Right: after police raids in the USA, protests erupted outside courthouses where patients treated with cannabis were on trial.
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Arguments against immediately legalising the medicinal use of cannabis
1. Cannabis is a potentially harmful substance
There are many doctors who are concerned that those using marijuana for medicinal purposes are under-estimating its potentially harmful side-effects.
Professor Nicholas Talley of the Royal Australian College of Physicians has stated, 'I think we need to be very, very careful... people who drive and are taking marijuana: well, they're putting themselves and others at risk. There's an increased risk, based on studies, of suicide. There's an increased risk of certain cancers with chronic marijuana use. This is not a totally safe product, like some people - in fact, perhaps many people - believe.'
A wide range of reports on the safety of marijuana have concluded that marijuana impairs functions important for safe driving and the operation of machinery. There is also increasing concern about the long-term developmental effects of marijuana use on children and adolescents.
Research suggests that cannabis use can make existing psychotic symptoms worse. Cannabis use can cause a condition known as drug-induced psychosis. Symptoms usually appear quickly and last a few days until the effects of the cannabis wear off. Disorientation, memory problems and hallucinations (seeing or hearing things that are not really there) are the most common symptoms. The effects of cannabis begin within minutes and can last several hours. However, for people with a psychotic illness (such as schizophrenia), the effects can be longer lasting and more intense.
If someone has a predisposition to a psychotic illness such as schizophrenia, use of drugs such as cannabis may trigger the first episode in what can be a lifelong, disabling condition. There is increasing evidence that regular cannabis use precedes and causes higher rates of psychotic illness.
2. Cannabis use should only be legalised after rigorous trials
Many of those who potentially support the legal therapeutic use of cannabis argue that this should only occur once rigorous testing has taken place to ensure the product's efficacy and safe dosage levels.
The president of the New South Wales branch of the Australian Medical Association has praised his state's government for not taking further action to legalise the medicinal use of marijuana until thorough trials have been conducted. It has been claimed that the 'evidence' available from unregulated, informal and unmonitored community use is of no scientific value and that the trials the drug has undergone so far to determine its effective medicinal use have been inadequate.
Dr Smith has stated, 'All of the trials that have been performed to date have really had flawed research protocols and methodology. You can't compare across the trials because they are all very different products, all very different situations.
That's why it's so important that the New South Wales Government has taken this step to have this discussion within a medical trials framework.'
The same position has been adopted by the Victorian branch of the Australian Medical Association which has criticised the new Victorian Government for proposing legalisation in advance of further trials.
The president of the Victorian branch of the Australian Medical Association, Dr Tony Bartone, has stated, 'The changes to legislation and other regulatory laws need to occur to allow the clinical trials to continue in a meaningful and robust manner...We've got to make sure we don't put the horse before the cart.'
Dr Bartone has further argued that marijuana should be treated no differently to any other drug seeking to be authorised for therapeutic purposes. Any new drug has to be trialled to ensure its safety and optimal dosage. Those seeking further trials of marijuana claim it is no different. The Australian Medical Association (AMA) is lobbying governments to consider only a fully tested medicine that has been approved by the Therapeutic Goods Administration (TGA).
Dr Bartone has argued, 'What we are seeking to do is exactly what any other new medicine would be required to do coming onto the market.'
The AMA has maintained that the raw plant, and any oils or tinctures made from it, should not be trialled or legalised. The Association wants trials to use only cannabis-based pharmaceutical products already on the market overseas, but not yet available in Australia.
There are two types of these drugs. One contains a synthetic version of THC, the main mind altering molecule in cannabis and includes drugs called dronabinol and nabilone.
The other type is new on the market, and is an extract of the cannabis plant called Sativex. It contains equal amounts of THC and another key molecule, CBD. It is the only cannabis-based medicine approved by Australia's TGA, but only for the treatment of spasticity in muscular sclerosis.
3. The medicinal use of cannabis should only be legalised when there is quality-assured supply
Opponents of the immediate legalisation of medicinal marijuana are concerned about quality control issues and argue that the drug should only be made legal for medicinal purposes once secure, regulated and quality assured sources are available.
The Victorian state president of the Australian Medical Association (AMA), Dr Tony Bartone, has stated that the drug must be legalised in consultation with medical authorities to ensure the safe distribution and administration of the substance.
Dr Bartone is concerned about the variability of 'street cannabis' currently illegally available for medicinal use and does not wish to see restrictions against these products removed.
Dr Bartone has stated, 'We are in no form ... looking at the crude plant and legalising the plant for medicinal purposes...We know that the composition between leaves can vary, depending on where it's sourced, how it's grown, and what time of year it's harvested.'
Many doctors are concerned that without a properly regulated product there cannot be accurate administration of the drug. Dosage and the form which should be used will simply be a matter of guesswork.
Professor Nicholas Talley of the Royal Australian College of Physicians has described the problems which have occurred in the current unregulated environment. Talley has stated, 'The problems have been that practitioners don't quite know how to dose, how to prescribe, how to ensure people will actually get effective levels of drug, what the effective levels are, who to prescribe it for, what indications. They're pretty serious issues.'
4. Measures can be taken to avoid the criminalisation of those using cannabis for medicinal purposes
It has been claimed that even without formal decriminalisation or legalisation of medicinal marijuana it is possible to allow patients to use marijuana for medical purposes without the risk of prosecution.
Currently within Australia, cannabis users who claim to use the plant for medical purposes are treated the same as anyone else using non-industrial cannabis, that is, first or second-time offenders caught with small amounts will be offered treatment and can avoid any criminal sentence or a criminal record. Repeat offenders caught with small amounts are likely to be fined and forced into treatment rather than sent to jail, though they may still obtain a criminal record. In the case of the case of medicinal users, some jurisdictions appear to turn a blind eye to criminal charges and allow families and treating physicians to use the substance in a variety of forms without charges being laid.
In September, 2014, the Baird government in New South Wales announced its intention to establish new guidelines which would ensure that the terminally ill, being treated with marijuana, could be in possession of up to 15 grams of cannabis without prosecution. The scheme stops short of either decriminalisation or legalisation; however, it is intended to extend officers' current ability to use discretion to caution adults caught with small amounts of the drug.
5. Hasty legalisation of cannabis for medicinal purposes could increase its recreational use
There are those who oppose the legalisation of marijuana for medical purposes because they believe that this can readily lead to an increase in the drug's use for recreational purposes.
On November 13, 2014, UConn, the University of Connecticut's Internet site gave the opinion of Dr. Yifrah Kaminer, child and adolescent psychiatrist at UConn Health, on the use of marijuana for medical purposes. Referring to the establishment of legal dispensary to make the drug available for medical use, Dr Kaminer stated, 'proximity to dispensaries has been associated with increased availability for people other than medical marijuana card holders - in particular minors. Decriminalization, medicalisation, and legalization of marijuana each increase the number of marijuana first-time users and decrease age of first use. This could lead to growing public health problems, including medical, psychosocial, academic, and financial consequences.'
Dr Kaminer went on to claim, 'The effects of medical marijuana implementations have been negative for the community and have led to an increase in crime rate, vehicular accidents among users, availability of medical marijuana to youth, increased emergency department referrals associated with marijuana ingestion by children, butane hash-oil lab explosions that resulted in burns and property damage (similarly to methamphetamine labs), increased marijuana use by teens with related school suspensions, and more.'
On October 9, 2014, The Tampa Tribune noted, 'Sixty-six percent of those who responded to the annual Sunshine State Survey, conducted by the University of South Florida, said they believe that passing a constitutional amendment legalizing medical marijuana would soon lead to voters' approval of all marijuana use.'
Susan MacManus, a University of South Florida political scientist and the survey's director stated, 'People are aware of the potential first-step nature of the medical marijuana amendment, if it passes.'