Legalization of Marijuana

BACKGROUND

Over the last 40 years, the legal status of marijuana has been debated vigorously. Proponents of policies that would permit individual possession of small amounts of marijuana argue that it is a safe drug and that criminal sanctions against personal use and possession represent at worst excessively harsh and at best unnecessary penalties. Echoing these sentiments, editors of The Lancet have concluded that "cannabis per se is not a hazard to society but driving it further underground may well be."1 Advocates for legalization also point out that the morbidity, mortality, and economic costs to society associated with alcohol and tobacco use in the United States dwarf those associated with marijuana use.

Those opposing liberalization of current laws counter that marijuana is not a benign drug, especially in light of new psychopharmacologic information demonstrating that marijuana shares many features with other illicit drugs. They also contend that legalization or decriminalization of personal use of marijuana likely would trigger a substantial increase in use, with foreseeable increases in the social, economic, and health costs.

Most recently, the debate has focused on the medical use of marijuana (that is, the use of smoked marijuana to treat a variety of medical conditions). Eight states (Alaska, Arizona, California, Colorado, Maine, Nevada, Oregon, and Washington) have passed ballot initiatives that provide for medical use of marijuana under certain circumstances; one other state (Hawaii) has enacted state legislation permitting medical marijuana use.2 The federal government has opposed vigorously any efforts to permit physicians to prescribe marijuana for medical purposes, an approach characterized by the former editor of the New England Journal of Medicine as "misguided, heavy-handed, and inhumane."3

Controversy regarding marijuana is not limited to the United States. Australia has decriminalized the use of marijuana in some territories, and Canada4 as well as Switzerland and other European countries5 are reconsidering their approach to marijuana. However, the most widely publicized approach to regulation of marijuana is that of The Netherlands. Under a complex system of "law-on-the-books" and "law-in-action," Dutch law permits personal use of marijuana but outlaws possession.6

Pediatricians, too, are not of one mind in their views regarding the legal status of marijuana. In a periodic survey of fellows of the American Academy of Pediatrics (AAP) conducted