patrons of nearby legitimate businesses causing loss of revenues and deterioration of the
affected business district Likewise empty homes used as grow houses emit noxious odors in
residential neighborhoods project imtating sounds of whimng fans and promote the din of vehicles
coming and going at all hours of the day and night Near harvest time rival growers and other
uninvited enterprising criminals sometimes invade grow houses to beat clip crews to the site and rip
off mature plants ready for harvesting As a result violence often erupts from confrontations in the
affected residential neighborhood
ULTIMATE CONCLUSIONS REGARDING ADVERSE SECONDARY EFFECTS
On balance any utility to medical marijuana patients in care giving and convenience that marijuana
dispensaries may appear to have on the surface is enom ously outweighed by a much darker reality
that is punctuated by the many adverse secondary effects created by their presence in communities
recounted here These drug distribution centers have even proven to be unsafe for their own
proprietors
POSSIBLE LOCAL GOVERNMENTAL RESPONSES TO MARIJUANA DISPENSARIES
A IMPOSED MORATORIA BY ELECTED LOCAL GOVERNMENTAL
OFFICIALS
While in the process of investigating and researching the issue of licensing marijuana dispensaries as
an interim measure city councils may enactdate specific moratoria that expressly prohibit the presence
of marijuana dispensaries whether for medical use or otherwise and prohibiting the sale of marijuana
in any form on such premises anywhere within the incorporated boundaries of the city until a
specified date Before such a moratorium s date of expiration the moratoriwn may then either be
extended or a city ordinance enacted completely prohibiting or otherwise restricting the establishment
and operation of marijuana dispensaries and the sale of all marijuana products on such premises
County supervisors can do the same with respect to marijuana dispensaries sought to be established
within the unincorporated areas of a county Approximately 80 California cities including the cities
of Antioch Brentwood Oakley Pinole and Pleasant Hill and 6 counties including Contra Costa
County have enacted moratoria banning the existence of marijuana dispensaries In a novel approach
the City of Arcata issued a moratorium on any new dispensaries in the downtown area based on no
agricultural activities being permitted to occur there
OO 2009 California Police Chiefs Assn 14 All Rights Reserved

B IMPOSED BANS BY ELECTED LOCAL GOVERNMENTAL OFFICIALS
While the Compassionate Use Act of 1996 permits seriously ill persons to legally obtain and use
marijuana for medical purposes upon a physician
recommendation it is silent on marijuana
dispensaries and does not expressly authorize the sale of marijuana to patients or primary caregivers
Neither Proposition 215 nor Senate Bi11420 specifically authorizes the dispensing of marijuana in any
form from a storefront business And no state statute presently exists that expressly permits the
licensing or operation of marijuana dispensaries9 Consequently approximately 39 California cities
including the Cities of Concord and San Pablo and 2 counties have prohibited marijuana dispensaries
within their respective geographical boundaries while approximately 24 cities including the City of
Martinez and 7 counties have allowed such dispensaries to do business within their jurisdictions
Even the complete prohibition of marijuana dispensaries within a given locale cannot be found to run
afoul of current California law with respect to permitted use of marijuana for medicinal purposes so
long as the growing or use of inedical marijuana by a city or county resident in conformance with state
law is not proscribed
In November of 2004 the City of Brampton in Ontario Canada passed The Grow House Abatement
By law which authorized the city council to appoint inspectors and local police officers to inspect
suspected grow houses and render safe hydro meters unsafe wiring booby traps and any violation of
the Fire Code or Building Code and remove discovered controlled substances and ancillary equipment
designed to grow and manufacture such substances at the involved homeowner s cost And afrer
state legislators became appalled at the proliferation offor profit residential grow operations the State
of Florida passed the Marijuana Grow House Eradication act House Bill 173 in June of 2008 The
governor signed this bill into law making owning a house for the purpose of cultivating packaging
and distributing marijuana athird degree felony growing 25 or more marijuana plants a second
degree felony and growing 25 or more marijuana plants in a home with children presenY a first
degree felony It has been estimated that approximately 17 500 marijuana grow operations were
active in late 2007 To avoid becoming a dumping ground for organized crime syndicates who
decide to move their illegal grow operations to a more receptive legislative environment Califomia
and other states might be wise to quickly follow suit with similar bills for it may already be
happening o0
C IMPOSED RESTRICTED ZONING AND OTHER REGULATION BY ELECTED
LOCAL GOVERNMENTAL OFFICIALS
If so inclined rather than completely prohibit marijuana dispensaries through their zoning power city
and county officials have the authority to restrict owner operators to locate and operateso called
medical marijuana dispensaries in prescribed geographical areas of a city or designated
unincorporated areas of a county and require them to meet prescribed licensing requirements before
being allowed to do so This is a risky course of action though for would be dispensary operators and
perhaps lawmakers too since federal authorities do not recognize any lawful right for the sale
purchase or use of marijuana for medical use or otherwise anywhere in the United States including
California Other cities and counties have included as a condition of licensure for dispensaries that the
operator shall violate no federal or state law which puts any applicant inaCatch 22 situation
since to federal authorities any possession or sale of marijuana is automatically a violation of federal
law
Still other municipalities have recenUy enacted or revised comprehensive ordinances that address a
variety of inedical marijuana issues For example according to the City of Arcata Community
OO 2009 California Police Chiefs Assn 15 All Rights Reserved

Development Department in Arcata California in response to constant citizen complaints from what
had become an extremely serious community problem the Arcata City Council revised its Land Use
Standards for Medical Marijuana Cultivation and Dispensing In December of 2008 City of Arcata
Ordinance 1382 was enacted It includes the following provisions
Categories
I Personal Use
2 Cooperatives or Collectives
Medical Marijuana for Personal Use An individual qualified patient shall be allowed to cultivate
medical marijuana within his her private residence in conformance with the following standards
1 Cultivation area shall not exceed 50 sauare feet and not exceed ten feet 10 in hei
a
Cultivation lighting shall not exceed 1200 watts
b Gas products COZ butane etc for medical marijuana cultivation or processing is
prohibited
a
Cultivation and sale is prohibited as a Home Occupation sale or dispensing is
prohibited
d Qualified patient shall reside in the residence where the medical marijuanacu tivation
e
occurs
Qualified patient shall not participate in medical marijuana cultivation in any other
residence
f Residence kitchen bathrooms and primary bedrooms shall not be used primarily for
medical marijuana cultivation
g Cultivation area shall comply with the California Building Code 1203 Ventilation or 402 3 Mechanical Ventilation
h
The medical marijuana cultivation azea shall not adversely affect the health or safety
of the nearby residents
2
City Zoning Administrator my approve up to 100 squaze foot
a
Documentation showing why the 50 square foot cultivation area standard is not
feasible
b
Indude written permission from the property owner
a
City Building Official must inspect for California Building Code and Fire Code
d
At a minimum the medical marijuana cultivation area shall be constructed with a 1
hour firewall assembly of green board
e
Cultivation of inedical marijuana for personal use is limited to detached single family
residential properties or the medical marijuana cultivation area shall be limited to a
garage orself contained outside accessory building thatis secured locked and fully
enclosed
Medical Marijuana Cooperatives or Collectives
1 Allowed with a Conditional Use Permit
2
In Commercial Industrial and Public Facility Zoning Districts
3
Business form must be a cooperative or collective
4
Existing cooperative or collective shall be in full compliance within one year
5 Total number of inedical marijuana cooperatives or collectives is limited to four and
ultimately two
6 Special consideration if located within
a
A 300 foot radius from any existing residential zoning district
b
Within 500 feet of any other medical narijuana cooperative or collective
OO 2009 California Police Chiefs Assn 16 All Rights Reserved

c
Within 500 feet from any existing public park playground day care or school
7 Source of inedical marijuana
a
Permitted Cooperative or Collective On site medical marijuana cultivation shall not
exceed twenty five 25 percent of the total floor area but in no case greater than
1500 squaze feet and not exceed ten feet 0 in height
b
Off site Permitted Cultivation Use Pernut application and be updated annually
c
Qualified Patients Medical marijuana acquired from an individual qualified patient
shall received no monetaty remittance and the qualified patient is a member of the
inedical marijuana cooperative or collective Collective or cooperative may credit its
members for medical marijuana provided to the collective or cooperative which they
may allocate to other members
8
Operations Manual at a minimum include the following information
a
Staff screening process including appropriate background checks
b Operating hours
c
Site floor plan of the facility
d
Security measures located on the premises including but not limited to lighting
alanns and automatic law enforcement notification
e
Screening registration and validation process for qualified patients
f
Qualified patient records acquisition and retention procedures
g Process for tracking medical marijuana quantities and inventory controls including
on site cultivation processing and or medical marijuana products received from
h
outside sources
Measures taken to minimize or offset energy use from the cultivation or processing of
medical marijuana
i
Chemicals stored used and any effluent discharged into the City s wastewater and or
storm water system
9 Operating Standards
a
No dispensing medical marijuana more than twice a day
b Dispense to an individual qualified patient who has a valid verified physician
recommendation The medical marijuana cooperative or collective shall verify that
the physician
recommendation is cunent and valid
c
Display the client rules and or regulations at each building entrance
d Smoking ingesting or consuming medical marijuana on the premises or in the
vicinity is prohibited
e
Persons under the age of eighteen 18 are precluded from entering the premises
f
No on site display of marijuana plants
g No distribution of live plants starts and clones on through Use Pennit
h
Permit the on site display or sale of marijuana paraphernalia only through the Use
Pennit
i
Maintain all necessary permits and pay all appropriate taxes Medical marijuana
cooperatives or collectives shall also provide invoices to vendors to ensure vendor s
tax liability responsibility
j Submit an Annual Performance Review Report which is intended to identify
effectiveness of Yhe approved Use Pernut Operations Manual and Conditions of
Approvai as well as the identification and implementation of additional procedures as
deemed necessary
k
Monitoring review fees shall accompany the Annual Performance Review Report
for costs associated with the review and approval of the report
10
Permit Revocation or Modification A use permit may be revoked or modified for non
compliance with one or more of the items described above
OO 2009 California Police Chiefs Assn 17 All Rights Reserved

LIABILITY ISSUES
With respect to issuing business licenses to marijuana storefront facilities a very real issue has
arisen counties and cities are arguably aiding and abetting criminal violations of federal law Such
actions clearly put the counties permitting these establishments in very precarious legal positions
Aiding and abetting a crime occurs when someone commits a crime the person aiding that crime
knew the cruninal offender intended to commit the crime and the person aiding the crime intended
to assist the criminal offender in the commission of the crime
The legal definition of aiding and abetting could be applied to counties and cities allowing marijuana
facilities to open A county that has been informed about the Gonzales v Raich decision knows that
all marijuana activity is federally illegal Furthermore such counties know that individuals involved
in the mazijuana business are subject to federal prosecution When an individual in Califomia
cultivates possesses transports or uses marijuana he or she is committing a federal crime
A county issuing a business license to a marijuana facility knows that the people there are
committing federal crimes The county also knows that those involved in providing and obtaining
marijuana are intentionally violating federal law
This very problem is why some counties arere thinking the presence of marijuana facilities in their
communities There is a valid fear of being prosecuted for aiding and abetting federal drug crimes
Presently two counties have expressed concern that California s medical marijuana statutes have
placed them in such a precarious legal position Because of the serious criminal ramifications
involved in issuing business permits and allowing storefront marijuana businesses to operate within
their borders San Diego and San Bernardino Counties filed consolidated lawsuits against the state
seeking to prevent the State of California from enforcing its medical marijuana statutes which
pofentially subject them to criminal liability and squarely asserting that California medical
marijuana laws are preempted by federal law in this area After California s medical marijuana laws
were all upheld at the trial level California s Fourth District Cour of Appeal found that the State of
California could mandate counties to adopt and enforce a voluntary medical marijuana identification
card system and the appellate court bypassed the preemption issue by finding that San Diego and
San Bernardino Counties lacked standing to raise this challenge to Califomia s medical marijuana
laws Following this state appellate court decision independent petitions for review filed by the two
counties were both denied by the California Supreme Court
Largely because of the quandary that county and city peace officers in California face in the field
when confronted with alleged medical marijuana with respect to enforcement of the total federal
criminal prohibition of all marijuana and state exemption from criminal penalties for medical
marijuana users and caregivers petitions for a writ of certiorari were then separately filed by the two
counties seeking review of this decision by the United States Supreme Court in the consolidated
cases of County of San Diego County ofSan Bernardino and Ga y Pen od as Sheriffof the County
of San Bernardino v San Diego Nonn State ofCalifornia and Sandra Shew y Director of the
California Department ofHealth Services in herocial capacityCt App Case NoD5333 The
High Court has requested the State of California and other interested parties to file responsive briefs
to the two counties and Sheriff Penrod s writ petitions before it decides whether to grant or deny
review of these consolidated cases The petitioners would then be entifled to file a reply to any filed
response It is anticipated that theUS Supreme Court will formally grant or deny review of these
consolidated cases in late April or early May of 2009
OO 2009 California Police Chiefs Assn 18 All Rights Reserved

In another case City of Gurden Grove v Superior Court 2007 157 Ca1 App 4th 355 although the
federal preemption issue was not squarely raised or addressed in its decision California s Fourth
District Court of Appeal found that public policy considerations allowed a city standing to challenge
a state trial court s order directing the return by a city police department of seized medical marijuana
to a person determined to be a patient Afrer the court ordered return of this federally banned
substance was upheld at the intermediate appellate level and not accepted for review by the
California Supreme Court a petition for a writ of certiorari was filed by the City of Garden Grove to
the US Supreme Court to consider and reverse the state appellate court decision But that petition
was also denied However the case of People v Kelly 2008 163 Ca1 App 4th 124 in which a
successful challenge was made to Califomia s Medical Marijuana Program s maximum amounts of
marijuana and marijuana plants permitted to be possessed by medical marijuana patients CaL HS
Code sec 11362 77 et seq which limits were found at the court of appeal level to be without legal
authority for the state to impose has been accepted for review by the California Supreme Court on
the issue of whether this law was an unproper amendment to Proposition 215 s Compassionate Use
Act of 1996
A SAMPLING OF EXPERIENCES WITH MARIJUANA DISPENSAT2IES
L
MARIJUANA DISPENSARIES THE SAN DIEGO STORY
After the passage of Proposition 215 in 1996 law enforcement agency representatives in San Diego
California met many times to formulate a comprehensive strategy of how to deal with cases that may
arise out of the new law In the end it was decided to handle the matters on a by case basis In
addition questionnaires were developed for patient caregiver and physician interviews At times
patients without sales indicia but large grows were interviewed and their medical records reviewed
in making issuing decisions In other cases where sales indicia and amounts supported a findin of
sales the cases were pursued At most two cases a month were brought for felony prosecution
In 2003 San Diego County s newly elected District Attorney publicly supported Prop 215 and
wanted her newly created Narcotics Division to design procedures to ensure patients were not caught
up in case prosecutions As many already know law enforcement officers rarely arrest or seek
prosecution of a patient who merely possesses personal use amounts Rather it is those who have
sales amounts in product or cultivation who are prosecuted For the next two years the District
Attorney s Office proceeded as it had before But on the cases where the patient had too many
plants or product but not much else to show sales the DDAs assigned to review the case would
interview and listen to input to respect the patient s and the DA s position Some cases were
rejected and others issued but the case disposition was often generous and reflectedasin no more
view
All of this changed after the passage of SB 420 The activists andpro marijuana folks started to
push the envelope Dispensaries began to open for business and physicians started to advertise their
availability to issue recommendations for the purchase of inedical marijuana By spring of 2005 the
first couple of dispensaries openedup but they were discrete This would soon change By fhat
summer 7 to 10 dispensaries were open for business and they were selling marijuana openly In
fact the local police department was doing a smallbuy walk project and one of its target dealers said
he was out of pot but would go get some from the dispensary to sell to the undercover officer UC
he did It was the proliferation of dispensaries and ancillary crimes that prompted the San Diego
Police Chief the Chief was a Prop 215 supporter who sparred with the Fresno DEA in his prior job
over tbis issue to authorize his officers to assist DEA
O 2009 California Police Chiefs Assn 19 All Rights Reserved

The Investigatiou
San Diego DEA and its local task force NTF sought assistance from the DA s Office as well as the
US Attomey s Office Though empathetic about being willing to assist the DA s Office was not
sure how prosecutions would fare under the provisions of SB 420 The US Attorney had the easier
road but was noncommittal After several meetings it was decided that law enforcement would work
on using undercover operatives UCs to buy so law enforcement could see exactly what was
happening in the dispensaries
The investigation was initiated in December of 2005 after NTF received numerous citizen
complaints regarding the crime and traffic associated with medical marijuana dispensaries The
City of San Diego also saw an increase in crime related to the marijuana dispensaries By then
approximately 20 marijuana dispensaries had opened and were operating in San Diego County and
investigations on 15 of these dispensaries were initiated
During the investigation NTF learned that all of the business owners were involved in the
transportation and distribution of large quantities of marijuana marijuana derivatives and marijuana
food products In addition several owners were involved in the cultivation of high grade marijuana
The business owners were making significant profits from the sale of these products and not
properly reporting this income
Undercover Task Force Officers TFO s and SDPD Detectives were utilized to purchase marijuana
and marijuana food products from these businesses In December of 2005 thirteen state search
warrants were executed at businesses and residences of several owners Two additional foliow up
search warrants and a consent search were executed the same day Approximately 977 marijuana
plants from seven indoor marijuana grows 564 88 kilograms of marijuana and marijuana food
products one gun and over58 000 US currency were seized There were six arrests made during
the execution of these search warrants for various violations including outstanding warrants
possession of marijuana for sale possession of psilocybin mushrooms obstructing a police officer
and weapons violations However the owners and clerks were not arrested or prosecuted at this
time just those vho showed up witt weapons or product to sell
Given the fact most owners could claim mistake of law as to selling though not a legitimate defense
it could be ajury nullification defense the DA s Office decided not to file cases at that time It was
hoped that the dispensaries would feel San Diego was hostile ground and they would do business
elsewhere Unfortunately this was not the case Over the next few months seven of the previously
targeted dispensaries opened as well as a slew of others Clearly prosecutions would be necessary
To gear up for there opened and new dispensaries prosecutors reviewed the evidence and sought a
second round of UC buys wherein the UC would be buying for themselves and they would have a
second UC present at the time acting as UC1 s caregiver who also would buy This was designed to
show the dispensary was not the caregiver There is no authority in the law for organizations to act
as primary caregivers Caregivers must be individuals who care for a marijuana patient A primary
caregiver is defined by Proposition 215 as codified inHS Code section 11362 5e as For the
purposes of this section primary caregiver means the individual designated by the person exempted
under this section who has consistently assumed responsibility for the housing health or safety of
that person The goal was to show that the stores were only selling marijuana and not providing
care for the hundreds who bought from them
O 2009 California Police Chiefs Assn 20 All Rights Reserved

In addition to the caregiver controlled buys another aim was to put the whole matter in perspective
for the media and the public by going over the data that was found in the raided dispensary records
as well as the crime statistics An analysis of the December 2005 dispensary records showed a
breakdown of the purported illness and youthful nature of the patients The charts and other PR
aspects played out after the second take down in July of 2006
The final attack was to reveal the doctors the gatekeepers for medical marijuana for the fraud they
were committing UCs from the local PD went in and taped the encounters to show that the pot docs
did not examine the patients and did not render care at all rather they merely sold a medical MJ
recommendation whose duration depended upon the amount of money paid
In April of 2006 two state and two federal search warrants were executed at a residence and storage
warehouse utilized to cultivate marijuana Approximately 347 marijuana plants over 21 kilograms
of marijuana and2855 US currency were seized
Due to the pressure from the public the United States Attorney s Office agreed to prosecute the
owners of the businesses with large indoor marijuana grows and believed to be involved in money
laundering activities The District Attorney s Office agreed to prosecute the owners in the other
investigations
n Tune of 2006 a Federal Grand Jury indicted six owners for violations of Title 21 USC sections
846 and 841 a1 Conspiracy to Distribute Marijuana sections 846 and 841 a Conspiracy to
Manufacture Marijuana and Title 18 USC Section 2 Aiding and Abetting
In July of 2006 11 state and 11 federal search warrants were executed at businesses and residences
associated with members of these businesses The execution of these search warrants resulted in the
arrest of 19 people seizure of over 19Q000 in US currency and other assets four handguns one
rifle 405 marijuana plants from seven grows and over 329 kilograms of marijuana and marijuana
food products
Following the search warrants two businesses reopened An additional search warrant and consent
search were executed at these respective locations Approximately 20 kilograms of marijuana and
32 marijuana plants were seized
As a resu t all but two of the individuals arrested on state charges have pled guilty Several have
already been sentenced and a few are still awaiting sentencing All of the individuals indicted
federally have also pled guilty and are awaiting sentencing
After the July 2006 search warrants a joint press conference was held with the US Attorney and
District Attorney during which copies of a complaint to the medical board photos of the food
products which were marketed to children and the charts shown below were provided to the media
Directly after these several combined actions there were no marijuana distribution businesses
operating in San Diego County Law enforcement agencies in the San Diego region have been able
to successfully dismantle these businesses and prosecute the owners As a result medical marijuana
advocates have staged a number of protests demanding DEA allow the distribution of marijuana
The closure of these businesses has reduced crime in the sunounding areas
OO 2009 California Police Chiefs Assn 21 All Rights Reserved

The execution of search warrants at these businesses sent a powerful message to other individuals
operating marijuana distribution businesses that they are in violation of both federal law and
California law
Press Materials
Reported Crime at Marijuana Dispensaries
From January 1 2005 through June 23 2006
18 t
s
4
y
16 F
II
E
s
14
2
10
t
r
8 M C
6
4
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rk
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r s
3
49
E
x
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i
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r
3 a vin y
a
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o
4
2
0
tAw
4 L
ti
Y
Burglary Attempted Criminal Attempted Armed Battery
Burglary Threat Robbery Robbery
r
w
r
x
w
Information showing the dispensaries attracted crime
The marijuana dispensaries were targets of violent crimes because of the amount of marijuana
currency and other contraband stored inside the businesses From January I 2005 through June 23
2006 24 violent crimes were reported at marijuana dispensaries An analysis of financial records
seized from the marijuana dispensaries showed several dispensaries were grossing over 300 000 per
month from selling marijuana and marijuana food products The majority of customers purchased
marijuana with cash
Crime statistics inadequately reflect the actual number of crimes committed at the marijuana
dispensaries These businesses were ofren victims of robberies and burglaries but did not report the
crimes to law enforcement on account of fear of being arrested for possession of marijuana in excess
of Prop 215 guidelines NTF and the San Diego Police Department SDPD received nwnerous
citizen compiaints regarding every dispensary operating in San Diego County
Because the complaints were received by various individuals the exact number of complaints was
not recorded The following were typical complaints received
high levels of traffic going to and from the dispensaries
people loitering in the parking lot of the dispensaries
people smoking marijuana in the parking lot of the dispensaries
O 2009 California Police Chiefs Assn 22 All Rights Reserved

vandalism near dispensaries
threats made by dispensary employees to employees of other businesses
citizens worried they may become a victim of crime because of their proximity to
dispensaries
In addition the following observations from citizen activisYs assisting in data gathering were made
about the marijuana dispensaries
Identification was not requested for individuals who looked under age 18
Entrance to business was not refused because of lack of identification
Individuals were observed loitering in the parking lots
Child oriented businesses and recreational areas were situated nearby
Some businesses made no attempt to verify a submitted physician
recommendation
Dispensary Patients By Age
Ages 71 75 4 0
Ages66 70 191Ages 76 80 0 0
Ages61 65 47 2IA9es 81 85 0 0
Ages 56 60 89 3
Ages 51 55 173 6
AgBS46 50 210 7
No Age listed 118 4
Ages 17 20 364 12
Ages41 45 175 6
Ages 36 40 270 9 Ages 21 25 719 23
Ages 31 35 302 10
Ages 26 30 504 17
An analysis of patient records seized during search warrants at several dispensaries show that 52
of the customers purchasing marijuana were between the ages of 17 to 30 63 of primary
caregivers purchasing marijuana were betwecn the ages of 18 through 30 Only205 of customers
submitted a physician
recommendation for AIDS glaucoma or cancer
Why these businesses were deemed to be criminal not compassionate
The medical marijuana businesses were deemed to be criminal enterprises for the following reasons
Many of the business owners had 6istories of drug and violence related arrests
The business owners were street level marijuana dealers who took advantage of Prop 215 in
an attempt to legitimize marijuana sales for profit
Records or lack of records seized during the search wanants showed that all the owners
were not properly reporting income generated from the sales of marijuana Many owners
were involved in money laundering and tax evasion
The businesses were selling to individuals without serious medical conditions
There are no guidelines on the amount of marijuana which can be sold to an individual For
OO 2009 California Police Chiefs Assn 23 Afl Rights Reserved

example an individual with a physician
recommendation can go to as many marijuana
distribution businesses and purchase as much marijuana as she wants
Califomia law allows an individual to possess 6 mature or 12 immature plants per qualified
person However the San Diego Municipal Code statesacaregiver can only provide care
to 4 people including themselves this translates to 24 mature or 48 immature plants total
Many of these dispensaries are operating large marijuana grows with far more plants than
allowed under law Several of the dispensaries had indoor marijuana grows inside the
businesses with mature and or immature marijuana plants over the limits
State law allows a qualified patient or primary caregiver to possess no more than eight
ounces of dried marijuana per qualified patient However the San Diego Municipal Code
allows prunary caregivers to possess no more than two pounds of processed marijuana
Under either law almost every marijuana dispensary had over two pounds of processed
marijuana during the execution of the search warrants
Some marijuana dispensaries force customers to sign forms designating the business as their
primary caregiver in an attempt to circwnvent the law
2 EXPERIENCES WITH MARIJUANA DISPENSARIES IN RIVERSIDE COUNTY
There were some marijuana dispensaries operating in the County of Riverside until the District
Attorney s Office took a very aggressive stance in closing them In Riverside anyone that is not a
qualified patienY or primary caregiver under the Medical Marijuana Program Act who possesses
sells or transports marijuana is being prosecuted
Several dispensary closures illustrate the impact this position has had on marijuana dispensaries For
instance the Palm Springs Caregivers dispensary also known as Palm Springs Safe Access
Collective was searched after a warrant was issued All materials inside were seized and it was
closed down and remains closed The California Caregivers Association was located in downtown
Riverside Very shortly after it opened it was also searched pursuant to a warrant and shut down
The CannaHelp dispensary was located in Palm Desert It was searched and closed down early in
2007 The owner and two managers were than prosecuted for marijuana sales and possession of
marijuana for the purpose of sale However a judge granted their motion to quash the search
warrant and dismissed the chazges The District Attorney s Office then appealed to the Fourth
District Court of Appeal Presently the Office is waiting for oral azguments to be scheduled
Dispensaries in the couniy have also been closed by court order The Healing Nations Collective
was located in Corona The owner lied about the nature of the business in his application for a
license The city pursued and obtained an injunction that required the business to close The owner
appealed to the Fourth District Court of Appeal which ruled against him Ciry of Corona v Ronald
Naa lls et al Case No E042772
3 MEDICAL MARIJUANA DISPENSARY ISSUES IN CONTRA COSTA COUNTY
CITIES AND IN OTHER BAY AREA COUNTIES
Several cities in Contra Costa County California have addressed this issue by either banning
dispensaries enacting moratoria against them regulating them or taking a position that they are
simply not a permitted land use because they violate federal law Richmond El Cerrito San Pablo
Hercules and Concord have adopted permanent ordinances banning the establishment of marijuana
dispensaries Antioch Brentwood Oakley Pinole and Pleasant Hill have imposed moratoria
against dispensaries Clayton San Ramon and Walnut Creek have not taken any formal action
regarding the establishment of marijuana dispensaries but have indicated that marijuana dispensaries
O 2009 California Police Chiefs Assn 24 All Rights Reserved

are not a permitted use in any of their zoning districts as a violation of federal law Martinez has
adopted a permanent ordinance regulating the establishment of marijuana dispensaries
The Counties of Alameda Santa Clara and San Francisco have enacted permanent ordinances
regulating the establishment of marijuana dispensaries The Counties of Solano Napa and Marin
have enacted neither regulations nor bans A brief overview of the regulations enacted in
neighboring counties follows
A
Alameda County
Alameda County has a nineteen page regulatory scheme which allows the operation of three
permitted dispensaries in unincorporated portions of the county Dispensaries can only be located in
commercial or industrial zones or their equivalent and may not be located within1000 feet of other
dispensaries schools parks playgrounds drug recovery facilities or recreation centers Permit
issuance is controlled by the Sheriff who is required to work with the Community Development
Agency and the Health Care Services agency to establish operating conditions for each applicant
prior to final selection Adverse decisions can be appealed to the Sheriff and aze ruled upon by the
same panel responsible for setting operating conditions That panel s decision may be appealed to
the Board of Supervisors whose decision is final subject to writ review in the Superior Court per
CCP sea 1094 5 Persons violating provisions of the ordinance are guilty of a misdemeanor
B
Santa Clara Counly
In November of 1998 Santa Clara County passed an ordinance permitting dispensaries to exist in
unincorporated portions of the county with permits first sought and obtained from the Department of
Public Health In spite of this regulation neither the County Counsel nor the District Attorney s
Drug Unit Supervisor believes that Santa Clara County has had any marijuana dispensaries in
operation at least through 2006
The only permitted activities are the on site cultivation of inedical marijuana and the distribution of
medical marijuana medical marijuana food stuffs No retail sales of any products are permitted at
the dispensary Smoking ingestion or consumption is also prohibited on site All doctor
recommendations for medical marijuana must be verified by the County s Public Health
Department
C
San Francisco County
In December of 2001 the Board of Supervisors passed Resolution No 012006 declaring San
Francisco to beaSanctuary for Medical Cannabis City voters passed Proposition S in 2002
directing the city to explore the possibility of establishing a medical marijuana cultivation and
dish program run by the city itself
San Francisco dispensaries must apply for and receive a permit from the Department oFPublic
Health They may only operate as a collective or cooperative as defined by California Health and
Safety Code section 11362 7 see discussion in section 4 under California Law above and may
only sell or distribute marijuana to members Cultivation smoking and making and selling food
products may be allowed Permit applications are refened to the Departments of Planning Building
Inspection and Police Criminal background checks are required but exemptions could still allow
the operation of dispensaries by individuals with prior convictions for violent felonies or who have
had prior permits suspended or revoked Adverse decisions can be appealed to the Director of
O 2009 California Police Chiefs Assn 25 All Rights Reserved

Public Health and the Board of Appeals It is unclear how many dispensaries aze operating in the
city at this time
D
Crime Rates in the Vicinity of MariCare
Sheriff s data have been compiled for Calls for Service within a half mile radius of 127 Aspen
Drive Pacheco However in research conducted by the El Cerrito Police Department and relied
upon by Riverside County in recently enacting its ban on dispensaries it was recognized that not all
crimes related to medical marijuana take place in or around a dispensary Some take place at the
homes of the owners employees or patrons Therefore these statistics cannot paint a complete
picture of the impact a marijuana dispensary has had on crime rates
The statistics show that the overall number oF calls decreased3746 in 2005 versus3260 in 2006
However there have been increases in the numbers of crimes which appear to be related to a
business which is an attraction to a criminal element Reports of commercial burglaries
increased 14 in 2005 24 in 2006 as did reports of residential burglaries 13 in 2005 16 in 2006
and miscellaneous burglaries 5 in 2005 21 in 2006
Tender Holistic Care THC marijuana dispensary formerly located on N Buchanan Circle in
Pacheco was forcibly burglarized on June 11 2006 4800 in cash was stolen along with
marijuana hash marijuana food products marijuana pills marijuana paraphernalia and marijuana
plants The total loss was estimated to be16 265
MariCare was also burglarized within two weeks of opening in Pacheco On Apri14 2006 a
window was smashed after 11 00pm while an employee was inside the business working late to
get things organized The female employee called 911 and locked herself in an office while the
intruder ransacked the downstairs dispensary and stole more than 200 worth of marijuana
Demetrio Ramirez indicated that since they were just moving in there wasn t much inventory
Reports of vehicle thefts increased 4 in 2005 6 in 2006 Disturbance reports increased in nearly all
categories Fights 5 in 2005 7 in 2006 Harassment 4 in 2005 5 in 2006 Juveniles 4 in 2005 21
in 2006 Loitering 11 in 2005 19 in 2006 Verbal 7 in 2005 17 in 2006 Littering reports
increased from 1 in 2005 to 5 in 2006 Public nuisance reports increased from 23 in 2005 to 26 in
2006
These statistics reflect the complaints and concems raised by nearby residents Residents have
reported to the District Attomey s Office as well as to Supervisor Piepho s office that when calls
are made to the Sheriffls Department the offender has ofrentimes eft the area before law
enforcement can arrive This has led to less reporting as it appears to local residents to be a futile
act and residents have been advised that law enforcement is understaffed and cannot always timely
respond to all calls for service As a result Pacheco developed a very active visible Neighborhood
Watch program The program became much more active in 2006 according to Doug Stewart
Volunteers obtained radios and began frequently receiving calls directly from local businesses and
residents who contacted them instead of law enforcement It is therefore significant that there has
still been an increase in many types of calls for law enforcement service although the overall
number of calls has decreased
Other complaints from residents included noise odors smoking consuming marijuana in the area
littering and trash from the dispensary loitering near a school bus stop and in the nearby church
parking lot observations that the primary patrons of MariCare appear to be individuals under age 25
OO 2009 California Police Chiefs Assn 26 All Rights Reserved

and increased traffic Residents observed that the busiest time for MariCare appeared to be from
400pm to600pm On a typical Friday 66 cazs were observed entering MariCare s facility 49
of these were observed to contain additional passengers The slowest fime appeared to be from
100pm to300pm On a typical Saturday 44 cars were counted during this time and 29 of these
were observed to have additional passengers MariCare has claimed to serve4000 patients
E
Impact of Proposed Ordinance on MedDelivery Dispensary EI Sobrante
It is the position of Contra Costa County District Attorney Robert J Kochly that a proposed
ordinance should terminate operation of the dispensary in El Sobrante because the land use of that
business would be inconsistent with both state and federal law However the Community
Development Department apparently believes that MedDelivery can remain asalegal non
conforming use
F
Banning Versus Regulating Marijuana Dispensaries in Unincorporated
Confra Costa County
It is simply bad public policy to allow the proliferation of any type of business which is illegal and
subject to being raided by federal and or state authorities In fact eight locations associated with the
New Remedies dispensary in San Francisco and Alameda Counties were raided in October of 2006
and eleven Southern California marijuana clinics were raided by federal agents on January 18 2007
The Los Angeles head of the federal Drug Enforcement Administration told CBS News after the
January raids that Today s enforcement operations show that these establishments are nothing more
thandrug trafficking organizations bringing cruninal activities to our neighborhoods and drugs near
our children and schools A Lafayette California resident who owned a business that produced
marijuana laced foods and drinks for marijuana clubs was sentenced in federal court to five years
and 10 months behind bars as well asa25Q000 fine Several of his employees were also convicted
in that case
As discussed above there is absolutely no exception to the federal prohibition against marijuana
cultivation possession transportation use and distribution Neither California s voters nor its
Legislature authorized the existence or operation of marijuana dispensing businesses when given the
opportunity to do so These enterprises cannot fit themselves into the few narrow exceptions that
were created by the Compassionate Use Act and Medical Marijuana Program Act
Further the presence of marijuana dispensing businesses contributes substantially to the existence of
a secondary market for illegal street level distribution of marijuana This fact was even recognized
by the United States Supreme Court The exemption for cultivation by patients and caregivers can
only increase the supply of marijuana in the California market Tbe likelihood that al such
production will promptly terminate when patients recover or will precisely match the patients
medical needs during their convalescence seems remote whereas the danger that excesses will
satisfy some of the admittedly enormous demand for recreational use seems obvious Gonzales v
Raich supra 125 SCt atp 2214
As outlined below clear evidence has emerged of such a secondary market in Contra Costa County
In September of 2004 police responded to reports of two men pointing a gun at cars in
the parking lot at Monte Vista High School during an evening football game dance Two
19 year old Danville residents were located in the parking lot which was full of vehicles
and pedestrians and in possession of a silver Airsoft pellet pistol designed to replicate a
O 2009 California Police Chiefs Assn 27 All Rights Reserved

eal Walthersemi automatic handgun Marijuana hash and hash oil with typical
dispensary packaging and labeling were also located in the car along with a gallon
bottle of tequila 14 full a bong with burned residue and rolling papers The young
men admitted to having consumed an unknown amount of tequila at the park next to
the school and that they both pointed the gun at passing cars as ajoke They fired
several BBs at a wooden fence in the park when there were people in the area The
owner of the vehicle admitted that the marijuana was his and that he was not a medicinal
marijuana user He was able to buy marijuana from his friend Brandon who used a
Proposition 215 card to purchase from a cannabis club in Hayward
In February of 2006 Concord police officers responded to a report of a possible drug sale
in progress They arrested a high school senior for two outstanding warrants as he came
to buy marijuana from the cannabis club located on Contra Costa Boulevard The young
man explained that he had a cannabis club card that allowed him to purchase marijuana
and admitted that he planned tore sell some of the marijuana to friends He also
admitted to possession of nearly 7 grams of cocaine which was recovered A21 year old
man was also arrested on an outstanding warrant In his car was a marijuana grinder a
baggie of marijuana rolling papers cigars andab1unY hollowed out cigar filled with
marijuana for smoking with one end burned The21 year old admitted that he did not
have a physician
recommendation for marijuana
Also in February of 2006 a 17 year old Monte Vista High School senior was charged
with felony furnishing of marijuana to a child after giving a4year old boy a marijuana
laced cookie The furnishing occurred on campus during a child development class
In March of 2006 police and fire responded to an explosion at a San Ramon townhouse
and found three young men engaged in cultivating and manufactwing honey oil for local
pot clubs Marijuana was also being sold from the residence Honey oil is a concentrated
form of cannabis chemically extracted from ground up marijuana with extremely volatile
butane and a special honey oiP extractor tube The butane extraction operation exploded
with such farce that it blew the garage door partia ly off its hinges Sprinklers in the
residence kept the fire from spreading to the other homes in the densely packed residential
neighborhood At least one of the men was employed by Ken EsYes owner of the
Dragonfly Holistic Solutions pot clubs in Richmond San Francisco and Lake County
They were making the honey oil with marijuana and butane that they brought up from
one of Estes San Diego pot clubs after it was shut down by federal agents
Also in March of 2006 a16 year old El Cerrito High School student was arrested afrer
selling pot cookies to fellow students on campus many of whom became ill At least
four required hospitalization The investigation revealed that the cookies were made with
a butter obtained outside a marijuana dispensary a secondary sale Between March of
2004 and May of 2006 the El Cerrito Police Department conducted seven investigations
at the high school and junior high school resulting in the arrest of eight juveniles for
selling or possessing with intent to sell marijuana on or around the school campuses
In June of 2006 Moraga police officers made a traffic stop for suspected driving under
the influence of alcohol The car was seen drifring over the double yellow line separating
north and southbound traffic lanes and driving in the bike lane The20 year old driver
denied having consumed any alcohol as he was the designated driver When asked
about his bloodshot watery and droopy eyes the collegejunior explained that he had
OO 2009 California Police Chiefs Assn 28 All Rights Reserved

smoked mazijuana earlier confirmed by blood tests The young man had difficulty
performing field sobriety tests slurred his speech and was ultimately arrested for driving
under the influence He was in possession of a falsified California Driver s License
marijuana hash a marijuana pipe a scale and12 288 The marijuana was in packaging
from the Compassionate Collective of Alameda County a Hayward dispensary He
explained that he buys the marijuana at Pot Clubs sells some and keeps the rest He
only sells to close friends About3000 to4000 of the cash was from playing high
stakes poker but the rest was earned selling marijuana while a freshman at Arizona State
University The18 year old passenger had half an ounce of marijuana in her purse and
produced a doctor s recommendation to a marijuana club in Oakland the authenticity of
which could not be confirmed
Another significant concem is the proliferation of marijuana usage at community schools In
February of 2007 the Healthy Kids Survey for Alameda and Contra Costa Counties found that
youthful substance abuse is more common in the East Bay s more affluent areas These areas had
higher rates of high school juniors who admitted having been high from drugs The regional
manager of the study found that the affluent areas had higher alcohol and marijuana use rates USA
Today recently reported that the percentage of 12 Grade students who said they had used marijuana
has increased since 2002 from 336 to 36 2 in 2005 and that marijuana was the most used
illicit drug among that age group in 2006 KSDK News Channel 5 reported that high school students
are finding easy access to medical marijuana cards and presenting them to school authorities as a
legitimate excuse for getting high School Resource Officers for Monte Vista and San Ramon
Valley High Schools in Danville have reported finding marijuana in prescription bottles and other
packaging from Alameda County dispensaries Marijuana has also been linked to psychotic
illnesses A risk factor was found to be starting marijuana use in adolescence
For all of the above reasons it is advocated by District Attomey Kochly that a ban on land uses
which violate state or federal law is the most appropriate solution for the County of Contra Costa
4 SANTA BARBARA COUNTY
According to Santa Barbara County Deputy District Attorney Brian Cota ten marijuana dispensaries
are currently operating within Santa Barbara County The mayor of the City of Santa Barbara who
is an outspoken medical marijuana suppor er has stated that the police must place marijuana behind
every other police priority This has made it difficult for the local District Attomey s Office Not
many marijuana cases come to it for filing The District Attomey s Office would like more
regulations placed on the dispensaries However the majority of Santa Barbara County political
leaders and residents are very liberal and do not want anyone to be denied access to medical
marijuana if they say they need it Partly as a result no dispensazies have been prosecuted to date
5 SONOMA COUNTY
Stephan R Passalocqua District Attorney for the County of Sonoma has recently reported the
following information related to distribution of inedical inarijuana in Sonoma County In 1997 the
Sonoma County Law Enforcement Chiefs Association enacted the following medical marijuana
guidelines a qualified patient is permitted to possess three pounds of marijuana and grow 99 plants
in a 100 square foot canopy A qualified caregiver could possess or grow the above mentioned
amounts for each qualified patient These guidelines were enacted afrer Proposition 215 was
overwhelmingly passed by the voters of California and afrer two separate unsuccessfixl prosecutions
in Sonoma County Two Sonoma County juries returned not guilty verdicts for three defendants
OO 2009 California Police Chiefs Assn 29 All Rights Reserved

who possessed substantially large quantities of marijuana 60 plants in one case and over 900 plants
in the other where they asserted a medical marijuana defense These verdicts and the attendant
publicity demonstrated that the community standards are vastly different in Sonoma County
compared to oYher jurisdicYions
On November 6 2006 and authorized by Senate Bi11420 the Sonoma County Boazd of Supervisors
specifically enacted regulations that allow a qualified person holding a valid identification card to
possess up to three pounds of dried cannabis a year and cultivate 30 plants per qualified patient No
individual from any law enforcement agency in Sonoma County appeared at the hearing nor did any
representative publicly oppose this resolution
With respect to the People v Sashon Jenkins case the defendant provided verified medical
recommendations for five qualified patients prior to trial At the time of arrest Jenkins said that he
had a medical marijuana card and was a care provider for multiple people but was unable to provide
specific documentation Mr Jenkins had approximately 10 pounds of dried marijuana and was
growing 14 plants which number of plants is consistent with the 2006 Sonoma County Board of
Supervisors resolution
At a preliminary hearing held In January of 2007 the defense called five witnesses who were
proffered as Jenkins patients and who came to court with medical recommendations Jenkins
also testified that he was their caregiver Afrer the preliminary hearing the assigned prosecutor
conducted a thorough review of the facts and the law and concluded that a Sonoma Countyjury
would not returnaguilty verdict in this case Hence no felony information was filed With
respect to the return of property issue the prosecuting deputy district attorney never agreed to
release the marijuana despite dismissing the case
Other trial dates aze pending in cases where medical marijuana defenses are being alleged District
Attomey Passalacqua has noted that given the overwhelming passage of proposition 215 coupled
with at least one United States Supreme Court decision that has not struck it down to date these
factors present current challenges for law enforcement but that he and other prosecutors will
continue to vigorously prosecute drug dealers within the boundazies of the law
6 ORANGE COUNTY
There are 15 marijuana dispensaries in Orange Counry and several delivery services Many of
the delivery services operate out of the City of Long Beach in Los Angeles County Orange
County served a search warrant on one dispensary and closed it down A decision is being made
whether or not to file criminal charges in Yhat case It is possible that the United States Attorney
will file on that dispensary since it is a branch of a dispensary that the federal authorities raided
in San Diego County
The Orange County Board of Supervisors has ordered a study by the county s Health Care
Department on how to comply with the Medical Marijuana Program Act The District
Attorney s Office s position is that any activity under the Medical Marijuana Program Act
beyond the mere issuance of identification cards violates federal law The District Attorney s
Office has made it clear to County Counsel that if any medical marijuana provider does not meet
a strict definition of primary caregiver that person will be prosecuted
OO 2009 California Police Chiefs Assn 30 All Rights Reserved

PENDING LEGAL QUESTIONS
Law enforcement agencies throughout the state as well as their legislative bodies have been
struggling with how to reconcile the Compassionate Use Act CUA Cal Health Safety
Code secs 11362 5 et seq with the federal Controlled Substances Act CSA 21USC sec
801 et seq for some time Pertinent questions follow
QUESTION
1
Is it possible for a storefront marijuana dispensary to be legally operated
under the Compassionate Use Act of 1996 Health Sa Code sec 11362 5
and the Medical Marijuana Program Act Health Saf Code secs 11362 7
11362 83
AN5WER
1 Storefront marijuana dispensaries may be legally operated under the CUA
and the Medical Marijuana Program Act D4MPA Cal Health Safety
Code secs 711362 83 as long as they are cooperatives under the
MMPA
ANALYSIS
The question posed does not specify what services or products are available atastorefront
marijuana dispensary The question also does not specify the business structure of a
dispensaryAdispensary is often commonly used nowadays as a generic term for a facility
that distributes medical marijuana
The term dispensary is also used specifically to refer to marijuana facilities that are operated
more like a retail establishment that are open to the public and often sell medical marijuana to
qualified patients or caregivers By use of the term store front dispensary the question may be
presuming that this type of facility is being operated For purposes of this analysis we will
assume thatadispensary is a generic term that does not contemplate any particular business
structure Based on that assumptionadispensary might provide assistance to a qualified
patient or a person with an identification card or his or her designated primary caregiver in
administering medical marijuana to the qualified patient or person or acquiring the skills
necessary to cultivate or administer marijuana for medical purposes to the qualified patient or
person and be within the permissible limits of the CUA and the MMPA Cal Health Safety
Code sec 11362 765b3
1 As the term dispensary is commonly used and understood marijuana dispensaries
would not be permitted under the CUA or the MMPA since they sell medical marijuana and
are not operated as true cooperatives
O 2009 California Police Chiefs Assn 31 All Rights Reserved

The CUA permitsapatienY orapatienYs primary caregiver to possess or cultivate marijuana
for personal medical purposes with the recommendation of a physician Cal Health Safety
Code sec 11362 5d Similarly the MMPA provides that patients or designated primary
caregivers who have volunfarily obtained a valid medical marijuana identification card shall not
be subject to arrest for possession transportation delivery or cultivation of inedical marijuana in
specified quantities Cal Health Safety Code sea ll362 71 deAstorefront
dispensary would not fit within either of these categories
However the MMPA also provides thatqualified patients persons with valid identification
cards and the designated primary caregivers of qualified patients and persons with identification
cards who associate within the State of California in ardercol ectively or cooperatively to
cultivate marijuana for medical purposes shall not solely on the basis of that fact be subject to
state criminal sanctions under section 11357 possession 11358 planting harvesting or
processing 11359 possession for sale I 1360 unlawful transportation importation sale or
gift 11366 opening or maintaining place for trafficking in controlled substances 11366 5
providing place for manufacture or distribution of controlled substance Fortifying building to
suppress law enforcement entry or 11570 Buildings or places deemed nuisances subject to
abatement Cal Health Safety Code sec 11362 775 Emphasis added
Since medical marijuana cooperatives are permitted pursuant to the MMPAastorefront
dispensary that would qualify as a cooperative would be permissible under the MMPA Cal
Health
Safety Code sec 11362 775 See also People v Ur iceunu 2005 132 Cal App 4th
747 finding criminal defendant was entitled to present defense relating to operation of inedical
marijuana cooperative In granting are trial the appellate court in Urziceane found thaY the
defendant could present evidence which might entitle him to a defense under the MMPA as to
the operation of a medical marijuana cooperative including the fact that the cooperative
verified physician recommendations and identities oF individuals seeking medical marijuana and
individuals obtaining medical marijuana paid membership fees reimbursed defendant for his
costs in cultivating the medical marijuana by way of donations and volunteered at the
cooperative Id at p 785
Whether or not sales are permitted under Urziceanu and the MMPA is unclear The
Urziceanar Courf did note that the incorporation of secYion 11359 relating to marijuana sales
in section 11362 775 allowing the operation of cooperatives contemplates the formation and
operation of inedicinal marijuana cooperatives that would receive reimbursement for marijuana
and the services provided in conjunction with the provision of that marijuana Whether
reimbursemenY may be in the form only of donations as were the facts presented in Urziceanu
or whether purchases could be made for medical marijuana it does seem clear that a medical
marijuana cooperative may not makeaprofit but may be restricted to being reimbursed for
actual cosYs in providing Yhe marijuana to its members and if there are any profits these may
have to be reinvested in the cooperative or shared by its members in order for a dispensary to
1
O 2009 California Police Chiefs Assn 32 All Rights Reserved

e truly considered to be operating asacooperative If these requirements aze satisfied as to a
storefront dispensary then it will be permissible under the MMPA Otherwise it will be a
violation of both the CUA and the MMPA
QUESTION
2 If the governing body of a city county ar city and county approves an ordinance
authorizing and regulating marijuana dispensaries to implement the Compassionate
Use Act of 1996 and the Medical Marijuana Program Act can an individual board or
council member be found to be acting illegally and be subject to federal criminal
charges including aiding and abetting or state criminal charges
ANSWER
2
If a city county or city and county authorizes and regulates marijuana
dispensaries individual members of the legislative bodies may be held criminally
liable under state or federal law
ANALYSIS
A
Federal Law
Generally legislators of federal state and local legislative bodies are absolutely
immune from liability for legislative acts US Const art I sec6Speech and
Debate Clause applicable to members of Congress Fed Rules Evid Rule 501
evidentiary privilege against admission of legislative acts Tenney v Brandhove
1951 341 US 367 legislative immunity applicable to state legislators Bogan
v Scott Harris 1998 523 US 44 legislative immunity applicable to local
legislators However while federal legislators are absolutely immune from both
criminal and civil liability for purely legislative acts local legislators are only
nnmune from civil liability under federal law United States v Gillock 1980
445 US 360
Where the United States Supreme Court has held that federal regulation of marijuana by way of
the CSA including any medical use of marijuana is within Congress Commerce Clause
power federal law stands as a baz to local action in direct violation of the CSA Gonzales v
Razch 2005 545 US 1 In fact the CSA itself provides that federal regulations do not
zA is defined as follows An enterprise or organization that is owned or managed
jointly by thOSe wh0 uSe itS faCi11t1eS OC Serv1CeS THE AMERICAN HERITAGE DICTIONARY OF THE
ENC stiLnN unGe by Houghton Mifflin Company 4th Ed 2000
3 Indeed the same conclusion would seem to result from the adoption by state legislators of the
MMPA itself in authorizing the issuance of inedical marijuana identification cards Cal Health
Safety Code secs 11362 71 et seq
OO 2009 California Police Chiefs Assn 33 All Rights Reserved

exclusively occupy tbe 8eld of drug regulation unless there is a positive conflict between that
provision of this title the CSA and that state law so that the two cannot consistently stand
together 21USC sec 903
Based on the above provisions then legislative action by local legislators cou d subject the
individnal legislators to federal criminal liability Most likely the only violation of the CSA that
could occur as a result of an ordinance approved by local legislators authorizing and regulating
medical marijuana would be aiding and abetting a violation of the CSA
The elements of the offense of aiding and abetting a criminal offense are 1 specific intent to
facilitate commission of a crime by another 2 guilty knowledge on the part of the accused 3
fhat an offense was being committed by someone and 4 that the accused assisted or
participated in the commission of an offense United States v Raper 1982 676F2d 841
United States v Staten 1978 581 F2d 878
Criminal aiding and abetting liability under 18USC section 2 requires proof that the
defendants in some way associated themselves with the illegal venture that they participated in
the venture as something that they wished to bring about and that they sought by their actions to
make the venture succeed Central Bank NA v First Interstate BarzlG NA 1994 511 US
164 Mere fumishing of company to a person engaged in a crime does not render a companion
an aider or abettor United States v Garguilo 2d Cir 1962 310F2d 249 In order for a
defendant to be an aider and abettor he must know that the activity condemned by law is actually
occurring and must intend to help the perpetrator United States v McDaniel 9th Cir 1976
545 F2d 642 To be guilty of aiding and abetting the defendant must willfully seek by some
action of his own to make a criminal venture succeed United States v EhrenbergED Pa
1973 354 F Supp 460 cert denied 1974 94 S Ct 1612
The question as posed may presume that the local legislative body has acted in a manner that
affirmatively supports marijuana dispensaries As phrased by Senator Kuehl the question to be
answered by the Attomey General s Office assumes that a local legislative body has adopted an
ordinance that authorizes medical marijuana facilities What if a local public entity adopts an
ordinance that explicitly indicates that it does not authorize legalize or permit any dispensary
that is in violation of federal law regarding controlled substances lf the local public entity
grants a permit regulates or imposes locational requirements on marijuana dispensaries with the
announced understanding that it does not thereby allow any illegul activity and that dispensaries
are required to comply with all applicable laws including federal laws then the public entity
should be entifled to expect that all laws will be obeyed
It would seem that a public entiYy is not intentionally acting to encourage or aid acts in violation
of the CSA merely because it has adopted an ordinance which regulates dispensaries even the
issuance ofapermit if it is expressly not allowing violations of federallaw cannot necessarily
support a charge or conviction of aiding and abetting violation of the CSA A public entity
should be entitled to presume that dispensaries will obey all applicable laws and that lawful
business will be conducted at dispensaries For instance dispensaries could very well not engage
in actual medical marijuanadish but instead engage in education and awareness activities
as to the medical effects of marijuana the sale of other legal products that aid in the suffering of
OO 2009 California Police Chiefs Assn 34 All Rights Reserved

ailing patients or even activifies directed at effecting a change in the federal laws relating to
regulation of marijuana as a Schedule I substance under the CSA
These are examples of legitimate business activities and First Amendment protected activities at
that in which dispensaries could engage relating to medical marijuana but not apparently in
violation of the CSA Public entities should be entitled to presume that legitimate activities can
and will be engaged in by dispensaries that are permitted and or regulated by local regulations
In fact it seems counterintuitive that local public entities within the state should be expected to
be the watchdogs of federal law in the area of controlled substances at least local public entities
do not have an affirmative obligation to discem whether businesses are violating federal law
The California Attorney General s Office will note that the State Board of Equalization BOE
has already done precisely what has been suggested in the preceding paragraph In a special
notice issued by the BOE this year it has indicated that sellers of inedical marijuana must obtain
a seller
permit Seehttp www boe ca gov news
medse11er2007 pdf Special Notice
Important Information for Sellers of Medical Marijuana As the Special Notice explicitly
indicates to medical marijuana facilitieshaving a seller
permit does not mean you have
authority to make unlawful sales The permit only provides a way to remit any sales and use
taxes due The pennit states NOTICE TO PERMITTEE You are required to obey all federal
and state laws that regulate or control your business This permit does not allow you to do
otherwise
The above being said however there is no guarantee that criminal charges would not actually be
brought by the federal government or that persons so charged could not be successfully
prosecuted It does seem that arguments contrary to the above conclusions could be persuasive
in convicting local legislators By permitting and or regulating marijuana dispensaries by local
ordinance some legitimacy and credibility may be granted by governmental issuance of permits
or authorizing and allowing dispensaries to exist or locate within a jurisdiction
All of this discussion then simply demonstrates that individual board or council members can
indeed be found criminally liable wtder federal law for the adoption of an ordinance authorizing
and regulating marijuana dispensaries that promote the use of marijuana as medicine The
actual likelihood of prosecution and its potential success may depend on the particulaz facts of
the regulation that is adopted
a
Of course the question arises as to how far any such liability be taken Where can the line be
drawn between any permit or regulation adopted specifically with respect to marijuana
dispensaries and other permits or approvals routinely and often ministerially granted by local
public entities such as building permits or business licenses which are discussedir fi a If local
public entities are held responsible for adopting an ordinance authorizing and or regulating
marijuana dispensaries cannot local public entities also be subject to liability for providing
general public services for the illegal distribution of medical marijuana Could a local public
entity that knew a dispensary was dislributing medical marijuana in compliance with state law
be criminally liable if it provided electricity water and trash services to that dispensary How
can such actions really be distinguished from the adoption of an ordinance that authorizes and or
regulates marijuana dispensaries
O 2009 California Police Chiefs Assn 35 All Rights Reserved

B
State Law
Similarly under California law aside from the person who directly commits a
crunina offense no other person is guilty as a principal unless he aids and
abets People v Dole 1898 122 Cal 486 People v Stein 1942 55 Cal App 2d
417 A person who innocently aids in the commission of the crime cannot be found
guilty People v Fredoni 1910 12 Cal App 685
To authorize a conviction as an aider and abettor of crime it must be shown not
only that the person so charged aided and assisted in the commission of
the offense but also that he abetted the act that is that he criminally or with
guilty knowledge and intent aided the actual perpetrator in the commission of the
act People v Terman 1935 4 Cal App 2d 345 To abet another in
commission of a crime implies a consciousness of guilt in instigating encouraging
promoting or aiding the commission of the offense People v Best 1941 43 Cal App
2d 00 Abet implies knowledge of the wrongful purpose of the perpetrator of the
crime People v Stein sacpra
To be guilty of an offense committed by another person the accused must not only aid
such perpetrator by assisting or supplementing his efforts but must with knowledge of
the wrongful purpose of the perpetrator abet by inciting or encouraging him People v
Le Grant 1946 76 Cal App 2d 148 72 People v Carlson 1960 177 CaL App 2d
201
The conclusion under state law aiding and abetting would be similar to the analysis above under
federal law Similar to federal law immunities available to local legislators discussed above
state law immunities provide some protection for local legislators Local legislators are certainly
immune from civil liability relating to legislative acts it is unclear however whether they would
also be immune from criminal liability Sterner v Superior Court 50Ca1 App 4th 1771
assuming but finding no California authority relating toacriminal exception to absolute
immunity for legislators under state law Given the apparent state of the law local egislators
could only be certain that they would be immune from civil liability and could not be certain that
5 Although the Steiner Court notes thatwell
established federal law supports the exception
when federal case authority is applied in a state law context there may be a different outcome
Federal authorities note that one purpose supporting criminal immunity as to federal legislators
from federal prosecution is the separation of powers doctrine which does not apply in the
context offederal criminal prosecuYion of local legislators However if a state or county
prosecutor brought criminal charges against a local legislator the separation of powers doctrine
may bar such prosecution CaL Const art III sec 3 As federal authorities note bribery or
other criminal charges that do not depend upon evidence of and cannot be said to further any
Iegislative acts can still be prosecuted against legislators SeeBr v Riddle 4th Cir 1980
631 F2d 272 279 Illegal acts such as bribery are obviously not in aid of legislative activity
and legislators can claim no immunity for illegal acts United States v Brewster 408 US 501
indictment for bribery not dependent upon how legislator debated voted or did anything in
chamber or committee prosecution need only show acceptance of money for promise to vote
not carrying through of vote by legislator United States v Swi sdallllth Cir 1992 971 F2d
O 2009 California Police Chiefs Assn 36 All Rights Reserved

they would be at all immune from criminal liability under state law However there would not
be any criminal violation if an ordinance adopted by a local public entity were in compliance
with the CUA and the MMPA An ordinance authorizing and regulating medical marijuana
would not by virtue solely of its subject matter be a violation of state law only if the ordinance
itself permitted some activity inconsistent with state law relating to medical marijuana would
there be a violation of state law that could subject local legislators to criminal liability under state
law
QUESTION
3 If the governing body of a city city and county or county approves an ordinance
authorizing and regulating marijuana dispensaries to iinplement the
Compassionate Use Act of 1996 and the Medical Marijuana Program Act and
subsequently a particular dispensary is found to be violating state law regarding
sales and trafficking of marijuana could an elected official on the goveming body
be guilty of state criminal charges
ANSWER
3 Afrer adoption of an ordinance authorizing or regulating marijuana dispensaries
elected officials could not be found criminally liable under state law For the
subsequent violation of state law by a particular dispensary
ANALYSIS
Based on the state law provisions referenced above relating to aiding and abetting it does not
seem that a local public entity would be liable for any actions of a marijuana dispensary in
violation of state law Since an ordinance authorizing andlor regulating marijuana dispensaries
would necessarily only be authorizing and or regulating to the extent already permitted by state
law local elected officials could not be found to be aiding and abetting a violation of state law
In fact the MMPA clearly contemplates local regulation of dispensaries Cal Health Safety
Code sec 11362 83 Nothing in this article shall prevent a city or other local goveming body
from adopting and enforcing laws consistent with this article Moreover as discussed above
there may be legislative immunity applicable to the legislative acts of individual elected officials
in adopting an ordinance especially where it is consistent with state law regarding marijuana
dispensaries that dispense crude marijuana as medicine
1531 1549 evidence of legislative acts was essential element of proof and thus immunity
applies Therefore a criminal prosecution that relates solely to legislative acts cannot be
maintained under the separation of powers rationale for legislative immunity
O 2009 California Police Chiefs Assn 37 All Rights Reserved

QUESTION
4
Does approval of such an ordinance open the jurisdictions themselves to civil or
criminal liability
ANSWER
4
Approving an ordinance authorizing or regulating marijuana dispensaries may
subject the jurisdicrions to civil or criminal liability
ANALYSIS
Under federal law criminal liability is created solely by statute Dowling v United States
1985 473 US 207 213 Although becoming more rare municipalities have been and still
may be criminally prosecuted for violations of federal law where the federal law provides not
just a penalty for imprisonment but a penalty for monetary sanctions See Green Stuart P The
Criminal Prosecution ofLocal Governments 72NC L Rev 1197 1994 discussion of history
of inunicipal criminal prosecution
The CSA prohibits persons from engaging in certain acts including the distribution and
possession of Schedule I substances of which marijuana is one 21USC sec 841 A person
for purposes of the CSA includes any individual corporation government or govermnental
subdivision or agency business trust partnership association or other lega entity 21CFR
sec 1300 01 34 See also 21CFR sea 1301 02 Any term used in this part shall have the
definition set forth in section 102 of the Act 21USC 802 or part 1300 of this chapter By
its very terms then the CSA may ba violated by a local public entity If the actions of a local
public entity otherwise satisfy the requirements of aiding and abetting a violation of the CSA as
discussed above then local public entities may indeed be subject to criminal prosecution for a
violation of federal law
Under either federal or state law local public entities would not be subject to civil liability for
the mere adoption of an ordinance a legislative act As discussed above local legislators are
absolutely immune from civil liability for legislative acts under both federal and state law In
addition there is specific immunity under sfafe law relafing fo any issuance or denial of permits
QUESTION
5
Does the issuance of a business license to a marijuana dispensary involve any
additional civil or criminal liability far a city or county and its elected governing
body
ANSWER
5 Local public entities will likely not be liabla for the issuance of business licenses
to marijuana dispensaries that plan to dispense crude marijuana as medicine
OO 2009 California Police Chiefs Assn 38 All Rights Reserved

ANALYSIS
Business licenses are imposed by cities within the State of Califomia oftentimes solely for
revenue purposes but are permitted by state law to be imposed for revenue regulatory or For
both revenue and regulatory purposes Cal Gov Code sea 37101 Assuming a business
license ordinance is for revenue purposes only it seems that a local public entity would not have
any liability for the mere collection of a tax whether on legal or illega activities However any
liability that would attach would be analyzed the same as discussed above In the end a local
public entity could hardly be said to have aided and abetted the distribution or possession of
marijuana in violation of the CSA by its mere collection of a generally applicable tax on all
business conducted within the entity s jurisdiction
OVERALL FINDINGS
All of the above further exemplifies the catch 22 in which local public entities are caught in
trying to reconcile the CUA and MMPA on the one hand and the CSA on the other In light of
the existence of the CUA and the MMPA and the resulting fact that medical marijuana is being
used by individuals in California local public entities have a need and desire to re ulate fhe
location and operation of inedical marijuana facilities within their jurisdiction 6 io
However because of the divergent views of the CSA and Califomia law regarding whether there
is any accepted medical use of marijuana state and loca legislators as well as local public
entities themselves could be subject to criminal liability for the adoption of statutes or
ordinances furthering the possession cultivation distribution transportation and other act
prohibited under the CSA as to marijuana Whether federal prosecutors would pursue federal
criminal charges against state and or local legislators or local public entities remains to be seen
But based on past practices of locally basedUS Attorneys who have required seizures of large
amounts of marijuana before federal filings have been initiated this can probably be considered
unlikely
6 Several compilations of research regarding the impacts of marijuana dispensaries have been
prepared by the California Police Chiefs Association and highlight some of the practical issues
facing local public entities in regulating these facilities Links provided are as fol2ows
Riverside County Office of the District AfYorney White Paper Medical Marijuana History
and Current Complications September2006 Recent Information Regarding Marijuana and
Dispensaries EI Cerrito Police Department Memorandum dated January 12 2007 from
Commander M Regan to Scott C Kirkland Chief of Police Marijuana Memorandum El
CerriTO Police Department Memorandum dated April 18 2007 from Commander M Regan to
Scott C Kirkland Chief of Police Law Enforcement Concerns to Medical Marijuana
Dispensaries Impacts of Medical Marijuana Dispensaries oncom nunities between 75 000 and
100 000 population Survey and council agenda report City of Livermore
O 2009 California Police Chiefs Assn 39 All Rights Reserved

CONCLUSIONS
In light of the United States Supreme Court s decision and reasoning in Gonzales v Raich
the United States Supremacy Clause renders Califomia s Compassionate Use Act of 1996
and Medical Marijuana Program Act of 2004 suspect No state has the power to grant its
citizens the right to violate federal law People have been and continue to be federally
prosecuted for marijuana crimes The authors of this White Paper conclude that medical
marijuana is not legal under federal law despite the current California scheme and wait for
the United Stafes Supreme Court to ultimately rule on this issue
Furthermore storefront mazijuana businesses are prey for criminais and create easily
identifiable victuns The people growing marijuana are employing illegal means to protect
their valuable cash crops Many distributing marijuana are hardened criminals Several
are members of stepped criminal street gangs and recognized organized crime syndicates
while others distributing marijuana to the businesses are perfect targets for thieves and
robbers They are being assaulted robbed and murdered Those buying and using medical
marijuana are also being victimized Additionally illegalso called medical marijuana
dispensaries have the potential for creating liability issues for counties and cities All
marijuana dispensaries should generally be considered illegal and should not be permitted to
exist and engage in business within a county s or city s borders Their presence poses a clear
violation of federal and state law they invite more crime and they compromise the health
and welfare oflaw abiding citizens
O 2009 California Police Chiefs Assn 40 All Rights Reserved

ENDNOTES
US Const art VI cl 2
US Const art I sec 8 cl 3
Gonzales v Raich 2005 125 SCt 2195 at p 2204
Gonzales v Raich See also United States v Oakland Cannabis Btryers Cooperative 2001 121 SCt
1711 1718
Gonzales v Raich 2005 125 SCt 2195 see also lnited Slates v Oakland Cannabis Buyers
Cooperative 121 SCt 1711
6 Josh Meyer Scott GloverUS won t prosecute medical pot sales Los Angeles Times 19 March
2009 available athwww latimes com news local lame medpotl9
2009mar19 04987571 story
See People v Mower 2002 28 Cal 4th 457 463
e Health and Safety Code section ll362 5b 1 A All references hereafrer o the Health and Safety
Code are by section number only
9HS Code sec 113625 a
10HS Code sec I 1362 7 et seg
HS Code sec 11362 7
HS Code secs 71 11362 76
13 HS Code sec 11362 77
14HS Code secs 11362 765 and 11362 775 People v Urziceanu 2005 132 Cal App 4 747 at p 786
15 HS Code sec 11362 77 whether or no this section violates the Califomia ConstiNtion is currendy
under review by the California Supreme Court See People v Kelly 2008 82 Ca1 Rptr3d 167 and People
v Pbomphakdy 2008 SS Cal Rptr 3d 693
16 HS Code secs 11357 11358 11359 1136Q 11366 11366 5 and 11570
HS Code sea ll362 7h gives a more comprehensive list AIDS anorexia arthritis cachexia
cancer chronic pain glaucoma migraine persistent muscle spasms seizures severe nausea and any other
chronic or persistent medical symptom that either substantially limits the ability of a person to conduct one
or more lifeac ivities as defined in the ADA or may cause serious harm to the patien s safery or physical
or mental health if not alleviated
1e People v Mower 2002 28 CalAth 457 at p 476
19 Id Emphasis added
Packel Organization and Operation ofCooperatives Sth ed Philadelphia American Law Institute
1970 45
Sam Stanton Pot C1ubs Seized Plants NewPresiden Manjuana
Future ls Hazy Sacramendo
Bee 7 December 2008 19A
For a statewide list seehttp canortnl org prop cbclist html
Laura McClure Fuming Over the Pot Clubs Califa nia Lawver Magazine Sune 2006
HS Code sec 11362 765 c see eg People v Urziceanu 132Cal AppAth 747 at p 764
Gonzales v Raieh supru 125 SCt at page 2195
People v C7i ziceanu 2005 132 Ca1 App 4th 747 see alsoHS Code sec 11362 765
Israel Packel 45 Italics added
HS Code sea 11362 7d1
See eg McClure Fuming Over Pot Clubs CalifornraLawyerMagazine June 2006
30HS Code secs 11362 5e and 11362J d123 and e see also People ez rel Lungren v Peron
1997 59Cal App 4th 1383 1395
People Mower 28 CalAth at 476 Emphasis added
Glenda Anderson Laytonville Marijuana Guru Shot to Death 2 Others Beaten in Home No Suspeets but
Officials Believe Killing Related to Pot Growing Santa Rosa Press Democrat 19 November 2005
available athttp wwwl
oressdemocrat com anps obcsdll article All 2001119 NEWSll 190303 1033
33 Medical Marijuana Shop Robbed Santa Barbm
Indepeiident 10 August 2006 available a
httn
independentcom news 2006 a ue10 med ieaIma riiuana shon robbed
34 Mark Scaramella No Good Deed Goes Unpunished Anderson Valley Adverziser 16 June 2004
available athttp www theava com 04 0616 cerelli hfiil
OO 2009 California Police Chiefs Assn 41 All Rights Reserved

js Ricci Graham Police Arrest Suspeci in Deadly San Leandro Pot Club Robbery OaklandTi ibfane S
August 2006 available athttn findarticles com oarticles mi qn4176 is 20060808 ai n16659257
ab Ricci Graham Man Faces Murder Charge in Pot Robbery Oaklaiid Tribime 24 August 2005
available athwww hisl beam com doc 1P2 7021933 html
3 Ricci Graham Another Medical Marijuana Clinic Robbed Oqkland Tribune 10 September 2005
availableathttp findarticles com particles mi an4176 is 20050910 ai n158091 9print
3s Laura Clark Po Dispensary Owner Slain at Home Ckiah DailyJourna I9 November 2007 available at
hwww mariivana com drue war headline news 24910 ca pot dispensarv
ownervslain home html
3B Laura Clark Breaking News Medical Marijuana Supplier Les Crane Killed Ukiah DailyJow 19
November 2005 Laura Clark Les Crane Murder Imestigation ContinuesLkiah Daily Journal 27
November 2005 Glenda Anderson Laytonville Marijuana Guru Shot to Death Santa Rosa Po
Democrat 19 November 2005 Glenda Anderson Pot Activist Likely Knew Killers Police Believe Gunmen
Who Robbed Laytonville Man Familiar With Home Sant Rosa Press Democrat 20 November 2005
available athttn www eaualri hts4all us
contenUview 192 50
40 Mark Scaramella The Mendo Pot Chronicles Anderson Valley Advertiser 3 Oc ober 2007 available at
htto wwwtheava com 04 0616 cerellihtm I
41 Kirk Johnson Killing Highlights Risk of Selling Marijuana Even Legally New York Times 13 March
2007 available at
httpJ www vtimescoml2007 03
us
02cannabishtml ex 1 I81880000 en
c609936094adda 0ei 5070
Tami Abdollah Richard Winron Po Theft Claimed in Boy s Shooting Death Los Angeles Times 23
January 2007 available at
http www californiavolicechiefs ore nav tiles mariivana filesibellflower shootine dea h odf
43 Will Bigham Claremont Marijuana Dispensary BurglarizedIn and Valley Daily Bulletin 27 January 2007
available athttp www
dailvbulletin wn ci 5104514
Planning Commission Agenda available athttp www el eelrito ore see also Ala Lopez E Cerri o
Moves to Ban Dispensaries ConG Costa Times 24 June 2006 available at
httpwwwthc m in istrvneUforum a rchive el cerritomoves
bancamiab isclubs 6974 htm
45 Pred Ortega City Bans Outlets for Medical Marijuana San Gabriel ValleyTi ibune 17 August 2006
available at
http www lca uk ore Icaforum viewtooic php f6t2436 stam0 sid 1566da l 15 a0da43 facb 17644195cbb
46 Ortega
47 Greg Beato Pot Clubs in Peril Are San Francisco Zoning Boards a Bigger Threat to Medical Manjuana
Than de DEA Reason Magazine February 2007 available at
httwww reason eom news show 118314 html Craig T Steckler Ciry ofFremont Police Depm tment
1lemoranderm re Medicnl Marijunnn Dispensaries Potentia Secondarv Impacts 20 June 2006 Tim
Miller Ciry ofAnaheim Police Department Special Operations Division Memoranduin re Medical
Mar yuana Dispensary MMD Ban Ordinance 13 June 2007
48 Jeff McDonald 15 Held in Raids on Pot Stores San Diego Union Tribune 7 July 2006 available at
http
wwwsienonsandieeo com uniontrib 20060707 news 7m7not html
49 McDonald Beato
i0 CaL HS Code sec 11362 5
Ethan Stewart The Medical Marijuana Movemen Grows in Santa Barbara Emerald Dreams and
Smoky Realities Santa Barbmn Lzdependent 3 May 2007 available at
http
independentcom new5i2007 mav 03 medical mariivaua movement erows santa barbara see also
Adam Ashton DEA Busts Pot Store Day After Council Talk Modesto Bee 28 September 2006
5 McDonald
Stewart
54 Stewart
5i Stewart
sb National DrugIn elligence Center Domesttc Cannabis Cultivation Assessment 2007 Pebruary 2007
available athttu www usdoj
ovMdidoubs2l 224R6 Jaxon Van Derbeken Charlie Goodyear Rachel
Gordon 3 SF Pot Clubs Raided in Probe of Organized Cnme San Francisco Chronicle 23 June 2005
available athttp www sfgate con cgi bin article egi file ca2005 06 23
MNGRODDG321 DTL
LAPD report information 2007
O 2009 California Police Chiefs Assn 42 All Rights Reserved

5 Van Derbeken et al
58 Kate Heneroty Medical marijuana iudictment unsealed Jtn ist 24 June 2005 available at
http iurisLlaw pitt edu
paperchase 2005 06 medical marijuana indic ment unsealed hp Sacy Finz 19
Named in Medicinal Pot Indictment More Than9300 Marijuana PlanLS Were Seized in Raids San
Francisco Chroiiicle 24 June 2005 available at
hsfeate condcgi bii article cei file ca2005 06 24
BAGV9DEC4C1 DTL
5 Organized Crime Bahind Medical Marijuana Dispensary in Califomia Pushirigback 29 September 2006
available athttp
pushineback com bloas pushinaback archive 2006 09 29 791 asox Ashton
bo City of San Diegq Crame Stanstics 2007 available athtto www sandieeo eov
61 National Drug Intelligence Center Marijuano January 2001 available athttp www usdoi eov
b George Anastasia Viet Gangs on the Rise Agaic The Emergiug American Underworld angs
Plant filled Houses a Growing Part of Drug Trade Chronrcle ofBoredom 18 Apri1200 7
63 W ill Bigham Houses Linked to Asian Gangs Inland Valley DailyBu letin 23 September 2007
available ahttn www
dailvbulletin eom newsci 6980682
ba Bigham 23 September 2007
bs Feds Came and Went Now What Humboldt County News 30 June 2008 available at
http new s hum co untvcom archives 2008 6
06 LAPD Report NumberDR
060625000 16 August 2006
6 LAPD Report NumberDR
060625001 16 August 2006
bs Tim Miller Ciry ofAnaheim Police Department Special Opera ions Division Memorandum re
Marijuana Dispensary MMD Ban Ordinance 25 October 2006 Johnson Gaig T Steckler City of
Fremon Police Department Memorandum re Medical Marijuana Dispensaries Potential Secondary
Impacts 20 June 2006
09 Stewart
Johnson
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What has the US DEA said about medical marijuana Medical Marijua ProCon org 2005 What
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Jim Avila Marijuana McMansions Cops Say Organized Crime Is Sending Families Into the Suburbs to
Grow Marijuana ABC News 14 June 2007 available athttp abenews eo con print id 3242760
Avila Anastasia DEA Raids Miami Grow House CBSS com 30 April 2008 available a
hUcbsS com
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Bigham 23 September 2007Ehan Baron Angel Linked to Grow op The Prorince CNBC 21 May
2005 availableat hvww mapine ore ewstcl v05 n823 a02 html
Bigham 23 September 2007
Bigham 23 September 2007
Hea her Allen Marijuana Grow Houses Flourish as Southwest Florida Marke Drops IieraldTribune com 24 July
2007 available athcom article
20070724MEWS
70724049R
80 Eric Bailey and Tim Reiterman Where Mary Jane is the girl next door Los Angeles Times 31 May
20D8 available athttp articles latimes com 2008 mav 31local me root31
81 Eureka House Fire the Result ofYou know wha Humboldt Cowtry News 7 September 2008 available
athttp news humcountv com written remarks of Arcata Police Chief Randy Mendosa 1 March 2009
e Jesse McKinley Marijuana Hotbed Retreats on Medicinal Use New York Times 9 June 2009
availableathttp www ytimes com 2008 06 09 us pot hmlr1em ex 1213329
83 Deputies Fire Damages Holiday Marijuana Grow Home tampabay com 15 February 2008 available at
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86 Sandy Louey Arrests Take Toll onIocal Gang The Sacramento Bee 14 August 2008 available at
http
wwwsacbee com elk rove voinUstorv 1152310 html
Avila
OO 2009 California Police Chiefs Assn 43 All Rights Reserved

88 Scott Glover Morro Bay Pot Dispensary Owner Found Guilty of Federal Charges Los Angeles Times 6
August 2008 available ahttp articles latimes com 2008 aue 06 locaUme pot6
B Bailey and Reiterman
90 Janis Ramsay Special Report Grow op House Can Still Be Dream Home Realtor Says The Bmrie
Advance 25 August 2008 available athttp www maoine or dru news v08 n818 a06 html
91 Avila
Bailey and Reiterman
93 Steve Davis Grow Securiry Cannabis Culture Mugazine 6 August 2004 available at
httn www eannab isculturecom articles 3441 html
94 Bailey andRei erman
9 See People v Urziceanu 132Cal App 4th 747
96 City of Pleasant Hill Presentation to Its Planning Commission by Planning Division Staff on April 24 2007
B4 Office Consolidation By law 361 2004 of the City of Brampto Ontario Canada
98 Bi11 McCollum Landmark Bill Targeting Marijuana Grow Houses Becomes Law Attomey General Bill
McCollum News Release 17 June 2008 available at
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myfloridalegaLcom
nsf
newsreleases
AFAE7E2BCC16SSD15525746B0070D23B
9B Asian Gangs Move Grow ops The Asian Pacific Post 27 September 2007 available at
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ftk080811548063f0115482401d00003 asian eanas move
ops do html
ioo See Asian Gangs Move Grow ops
101 See Does Marijuana Con ribute to Psychotic Ilinesses Current Psychiany Online62 February 2007
10 See eghttp www
californiaroolicechief
ore navfiles research ordinances html
1 National Drug Intelligence Center
row
OO 2009 California Police Chiefs Assn 44 All Rights Reserved

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OO 2009 California Police Chiefs Assn 49 All Rights Reserved

MARIJ UANA DISPENSARI ES
AND THE FEDERAL GOVERNMENT
RECOMMENDATIONS TO THE
OBAMA ADMiNISTRATION
Z DO9

MARIJUANA DISPENSARIES
AND THE FEDERAL GOVERNMENT
RECOMMENDATIONS TO
THE OBAMA ADMINISTRATION
sr
Fri
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DEFINITIONS
The terms cannabis and marijuana are used interchangeably in this paper to refer to the psychoactive
material in either herbal or resinous form from the Cannobis genus of flowering plants
The use of the terms medical marijuana and medical marijuana dispensaries in this paper should not be
taken as conferring or acknowledging any validity to the use or distribution of cannabis for medical purposes

TABLE OF
CONTENTS
Introduction 6
The Legal Status and Common Practices of Cannabis Dispensaries8
Most Cannabis Dispensaries are Illegal Under State Medical Marijuana Laws8
The Operation of Cannabis Dispensaries Will Not Generate Scientific Da Leading to a
Meaningful
Assessment of Cannabis based Medications
io
Cannabis Dispensaries May Put Seriously III Patients at Risk
ii
Cannabis Dispensaries May Take Advantage of Desperate Patients
The Need for Regulatory Protections15
Allowing a Proliferation of Cannabis Dispensaries Will Seriously Undercut the FDA Drug
Approval System and Deprive Patients of Important Regula ory Protections 15
The Requirements of the Food Drug and Cosmetic Act Reduce the Likelihood tha Patients
Will be Exposed
o Harmful or InefFective Products
i5
i4
The Controlled Substances Act Plays a Critical Role in Ensuring hat Properly Tested
Medications are Made Available for Appropriate
Medical Use
i6
Under the CSA Schedule II Placement Does Not Make a Substance Available for Direct Use By Patients 17
PDA Approval is Required in Order for a Specific Finished Medication to be
Marketed and Distributed to Patients 18
TheScientific Process
zo
Crude Herbal Cannabis and Unstandardized Cannabis Preparations Do Not Meet
the Standards of Modern Medicine20
Only Recently Has 7echnology Made Possible the Development of Modern
Cannabis Derived and Cannabinoid Medica ions
The Administration Should Respect and Support the Proper Workings of the Scientific Process
z3
The FDA Has Limi ed Power to Protect Patients Who Seek Medical Treatment
and Advice From Cannabis Dispensaries 25
States Laws and Regulatory Bodies Should Enhance Rather Than Undermine
the Protections Provided by the FDA System
Cannabis Dispensaries Are Not Subject to State Laws and Regulations Applicable
to Entities Operating
in the Health Care Area
z8
Cannabis and Cannabis derived Products Should be Governed by the Quality
Control and Other Testing Procedures Applicable
to All Modern Medications
z9
ZS
The United States International Obligations 31
Good Science Should Also Guide Decisions Implementing Our Obligations
Under International Drug Control Treaties31
The Controlled Substances Act Was Enacted in Part m fulfill Our Obligations
Under the Single Convention and the Proliferation of Cannabis Dispensaries
Cannotbe Left Solely to State Control 35
Conclusion 38

INTRODUCTION
In the early weeks of his administration President Barack Obama has voiced a number of laudable goals
has stressed that Science and the scientific process must inform and guide decisions of my Administration
on a wide range of issues He has expressed compassion for seriously ill pa ien s and their families With
regard to the use of marijuana for medical purposes the president is said to believe that federal resources
should not be used to circumvent state laws Prior to his electionthe Senator Obama noted that any use
of marijuana for medical circumstances should take place under strict guidelines in the same way that other
pain relievers or palliative drugs would be prescribed These aspirations are not necessarily inconsistent As
this paper will show each of these goals can be met without allowing marijuana dispensaries to multiply free
of federal control and intervention
He
The Administration need not fear that Drug Enforcement Agency DEA intervention ino cannabis dispensaries
will conflict with state law indeed dispensaries are in almost all instances not permitted by sta e medical
marijuana laws Nevercheless cannabis dispensaries are proliferating at a rapid rate a cause for concern
given the potential for such operations to take advantage of desperate patients and put seriously ill patients at
affirmative risk Local jurisdictions do not have sufficient resources to deal with these abuses
Requiring the
DEA unequivocally to takeahands off approach no matter how egregious the dispensary
practices will not
serve the best interests of patients
Uncontrolled proliferation of these dispensaries will seriously undercut our Food and Drug Administration
FDA drug approval system and deprive patients of important regulatory protections Such a result will defeat
the Administration
avowed desire to support and follow the results of sound science
As Presiden Obama
has stressed medical marijuana should be controlled the same as other drugs prescribed by doctors Other
prescription medications such as morphine are subject to a host of quality safety and efficacy requirements
Without such requirements wlnerable patients can be exposed to harmful or inefrective products
The Food Drug and Cosmetic Act FDCA and the Controlled Substances Act CSA are carefully integrated
to ensure that patients access to medications is determined by good medical science not politics The FDA
approves specific medical products for marketing and thereafter for distribution to patients based on a
determination of those products safety and effectiveness
Through the scheduling pro ess the DEA
a scientific and medical evaluation by the Department of Heal h and Human Services the FDA in particular
after
i Office of he Press Secretary The White House Memorandum for he Heads of Executive Deparxments and Agencies
March 9 zoo9 hereinafter Memorandum at p ihttp Jwww
whitehouse gov
press office
Memorandum forvthe
Heads of Executive Depa rtments and Agencies 3909
2 Montopoli 6 Obama Announces Stem Cell Decision CBS News Political Hotsheet March 9 2oo9 President Obama
remarks in full at p z
3 Egelko 6 Feds Hint No More Raids on Pot tlubs in State San Francisco Chronide A1 Feb 27 2009
4 Town hall meeting in Audubon lowa Nov z4 ioo7 Medical Marijuana ProCOn orghttp
Jmedicalmarijuana procon
org vi ewsource asp IDoo2447
6 z009 Marijuqna Dispensaries
and the Federal Government

determines whether and which restrictions should be placed on basic classes of substances that may have
abuse liabili2y Underthis coordinated system only individual products ha have undergone rigorous scien ific
testing can be made available for medical use crude botanical substances such as opium coca and cannabis
cannot be sold to patients
Cannabis dispensaries by distributing herbal cannabis and unapproved cannabis
preparations directly to patients significantly ndermine this system
In addition to maintaining the integrity of our domestic drug approval system the United States must uphold its
international treaty obligations Under the Single Convention on Narcotic Drugs which governs the cultivation
distribution and use of marijuana the US must prohibit or strictly regulate such activities When Congress
enacted the CSA which is enforced by the DEA it expressly recognized our obligation to adhere to this
and other drug control treaties Again the scientific process should guide our path as we fulfill our global
responsibilities The Administration shouid herefore allow the DEA to determine when and to what extent
federal intervention is required to meet our commitments in this area
zoo9 Marrjuana Dispensaries and the federal Government 7

THE LEGAL STATUS AND COMMON PRACTICES OF
CANNABIS DISPENSARIES
Most Cannabis Dispensaries are Illegal Under State Medical Marijuana Laws
The DEA s intervention into he practices of marijuana dispensaries does not circumvent state law or violate
the concept of states rights First state legislation relating to the use of cannabis for medical purposes is
generally quite limited in scope 7hese laws merely qualify the reach of the state
existing criminal legislation
prohibiting the use possession cultivation etc of cannabis California s medical marijuana law the oldest in
the nation
clearly illustrates this fact Proposition z15 he California Compassionate Use Act of 1g96 CCUA
was enacted by the voters in 1996
The Act renders possession and cultivation of cannabis noncriminal under
specified condi ions that is it creates a potential defense against criminal prosecution and conviction The
California Supreme Court has specifically ruled that the Act confers only a limited immunity which operates
by decriminalizing conduct that otherwise would be criminal Such enactments do not fall within the realm
of classic states rights
Second in most cases cannabis dispensaries are not actually authorized under these state medical marijuana
laws
In California for example the original CCUA decriminalized the cultivation and possession of cannabis
5 See National Organization for the Reform of Marijuana laws NORML Active5ate Medical Marijuana Programs http
norml comJindex cfm Group ID 339i In zooq Oregon voters rejected an initiative that would have authorized dispensaries
in thac sxate At present under SB 1085 efrective Jan 1 2006 Oregon permits a patien m registeramarijuana grow
site which can cul ivace cannabis for no more than four pacients
In March zoo9 New Mexico gran ed the first license
for a cannabis dispensary the name and location of which are undisdosed See Major Holmes S First medical marijuana
producer in NM approved The Associaced Press March 19 Zoo9 in Michigan dispensaries are springing up even though
the recently enacted medical marijuana law does not authorize xhemhtxp www mlive com news
flinyindexssf zoo9 o3
group to oHer marijuana advic html
6 Calif Health Safeiy Code du36i 5
7 People e Mower 28 Cal 4th 457 47 122Cai Rptcid 326 2002 It is not uncommon for a stace to render certain conduct
noncriminal thatotherwise would be criminal under its laws Seeeg Calif Penal Code sec 6oz n the crime of trespass on
another s property is not applicable to persons engaged in lawful labor union activities Calif Insurance Code sec iz9zq b
no individual shall be prosecuted or be subjected o punishment for any crime concerning which she is compelled by
the Insurance Commissioner to estify or produce other evidence J
8 People v Mower supro at p 473 This limited immunity en itles a defendant to raise a defense at trial and o bring a
motion to set aside an indictment or information prior to trial Id at p 470 It does not confer complete immunity from
arrest and prosecution Id at p q7q
9Neither the CCUA nor subsequendy its darifying legislation created other affirmative rights Por example there is
no requirement for any accommodation of the use of cannabis on the property or premises of any place of employment or
duringthe hours of employment See Calif Heaith SafetyCode pu36z 785 a Fur hermore noching predudes an employer
from discharging an employee who fails a drug test as a result of his her use of cannabis for medical purposes even ouaide
of working hours or the workplace See CaliE Heatth Safety Code jlti362 785 a Ross v Ragingwire Telecommunications
ioo8 44Z CalAth 9zo 7o Cal Rpir 3d 38zpre
employment drug testing These provisions demonstrete that no robust
rights are created by che limited grant of immuniiy
8 2009 Marijuana Dispensaries
and the Federal Government

y a patient or by that patient s primary caregiver if the use of cannabis was recommended by the patienYs
physician
A primary caregiver was defined as the individual designated by the patient who has consistently
assumed responsibility for the patient s housing health or safety The California Supreme Court has ruled that
a person whose responsibili ies consist principally of supplying cannabis and instructing on its use and who
othenvise only sporadically takes a patient to medical appointments cannot qualify as a primary caregiver
under the CCUA The Cour concluded that a primary caregiver must prove at a minimum that he or she
consistently provided caregiving independent of any assistance in taking medical marijuana at or before he
time he or she assumed responsibili y for assisting with medical marijuana A primary caregiver must be the
principal lead or central person responsible for rendering assistance in the provision of daily life necessities
In 2003 he California sta e legislature enacted the Medical Marijuana Program MMP The MMP clarified
but did not modify or expand the reach of the CCUA The MMP acknowledges that patients and their primary
caregivers may associate in order to cultivate cannabis cooperatively or collec ively for medical purposes
without becoming subject to criminal sanctions solely because of that fact
This language does not establishagreen light for cannabis dispensaries The California Attorney General has
recognized that this provision was intended to be quite narrow
issued guidelines to iden ify legitimate cooperatives and collectives
In August zoo8 the State Attorney General
The guidelines stressed that neither
cooperatives nor collec ives should purchase cannabis from or sell tonon members instead they should only
provide a means for facilitating or coordinating transactions between members
eoth types of entities must
carefully monitor their members and both should documen each member s contribution of labor resources
or money as well as racking and recording the source of the cannabis Neither type of entity should profit
from the sale or distribution of cannabis
These guidelines allow for small groups of patients and primary caregivers to share the labor expenses and
other responsibilities of cultivation on a common piece of land oroher facility This description does not
apply to the vas2 majori y of cannabis dispensaries in California which have hundreds or even thousands of
members
10 People v Mentch z008 45 Cal 4th 274 85CaI Rp r3d 480
n CaliE Health
Safety Code jfj111362J 11362 83
1i Under Califomia law he legislature cannot amend an initiative such as he CCUA unless the initiative gran s he
legisla ure auchority to do so CaliE Const art 1 10 subd The CCUA does not give the legislature authority to amend
it without voter approval
13 California Department of Justice Guidelines for the Security and Non diversion of Marijuana Grown for Medical
Use Aug zoo8 hereinafter Attorney General Guidelineshttp ag ca gov cros
attachmena press pdfs ni6oi
medicalmarijuanaguidelines pdf
14 Members also may reimburse the collec ive or cooperative for marijuana that has been allocated co them Any
monetary reimbursement that members provide to the collec ive or cooperative should oniy be an amount necessary to
cover overhead costs and operating expenses Id
zoo9 Marijuana Dispensaries
and the Federat Government 9

In California dispensaries have had 13 years to flourish and it is in California that their abuses have become
evident
Most dispensaries are merely retail storefronts that distribute cannabis to customers The California
Attorney General has made clear that such dispensaries are operating outside the boundaries of state law
dispensaries that merely require a
patient to complete a form summarily designating the business owner as
their primary caregiver and hen offering cannabis in exchange for cash donation are likely unlawfal s
Nevertheless dispensaries have proliferated across California s
It is the current system and practices of inedical marijuana dispensaries in California and
not the DEA s
disruption of their merchandising operations that circumvent state law both medical marijuana laws and
laws prohibiting the sale or possession of cannabis for non medical purposes
The Operation of Cannabis Dispensaries Will Not Generate Scientific Data Leading to
a
Meaningful Assessment of Cannabis based Medications
The practices of cannabis dispensaries will not enable this country to answer the pivotal ques ion what are
the scientific data which demonstrate the risks and benefits of cannabis or cannabis derived medications
Without such data no new medical product can gain acceptance by the medical profession policymakers and
an informed public California s cannabis dispensaries offer a broad menu of cannabis products to a wide and
shifting range of customers
extracts and edibles are available
Different strains of herbal materials as well as capsules highly concentrated
Herbal material may be smoked or otherwise inhaled by means of a wide
variety of devices Patients may try one product or one dispensary then another Some patients will have
adverse reactions or will obtain no benefit
Those individuals will simply not make further purchases their
experiences will not be recorded or otherwise captured for medical benefit risk analysis
Such practices cannot generate reliable controlled data that could lead to a
meaningful assessment of the
future of cannabis or wnnabis based medical products certainly not data on the myriad different cannabinoid
prepara ions and dosage forms Acceptable and usable scientific data can be genera ed only by ransforming
crude herbal material into standardized formulations of known and reproducible composition and dose
incorporating those into appropriate delivery forms and testing such combinations through the modern
regulatory system
15 Attorney General Guidelines a p 11
16 See the partial listing of publidy advertised dispensaries athctp www canorml org prop cbclist htmi
io
zoog Marrjuana Dispensaries and the Federal Government

Cannabis Dispensaries May Put Seriously III Patients at Risk
State medical marijuana laws themselves recognize that cannabis is notaharmless herb akin to a dietary
supplement or a home remedy These laws treat cannabis more like a prescription medication making a
licensed physician the gatekeeper to a
patient s access to cannabis the physician however is not required
to be federally registered despite the fact tha cannabis holds Schedule I status under the CSA Despite this
quasi prescrip ion status there isli tle assurance of quality consistency safety or efficacy Canna6is in herbal
form or contained in crude preparations is not a homogeneous substance Depending on the concentration
of various cannabinoids and other plant components use of inert excipients and delivery system or dosage
form pa ients may be exposed to a variety of active ingredients with qui e different pharmacological effects
Increasingly cannabis cultivated in North America and Europe is being bred to express very high concentrations
of tetrahydrocannabinol THC s By contrast cannabidiol CBD anon
prychoactive cannabinoid that dampens
down he effec s including he psychoactive effecis of THC and whkh was presenT in significant amounu in
cannabis used centuries ago has been bred out of modern cannabis
The delivery system also enormously afiFects he impact that a cannabinoid product has on a patient If
inhaled as in smoking or vaporizing THC blood levels rise rapidly and then fall dramatically which is likely
to cause undesirable psychoac ive side effects Indeed when smoked cannabis is compared with standardized
cannabis derived product containing equal amounts of THC and CBD and delivered by a sublingual method
the patients using smoked cannabis report more significant adverse events In addition in a recent small
sudy examining the effects of cannabis delivered inanon FDA approved vaporizer the subjects experienced
17 For example patients cannotself diagnose as they do when purchasing dietary supplements nor can pa ients seek
a physician
approval only after their use of cannabis in an effort retroactively to validate suchself diagnosis See eg
People v Rigo i999 69Cal App qth 409
18 This is also true of op um Different strains of the opium poppy may be rich in morphine thebaine or oripavine
These substances in turn are used co prepare very difFerent medications See DEA Authorized Sources of Narcotic Raw
Materials 73 Fed Reg 6843 Feb 6 zo08
19 Pot er DJ Clark P Brown MB Potency of Delta9THC and Other Cannabinoids in Cannabis in England in zoOS
Implications for Psychoactivity and Pharmamlogy JournaloFore sic Sciences 2008 Jan 531904 Mehmedi Z Mar in
J Foster S ElSohly MA editors Delta 9TNC and Other Cannabinoids Content of Confiscated Marijuana Pocency 7rends
i993 Z003In ernational Association of Canna6is as Medicine 2005 September 10 Leiden Netherlands Intemational
Association of Cannabis as Medicine ElSohly MA Ross SA Mehmedic Z Arafat R Vi B Banahan Bf 3rd Porency Trends
of Delta9 7HC and Other Cannabinoids in Confiscated Marijuana from1980 1997 Journol of Forensic Sciences 200045124
30 a complete description of the adverse health effects of high potency inhaled herbal cannabis is beyond he scope of
this documen
20 Russo EB History of Cannabis and its Preparations in Saga Science and Sobriquet Chemistry Biodiversity 2007
4S2624 45 Periwee RG Cannbidiol as a Potential Medicine 47 65 in Mechoulam R ed Cannobinoids os 7herapeutics
Basel Switzerland Birkhauser Verlag zoo5
2i Russo EB The Solution to the Medicinal Cannabis Problem in Schatman ME and Gan BL eds Ethicallssues in
Chronic Pain Mpnagement 765 176 181 Boca Ra on FL Taylor
Francis
zz The Volcanon is produced by Storz Bickel GmbH Co in Germany A description and drawing can be found in Abrams
D infra It has limited portability In use outside the climcal trial setting the dose of cannabinoids and the extent of
zoo9 Marijuana Dispensaries and the Federal Government 11

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notable intoxication they found the cannabis with an intermediate THC concentration34 more tolerable
than the higherTHC concentration68 material Oral consumption has delayed and unpredictable effccts
This varia6ility and unreliability of effect may be particularly harmful o seriously ill patients who are often
debilitated and likely to be taking a range of other prescription medications
Cannabis distributed by dispensaries also poses other even more serious risks for patien s It may be
contaminated by pesticides heavy metals or fungus For example in the Netherlands cannabis is grown
for medical use by cwo cultivators who are licensed by he government s Office of Medicinal Cannabis The
cannabis has such high microbial content that it must be irradiated before it can be distributed to patients
pyroly ic products will vary with the temperature setting and the patient s inhalation practices
23 Abrams D et al Vaporization as a Smokeless Cannabis Delivery System q pilo Study Clinical Pharmacology
Therapeutics April zoo7 at p 4http www namre comJcpt
2q Joy J Wa son SJ Benson JA Jc Norijuano and Medicine Aasessing the Science Bose Washington DC Ins itute of
Medicine 1999 at p zo3 Variation in individual responses is highest for oral THC and bioavailability is lowest
z5 There is no requirement in Iocal legislation that cannabis sold in dispensaries must be organic indeed one
dispensary in San Francisco advertises itself as the only dispensaryofering organic cannabis in the City http www
sanfranciscocannabisdubs com directory
sarnfrancisco al ernative patient w regivers hm
26 Schol en W Therapeutic Cannabis in the Netherlands Drug Informanon Association Annual Meeting June i7 2004
presen ation Hazekamp A An Evaluation of the Quality of Medicinal Grade Cannabis in he Netherlands Cannobinoids
12 2009 Marijuana Dispensaries
and the Federa Government

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In a US cannabis dispensary however there is no such quality control If seriously ill patients sufrer harm
from such contamination they will receive no compensation there will be no product recall or governmental
investigation and there is no tool to deter future malfeasance In short none of the federal and state regulatory
protections are in place and the cannabis distributed by dispensaries is not subject to reliable oversight
2006i9 Canada also has a small governmen sponsored and licensed cultivation program There too the cannabis
must be irradiated before it is distribu ed to patients See Health Canada Product Information Sheet on Dried Marihuana
http www ho sc gcca dhp mps marihuana supply approvis dried information sechee eng php Certain hlgh technology
cultivation practices eg a computervcontrolled greenhouse opera ed by a pharmaceutical company under scnct standard
operating procedures can preven such fungal growthhttp www gwpharm com
17 One scienust has scressed that certain pathogens such as aflatoxins are not destroyed by heat as in smo ing or
vaporizing and are Increasingly being recognized as an underestimated source of neurological toxicity or infections such
asaspergillosrs Individualswhoareusinganti
infammarorysteroidsorhavecompromisedimmunesystemsareespeually
vulnerable to such infections See Hazekamp supra at p 6
i8 Smoking also produces harmful pyrolytic products that can impair a patient S pulmonary function and cause other
harm Tashkin DP Smolced Marijuana as a Gause of Lung Injury Monaldi Arch Ches Dis 2oo5 June63293 l00 In
addition many dispensaries permit cannabis consumption on the premises However if cannabis jmnts or vaporizers are
sfiared dangerous pathogens can be spread 2mongs senously ill patients Zanocco V Meningowccal Cases Linked by
SharingJoints Vancouver BC Canada VancouverCoas aI Health 2005 Apri181ht pwww vch ca news docs 2oo5 o4 07
mening oints pdf
zoo9 Marijuana Dispensaries and the Federal Government 13

Cannabis Dispensaries May Take Advantage of Desperate Patients
Reverend Scott Imler one of the early California proponents of medical marijuanaco author of Proposition
zi5 and a founder of one of the original dispensaries has voiced concern that dispensaries can be preda ory
taking economic advantage of desperate and vulnerable patients
We created Prop z15 so that patients would not have to deal with black market profiteers But today it
is all about the money Most of the dispensaries operating in California are little more than dope dealers
with store fronts
There is little doubt as to why cannabis dispensaries are multiplying at such a rate The price of cannabis in
dispensaries ranges from i2 5o to z5 per gram z8 grams per ounce The average medical user with
a chronic medical condition may consume from 15 to 3o grams per day Therefore the monthly cost to
patients ranges from 56z 15 grams day atiz 5o gm to z5o 3 grams day atz5 gm Since the herbal
cannabis which is of varying strains and quality has not received FDA approval none of this expense is covered
by a patient s health insurance and there is no assurance of quality control or accurate dosage information
This system actualiy impedes access by patients to cannabis derived medications
If a medication has gone
through the FDA process there is at leastan opportunity for itto be covered by public or private health insurance
Given its exclusion from health insurance plans its cost exceeds that which most seriously ill patiencs many of
whom may not be working can afford to purchase
are not in fact patients who require cannabis for medical purposes
are profiting some dispensaries take in over 20 00o per day
This cost in turn implies that the majority of purchasers
In the meantime cannabis dispensaries
i9 Office of National Drug Control Policy Medical Marijuana Realiry Checkhitp Jwww
whitehousedrugpolicy gov
drugfact
sht medical marijuana html Accessed Feb z7 zoo9 Alterna ives Magazine FaII 1oo61ssue 39
30 CNBC A Gallery of Medical Marijuanahttp Jwww cnbc com id 285618g6 Accessed March i 2009
3i People v Mencch 2008 45 CalAth 274 85Ca Rptr 3d 480 patient using 3 grams per day
3z In Califomia for example state law does not require a govemmen private or any other health insurance provider or
health care service plan to be liable for any daim for reimbursement for he use of inedicinal cannabis Calif Heal h
Safety Code 11362 785 dj
33 CNBC A Gallery of Medical Marijuanahttp www cnbccom
idjz856i896 Accessed March 1 2009
America s Pot Industry Jan z2 zoo9
CNBC Inside
14 2oog Marijuana Dispensaries and the Federal Government

THE NEED FOR REGULATORY PROTECTIONS
Allowing a Proliferation of Cannabis Dispensaries Will Seriously Undercut the FDA
Drug Approval System and Deprive Patients of important Regulatory Protections
President Obama has expressed his desire to ensure that the US provides continued global leadership in
scientific discoveries and technological breakthroughs
He has assured the public that modern scientific
developments will guide the Administration
policy decisions A proliferation of cannabis dispensaries in
states across the country would have the opposite efFect seriously undermining the FDA approval system The
federal Food Drug and Cosmetic Act FDCAp and the federal Controlled SubsTances Act CSA work in synergy
to form this impressive regulatory fabric
The FDCA requires that rigorous scientific data determine which
medications may enter the marketplace and thereafter be prescribed and distribu ed o patients
The CSA
establishes a process scheduli g through which those scientific data can be used to ensure that controlled
substances are made available for and limited to appropriate medical and scientific use hrough a closed
system ofdis ribution thac includes proper registration security recordkeeping reporting quota and other
requirements
The Requirements of the Food Drug and Cosmetic Act Reduce the Likelihood that
Patients Will be Exposed to Harmful or Ineffective Products
The FDCA has been developed over more than a century to protect the health and safety of vulnerable patients
It enforces rigorous standards at all stages in the development of a new medicine
Before a
medical product may be approved by he FDA and be released for marketing it must be assessed in
various nonclinical and preclinica laboratory tests including drug and drug food interaction tests
final formulation must be analyzed for ba ch consistency stability and absence of dangerous contaminants Is
manufacturing process must be validated and quality controlled
Its
Even after extensive predinical studies have demonstrated the likely safety of he product for human use
several phases of clinical human research must be conducted If a product is intended to be used for a chronic
condition carcinogenicity and reproduc ive toxicity tests must be performed Adverse events must be reported
34 Montopoli B Obama Announces Stem Cell Decision CBS News Political Hotsheet March 9 2009 President Obama
remarks in full at p 3
35 zlUS0 ffj 3oi 399a
36 uUS0 dJ 801 971
37 Even at the research stage an investigational product may be tested in actual patients only if the physician
investigator
has preliminary evidence of safety and a protocol approved by the FDA The pro ocol must undergo careful scrutiny from
an Institutional Review Board IRB
zoo9 Marijuana Dispensaries
and the federal Gavernment i5

and described in the product label The research is pubifshed in peer reviewed journals enabling physicians to
judge the quality of the research as well as the relative safety and efficacy of the product
The FDA also inspects and supervises he pharmaceutical manufacturer s facility If a flaw exists in the
manufacturing process the FDA can withhold marketing approval Subsequent to approval if the FDA receives
reports of serious unrecognized side effects a product s label can be amended to indude heigh ened warnings
or the product can be removed from the market entirely
This thorough and dynamic process reduces the likelihood that patients will be exposed to dangerous or
ineffective products and provides important data to allow physicians to conduct meaningful dialogues with
and give informed advice to patients regarding treatment options
The Controlled Substances Act Plays a Critical Role in Ensuring that Properly Tested
Medications are Made Available for Appropriate Medical Use
The CSA and the Drug Enforcement Administration DEA piay important roles in this system of inedication
development When medications contain controlled substances and herefore pose a potential risk of abuse
or addiction the regulatory system is even more cautious Mere FDA approval of such a medication is not
sufficient the product must also undergo review through an administrative process under the CSA
scheduling process
the
Cannabis proponents often contend that herbal cannabis should be moved from Schedule I to Schedule II in
order to increase its availability to patients through cannabis dispensaries This argument however reFlects
a misunderstanding of the scheduling process as it relates to the ultimate FDA approval and marketing of a
medication That process must be viewed in the context of the larger FDAjDEA regulatory scheme
When Congress enacted the CSA it established five categories known as schedules to which different levels
of requirements restrictions and prohibitions are attached A drug s dassifica ion in a specific schedule is
determined by its abuse and dependence potentials on the one hand and by the evidence of its safety and
therapeutic effectiveness on the other The scheduling process involves indepe dent but complementary roles
for the DEA Deparcment of Health and Human Services the FDA and the National Institute on Drug Abuse
NIDA in particular
38 Congress placed most of these substances in their respec ive schedules as part of the CSA s enactment in 197o but new
substances are continually scheduled and exis ing substances are moved between schedules as new scientific data become
avai able DEA Controlled Substanre Schedules Chronological Orderhtp www
deadiversion usdoj gov schedules
schedules htm
i6
z009 Marijuana Dispensaries
and the Federal Government

THE
UNITED STATES INTERNATIONAL OBLIGATIONS
Good Science Should Also Guide Decisions Implementing Our Obligations Under
International Drug Control Treaties
President Obama has announced his intention to trust science and research when designing our international
as well as domestic policies Sound science shouid inform and guide this Administration as it implements
our international responsibilities in the field of drug control policy The US and thereby he Department of
Justice has an obligation under our international drug control treaties to control strictly the manufacture
and distribution of controlled substances including the cultivation and distribution of cannabis within our
borders
In particular if the US permits the cultivation of cannabis plants for medical use i must apply the same
provisions as are imposed for the cultivation of the opium poppy for medical use
controls must be maintained by a single government agency
over the prolifera ion of cannabis dispensaries
This rigorous system of
States therefore cannot have sole jurisdiction
The United States is a signatory to the Single Convention on Narcotic Drugs 1961 Single Convention This
treaty was intended to ensure that the production and use of narcotic substances are limited exclusively to
bona fide medical and scientific purposes Accordingly the Single Convention requires a party to impose strict
controls not merely on international trade but also on domestic manufacture distribution import export
and possession of botanically derived controlled subs ances such as coca opium and cannabis
The phrase medical and scientific purposes has a clear meaning The treaty was promulgated at a time
when governments around the world were developing regulatory procedures to ensure the quality and safety
of inedical products Crude narcotic plant material was not considered suitabie for direct medical use For
example under the treaty opium smoking was not an accepted method for delivering the therapeutically useful
components contained within the herbal material
102 Single Convention on Narco ic Drugs March 30 1961 18 UST 1407
io3 Single Convention preamble Art 4c
104 The need for the prectice of inedicine to be evidence based had become wel6established particularly in the Western
worid For several decades scientists had been conducting randomized placebo controlled dinical trials to imestigate the
safety and efficacy of irnestigational medical products Chow S and Liu J Design andAnatysrs of Ginical Triats p4i998
Then as now the results of such clinical trials formed the basis both of governmental regulators marketing approvals and
physicians prescribing practices See Guyatt G et al Evidence Based Medicine Principles for Applying the Users Guides
o Patient Care 284Joumal of the Ame ican Medical Association 1290 Sept 13 2000
I
1o5 Cannabis and cannabis resin were placed in Schedule IV he treaty s most restrictive schedule whereas oral cannabis
preparationsie tincwres and extracts were placed in Schedule I along with most other narcotic drugs The Single
Convention s schedule structure does not parallel that of the Convolled Substances Act in which Schedule is the most
restric ive
zoo9 Marijuana Dispensaries and the FederaJ Government 31

The Single Convention recognized that different coun ries may have different regulatory systemslo However
the treaty expected that each party would in good faith adhere to modern scientific standards that is employ
conventional
regulatory standards when determining whether when and which narcotic substances and
products could be made available for medical use
Nowhere in the treaty is there any suggestion that a Par y
may allow a diluted or informal medical system solely for a specific controlled substance such as cannabis
In response to the activities of inedical cannabis proponents the International Narcotics Control eoard INCB
stressed that a party may not allow cannabis to be cultivated manufactured and used for medical purposes
uniess such products have satisfied the rigorous regulatory standards that apply to oher medical products
Such use must 6e supported by objective scientific data from properly conducted research studies and must
otherwise accord with principles of modern medicine
The Singie Convention places parcicularly severe restrictions on the cultivation of cannabis opium and coca
bush Artfde 23 requires that if a
must establish and maintain a
party permits cultivation of opium poppies within its borders the Party
national Agency to carry out the Party s obligations
Articles z6 and z8 apply
those requirements o he cultivation of the coca bush and the cannabis plant respectively Article 23 requires
that only nationally licensed cultivators whose license specifically identifies the precise extent and location
of the land that they are authorized to cultivate may grow such narcotic plants They must deliver their
total crops to the Agency and only the national Agency may deal with such crops The Agency must have the
exdusive right of imporcing exporting wholesale trading and maintaining stocks
iob See Secretary General of the United Nations Commenmry on the Single Convention on Norcotic Drugs i96i i973 pare
ii pmlegitimate existing systems of indigenous medicine may be taken into account hereafter Commencary
107 The INCB is the United Na ions organ created by the Single Conven ion to implement and monitor compliance with
the Convention See Single Convention arts 59i5 19 zo
108 INCB Report 1002 a p 21 2003
io9 The treaty imposes other very specific restrictions on the cultivation of cannabis opium and coca Anide zz requires
a Party to prohibit cultivation if the Party condudes in good fai h that the prevailing conditions in the country make such
prohibition the most sui able measure of protecting the public health and safety Fur hermore a Party that prohibits such
cultivation must take appropriate measures to seize and destroy any planu that are illegallycul ivated ezcept for small
quantities that the Parry itself may need for scientific or research purposes
uo The Commentary also indicates that under the Single Convention all licensed cultivators should to the greatest
extent possible be located in the same part of the country and be contiguous in order to facilitate more effective control
Commentary at p 280
locations all over the US
This provision would not permit the establishment of cannabis cultivation si es in
numerous
111 Preparations of cannabis such as pharmaceutical grade extracts and tinc ures are exempt from the government
monopoly on wholesale distribution Single Convencion art z3 paraie The treaty also does not extend the governmenCs
exclusive rights to medicinal opium and opium prepara ions d at art z3 paraie Medicinal opium is a form of
opium powder to which lactose has been added o reduce the morphine concent o the standard of about io percen
Commentary at p zi 1z In other words the term referred to a product which had not only been extracted from the opium
poppy but had also undergone severa further processes to prepare it for use in other drugs and to obtain a specific and
standardized content of morphine iis primary active ingredienL DEA Lyle E Craker Denial of Applica ion 74 Fed Reg
zio1 21o4 1an 14 zoo9 at p i116 Tlhere were recognized standards for the substance
manufacwre and composition
and the drug had an accepted medical use in humans Id ey contrast there are no recognized standards with respect
3z
zoo9 Marijuana Dispensories and the Federal Government

The National Institute on Drug Abuse NIDA serves as the US national Agency under the Single Convention
Underthe auspices of NIDA the US maintains a domestic cultivation facility in which research grade cannabis
is cultivated by the National Center for Natural Products Research at the University of Mississippi under
contract with NIDA This wnnabis is supplied to investigators who have research protocols that have been
approved by the FDA and by an expert committee of the Public Heaith Service and who have obtained research
registrations from the DEA As of April 2004 the University of Mississippi with the approval of NIDA and the
PHS committee had provided cannabis to more than 17 clinical and preclinical studies funded by the Center
of Medicinal Cannabis Research CMCR at the University of California San Diego ve
If in he future cannabis derived medications were to be developed and approved for marketing it would
not be necessary for the cannabis cultivation production of starting materials to take place in the United
States
The herbal material or the Botanical Drug Substance extracts could be imported into the US for
further formulation
For over 85 years it has been the policy of the US no to cultivace or produce narcotic
raw material NRM such as opium poppy straw and concentrate of poppysraw CPS By long standing
international policy he US is a
country that imports and consumes rather than one that produces and
m herbal marijuana Id Therefore cannabis even if intended for medical use does not fall outeide of the jurisdittion of
a national Agenty
11z NIDA Provision of Marijuana and Other Compounds Por Scientific Research
Recommendations of he National Institute
on Drug Abuse National Advisory Councilht pJwww nida nih gov about
organization nacda
marijuanastatement html
113 See DEA Lyle E Craker Denial of Application 74 ied Reg 2101 Ilo4 Qan 14 2009 hereinafter Craker ApplicationJ
Professor Lyle Craker a plant scientist at the University of Massachusetts sought to be registered as a bulk manufacturer
to cultiva e herbal wnnabis which he
intended to provide to researchers with FDA approved INDS and DEA
research
registrations The DEA Deputy Admmistrator denied his application on a number of bases 1 there was no evidence
that the quality or supply of NIDA cannabis was inadequate nor its cost excessive 2 Prof Creker and his sponsor he
Multidisciplinary Association for Psychedelic Studies MAPS were seeking to dismantle the existing Government control
over the distribu ion of cannabis produced by growers and avoid the governmental monopoly over the wholesale
distribution of marijuana that is mandated by the Single Convention by distribucing it oucside of the HHS system id at pp
ii14 i117 i1z2 3 Prof Craker unlike Dr Mahmoud ElSohiy the Principal Investiga or of the Na ional Center project had
no experience in Che manufacture of controlled substances and could not demonstrate that he was capable of producing
cannabls with any degree of quality rontrol id at p z1z1 fn 74 a there was no evidence chat MAPS had the knowledge or
ezper ise to use such wnnabis to develop an FDA approved produc id at p 2i06 ui3 This case leaves open the question
of whether the DEA might agree to register an additional bulk manufacmrer who possessed che appropriate expertise and
who was willing to abide by the provisions of the Single Convention See fn ll5 below The DEA no ed tha he UK has
gran ed GW Pharmaceuticals a license to grow cannabis far the limited purpose of producing extract for a pharmaceutical
product Id at p 2115 fn 55
114 TheNa
ionalCenrerholdsanadditional regisvation to manufacturecannabisandTHCunderthetermsofa Memorandum
of Agreement with the DEA in ig99 The purpose of this registration is to allow the Cen er o develop a new product
formulation for effecting delivery oflTHt in a pharmaceutically acceptable dosage form suppository and to provide crude
THC extract to a DEA registered manufatturer of THC for further purification Id at 21o4 fn 1
n5 In i999 the National Institu es of Health announced new procedures for making research grade cannabis available to
researchers induding those whose research is privately fundedhttp www nih gov news
medmarijuana hhsfact htm
u6 Craker Application at p uo5
117 See DEA Authorized Sources of Narcotic Raw Materials 73 Fed Reg 6843 Feb 6 2oo8
zoo9 Marijuano Dispensaries
and the Federal Government 33

supplies NRM The US relies on a specific list of councries authorized to import NRM inio the US in order
to mee the legitimate medical needs of the US This list is deliberately kept very short in order to prevent a
proliferation of NRM producing countries
Furthermore the treaty imposes additional controls on all manufacture and distribution of cannabis derived
and other controlled substances Such activities must be conducted by federally licensed and regulated en ities
that are producing standardized products for medical or research purposes
Therefore were the US to
permit dispensaries in various states across the country to distribute or cultivate cannabis for medical use
the US would be in viola ion of these unmistakably clear treaty obligations
position
The INCB has confirmed this
The control measures applied in California for the cultivation production and use of cannabis do not
meet the control standards set in the 1961 Convention to prevent diversion of narcotic drugs for illicit use
Such standards require inter alia the control of cultivation and production of cannabis by a national
cannabis agency and detailed record keeping and reporting on the activities with cannabis including
reporting to INCB
118 44 Fed Reg 33696 June 1i 1979
119 Those countries are India Turlcey France Poland Hungary Aus ralia and Spain See
Narcotic Raw Materials 73 Fed Reg 6843 feb 6 2008
DEA Au horized Sourcei of
1zo The treary obligates he US and other parties to license and control all persons and encities engaged in he manufacture
of narcotic substances and products as well as to control under Iicense the premises where such manufacture akes
place In addi ion those manufac urers must ob ain periodical permits indicating the kinds and amounts of drugs they
are authorized o manufacture Art ig The Party must control all persons and entities distributing suth subs ances
and license the premises in which such distribution takes place Art 30 Finally the Parties must require all licensees to
have adequa
qualifications Art 34a They mus require all mawfacturers traders scientists scientifit institu ions
and hospitals to keep records for two years showing 1 the quantities of each drug manufacwred and z each individual
acquisition and disposal of drugs Arc 34 b The Parties are obligated to impose spetific requirements and res rictions
on the labeling and import export of a mediwtion Art 3o 31 The provisions of the CSA in conjunction with those of the
Food Drug Cosmetic Act satisfy these obligations
i2i In addition to these controls the Single Convention in an effort to prevent Iegitimate medical products from being
diverted co ilhcit use imposes strict requirements on Parcies co provide annual estimaces regarding quantities of drugs
utilized or held for specific purposes Art i9 as well as statistical retums conceming among other things production
manufacture consumption imports exporcs seizures disposals and year end ecocks Art zo These requirements apply
even to substances used in research INCB Narcotic Drugs iooz atp97 003 recognizing appropriateness of UK reporting
of amounts of wnnabis extracts used for medicai research Even if an individual practitioner or scientist wishes to conduct
a small study using cannabis or some other narcotic substance the Party must ensure that those small amounts are
accounted for through he estimate and statistical rewm rystem if distributors or dispensers in any State authorizing
it could cultivace and distribute cannabis on a physician
advice this entire system would rapidly become disrupted and
meaningless
1i2 INCB press release feb 8 2D08j
34 zoo9 Marijuana Dispensarres and the Federal Government

The Controlled Substances Act Was Enacted in Part to Fulfill Our Obligations Under
the Single Convention and the Proliferation of Cannabis Dispensaries Cannot be Left
Solely to State Control
The federal CSA was enacted in part to fulfill the United States obligations underthe Single Convention The
CSA and its implementing regulations have two prongs They are designed
i to ensure that there is a sufficient supply of controlled substances for legitimate medical scientific
research and industrial purposes and
z to prohibit deter and punish the sale and use of controlled substances to illegal purposes
These goals parallel hose of the Single Convention to ensure that narcotic and other psychoactive substances
are manufactured traded and used only for legitimateie evidence based medical and scientific purposes If
the DEA were prohibited from shuttering cannabis dispensaries and seizing the materials purveyed herein the
US would have failed to comply with its international responsibilities
If the US does not abide by its treaty
obligations other countries will be unlikely to adhere to theirs As in other arenas the US should seek to be a
leader with respect to modern medical science and its responsibilities under internationai agreements
The CSA achieves its purposes by
1 establishing a process scheduling through which scientific and oiher data may be used to ensure
appropriate levels of control of abuseable substances and the adequate availability of inedications
containing them and
z creatingaclosed system in which every importer exporter manufacturer distributor dispenser
and researcher handling a controlled substance must meetsrict licensing recordkeeping and security
requirements which are consistent with those required by the Single Convention
Cannabis dispensaries operate entirely outside of this system of controls It is hard to see the logic or merit
of any position that would relieve cannabis dispensaries from federal oversight despite the fac that cannabis
is a Schedule I substance while requiring manufacturers and distributors of Schedule II substances to secure
DEA registrations adhere to quotas keep accurate records and instituLe strict security measures The DEA has
iz3 See ziUS0 Q
Soi 7 findings
iia Congress has recognized that our intemational treaty obliga ions can actually trump the normal scheduling process
Generally in that process the Attorney General delegaxed to the DEA is bound by DHHS s and FDA s medical and scientific
evaluation of and recommendations upon certain statu ory criteria relating to scientific knowledge pharmacological
effect and abuse potential However if control is required by the United States obligations under intemational treaties
theAttomey General must issue an order controlling the drug under the schedule he or she deems most appropriate to carry
out such obligations without regard to any of the findings described above uUSC d8u
2009 Marijuana Dispensaries and he federal Government 35

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both the power s and the obligation to curb the proliferation of cannabis dispensaries It cannot abdicate this
responsibility in the name of deferring to states rights
Under the Single Convention the United States must in good faith strive to prevent the non medical sale and
use of controlled substances A decision by the Administration to prevent the DEA from intervening in cannabis
dispensaries if they are authorized under state law will effectively prevent he agency from enforcing the CSA
against cannabis retail storefronts that are merely subterfuges for non medical distribution of cannabis
State and local law enforcement do not alone possess adequate resources to stem the proliferation of dispensaries
that distribute cannabis fornon medical use Moreover local law enforcement needs the assistance of the DEA
in combating these operations These entities do not have access to the highly efficient law enforrement tools
that the DEA has at its disposal For example local law enforcement cannot utilize federal asset Forfeiture laws
to deter landlords from permitting cannabis distribution activities to take place on their property Indeed
i25 Gonzales v Raich 545 US12005
i16 It should 6e noted tha the federal government first intervened in cannabis dispensaries under President Clinton s
administracion See US v Oak ond Connabis 6uyers Cooperotive zool 53 US 483 no exception for medical necessity
under the CSA for distribution of cannabis for medi al purposes
iz7 In aoo7 the DEA sent notices to landlords in CaliPomia waming them that their property could be seized if it were being
used for the purpose of marijuana distribu ionhttp Jwwwsafeaccessnow org downloads DEA Landlord Letter pdf
36 zoo9 Marijuana Dispensaries
and the Federal Government

attempting to require the DEA selectively to halt only non medical distribution centers will require the DEA to
dissipate its limited resources in a futileline drawing exercise
The process of identifying canna6is dispensaries that distribute cannabis for non medical use
extremely onerous for a federal agency
would be
In order to fulfillis unquestioned obligation to enforce the CSA s and
Single Convention s prohibitions against non medical distribution the DEA would be required to examine the
records of dispensaries to make the followirtg assessments the true non profit nature of the entity the means
by which physician recommendations are verified the bona fides of inembers and the relative labor monetary
or other resource contributions of those members to the non profit enterprise the source of the cannabis and
whether it can be determined to have been cultivated in all cases by legitimate members etc s
Moreover the DEA s resource intensive struggle to disxinguish between legitimate under state law and unlawful
under state law dispensaries would be compounded by the fact that increasingly cannabis dispensaries have
delivery services Such delivery services would make it even more difficult for the DEA to track and evaluate
cannabis distribution ac ivities for compliance with state law
Even for local jurisdictions detailed state guidelines such as those issued by the California Attorney General are
difficult enough to interpret and enforce To require the DEA to take a hands off approach to any dispensarythat
may be operating in accordance with such state guidelines would effectively ban the DEA from any significant
cannabis interdiction leading to a free for all of cannabis dispensaries across the state and potentially across
the nation As a result cannabis would become readily available for any use both medical and recreational
128 Some dispensaries boasamembership of 20 o00 with hundreds of new customers signing up monthly Manhattan
Project supra
1z9 See eg The Green Crosshttp
wwwsanfranciscocannabisdubs com directory
green cross htm
130 Even the mayor of San francisco does not support the legalization and regulation of cannabis for non medical use
See Legal Pot is Not Mayor s Cup of Tea San Francisco Chronide Feb z7 2009
2009 Marifuana Dispensaries
and the Federal Government 37

CONCLUSION
For the reasons sta ed above the Obama Administration must take a measured approach in addressing
marijuana dispensaries maintaining the commitment to enforcing the CSA that the Department of Justice has
recently reiterated 7his commitment must be met even in states that authorize medical use of marijuana
and especially where illegal distributors attempt to use state medicai marijuana laws as a pretex We recognize
that the Department of Justice and the DEA have limited resources and those resources must be spent wisely
The United States however also has both domestic and international responsibilities to protect the health and
safety of patients and to promote the responsible development of modern medications A fixed Administration
ruling against DEA intervention into the operations of cannabis dispensaries would allow informal quasi
medical networks to spring up across the nation thereby putting at risk the critical protec ions so carefully
crafted under the national food and drug legislation of the 2oth and 2ist centuries
38 zoog Marijuana Dispensaries
and the Federal Government

NOTES
2009 Marijuana Dispensaries and the Federal Government 39

Friends of the DEA
2009N14th Sireet
Suite 414
Arlington Virginia zzzoi
www
friendsofthedea org
x
Ima9
es pp 12 13p19 ond p 26 O Copyright 2009 County ofSan Diego District Attorney Used with permission

MARI UANA CHILDREN
THE WORK PLACE AND MEDICINE
ur
Presentation to
National Marijuana Initiative NMI
Campaign Against Marijuana Planting CAMP
2010 Conference
California
May 10 2010
BARRY R McCAFFREY
GENERAL USA RETIRED
2900 South Quincy Street Suite 300A 2900 Soulh Quincy SUeel Suite 300A
Adington VA 22206
GEN 3arry R McCaf ey OSA Ret Alington VA 22206
bm
QmccafTreyacsociates com 10 May 2010 brm@mccaffreyassocia 703 824 5160 www
mccatUeyassociates com 703 624 5160

90 OF AMERICANS DID NOT
USE MARI UANA LAST YEAR
Marijuana is the most commonly used illicit drug According to the 2008 National
Survey on Drug Use and Health 102 million Americans aged 12 or older have tried
marijuana at least once in their lifetimes 41 of the US population
The number of past year marijuana users in 2008 was approximately 258M103 of
the population the number of past month marijuana users was 15 2M61
Among 12 17 year olds67 reported past month marijuana use 165 of 18 25
year olds and42 of those aged 26 or older reported past month use of marijuana
In 2008 there were 2M persons aged 12 or older who had used marijuana for the
first time within the past 12 months this averages to about6000 initiates per day
A 2002 SAMHSA report concludes that the younger children are when they first use
marijuana the more likely they are to use cocaine and heroin and become dependent
on drugs as adults
Results of the 2008 Monitoring the Future survey indicate that 146 of eighth
graders 29 of tenth graders and 426 of twelfth graders reported lifetime use of
marijuana
GEN 6arry R McCaffrcy USA RcL
10 May 2010
www mccalt
ryassociates com 2 Of 16

80 OF STUDENTS DID NOT
USE MARI UANA LAST MONTH
The 2007 Youth Risk Behavior Surveillance System YRBSS study by the
Centers for Disease Control and Prevention CDC survey indicates that
381 of high school students reported using marijuana at some point in
their lifetimes
Additional YRBSS results indicate that 197 of students reported current
past month use of marijuana
Approximately 475 of college students and 567 of young adults ages
19 28 surveyed in 2007 reported lifetime use of marijuana
According to data from the Bureau of Justice Statistics approximately 776
of State prisoners and 712 of Federal prisoners surveyed in 2004 indicated
that they used marijuana hashish at some point in their lives
GHN 6arry R McCa Trey USA Re
10 May 2010
www meca teyassocia es com 3 Of 16

C C
IF YOUR LIFE REQUIRES CLEAR THINKING
CHRONIC MARI UANA USE WILL BE A PROBLEM
Marijuana abuse is associated with many detrimental health efFects These efFects can
include respiratory illnesses problems with learning and memory increased heart rate
and impaired coordination
A number of studies have also shown an association between chronic marijuana use
and increased rates of anxiety depression suicidal ideation and schizophrenia
Long term marijuana abuse can lead to addiction Withdrawal symptoms may include
irritability sleeplessness decreased appetite anxiety and drug craving
Someone who smokes marijuana regularly may have many of the same respiratory
problems that tobacco smokers do such as daily cough and phlegm production more
frequent acute chest illnesses a heightened risk of lung infections and a greater
tendency toward obstructed airways
Cancer of the respiratory tract and lungs may also be promoted by marijuana smoke
Marijuana has the potential to promote cancer of the lungs and other parts of the
respiratory tract because marijuana smoke contains 50 percent to 70 percent more
carcinogenic hydrocarbons than does tobacco smoke
Marijuana s damage to short term memory seems to occur because THC alters the way
in which information is processed by the hippocampus a brain area responsible for
memory formation
EBa
10 May 2010
www
mccafUeyassociates com 4 Of 16

MARI UANA USE CARRIES
SIGNIFICANT HEALTH RISKS WHICH INCREASE
AS THE DRUG S USEIN CREAS ES
In one study researchers compared marijuana smoking and nonsmoking
12th graders scores on standardized tests of verbal and mathematical skills
Those who were heavy marijuana smokersie those who used marijuana
seven or more times per week scored significantly lower in 12th grade than
nonsmokers
A study of college students found that among heavy users of marijuana
critical skills related to attention memory and learning were significantly
impaired even after they had not used the drug for at least 24 hours
Of an estimated 113 million emergency department ED visits in the US
during 2006 the Drug Abuse Warning Network DAWN estimates that
1742 887 were drug related DAWN data indicate that marijuana was
involved in 290 563 ED visits
From 1997 to 2007 the number of admissions to treatment in which
marijuana was the primary drug of abuse increased from 197 840 in 1997 to
287 933 in 2007 Marijuana admissions represented 123 of the total drug
alcohol admissions to treatment during 1997 and 158 of the treatment
admissions in 2007
fi
GEN Barry R McCn lcy USA Re
I O May 2010
www
mccatFreynssociates com 5 of 16

IF YOU GOT LOCKED UP FOR
MARI UANA OFFENSES
YOU WERE MOST LIKELY
DOING SOME SIGNIFICCRIMINAL ACTIVITY
T
a
According to the FBI there were an estimated total of1841 182 state and
local arrests for drug abuse violations in the United States during 2007 Of
these drug abuse violation arrests53 were for thesale
manufacture of
marijuana and 421 were for marijuana possession
According to the National Drug Intelligence Center there were5039 Federal
marijuana related arrests during 2006
During FY 2008 there were6337 Federal offenders sentenced for marijuana
related charges in US Courts Approximateiy 978 of these cases involved
trafficking and 16 of cases involved simple possession
The Arrestee Drug Abuse Monitoring ADAM program is designed to gather
information on drug use and related matters from adult male ofFenders in 10
US locations within 48 hours of arrest In 9 out of the 10 sites in 2008 45
or more of the arrestees reported using marijuana within the past year
GEN 6arry R McCalTrey USA ReL
10 May 2010
wwwmccalTmyassociamscom 6 Of 16

MARI UANA PRODUCTION AND
TRAFFICKING IS DANGEROUS CRIMINAL
AC TI VI TY DOMI NATED BY MEXICAN CARTELS
sY
The threat associated with marijuana trafficking and abuse is rising which is
largely the result of a growing demand forhigh potency marijuana and a
related increase in the drug s availability
Most foreign source marijuana smuggled into the United States enters
through or between points of entry at theUSMexico border During 2006
more than 1 million KGs of marijuana were seized along the Southwest
Border Cannabis cultivation in Mexico remains high and most of the
marijuana produced in that country is destined for US drug markets
There have been recent increases in cannabis cultivation and marijuana
production within the United States
According to ofFicers with the Forest Service and other agencies many of
California s illegal marijuana fields are controlled not by peace loving flower
children but by employees of Mexican drug trafficking organizations carrying
high powered assault weapons
GHN 6arry R McCaffrey USA Ret
IO May Z6 0
www
mccaRreyassociatescom 7 Of 16

x 1
P
e
DRUG USE IS NOT INEVITABLE
Dru prevention is a must and it must start at the kitchen table be on the
curriculum in schools and be reinforced in athletic programs religious
programs pediatric offices and in extra curricular activities
Kids that are busy are less likely to abuse drugs the most dangerous time
for kids is when they are home unsupervised after school
Prevention programs must be fact based
have been demonstrated to be effective
there are lots of programs that
Parent led and community supported programs are essential
Californians for Drug Free YouthDARE Illinois Drug Education Alliance
and many other prevention organizations are determined to keep our kids
drug free
GEN Barry R McCa Frey USA Ret
10 Muy 2010
www
mccafGeyussuciates com 8 Of 16

1
MARI UANA DOES NOT HAVE SCIENTIFICALLY
DEMONSTRATED MEDICAL VALUE
Marijuana is a Schedule I substance under the Controlled Substances Act Schedule I
drugs are classified as having a high potential for abuse no currently accepted medical
use in treatment in the United States and a lack of accepted safety for use of the drug
under medical supervision
In the case of United States v Oakland Cannabis Club the US Supreme Court ruled
that marijuana has no medical value as determined by Congress The opinion of the
court stated that In the case of the Controlled Substances Act the statute reflects a
determination that marijuana has no medical benefits worthy of an exception outside
the confines of a government approved research project The case reached the US
Supreme Court after the federal government sought an injunction in 1998 against the
Oakland Cannabis Buyers Cooperative and five other marijuana distributors in
California
The United States Court of Appeals for the District of Columbia Circuit issued a ruling
on May 24 2002 upholding DEA s determination that marijuana must remain a
schedule I controlled substance The Court of Appeals rejected an appeal that
contended that marijuana does not meet the legal criteria for classification in the most
restrictive schedule I
GEN Barry R McCaffrey USA Ret
10 May 2010
www
mccatTreyassocia es com 9 of 16

A
k x
i J
INHALED MARI7UANA SMOKE IS DANGEROUS
Marijuana as a smoked product has never proven to be medically beneficial Marijuana
smoke is a crude THC delivery system that also sends many harmful substances into
the body
In 1999 the Institute of Medicine IOM published a review of the available scientific
evidence in an effort to assess the potential health benefits of marijuana The review
concluded that smoking marijuana is not recommended for any long term medical use
and marijuana is not a modern medicine
Pot advocates claim that marijuana can alleviate numerous maladies including vaginal
pain genital herpes writer s cramp impotence nightmares color blindness
constipation and diarrhea
Medicines should not approved in this country by popular vote Before any drugs can
be released for public use they must undergo rigorous clinical trials to demonstrate
they are both safe and effective and then be approved by the Food and Drug
Administration Our investment and confidence in medical science will be seriously
undermined if we do not defend the proven process by which medicines are brought to
market
GEN Barry R McCa irey USA ReL
10 Muy 2010
wwwmccallieyassocia es com 10 Of 16

MEDICAL POT HAS BEEN A STALKING HORSE
FOR THE NORMALIZATION OF MARI UANA USE
7
In California there is no state regulation or standard of the cultivation and or
distribution of inedical marijuana Establishment of guidelines is up to local
jurisdictions which can widely vary Marin County allows up to six mature
plants and or a half pound dried mariJuana Its neighbor Sonoma County
permits possession of three pounds of marijuana and allows cultivation up to
99 plants and doctors may recommend more for exceptional patients
Local and state law enforcement counterparts cannot distinguish between
illegal marijuana grows and rows that qualify as medical exemptions Most
self designated medical mari uana growers are in fact growing mari uana for
ilegal recreational use
Elected law enforcement officialsie Sheriffs and District Attorneys in
California have been targeted by the marijuana lobby
Law enforcement agencies routinely report that large scale drug traffickers
hide behind and invoke Proposition 215 even when there is no evidence of
any medical claim
GEN 6arry R McCalTrey USA RCt
10 Mag 2010
www mccnEF eyassocia es com 11 of 16

THE MEDICAL AND SCIENTIFIC
COMMUNITIES SAY NO
The DEA and the federal government have strong scientific support to view smoked marijuana as
having no documented medical value
The American Cancer Society does not advocate inhaling smoke nor the legalization of marijuana
The American Academy of Pediatrics AAP believes that a change in the lega status of marijuana
even if limited to adults could affect the prevalence of use among adolescents
The National Multiple Sclerosis Society NMSS states that studies done to date have not provided
convincing evidence that marijuana benefits people with MS
The British Medical Association BMA voiced extreme concern that down grading the criminal
status of marijuana would mislead the public into believing that the drug is safe The BMA
maintains that mariJ uana has been linked to greater risk of heart disease lung cancer bronchitis
and emphysema The 2004 Deputy Chairman of the BMA s Board of Science said that the public
must be made aware of the harmful effects we know result from smoking this drug
The American Academ of Pediatrics asserted that from a public health perspective even a small
increase in fmarijuana use whether attributable to increased availability or decreased perception
of risk would have significant ramifications
The Institute of Medicine IOM reported that smoked marijuana
is a crude THC delivery
system that also delivers harmful substances The study concluded that there is little future in
smoked marijuana as a medically approved medication
GHN Barry R McCafTrey USA Re
I O May 20I0
www mcwll
reyassociates com 12 Of 16

C
MARINOL IS MEDICINE
POT IS NOT
Medical marijuana already exists It s called Marinol a pharmaceutical product
Marinol is widely available through prescription
It comes in pill form Alternate means
of delivery such as an inhaler or patch are being studied Its active ingredient is
synthetic THC which can relieve the nausea and vomiting associated with
chemotherapy and assist with loss of appetite
Unlike smoked marijuana which contains more than 400 different chemicals
including most of the hazardous chemicals found in tobacco smoke Marinol has been
studied and approved by the medical community and the Food and Drug Administration
FDA
Since the passage of the 1906 Pure Food and Drug Act any drug that is marketed in
the United States must undergo rigorous scientific testing This approva process
verifies claims of drug safety and therapeutic value
There are no FDA approved medications that are smoked Smoking is a poor way to
deliver medicine The harmful chemicals and carcinogens that are byproducts of
smoking create entirely new health problems There are four times the levei of tar in a
marijuana cigarette than in a tobacco cigarette
GEN Barry R McCa ftey USA Ret
10 May Z010
www
mccaCGeyassociates cum 13 Of 16

LAW ENFORCEMENT AGENCIES AND
COALITIONS MUST PROTECT OUR COMMUNITIES
FROM ILLEGAL DRUGS AND DRUG TRAFFICKERS
f
The mission of the National Mari uana Initiative NMI is to detect deter
disrupt and dismantle drug trafFicking organizations DTO responsible or
domestic marijuana production
NMI coordinates investigative interdiction and intelligence operations among
federal state and local law enforcement agencies to promote a unified
strategy identify best practices and provide oversight and expertise
Since its inception in FY01 the NMI has provided funding training and
intelligence support to 220 federal state and local law enforcement and land
mana ement agencies to advance their efforts to combat the DTOs These
agencies have dedicated personnel to establish multi agency task forces
The results are that over 36 million marijuana plants with an estimated street
value of 72 billion dollars have been eradicated and 43 DTOs have been
dismantled
GEN 6zrry R McCatGey USA Ret
10 May 2010
www mcca lreyassociates rom 14 Of 16

a
CAM P MAKES OU R SOCIETY
SAFER AND BETTER
The goal of the California Campaign Against Marijuana Planting CAMP
program is to eradicate marijuana illegally cultivated and trafficked in
California
CAMP seizes more marijuana than any other single organization in the United
States 4m plants worth 17 8B seized in 2009 This phenomenal
success is attributable to its partnership with the National Guard DEA
ONDCP and more than 75 federal state and local agencies
In addition to eradicating marijuana plants CAMP provides critical training to
law enforcement agencies throughout California including federal agencies
CAMP also educates the public about the dangers of marijuana cultivation
and its devastating impact on our environment
OEN Barry R McCaffrey USA Ret
10 May 2010
www
mccaCGeyassociates com 15 Of 16

k
POT AND THE POLITICAL PROCESS
California has 30 plus years of experience for better or worse with referendum
propositions that fundamentally affect how society is organized and governed
Passionate well funded advocates can hijack the system to attain goals that are
unachievable through other channels
The ballot box should not be the vehicle for determining what is a safe and effective
medicine
Pro pot advocates did not seek to legalize marijuana possession and usage 10 or 15
years ago via proposition 215 because they knew they would not succeed
There were more marijuana dispensaries in San Francisco than Starbucks coffee shops
i n 2008
Marijuana legalization legislation will soon be a reality unless concerned Californians act
now
Drugs are not harmful because they are illegal
harmful
they are illegal because they are
GEN ea ry R McCaffrey USA Ret
10 May 2010
www mceati
reyassociateacom 16 Of 16

Substances in both Schedules I and I I are su6ject to the greatest restrictions because they haveahigh potential
for abuse For the most part these restrictions are similar for example bulk manufacturers of Schedule I or
II substances are subject to produc ion quotas manufacturers of finished dosage forms produc s containing
Schedule I or II substances are subject to procurement quotas eecause they have no accepted medical
use Schedule I
research programs
substances are subject to some additional restrictions and may only be used in FDA approved
Under the CSA Schedule II Placement Does Not Make a Substance Available for
Direct Use By Patients
The CSA schedules contain basic types or classes of substances such as oxycodone not specific products
such as OxyContin0 or Fentora0 although each new branded medication undergoes a scheduling analysis
as part of the FDA approval process Placement of a substance in Schedule II is not sufficien to allow a specific
79 Examples of Schedule I botanical materials dassified as hallucinogens are marijuana cannabis psilocybin and
ibogaine Pure synthetic THC is also in Schedule L
u GER I13o8 11
40 A drug s potential for abuse is a threshold issue in determining the schedule into which he drug may be placed The
term is not defined in the CSA but the legislative history demonsirates that the following factors are indicators that a drug
or other substance has a potential for abuse
There is evidence ha individuals are taking he drug or other substance in amoun s sufficient to veate a hazard to
their health or to the safety of other individuals or to the community
There is significant diversion of fie drug or other subs ance from legitimate drugs channels
Individuals are taking che drug or other substance on cheir own iniciacive rather than on the basis of inedical advice
from a practitioner licensed by law to administer such drugs or
The drug is a new drug so related in its action to a drug or other subscance already listed as having a potential for abuse
to make it likely chatthe drugwill have che same poteneial for abuse as such drugs thus malcing it reasonable to assume
that there may be significant diversions from legitimate channels signifiwnt use contrary to or without medical advice
or that it has a substantial capability of creating hazards to the heal
of the user or to the safety of he community
Of course evidence of acival abuse of a substance is indicative that a drug has a potential for abuse
H R Rep No 1444 91st Cong zd Sess 1970 reprinted in 1970 US Code Cong Ad News 4566 4601
41 u CFR 13o3 u the registration application of a bulk manufacturer must pass through a noiice publication in the
Federal Register and commen procedure 21 CF R 1301 33
4 zlCFR 130312
43 Substances in Schedule IIV have an accepted medical use Substances in schedules III V also have lower abuse potential
and are subjec to fewer restrictions Interestingly in California wnnabis remains in Schedule I of the sta e controlled
substances law despite the fact that it has been decriminalized for imited medical use Calif Health Safeiy Code
uosa di3
zoo9 Marijuana Dispensaries
and the Federal Government i7

product containing the substance to be marketed and distributed directly o patients The latter requires FDA
approval
In order for a substance to move from Schedule I to Schedule 11 che DEA must determine that it has an accepted
medical use In order for a substance to have an accepted medical use the following criteria must be met
1 Its chemistry must be known and reproducible
z There must be adequate safety studies
3 There must be adequate andwell controlled studies proving efficacy
4 It must be accepted by qualified experts and
5 The scientific evidence must be widely available
These criteria can only be me by data of very high scientific quality essentially equivalent to the data that must
be generated in order for a specific finished product to achieve FDA approval Ae a practical matter therefore
the scheduling of new controlled substances generally occurs only after or simultaneously with FDA approval
of products containing those substances
FDA Approval is Required in Order for a Specific Finished Medication to be Marketed
and Distributed to Patients
By contrast to the CSA s scheduling of substances rather than individual products the FDA approves only specific
products for marketing and distribution to patients
The FDA does not approve pure active pharmaceutical
ingredien s APIs nor crude herbal substances such as narcotic raw materials NRM Only a finished dosage
form containing a specific type of controlled substance can obtain FDA approval and become a
prescription
medication
44 See 57 Fed Reg 10499 10506 March 26 1992 See Alliance forCannabrs Theropeutics v DEA i5 F3d ii3i DC Cir i994
The DEA originally developed these criteria during the scheduling of MDMA 53 Fed Reg Si56 Feb zz i98S Grinspoon v
Drug EnforcementAdministratioq 8z8 Fid 881 ls Cir 1987
45 Hence FDA approval of a specific finished product is generally sufficient m establish an accepted medical use for the
substance contained therein There are rare exceptions See eg dronabinol synthetic in sesame oiI and encapsulated
in a soft gela in wpsule in a US Food and Drug Administtation approved producY is in Schedule III and has a Drug Code of
7369 Zi GER jli3oS i3g whereas pure synthetic THC remains in Schedule I with a Drug Code of 7370 2iCFR jii3o8
d
See Si Fed Reg 1746 May 13 1986 64 fed Reg 359z8 Quly 2 i999 dronabinol product FDA approved products con aining
GHB are in Schedule III while stree GHB is in Schedule I 65 Ped Reg1i35 March 13 2000 Pub L 106 172 GHB Hence
a formulated cannabis derived produc tould be placed in Schedule II or III after FDA approval while crude herbal annabis
could remain in Schedule I
46 FDA approval is not techniwlly a legal precondition to rescheduling Grinspoon supro at p 8991
47 See eg tapentadol The finished pharmaceutical product manufacmred by Johnson Johnson was approved by the
FDA in November 2008 DEA has issued a proposed rule placing tapentadoi into Schedule 11 74 Fed Reg 7386 Feb i7 zoo9
The finished product does noc yet have a tradeie branded name
18 2009 Marijuana Dispensaries and the Federal Government

u
r
pr s
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INW7c Mmrf
7fR
r
k
5
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Frs9d
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zbaui
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Candy bars rontaining cannabis seized as
eviGente From dispensarics in San Dic o
December 2005
This applies to cannabis as well as to other controlled substance plant materials In ig7o at the time it enacted
the CSA Congress placed opium and coca leaves in Schedule II of the CSA because modem standardized
and refined medical products derived from these substances were already oo the market Such schedule II
placement did not put crude opium or coca leaves on the pharmacy shelves Opium and concentrate of poppy
straw CPS contain different concentrations of alkaloids such as morphine hebaine and oripavine These
alkaloids are themselves considered Schedule II substances from which final pharmaceutical products are
developed If a dispensary were to attempt to cultivate and distribute crude opium or coca leaves it is beyond
doubt that the DEA would have both the authority and the obligation to ake action against such conduct
whether or not that activity was decriminalized under state law
48 Under the CPS method used by all cultivating countries except India the plant is allowed to go ro seed purtiorts of
the plani are then processed into a concentrate It is generally believed that CPS is less divertible than opium CPS may be
rich in morphine hebaine or oripavine See DEA AUthorized Sources of Narcotit Raw Materials 73 Fed Reg 6843 Feb
6 2008
49 Thebaine is used to manufacture oxycodone which in wm can be used to manufacture hydromorphone oripavme is
used to make buprenorphine as well as naloxone an opioid antagonistJ id See 7z Fed Reg 54ZO8 Sept 24 Zoo7 oripavine
scheduted separately in Schedule 71 rather than as a derivative of thebaine to comply with ihe USs obligations under
the Single Convention
2009 Marijuana Dispensaries
and the Federal Government 19

THE SCIENTIFIC PROCESS
Crude Herbal Cannabis and Unstandardized Cannabis Preparations Do Not Meet the
Standards of Modern Medicine
The Institute of Medicine IOM has recognized that crude herbal cannabis has little future as a true
medication
Although marijuana smoked delivers THC and other cannanbinoids to the body it also delivers harmful
substances including most of those found in tobacco smoke
In addition plants contain a variable
mix ure of biologically active compounds and cannot be expected to provide a precisely defined drug
efFect
For those reasons there is little future in smoked marijuana as a medically approved medication
If there is any future in cannabinoid drugs i lies with agents of more cercain not less certain
composition
The IOM stressed that the purpose of clinical trials of smoked marijuana would not be to develop marijuana as a
licensed drug but rather to serve as a first step toward the development of nonsmoked rapid onset cannabinoid
delivery systems
The FDA agrees hat crude herbal cannabis is not a medication The California Medfcal Association recently
announced its intention tore examine the need for continued research on smoked herbal cannabis in light of
So Joy JE Watson SJ Benson A r eds Marijuona and Medicine Assessing he Science Base Washington DC Ins itute of
Medicine 1999 atpp 177 78 hereafter Marijuana and Medicine
Si CurrenNy popular vaporizers eliminate some but no all potentially harmful polyaromatic hydrocarbons Gieringer
D St LaurentJ Goodrich S Cannabis Vaporizer Combines Efficient Delivery of THC with Efrective Suppression of Pyrolytic
Compounds Joumal of Cannobis Theropeutics z004417i7 Vaporizers are also not efficient as a delivery devite
Hazekamp A Ruhaak R Zuurman L van Gerven J Verpoorte R Evaluation of a Vaporizing Device Volcano for the
Pulmonary Administration of Tetrahydrocannabinol Joumol of Pharm Sci zo06 une956i3o8 i7 See also McCarberg
W Cannabinoids Their Role in Pain and Pallia ion fournpl of Pain G PoHip ive Cpre PharmpcoCherapy 2oo7 213 19 28
vaporiza ion provides no assurance of consistency of dose or quality with unstandardized plant material Id at p 11
Sz In zooi in rejecting a pecition for che rescheduling of marijuana
the FDA stressed
The agency cannot condude hat marijuana has an acceptable level of safety without assurance of a consistent and
predictable potency and without proof that the substance is free of contamination If marijuana is to be investigated
more widely for medical use informacion and data regarding the chemistry manufacturing and specifications of
marijuana must be developed
DEA Notice of Denial of Petition 66 Fed Reg 20038 20045 April 18 z0oi The agency more recently confirmed its posi ion
FDA Interagency Advisory Regarding Claims That Smoked Marijuana is a Medicine April ioo4 http www fda gov bbs
topics news 2oo6 newoi36z html
zo
zoo9 Marijuana Dispensaries
and the Federal Government

ecent research on its benefits and harm and the long term prospect of smoked herbal canna6is as a medicine
The DEA also acknowledges the need for standardized product
Herbal cannabis should comprise only the starting material from which a bono fide medical product
is ultimately derived f5ltandardizing herbal statting material represen
only the first of manyseps
necessary o create a modern medicine that is safe and effective for use in specific medical conditions
A1 final medical product must also be delivered in a dosage form that is consis ent in composition and
that allows the patien o obtain an identifiable and reliable amount of inedication
Only Recently Has Technology Made Possible the Development of Modern Cannabis
derived and Cannabinoid Medications
There are good reasons why the development of cannabis derived medications has
of synthetic and naturaliy derived opioids and other modern medicatians
lagged far behind that
Given that the active ingredients
morphine codeine of opium are water soluble it was relatively simple in the 19th and early 2oh centuries
to isolate them and develop standardized and purified medications with the technologies that existed at tha
time
The story of cannabis is quite different Cannabinoids especially THC are lipophilicie not water soluble
and unstable making it difficult for early scientists to identify and isolate the active ingredients Consequentiy
potentially therapeutic appiications were limited to oral preparation of cannabis tinctures and extracts
which could not be adequately standardized Patient response was variable and unpredictable As more
modern medicines became available these unreliable extracts and tinctures fell ou of favor with the medical
profession
53 California Medical Association ON CALL document 1315Jn 2009ht pJwww cmanet org
54 DEA Lyle E Craker Denial of Application 74 Fed Reg 2101 2105 Jan i4 2009 citing Letter from Alice P Mead GW
Pharmaceuticals PLC o Christine V 8eato Acting Asst Sec for Heal h HHS Apr 12 2005
SS As technologies advanceA syn hetic medicines appeared neceesitating he promulgation of a
Psychotropic Convention of i971
subsequen treaty the
56 Cannabis was generally not smoked at that time for medical purposes
57 Unlike cannabis the medicinal and reveational forms of opium were dearly distinct Had medical technology been
advanced enough at chat time to allow cannabinoids to be identified formulated and delivered he medicol marijuana
movement would probobly not hove occurred As with the opium poppy prescription cannabinoid medications and crude
herbalcannabiswouldhavebeenusedinverydifferentvenues McCarberg
WHand6arkinRL TheFU
ureofCannabinoids
as Analgesic Agents A Pharmacologic Pharmacokinetic and Pharmacodynamic Overview 200 American Joumal of
Theropeutics i45 475 483 476 emphasis added
Zoo9 Marijuana Dispensaries and the federal Government 21

The modern era of cannabinoid research was in its infancy in 1964 When the primary psychoactive ingredient of
cannabis THC was isolated and then synthesized a Beginning in 1989 a robus body of cannabinoid research
began o develop foliowing scientists discovery of the human cannabinoid receptor system This delay in
the development of modern cannabinoid and cannabis derived medicationshas therefore been caused more
by past technological limitations than by governmental obstructionism That development gap is now slowly
closing and there is no justification for affording a
cannabis
non scientific accelerationieafree pass to herbal
This evolution has followed the same principles as the evolution of drug therapy in general The
direction has been away from crude substances of variable composition stability and potency toward
the development of progressively more specific or selectively active pure compounds chat permic more
precise dosage and reduced risk of unwanted side effects
This is
not to say that complex botanically derived preparations cannot pass FDA muster
There is strong
evidence that some properly tested and standardized plant preparations including those derived from cannabis
may offer different and better pharmacological efFects than a pure synthesized cannabinoid alone
The FDA has recognized that there is burgeoning scientific and public interestin botanically based products
and that modern technology makes it possible to develop medications of botanical origin in order to guide the
development of such products the agency has set forth the criteria that must be met to achieve FDA approval b
While allowing some Flexibility at the early stages of inedication developmen the guidance specifically states
that by the time of Phase 3
clinical studies b the requirements for a
botanical drug product are virtuaNy
the same as to those that apply to a new chemical entity NCE Botanical Raw Material BRM such as
herbal cannabis has no been formula ed incorporated into a specific dosage form and tested through his
demanding NCE process The FDA guidelines make it quite clear that even if crude herbal cannabis were moved
to Schedule II it could no thereby be marketed and distributed directly to patients
58 Gaoni Y Mechoulam R ISOlation Siruc ure and Partial Synihesis of an Active Constituen of Hashish JournalAm Chem
Soc 196486 1646 7
S9 Devane WA Hanus L 6reuer A Pertwee RG Stevenson LA Griffin G et al Isolation and Structure of a
Brain Consti uent
hat Binds to he Cannabinoid Receptor Science 199zZ58 5090 1946
Howle t AC Johnson MR Melvin LS Milne GM
NOndassical Cannabinoid Analgetics Inhibit Adenylate Cydase Development of a Cannabinoid Receptor Model Molecular
Pharmacology i988 Mar33Z97 3o2
6o Kalant H Smoked Marijuana as Medicine Not Much Future Clinica Phormpcology G Therppeutics April 2008 834
517 519 517
61MPartland JM Russo EB Cannabis and Gannabis Extracts Greater Than the sum of Their Parts7 JournaloConnobis
Therapeutics 2ooii34io3 i3Z
6z FDA Guidance for Industry Botanical Drug Products 2o04htp www fda gov cder guidance 459zfnl pdf hereinafter
Botanical Guidance at p 34
botanical product submitted for marketing approval as a drugwill be treated like any other
new drug under developmentPrevious human experience may be insufficient to demonstrate the safery of a botanical
product especially when it is indicated for chronic herapy
63 This is the last stage of human research before the submission of a marketing application or NDA
zz
zoo9 Marijuana Dispensaries and the Federal Government

The Administration Should Respect and Support the Proper Workings of the Scientific
Process
As a
result of modern technologies and as demonstrated by the receptor research mentioned above there
is significant interest wi hin the scientific and medical communities in cannabinoid research
Scien ists are
moving as expedi iously as possible to bring new cannabinoid products to market Time is required however for
such research to be conducted in accordance with modern medical standards In keeping withis commitment
to science his Administration should do nothing 2o discourage these efforts As Presiden Obama has stated
Medical miracles do not happen simply by accident They result from painstaking and costly research
from years of lonely trial and error much of which never bears fruit and from a government willing to
support that work
The United States is indeed supporting such work in this area For example the FDA has allowed a cannabis
derived produa to enter into advanced clinical trials in the US For the pas ten years research has been
underway in the Uni ed Kingdom by GW Pharmaceuticals to develop a range of prescription medications derived
from the components of the cannabis plant GW cul ivates particular strains of cannabis that have been
bred to express specific ratios of cannabinoids
in order to maintain the consistency of the plants chemical
composition they are grown by clones cuttings underhighly
standardized and computer controlled conditions
in secure glasshouses GW exvacts the pharmacologically active components of the plant removes waxes and
other unwanted constituents and formulates the resulting botanical drug substance into a final dosage form
of specified composition which is characterized by various standard chromatographic techniques
The company s lead product Sativex0 is an oromucosal inside of the mouth spray composed primarily of THC
and CBD
It is believed that this combination has distinct and important pharmacological activity The product
has already been approved in Canada for neuropathic pain in multiple sderosis and for cancer pain The DEA
has licensed the importer b ar d the research sites
A number of other companies including Alexa Pharmaceuticais Inc THC aerosol producq Aphios naturally
derived THC producq and Insys Therapeutia Inc are also developing cannabinoid products in the US All
64 Montopoli B Obama Announ es Stem Cell Decision CBS News PoliUCal Hotsheet Mar 9 20o9 President Obama
remarks in full at p 2
65 GW Pharmaceuticals Research Development Cannabis Cultivationhttp www gwpharm com research cultivation
asp
66 The origina reg rstration was originally granted in 2006 71 Fed Reg 64298 NOV 1 2006 and waS recently renewed 73
Ped Reg 9589 Feb u zo08 Clinical rials began in November zoo7http www gwpharm com states asp
67 Such efforts are not confined to the US see eg Echo Pharmaceuticals the Netheriands Namisol a naturally
derived THC in sublingual cablet form The US through NIDA has also provided research grade cannabis to a number
of researchers whose studies have been funded by grants from the Center of Medicinal Cannabis Research which is based
at the University of California San Diego The results of a
number of these studies have been published www cmcr ucsd
zoo9 Marijuana Dispensaries
and the Federal Government z3

of these research programs are moving through the conventional domestic regulatory process sF
None is
attempting to distribute crude herbal cannabis ornon
standardized botanical preparations to pharmacies
and patients
These research programs indicate that cannabis derived medications can and therefore should
be developed within che parameters of modern regulatory oversight Allowing a proliferation of cannabis
dispensaries would undermine these efforts o bring properiy tested medications to market a
with this Administration
position tha its policies should be based on sound science
result at odds
Developing properly standardized and
tested cannabis derived or cannabinoid medications is not an easy
matter it requires patience perseverance and a commitment of substantial resources But numerous medical
cragedies have proven that shortcuts to the FDA process do a disservice to patient safety and well being The
FDA drug approval process is not perfect as demonstrated by recent news about previously unknown dangers
of marketed medications such as VioxxOO
The lesson of these experiences however is not tha we should
do less testing or lower our current standards for prescription medicines Indeed those incidents have led to
demands for greater oversight by the FDA and recently for the establishment of an independent ins itute o
examine the comparative safety and effectiveness of inedica ions
eduJgeninfo marijuana htm and reepond o the IOM ssatemens that such dinical trials serve as a first step oward the
development of nonsmoked rapid onset cannabinoid delivery systems Marijuana and Medicine supra at p 11
68 Indeed even che scaunchest herbal cannabis advocates are recognizing the need to develop seandardized cannabis
pharmaceutical products with innovative formulationshttp www phytiva com
69 The path of Cannasa is instructive Cannasat the only firm in Canada devoted to the development of cannabinoid
medications initially extolled the benefrts of herbal cannabis plant material Recently it sold off its ownership interests in
the cannabis cultivation program operated under con ract from Health Canada and is developing synthetic cannabinoids
with proprietary formulations and drug delivery technologieshttp www
cannasaccom news Shtml http www
cannasat com
70 The Instiw e of Medicine has described the many financial and oher challenges that would be faced by a developer
of fegitimace cannabis derived pharmaceutical products even iF a parallel informal rystertt of dispensaries did not exist
To allow such dispensaries would increase these disincentives and poten ially prevent the US from responding mhe
IOM s call for the development of rapid onset altemative delivery systems for cannabis or cannabinoid based products
Marijuana and Medicine supra at pp 193 zi9
i For example the Elixir Sulfanilamide disaster led to the enac ment of the 1938 Food Drug Cosmetic Act PDCA June
15 1938 c675 SZ Stat 1040 which required among other hings that new drugs be tested for safety before marketing
The chalidomide vagedy in Europe led co the passage of the Drug Amendments of i962 Pub L 87 78i sec i Oct io i962
76 Stat 780 also known as the Kefauver Harris Amendmen s which required that produca be proved to be both safe and
effective before marketing
7Zhttp www fda gov
cderJdrugJinfopageJCOX2 defaulLhtm FDA Estimates Vioxx Caused 27J85 Deaths Nov 4 2ooq
hxtp www cons u m eraffa irs com newso4 vioxx esti mates htmI
73 Walker EP5imulus 8ill Gives 1 8illion for Comparative Efiectiveness Research MedPage Today feb 19 2009
24 zoo9 Marijuana Dispensaries and the FeQeral Government

The FDA Has Limited Power to Protect Patients Who Seek Medical Treatment and
Advice From Cannabis Dispensaries
The FDA has limited jurisdiction to address the dangers posed by cannabis dispensaries
The provisions of
he FDCA govern only products that have been introduced into interstate com merce Therefore it can be
argued that the activities of intra state cannabis dispensary operations are beyond the reach of the FDA
Ironically the FDA has greater power over dietary supplements which have generally passed through interstate
commerce and over health food stores han it does over cannabis dispensaries and their operators Indeed
the manufacturers of herbs and other dietary supplements and Yhe reiail establishments that sell them are
prohibited by federal law from making claims regarding the product s medical usefulness or specific health
effects Cannabis dispensaries however do give out advice and provide books and pamphlets containing
such medical claims
The DEA therefore plays a critical part in protecting patients from dangerous ineffective and federally
unapproved cannabis products
The CSA and therefore the DEA s authority extends to produc s containing
controlled substances and activities that may affect interstate commerce even if the specific products have
been manufactured and distributed solely within the state If this Administration ties the DEA s hands with
regard to dispensaries patients will lose altogether any avenue of federal protection
States Laws and Regulatory Bodies Should Enhance RatherThan Undermine the
Protections Provided by the FDA System
In cases other than medical marijuana the FDA and DEA are able to rely to a large extent on state regulatory
and law enforcement systems to support and augment the federal structures
States have generally accepted
his responsibility enacting their own food and drug laws to fili the gap in the FDA s jurisdiction These state
laws are for the mosi part modeled after the federal FDCA
In California for example the Sherman Food
Drug and Cosmetic Law Sherman Law establishes rigorous scientific standards that must be met before a
74 Dietary supplements are already subject co a lower standard of requlatory scrutiny because they are presumed to be less
dangerous than prescription medications and because they are not intended and cannot be Iabeled or advercised as for
use in diagnosingmi iga ing Veating or curing disease See the Dietary Supplement Health and Education Act of 1994
DSHEA nUSC 3z1 f Dietary supplemen
are orally ingested FDA Botanical Guidance at p 3
75 See The Dietary Supplement Health and Education Act of i994 DSHEA Pub L 1o3 4i7http www fda gov opacom
Iaws DSHEA html Whether a product is a drug under the fDCA turns on its intended use intended use in turn is
created by daims made by or on behalf of a manufacturer or distributor of che item to prospective purchasers such
as in advertising labefing or ora scatements zi US0 p3u gJ 1J B Botanical Gutdance at p z Dietary supplemen
manufacturers distributors or retailers cannot make specific health clalms See eg US v z4 Bottles SterlingVinegarand
HoneyAged in Wood Cider elended With Finest Honey Con ents i Pint ProductoSterling Cider Col Inc Sterling Mass 338 F2d
i5J nd Cir z964 Kordel e US 335 US 345 1948
76 See eg Califomia Law Enforcement Investiga ing POt Docs July 8 008http www officeccom web online iop
News Stories Ca I ifo rnia Law Enforce m e ntI nves i gati ngPot Docs 131450
77 Gonzales v Raich 545 US12005
zoo9 Marijuana Dispensaries and the Federal Government
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new drug may be marlceted for medical use
The Sherman Law states that a new drug generally may not be
sold delivered or given away unless a new drug application has been filed with and approved by the state or
federel governmentl
State regulatory boards and agencies similarly enhance the efFectiveness of the FDA and DEA
State boards of
medicine nursing pharmacy etc supervise the education training and practices of all health care providers
who examine or advise patients or dispense or distribute medications Health care providers who do not adhere
to accepted standards of inedical practice may incur sanctions from these boards as well as risl potential civil
liabilityforinappropriateprescribingorotherconductfallingbelowthestandardofcare Healthcarefacilities
are monitored and licensed by state departments of health services State tort systems allow patients who have
suffered injury from a medication to seek damages from the manufacturer even if that medication has been
FDA approved
These state mechanisms when they operate effectively provide patients with additional or
greater avenues of redress and protection and thereby complement federal food and drug provisions
78 Calif Health Safety Code ll155o
79 If physicians prescribe unapproved medica ions those that are not approved by the state or federel regulatory agenty
and a patient suffers harm as a result he physician
professional Ilabi iiy policy may not cover a daim for damages See
Educating Voices The Potential Medical Liabiliry for Physicians Recommending Marijuana as a Medicine white paper
http www
educatingvoices org EVl
WhicePaperl pdf
So Wyeth v Levine 555 US Mar 4 2009
z6
zo04 Marrjupna Dispensaries and the Federal Government

By contrast when states utilize their food and drug laws or enact other state legislation for the purpose
of circumventing the FDCA patien health and safety is jeopardized
controversy paralleis the Laetrile controversy of the i97os
In many ways the current cannabis
At that time Laetrile amygdalin was vigorously
promoted as a cancer treatment and preventative Despite efForts by its supporters to characterize it as a
dietary supplement Vitamin B17 the FDA determined that Laetrile was a new drug since it was intended
for medical use and was subject to premarketing approval 8 Since it had not been proven safe and effective
for medical use the FDCA precluded Laetrile s shipment in interstate commerce
spurred on by anecdotal reporcs of efficacy contended that they had a
Desperate cancer patiencs
right to use Laetrile despite evidence
of cyanide toxicity Laetrile advocates claimed that the FDA the American Medical Association the American
Cancer Society the pharmaceutical companies and others were conspiring against Laetrile s This political
pressure rather than scientific evidence caused twenty seven state legislatures to pass laws allowing the
sale and use of Laetrile within heir borders
manufacture Laetrile within each state
These state laws had little effect since it was not feasible to
Proponents hoped however that if enough states legalized its use
within the states Congress would change the federal law as well Ultimately the National Cancer Institute
conducted clinical testing and determined that Laetrile was not efFective as a cancer treatment
The lesson of
Laetrile is that state legislation should only be used to enhance rather than undermine he protections of the
federai regulatory system
The same is true with regard to controlled substances
Many states have adopted the Uniform Controlled
Substances Act a the provisions of which parallel those of the federal CSA States can serve as an early warning
system and have the flexibility to respond more quickly to abuses of controlled substances
substances with abuse potential
or of uncontrolled
within their borders sb For example as an added layer of protection states
may require that individuals who conduct research into controlled substances must be independently inspected
81 4 Fed Reg39 768
795 1977
82 Bone M MD laetrile Drug Never Proved to be EfFective Cancer 7reatment The Polm Beach Post Mar 20 2008
83 Wilson B MD The Rise and Fall of Laetrilehttp Jwww quackwa ch org
olQuackeryRelatedTOpics
CancerJlaetrile
hml
84 Moer el CG et al A Clinical Trial of Amygdalin Laetrile in the Treatment of Human Cancer New EnglondJournal of
Medicine 198i 306 4z01
Nevertheless even at present companies continue o promote and sell Laetrile as a cancer
Vea ment Chrough interne web sites See eg FDA Talk Paper FDA Takes Ac ion Against Firms Marke ing Unapproved
Drugs Sept 6 z000http www fda gov bbs topics
ANSWERS ANSOlo3z html
85 See National Conference of Commissioners on Uniform State Lawshttp www
org nccusl uniformact
summariesJuniformaccsucsa9o asp Calif Health Safety Code pfjii000 i1651
86 For example Salvio divinorum whose active constituent is salvinorin A is an herb that is increasingly used by the public
for its hallucinogenic effeccs Salvia is not currently controlled under the CSA although the DEA is observing It dosely As
of November iooS thirteen states had enacted legislation placing regulatory controls on Salvia divinorum andJor salvinorin
A a number of those states placed he subs ances in schedule I of state law Proposed legislation is pending in a number of
other states DEA Drugs and Chemicals of Concern Nov ioo8http www
deadiversion usdoj govJdrugs
concernJindex
html
zoo9 Marijuana Dispensaries and the Federal Government 27

licensed and or approved by state agencies in addition to obtaining DEA registrations States may enact
prescription monitoring programs to track physicians who prescribe controlled substances in order to identify
and stop inappropriate prescribing practices by physicians as well as doctor shopping by patients obtaining
prescriptions from multiple doctors simultaneously
States also have greater flexibility in cheir scheduling
actions If a state believes that a new substance has abuse potential and poses a threat to patient safety or
public health the state need not wait on the DEA it may schedule that substance more restrictively or prohibit
its sale and use altogether
Cannabis Dispensaries Are Not Subject to State Laws and Regulations Applicable to
Entities Operating in the Health Care Area
Cannabis dispensaries starkly conflict with this robus state system of patient oriented controls
Pot docs
for cash payments of several hundred dollars provide recommendations to patients including minors
with whom they have vir ually no physician patient relationship to enable them to use cannabis for a wide
variety of inedical conditions ss Patients purchase cannabis from dispensaries with which they have only a
retailer consumer relationship Dispensary personnei need not be licensed as health care providers nor are
they required to follow proper sterile techniques to protect against on site bacterial or other contamination
of the herbal materiaf although it is intended for consumption diredly by patients Despite their lack of
raining and accreditation such personnel freely offer medical information and advice to patients about the
87 The Research Advisory Panel RAP of the CaliforniaAorney General s office must approve all Schedule I and II research
projects and protocois Calif Heal h Safety Code pIIn48o 8ihctp wagstace ca us research
88 DEA State Prescription Drug Monitoring Programshtp www
deadiversion usdoj gov faq nc monitor htm When
controlled substances are at issue Che federal government also has authority to regulate direcdy some aspec
of a physician
medical practice Under the CSA physicians who prescribe or dispense controlled substances must hold a registration from
the DEA and such conV011ed subs ances must be prescribed for a legitimate medical purpose and in the course of regular
professional practice u CFR jf1306 04a US v Moore 4Z3 US 1i 137 140 42 1975 Although states bear he primary
responsibility for preventing and punishing he diversion of prescription controlled drugs by health care providers the DEA
in egregious cases may investigate and revoke the registracion of and even criminally prosecute a physician orother health
care provider who facilitaces and or promotes drug abuse and addiction
89 See eg Califomia Law Enforcemen Investigating POt Docs puly 8 008ht pwww officeccom web oniine iop
News Stories California Law
Enforcement
Investigating POt DOCS 131450 The Medical Board of Califomia has promulgated
guidelines for physicians who recommend cannabis however here has been very limited enforcement http www medbd
gov Medical Marijuana html Physicians who recommend cannabis can avoid the need for a DEA registration if they do
not prescribe other controlled substances
90 Salmonella and E coli are common baccerial contaminants that can be transmitted to botanical material through
improper handling rechniques
9i San Francisco regulations state that dispensaryoperators must require employees only to wash hands and use sanitary
utensils when handling cannabis rather than use sterile gloves and instruments Sec 33iz b3
9z AS one dispensary advertises We are also experienced and knowlecgeable about the various medications and how they
workforvariousailments sowecans
eeryoutowardananswer
notjustanotherdeadendhttp
greendragoncoop com
default him gdid
CKWtgr6wj5kCFRBbagodxhFTZg http Jwww mlive om news
flinyindexssf z0o9 o3 group to offer
28 2004 Marijuana Dispensaries and Che Federal Government

panoply of cannabis products including extracts capsules tablets and various types of edibles Some of these
products can reach THC concentrations as high as 80 which could produce significant side efFects especially
in seriously ill patients or those who have not used cannabis before
At best cannabis dispensaries are regulated at the local IeveL Where they are permi ted by local legislation
as in San francisco such dispensaries are not regulated as
or pharmacies answerable to the state department of health services
if they were health care facilities eg dinics
Nor are the employees who provide
direct patient serviceeg distributing medlcal marijuana or medlcal advice subject to the scope of practice
restrictions and requirements supervised by the state boards of pharmacy nursing and medicine
Rather
dispensaries are regulated as if they were retail establishments subject only to the Building Planning Housing
Police Fire and Health codes of the local jurisdiction
Cannabis and Cannabis Derived Products Should be Governed by the Quality Control
and Other Testing Procedures Applicable to All Modern Medications
Gradually even some cannabis dispensaries have begun to voice concern that these unregulated distribution
practices may be placing patients in danger
One operator has acknowledged that if cannabis is going to
become an accepted mainstream medicine there must be quality assurance and dosage information
fA dog wall s in the grow room and wags itstail anything can be coming off that dog s tail IYs gross
Fertilizers with E coli Compost
that they don t make right anaerobic tea that has elevated levels of
E coli and salmonella It has to come There s no way that this is sustainable AII it takes is one story of
immune
compromised people dying from Aspergillus infection
marijuana advichtmlhtp www
sanfranciscocannabisdubs mm directory
sarnfrancisco green door hm patients can
expect to deal wi h know edgeable staR membercJ
93 Downs D The Manhattan Project of Mari uana Eas Bay Express Mar 4 2009http jwww
eastbayexpress om ebx
PrintFriendly oid 96926 Hereinafter
ManhattanPro ect
94 Many cities have no reg aions and indeed have issued bans or mora oriahttp Jnwwscribd com dci94869i MedicaP
Mari uana moratorium map
95 Medical Cannabis Ac mvisions Of cial San
ordi nanceso9 o0015 09 Pdf
Franc sco We6sitehttp wvwsfgov org
uploadedfilesJbdsupvrs
96 Cannabis is a highly abuseable substance and if determined to have an accepted medical use in treatment in the
US would remain sub ect to he dosed system of distribution required by Me CSA State regulation does not fulfill this
reqwrement
97 Manhattan Projec supro
zoo9 Marijuana Dispensaries and the Federal Government 9

This operator has affiliated with an informal laboratory and envisions a testing program using such instruments
as a gas chromatograph and mass spearometer
He also no es however that IYs expensive to test every
single thing tha comes through the door thaYs the price you pay with a decentralized supply system five
pounds coming from here and two from there It is far from certain whether other dispensaries would
voluntarily join such an effort
These rudimentary laboratory testing efforts merely confirm the imporcance of adhering to the exis ing body of
tecf nological toois and methodoiogies mandated by state and federal regulatory agencies There is no need to
recreate the wheel for cannabis or cannabis derived preparations Drug manufacturers are already required to
institute extensive testing procedures to ensure that their products are quality controlled during manufacture
and that their formulations and dosage forms are standardized and reproducible Testing procedures mus be
validated instruments must be calibrated equipment operators must be appropnately educated and trained
careful records must be kept and practices must be sterile
Finished medical products must be analyzed
for to batch consistency and any degradants and minorcon aminants must be identified and strictly
limited
Should a sys em of cannabis testing laboratories ultimately develop at all it is hard to imagine that it would
be allowed to operate at a different or inferior level to the current US medication
development system
cannabis dispensaries are allowed o proliferate across he country our current regulatory system to which
the American Medical Association and all other major US medical associations give their unwavering support
may be seriously undermined
If
If there were only a single state with a few dispensaries the risk might not be as significant At present
however 13 states have laws decriminalizing the use of cannabis for medical purposes and bills are pending
in many more states If such cultivation and distribution activities are deemed to be beyond the reach of the
DEA dispensaries are likely to emerge all over the country
98 Of coursehis
9aborecory is a far cry from currendy acceptable scientific standards ooks Iike a bachelor pad with a
Iocked room in che back ld
99 d
100 For example bills are pending in Illinois Minnesota New Hampshire and New York among others to decriminalize
cannabis for medical usehtcp www mpp org legislation
ioi For example a bill is currently pending in the Rhode Island legislature to amend the existing medical marijuana
law to authorize cannabis dispensaries This bill has gained more force following Attorney General Eric Holder s remarks
alchough it failed in the state House of Representatives last year Members of the House have stated that the Attorney
General s comments have caused them to view the proposal much more fawrably than lastyear Needham C Bill Would
License Dispensaries o Sell Medical Marijuana Mar 5 2009http Jwww projo com news con ent MARI UANA BILL 03
OS O9 U N DH M 3Nv17 37894c1 htm I
3a
2009 Marijuana Dispensaries and the Federal Government