Medical marijuana has a long history of medicinal use dating back thousands of years. It was commonly used as a pain reliever in the United States until the 1900s when it faced increased criminalization. By the 1970s, marijuana was classified as a Schedule I drug and the "War on Drugs" began. Starting in the 1990s, states began passing laws allowing medical marijuana to treat conditions like chronic pain, cancer, AIDS, and seizures. Today, 24 states have medical marijuana programs, though the federal government still classifies marijuana as illegal. While medical marijuana can help certain conditions, there are safety concerns as its use cannot be verified like prescriptions.

1. Consideration for Medical Marijuana
(Trends in Drug and Health Screening Educational Series)
Todd Simo, M.D.
Chief Medical Officer
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4. Medical Marijuana - History
 Ancient accounts of marijuana used for medical purposes
» Egypt
– Multiple accounts going back as far as 1700 BC
• Hemp suppositories for relieving hemorrhoid pain
» China
– Cannabis is one of the 50 “fundamental” herbs in traditional Chinese medicine
• Cannabis was considered to be tonic, demulcent, laxative, emmenagogue (promotion of
menstruation), diuretic, and an antihelminthics (drug to expel parasitic worms)
» Greece
– The ancient Greeks used cannabis not only for human medicine, but also in
veterinary medicine to dress wounds and sores on their horses
» Multiple others
– India, medieval Islamic World, Southeast Asia
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5.  “Modern” World (1800’s - ~1900)
» Medicinal preparations of cannabis became available in American
pharmacies in the 1850s following an introduction to its use in
Western medicine
» Cannabis as a medicine became common throughout much of the
Western world by the 19th century
» It was used as the primary pain reliever until the invention of aspirin
Medical Marijuana - History
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6. Medical Marijuana - History
 “Modern” World (~1900 - ~1940)
» Criminalization process
– Poison Laws (1906 – 1923)
• Aimed to restrict all narcotics, including cannabis, as poisons, limit their sale to
pharmacies, and require doctor's prescriptions
– Uniform State Narcotics Act (1925 – 1932)
• Formation of the Federal Bureau of Narcotics (FBN)
• Harry Anslinger, the head of the FBN, claimed cannabis caused people to
commit violent crimes and act irrationally and overly sexual
– Marijuana Tax Act (1937)
• Made possession or transfer of cannabis illegal throughout the United States
under federal law, excluding medical and industrial uses, in which an expensive
excise tax was required
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7. Medical Marijuana - History
 “Modern” World (~1940 - ~1974)
» Criminalization process
– Mandatory Sentencing Laws (1952 & 1956)
• The acts made a first-time cannabis
possession offence a minimum of two to ten
years with a fine up to $20,000
– “War on Drugs” (1970’s)
• Term coined by President Nixon
• Drug Enforcement Agency formed
• Controlled Substances Act
– Marijuana a Schedule I drug
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8. Medical Marijuana - History
 Modern World (~1970 - Present)
» Decriminalization process
– Robert Randall sued the federal government for arresting him for using
cannabis to treat his glaucoma (1978)
• The judge ruled Randall needed cannabis for medical purposes
• Thirteen people were enrolled in the program when in 1992 George H.W. Bush
discontinued it
– Medical use advocacy
• Proponents of medical marijuana argue that it can be a safe and effective
treatment for the symptoms of cancer, AIDS, multiple sclerosis, pain, glaucoma,
epilepsy, and other conditions
– California Prop. 215 (1996)
• Voters passed statute that approves initiatives endorsing the legal use of
marijuana under a doctor’s supervision
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9. Medical Marijuana - History
 Modern World (~1970 - Present)
» Decriminalization process
– 1996, The Clinton administration announces its plan to institute criminal
prosecution of physicians who prescribe or recommend marijuana in
California and Arizona, and to deprive them of their right to write
prescriptions of any kind
• Multiple lawsuits ensue
– By 1998, multiple other states join California in decriminalizing medical
marijuana
• Alaska, Oregon, and Washington
– With the “ice broken,” other states have joined
• Currently there are 24 states with medical marijuana programs
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10. Why Is Medical Marijuana Used Today?
 Original intention
» To help people with extremely serious (often terminal) diseases to
live more comfortably
– Generally terminal patients
• End stage AIDS
• Cancer
• Severe debilitating neurologic diseases
 Today
» Most medical marijuana users list “chronic pain” as the reason they
use marijuana
– Several state studies identify over 90% of medical marijuana users identify
chronic pain as reason for their use
– Average age is under 50 years old
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11. Why Is Medical Marijuana Used Today?
 Medical marijuana is currently used for a number of
medical conditions:
– Agitation related to Alzheimer's disease
– Cachexia (severe loss of appetite)
– Cancer
– Glaucoma
– HIV+/AIDS
– Nausea
– Post Traumatic Stress Disorder (PTSD)
– Pain
– Seizures, including but not limited to epilepsy
– Persistent muscle spasms, including but not limited to those caused by
Multiple Sclerosis
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Medical Marijuana
States that have Medical Marijuana statutes in
place
» Legacy: 24 States - AK, AZ, CA, CO, CT, DE, HI, IL, ME,
MD, MA, MI, MN, MT, NV, NH, NJ, NM, NY, PA, OR, RI,
VT, WA, and Washington DC
» New: 4 States – AR, FL, ND, and OH
 Green = statute addresses need to accommodate when possible
 Red = Regulation/case law explicitly states that employers DO
NOT NEED to accommodate medical marijuana use
 Black = Regulation silent in regard to need to accommodate
 Gold = Statute still needs to be vetted
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Medical Marijuana
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Decriminalized Recreational Marijuana
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15. Medical Review Stance
 Medical marijuana is illegal
» DEA Schedule 1 medicine
– Illegal to possess, use, or prescribe
 State medical marijuana is a recommendation
» No prescription
– No checks and balances in terms of usage or strength
» Recommendation was originally intended for people who had no
other medical option
 Medical marijuana as standard is verified and reported
as a positive drug screen after MRO review
» All donors are told to address their medical marijuana use with their
employer
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16. Safety Concern
 Medical marijuana
» Physician recommendation - not a prescription
» No way to verify appropriate use
– No verifiable prescription dose
– Drug screening result by itself cannot be used to determine impairment
• Potential ability with oral fluid and blood
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