Willie Nelson once said, “I think people need to be educated to the fact that marijuana is not a drug. Marijuana is an herb and a flower. God put it here. If He put it here and He wants it to grow, what gives the government the right to say that God is wrong?” (Herb). The marijuana debate could be considered one of the most controversial debates in the entire world. As time has passed, specifically in the United States, state legislation has become more and more lenient regarding recreational usage. However, many argue that while used recreationally, marijuana can be defined as a gateway drug that can and will set up the course for a lifetime of risky decisions and drug abuse. Another side to the marijuana debate is that of medical marijuana. A question that many people wonder is how exactly has medical marijuana influenced and impacted the way that we treat the ill, and if these outcomes have been beneficial or not? Some dismiss medical marijuana as a hoax that exploits our natural compassion for the sick; others claim it is a uniquely soothing medicine that has been withheld from patients through regulations based on false claims. The answer to these questions lies within the components of the plant itself. The use of medical marijuana, specifically through cannabinoids which are the active constitutes of cannabis, is just beginning to define itself in the medical world. It is slowly, yet steadily, becoming the answer to so many unsolved problems that have haunted doctors for years. The difference between recreational use and medical use is the dosage and the parts that are being put into the body. Throughout history, marijuana has been experimented with for both recreational and medical reasons, and with this experimentation, countless studies have found that the benefits of marijuana, while administered by medical professionals, are proven to treat and heal patients that are suffering. 

Cannabis sativa, known as marijuana, has a long history of medicinal use, with the earliest documentation around 4000 B.C. in China for the treatment of rheumatism, pain, and convulsions (Maa). In fact, cannabis was available over-the-counter in U.S. pharmacies for a variety of maladies until 1941, following passage of the Marijuana Tax Act of 1937, which limited its access. Finally, the Controlled Substances Act of 1970 classified cannabis as Schedule I, making its use illegal (Maa). Marijuana is the most commonly used illicit drug across the world, including in the United States. The federal government prohibits the manufacture, distribution, dispensation, and possession of marijuana. Over the past few decades, some states have deviated from an across-the-board prohibition of marijuana. Evolving state-level positions on marijuana include decriminalization initiatives, legal exceptions for medical use, and legalization of certain quantities for recreational use. These latest moves have spurred a number of questions regarding their potential implications for related federal law enforcement activities and for the nation’s drug policies as a whole. Among these questions is whether or to what extent state initiatives to decriminalize, or even legalize, the use of marijuana conflict with federal law (Derrickson 74). In 1996, California voters passed Proposition 215, making the Golden State the fist in the union to allow for the medical use of marijuana. Since then, 28 more states have enacted similar laws and as of now allow for comprehensive public medical marijuana and cannabis programs (Garcia). The National Conference of State Legislators details the history of marijuana and medical marijuana classification and laws as follows: At the federal level, marijuana remains classified as a Schedule I substance under the Controlled Substances Act, where Schedule I substances are considered to have a high potential for dependency and no accepted medical use, making distribution of marijuana a federal offense (Garcia). In October of 2009, the Obama Administration sent a memo to federal prosecutors encouraging them not to prosecute people who distribute marijuana for medical purposes in accordance with state law. In late August 2013, the U.S. Department of Justice announced an update to their marijuana enforcement policy. The statement reads that while marijuana remains illegal federally, the USDOJ expects states like Colorado and Washington to create "strong, state-based enforcement efforts [...] and will defer the right to challenge their legalization laws at this time (NCSL)." The department also reserves the right to challenge the states at any time they feel it's necessary. Arizona and the District of Columbia voters passed initiatives to allow for medical use, only to have them overturned. In 1998, voters in the District of Columbia passed Initiative 59. However, Congress blocked the initiative from becoming law. In 2009, Congress reversed its previous decision, allowing the initiative to become law. The D.C. Council then put Initiative 59 on hold temporarily and unanimously approved modifications to the law. Before passing Proposition 203 in 2010, Arizona voters originally passed a ballot initiative in 1996. However, the initiative stated that doctors would be allowed to write a "prescription" for marijuana. Since marijuana is still a Schedule I substance, federal law prohibits its prescription, making the initiative invalid. Medical marijuana "prescriptions" are more often called "recommendations" or "referrals" because of the federal prescription prohibition (NCSL). Recreational marijuana abuse is what is keeping the federal government from following in the footsteps of state legislation and legalizing it all around. The benefits that go along with prescribed and controlled medical marijuana usage are too compelling and monumental to be simply pushed to the side.

Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects, however, the harmful effects to individuals from the perspective of possible medical use of marijuana are not the same as the harmful physical effects of a long term abuse of the drug. John A. Benson, Jr. and Stanley J. Watson, Jr. who are the two Co-Principal Investigators of Neuroscience in a study of medical marijuana for the National Academy of Sciences, state, 

Although marijuana smoke delivers THC and other cannabinoids to the body, it also delivers harmful substances, including most of those found in tobacco smoke. In addition, plants contain a variable mixture of biologically active compounds and cannot be expected to provide a precisely defined drug effect. For those reasons, the report concludes that the future of cannabinoid drugs lies not in smoked marijuana but in chemically defined drugs that act on the cannabinoid systems that are a natural component of human physiology. Until such drugs can be developed and made available for medical use, the report recommends interim solutions” (ix). 

The components of the cannabis plant that enables it to assuage maladies ranging from the common migraine to seizure disorders are compounds called cannabinoids. The most well-known are tetrahydrocannabinol (THC), which gives weed its psychoactive properties, and cannabidiol (CBD), which is naturally found in the plant (ELLE). The reason that these cannadinoids have such profound effects on us is because we are biologically primed to use them. The human body has a pre-existing endocannabinoid system that is a unique communication system in the brain and body that is integral to the nervous and immune systems and affects things like how a person feels, moves, and reacts (Degenhardt). When cannabinoids from plants, like marijuana, are added, they can interact with these receptors to help our own internal endocannabinoid system function more effectively, keeping our internal processes balanced. CBD has absolutely no psychoactive properties, unlike THC, but rather, when extracted from the THC component, it reacts with a person’s endocannabinoid system as a soothing and healing mechanism (Degenhardt). 

Benson and Watson used laboratory animals in order to experiment with cannabinoids and determine the different effects on bodily functions. Their conclusions included a decrease in motor functions as well as a decrease in short term memory, however they reduced reactivity to acute and chronic painful stimuli. Pain perception is controlled mainly by neurotransmitter systems within the central nervous system, and cannabinoids clearly play a role in the control of pain in those systems (Joy 53). They concluded that cannabinoids have a natural role in pain modulation, control of movement, and memory, and that heavy marijuana abuse can have long term effects on cognition and short-term memory. 

The question is not whether marijuana can be both harmful and helpful, but whether the perception of its benefits will increase its abuse. Many people argue that when it comes to marijuana use, the negative effects completely outweigh any positive effects. There are studies that give factual information detailing motor and cognitive deficits from heavy, long term abuse. For example, at Carleton University, At Carleton University, a group of doctors and psychologists analyzed data from a group of young people whom they have been following since birth. They analyzed IQ scores before, during, and after cessation of regular marijuana use to determine any impact of the drug on this measure of cognitive function. They compared the difference in IQ scores of current heavy users (at least five joints per week), current light users (less than five joints per week), former users (who had not smoked regularly for at least three months), and non-users (who never smoked more than once per week and no smoking in the past two weeks). Current marijuana use was significantly correlated in a dose-related fashion with a decline in IQ over the ages studied, so the negative effect was only in subjects who smoked five or more joints per week (Fried). This study exemplifies and concludes that marijuana does not have a long-term negative impact on global intelligence, but it does, however, decrease cognition in heavy users for a short period of time. Another study conducted by Bertha K. Madras, a leader in the division of alcohol and drug abuse at the Harvard University Medical School, wrote an article proposing factual evidence from a dopamine challenge that reveals neuroadaptive changes in marijuana abusers. Some of these changes that she explains are a result of repeated drug-induced dopamine surges that were shown to engender neuroadaptive changes in brain regions implicated in drug salience, drug reward, motivation, memory, and executive function. Symptoms of these neuroadaptive changes are a feeling of a “high” and it is a result of a manifestation in marijuana abusers that affect behavioral, psychological, and biological responses that induce a feeling of addiction similar to that of a cocaine or nicotine addiction. These studies accurately show how heavy and constant marijuana abuse can adversely affect cognition and can even result in a dependency for the drug, however, this is why, medically, things would be completely different. Yes, recreationally abusing marijuana in an uncontrolled setting can be addictive and harmful to the brain and body, but in a medical setting, there would be no abuse. Each and every aspect of the drug administration would be regulated with specific doses and controlled by licensed professionals. The use of medical marijuana is designed to heal its users, not to abuse the drug and lead to the harmful effects have been proven to be possible.

On the flip side, there are numerous case studies and stories that explain just how powerful marijuana can be when it is administered properly. Advances in cannabinoid science over the past 16 years have given rise to a wealth of new opportunities for the development of medically useful cannabinoid-based drugs. The accumulated data suggest a variety of indications, particularly for pain relief, antiemesis, and appetite stimulation. For patients who suffer simultaneously from severe pain, nausea, and appetite loss, such as those with AIDS or who are undergoing chemotherapy, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication. Charlotte Figi is a little girl who has been suffering from SCN1A-confirmed Dravet syndrome, which is a type of Epilepsy, since she was just three months of age. Through exhaustive research and assistance from a Colorado-based medical marijuana group (Realm of Caring), Charlotte's doctor’s started her on adjunctive therapy with a high concentration of CBD:THC strain of cannabis (Maa). This extract, slowly titrated over weeks and given in conjunction with her existing antiepileptic drug regimen, reduced Charlotte's seizure frequency from nearly 50 convulsive seizures per day to now 2–3 nocturnal convulsions per month. This effect has persisted for the last 20 months, and Charlotte has been successfully weaned from her other antiepileptic drugs (Maa). The strain of cannabis that is used for treating Charlotte’s condition is able to react with her endocannabinoid system in order to drastically slow down her seizures and reshape her entire lifestyle. Another example of how cannabis extracts can completely redefine how we treat diseases can be seen in the case of Hugh Hempel’s eleven-year old twin daughters. Hugh Hempel shared his daughter’s stories on a TED talk in 2015. His daughters have been suffering from a rare and fatal neurodegenerative disease called Niemann-Pick Type C (childhood Alzheimer’s) since they were diagnosed at ten years old. The twins suffered from intractable seizures that they experienced up to 100 times a week. Since that time, Hugh and his wife Chris have immersed themselves in science and medicine and discovered through their own research that a simple sugar compound called cyclodextrin would save their twins’ lives (TED). This form of CBD is the only thing that treats their seizures effectively and has reduced them to a minuscule amount. Hugh now sits on the Board of Directors for The Global Genes Project, a leading rare and genetic disease non-profit advocacy organization based in California. Their goal is to create a large scale cannabis clinical research clearing house in order to better elucidate the potential benefits of this cannabis plant. The creation of a pharmaceutical quality cannabis supply network is the first step towards this larger goal of building knowledge about using cannabis to improve health. 

It is people like the Hempel twins and Charlotte Figi who are the start to the next generation of medicine. The marijuana plant has so many different components to it that have yet to be even experimented with, however those that we have just begun to explore have shown promising results. Cannabidiol, being the most researched out of at least 80 known cannabinoids identified in marijuana and hemp, has already proven to react with a person’s internal endocannabinoid system and the cannabinoid receptors within. cannabinoid receptors are involved in a vast array of functions in the body, including helping to control brain and nerve activity (including memory and pain), energy metabolism, heart function, and the immune system. Medical marijuana is the answer to treating countless diseases that we have never been able to properly treat. It may not be a cure, but it is the next step towards healing patients and changing lives.
