HEARING ON MEDICAL MARIJUANA

House Committee on Government Reform: Subcommittee on Criminal Justice,
Drug Policy and Human Resources Holds a Hearing on Marijuana Medicine

SPEAKERS:

U. S. Representative Mark Souder (R-IN) Chairman

U. S. Representative Nathan Deal (R-GA) Vice Chairman

U. S. Representative John M. Mchugh (R-NY)

U. S. Representative John Mica (R-FL)

U. S. Representative Doug Ose (R-CA)

U. S. Representative Jo Ann Davis (R-VA)

U. S. Representative Edward L. Schrock (R-VA)

U. S. Representative John R. Carter (R-TX)

U. S. Representative Marsha Blackburn (R-TN)

U. S. Representative Elijah E. Cummings (D-MD) Ranking Member

U. S. Representative Danny K. Davis (D-IL)

U. S. Representative William Lacy Clay (D-MO)

U. S. Representative Linda T. Sanchez (D-CA)

U. S. Representative C. A. "Dutch" Ruppersberger (D-MD)

U. S. Representative Eleanor Holmes Norton (D-DC)

U. S. Representative Chris Bell (D-TX)

WITNESSES:

Nora Volkow, Director National Institute of Drug Abuse,
NIH

Robert Meyer, Director, Office of Drug Evaluation Center for Drug
Evaluation and Research, Food and Drug Administration

James Scott, Board Member, Oregon Board of Medical
Examiners

Joan Jerzak, Chief of Enforcement, Medical Board of
California

Dr. Claudia Jensen, Ventura, Calif.

Robert Kampia, Executive Director, Marijuana Policy Project

Dr. Robert Dupont, Institute for Behavior and Health
Inc.

Patricia Good, Chief, Liaison and Policy, Diversion Control Program,
Drug Enforcement Administration

SOUDER: Subcommittee will now come to order. Good afternoon, and thank
you all for coming. This hearing will address a highly controversial
topic: the use of marijuana for so-called medical purposes.

In recent years, a large and well-funded pro-drug movement has
succeeded in convincing many Americans that marijuana is a true
medicine to be used in treating a wide variety of illnesses.Unable
to change the federal laws, however, these pro-drug activists turned
to the state referendum process and succeeded in passing a number of
medical marijuana initiatives.

This has set up a direct conflict between federal and state law, and
put into sharp focus the competing scientific claims about the value
of marijuana and its components as medicine.

Marijuana was once used as a folk remedy in many primitive cultures,
and even in the 19th century was frequently used by some American
doctors, much as alcohol, cocaine and heroin were once also used by
doctors.

By the 20th century, however, its use by legitimate medical
practitioners had dwindled, while its illegitimate use as a
recreational drug had risen.

The drug was finally banned as a medicine in the 1930s. Beginning in
the 1970s, however, individuals began reporting anecdotal evidence
that marijuana might have medically beneficial uses, most notably in
suppressing the nausea associated with cancer chemotherapy.

Today, the evidence is still essentially anecdotal, but many people
take it as a fact that marijuana is a proven medicine. One of the main
purposes of this hearing is to examine that claim. At present, the
evidence in favor of marijuana's utility as a medicine remains
anecdotal and unproven.

An Institute of Medicine study published in 1999 reviewed the
available evidence and concluded that, at best, marijuana might be
used as a last resort for those suffering from extreme conditions.

This report is repeatedly cited by the pro-marijuana movement as proof
that marijuana is safe for medical use. In fact, the report stressed
that smoking marijuana is not safe, a safe medical delivery device,
and exposes patients to a significant number of harmful substances.

In contrast to its supposed medical benefits, the negative health
effects of marijuana are well known and have been proven in scientific
studies. Among other things, the drug is addictive, impairs brain
function, and when smoked greatly, increases the risk of lung cancer.

The respiratory problems associated with smoking any substance makes
the use of marijuana cigarettes as medicine highly problematic.
Indeed, no modern medicine is smoked.

It is quite possible, however, that some components of marijuana may
have legitimate medical uses. Indeed, the Institute of Medicine
report, so often erroneously cited as supporting smoked marijuana,
actually stated that, quote, "If there is any future of marijuana as a
medicine, it lies in its isolated components, the cannabinoids, and
their synthetic derivatives."

Interestingly, the federal government has already approved a marijuana
derivative called Marinol, but rarely do the pro-marijuana advocates
mention this.

The federal government has also approved further studies of the
potential use of marijuana or marijuana derivatives as medicine.
However, in the United Kingdom, a pharmaceutical company applied for a
license to market an inhalant form of marijuana called Sativex.

Thus, the real debate is not over whether marijuana could be used as
medicine. The debate is over the most scientifically safe and
effective that components of marijuana may be used as medicine. The
responsibility for ensuring that any drug, whether derived from
marijuana or not is safe and effective, whether it is safe and
effective, has been entrusted to the U. S. Food and Drug
Administration, FDA.

Under federal law, the FDA must review, test and approve each medicine
and determine what conditions or diseases each drug may be used to
treat and at what dosage level. The FDA continues to monitor each
drug, making sure that it is manufactured and marketed properly and
that unforeseen side effects do not jeopardize the public health.

State laws purporting to legalize marijuana for medicinal purposes
bypass these important safeguards. California and Oregon have adopted
the most wide-reaching such laws. They allow anyone to use, possess
and even grow his own marijuana, provided he obtains the written
recommendation of a doctor. Few if any restrictions are placed on what
conditions marijuana may be used to treat. Virtually no restrictions
are placed on the content, potency or purity of such medical
marijuana.The laws adopted in California, Oregon and other states
are extremely open ended. California law even allows marijuana to be
used for migraine headaches. This has led to a number of uses of
marijuana that I believe to be highly questionable.

For example, one of our witnesses, Dr. Philip Leveque, has personally
written recommendations for over 4,000 people to use marijuana.
Another of our witnesses, Dr. Claudia Jensen, has recommended that
teenagers use marijuana for the treatment of psychiatric conditions
like attention deficit disorder, ADD.

Only a small percentage of medical marijuana users in California and
Oregon have actually used the drug to treat the conditions for which
it was publicly promoted, namely the nausea associated with
chemotherapy and AIDS wasting syndrome.

In Oregon, statistics kept by the state medical marijuana program
indicate that well over half the registered patients use the drug
simply for pain, while less than half of them use it for nausea,
glaucoma or conditions related to cancer or multiple sclerosis.

In San Mateo, California, a study of AIDS patients showed that only 28
percent of the patients who used marijuana did so even to relieve
pain. Over half used it to relieve anxiety or depression, and a third
used it for recreational purposes.

This raises one of the key questions we must address today: If we are
going to treat marijuana as a medicine, will it be subjected to the
same health and safety regulations that apply to other medicines?

We do not allow patients to grow their own opium poppies to make pain
killers like morphine, oxycontin, or even heroin with just a doctor's
recommendation. We do not allow people to manufacture their own
psychiatric drugs like Prozac or Xanax to treat headaches.

Why, then, should we authorize people to grow their own marijuana,
when the potential for abuse is high and there is little or no
scientific evidence that it can actually treat all of the illnesses
and conditions.

Why should we abandon the regulatory process that ensures that drugs
are manufactured at the right potency level and contaminant free? Why
should we stop the oversight that makes sure that drugs are being
administered in the right dosage and in the safest manner?

Our witnesses today will try to answer those and other key questions
from a wide variety of perspectives. We welcome back Dr. Nora Volkow,
director of the National Institute on Drug Abuse, NIDA, at the
National Institutes of Health, the federal agency with the greatest
expertise on the health effects of marijuana and other drugs.

Representing the key federal agency with responsibility for regulating
medical drugs, we also welcome back Dr. Robert Meyer, director of
FDA's Office of Drug Evaluation II, Center for the Drug Evaluation and
Research.

Here to discuss the process of applying for a federal license to grow
marijuana for research purposes, we are joined by Ms. Patricia Good,
chief of liaison and policy section at the DEA's office of Diversion
Control.

We are also pleased to welcome two representatives of state medical
boards that have been forced to attempt to regulate the use of
marijuana by doctors, Dr. James D. Scott, a member of the Oregon Board
of Medical Examiners and Ms. Joan Jerzak, chief of enforcement for the
Medical Board of California.

We are also joined by two advocates of the use of marijuana as
medicine, Dr. Jensen and Mr. Robert Kampia of the Marijuana Policy
Project. I am grateful, in particular, to Dr. Jensen for her
willingness to come and testify about her controversial medical
practices, and I hope and anticipate a frank and open discussion with
her.

Dr. Leveque will not be able to be here, though he did not inform the
committee. So, if he shows up, we'll include him in the second panel.

Finally, we are pleased to welcome Dr. Robert Dupont of the Institute
for Behavior and Health, Inc., an expert on marijuana and drug abuse
and former head of NIDA.

We thank everyone for taking the time to join us today and I look
forward to all of your testimonies. Mr. Cummings

CUMMINGS: Thank you very much, Mr. Chairman. The possession and sale
of marijuana has been illegal under federal law since 1937 when
Congress passed the Marijuana Tax Act. Prior to that time, however,
Americans could legally purchase at least 27 medicines containing
marijuana, many of them manufactured by reputable pharmaceutical firms
that remain in existence today.

In 1970, Congress passed the Controlled Substances Act classifying all
illegal and prescription drugs according to five schedules.

Marijuana was and remains classified as a schedule-one substance,
meaning that it has a high potential for abuse, has no clearly
accepted medical use and treatment in the United States and cannot be
used in an acceptably safe manner under medical supervision.

Possession and the sale of schedule-one substances is generally
prohibited and punishable by federal criminal statutes. Clinical
trials involving schedule one and other controlled substances are
permitted subject to the approval of the Food and Drug
Administration.

The Controlled Substances Act allows for the reclassification of
substances on the basis of new evidence of their safety and efficacy.
Along with other federal law enforcement agencies, the Drug
Enforcement Administration enforces federal antidrug laws. And the DEA
also is responsible for approving applications by research
institutions to cultivate marijuana in bulk for research purposes.

Changes in the law have not altered the perception or belief of many
Americans who continue to believe that marijuana has medical or
medicinal benefits and that it should be legally available for the
treatment of various conditions and ailments.

Beginning in the 1990s, numerous states --California and Oregon
prominent among them --passed legislation or ballot initiatives
legalizing medical marijuana, resulting in a conflict in those states
between state law and the Controlled Substances Act.

In 2001, the Supreme Court ruled that California's medical marijuana
law, Proposition 215, did not create a valid defense to a federal
prosecution for marijuana possession or on the basis of medical necessity.

Still, Proposition 215 remains on the books and medical marijuana
remains legal as a matter of state law. Federal law enforcement
agencies have asserted their authority to enforce the federal
prohibition by conducting raids on medical marijuana distribution
centers and privates homes in medical marijuana states.

Further complicating the matter, a 2003 ruling by the Supreme Court
affirmed the right of physicians, under the First Amendment, to
recommend marijuana for their patients free of government censorship.

A few physicians have earned notoriety for prescribing marijuana for a
wide range of ailments, ranging from pain associated with cancer and
HIV/ AIDS to depression and attention deficit disorder.

Meanwhile, research has confirmed the efficacy of the synthetic
marijuana drug Marinol, which is classified separate from natural
marijuana on schedule three of the Controlled Substances Act.

As of 1999, the bulk of the scientific literature, as evaluated by the
Institute of Medicine in a prominent study, appears not to support the
use of smoked marijuana as a medicine, except in a small number of
unusual cases.

The IOM recommended, however, that additional scientific research
should be undertaken to determine the potential benefits of marijuana
and marijuana-derived drugs.

Our witnesses represent a wide range of perspectives, and will attempt
to help the subcommittee to sift through the competing claims
regarding the efficacy or potential efficacy of marijuana and
marijuana-derived medicines, as well as the harms that accompany
marijuana use and the public health implications of state medical
marijuana laws.

Hopefully, they will shed new light on the current state of research
within and beyond the United States, including recent developments in
the United Kingdom where a drug company has submitted an application
to market an inhalant form of marijuana to treat a variety of symptoms
and conditions. I look forward to the hearing today and I yield back.
Thank you, Mr. Chairman.

SOUDER: Mr. Carter, do you have any opening comments? Ms.
Norton?

NORTON: Thank you, Mr. Chairman. I'm not going to be able to stay to
hear the testimony, but I did want to come to say I appreciate your
having this hearing and the range of witnesses that you have invited
to testify because it is the absence of federal leadership that I
think has led many steps to move ahead on their own to try to at least
make medicinal marijuana available.

Of course, occasionally there are prosecutions but not a great many
because federal authorities obviously understand where they are most
needed when it comes to the prosecution of our drug laws. I would
think, though, that the fact that we have eight to 10 states moving
ahead to legalize medical marijuana would have caused far more
vigorous federal research and leadership than we have seen thus far.

This city was one of the several cities that have simply moved forward
on its own, not because the council or the legislative body for the
District of Columbia decided that medicinal marijuana was something
that the people of the District of Columbia should have, but because
the people of the District of Columbia voted to allow medical
marijuana in the city.

And Initiative 59, that provision of course was remanded by the
Congress of the United States, as it has not been able to do in any of
the states which have composed similar laws and shouldn't be able to
do to a local law here. In any case, the point of Initiative 59 should
be understood.

There was no elected officials that put it on the ballot. There is no
official body that put it on the ballot. An AIDS victim collected the
signatures and put the matter on the ballot.

That AIDS victim has since died. Essentially what he was seeking was
the legal use of medical marijuana to alleviate some of his own AIDS
symptoms.

I must say that there were some organizations and individuals seeking
legalization of marijuana for its own sake that morphed into the
district all of a sudden.

But it should be said that this proposition emanated from a patient
and was approved by the residents of the District of Columbia and had
nothing to do with the legalization of marijuana itself.

The people of the District of Columbia have been very clear that they
want the two to be distinguished. My own sense is that young people
should lay off of the entire set of controlled substances, whether
they are very harmful or terribly harmful, from marijuana to heroin.

And, by the way, heroin has become increasingly popular with young
middle-class students. And, for that matter, should lay off alcohol,
which is, perhaps, the drug of choice for young people in college
today. You know, you don't find me saying any of these things are good
for you or, because you're young and foolish, go right ahead.

When it comes to medical marijuana, we are about a serious matter and
one that, frankly, I think our government could have found the answer,
one way or the other to, long before now.

But the greatest objection I have is not about this medical
controversy. Most people with AIDS today are today are not going to
seek medical marijuana. This is not a raging controversy in the country.

Do you know what is a raging controversy in the county? It is putting
young people in jail for smoking pot. Wherever you stand on these
matters, it doesn't seem to me that we ought to ruin a kids life by
giving him a record for smoking pot.

And to the credit of most of the states of the United States, they
understand that. And there are very few such arrests made.
Nevertheless, as it stands, this is on the books that way. And you can
get yourself a prosecutor who will in fact enforce it that way,
particularly if you don't happen to be an empowered part of this
society, which brings me to the next point.

The Congress of the United States has gone so far as to say that you
can't get educational grants if you have a record of any kind for
smoking pot.

Do you know who that falls on? Middle-class white kids don't very
often have records for smoking pot. But if you live in drug-infested
parts of the inner city, where you're surrounded by drugs from the
moment you hit the streets as a kid, it is probably the case that you
will smoke something before you go to college.

The notion of denying Pell grants and denying, therefore, a college
education to kids who happen to live in a drug culture, no matter how
drug free they are today, is the real crime to me.

While this is an important hearing, because it's way past time for the
federal government to, in fact, straighten out this matter --the state
of the art research could have been done by now so that we lay this
matter to rest --there are far more serious matters affecting
controlled substances that deserve our attention. Thank you.

SOUDER: Thank you. A couple of things for the record. I think it needs
to be said that the 9th Circuit Court ruled and the Supreme Court
didn't review --which is a little different than the Supreme Court
making the decision.

The Supreme Court --and we're not going to debate today the preemption
law, because Supreme Court has already ruled on preemption, in fact,
fought a civil war over preemption. States do not have the right to
pass laws contrary to federal law anymore than the states had
referendums to pass and support slavery.

We fought a war and said federal law prevails. You don't have a right
to nullification. Now, how we enforce those is another question.

One other thing on the record as the author of an amendment I did not,
in the amendment, Congress did not pass a law that said if you had a
drug conviction you couldn't get a Pell Grant or a loan. Congress
passed a law that said if you have a Pell Grant, you will lose it. The
Clinton administration interpreted and the Bush administration falsely
continued that interpretation which we are about to appeal in the
Higher Ed Act.

I also, before we start, I want to take a point of personal privilege
because today is the last day for a longtime member of my staff,
Nicole Garrett. She came to us highly recommended from the California
Department of Justice Bureau of Narcotic Enforcement where she had
worked on California's growing problem of clandestine meth labs.

I hired her as a junior staff of the first week of June, 2002 and
promoted her to clerk of the Subcommittee on Criminal Justice Drug
Policy and Human Resources on July 28th of that year. Since then she
has been ably and efficiently handling the logistics and
follow-through that has been required for 36 Congressional hearings in
Washington and across America.

She has also made invaluable contributions to our policy work on
extradition and other criminal justice issues in, as our
subcommittee's primary public relations staffer was always both
pleasant and effective.

Her work on this subcommittee the California Department of Justice
Bureau of Narcotic Enforcement, the San Jose Police Department, and
her volunteer work with the concerns of police survivors does great
honor to the memory of her father, Sergeant George Garrett who was
head of the Redwood City's Police Department's narcotics detail. He
was killed in the line of duty on May 8th, 1981.

Nicole, I've been impressed by your dedication to making this country
a better place. And I wanted to say so on the record. I wish you and
your family all the best as you return to California. And we'll miss
you very much.

Now I'd like to ask unanimous consent that all members have five
legislative days to submit written statements and questions for the hearing
record and that any answers to written questions provided by the witnesses
also be included in the record. Without objection, it is so ordered.

I also ask unanimous consent that all exhibits, documents and other
materials referred to by members and witnesses may be included in the
hearing record and that all members be permitted to revise and extend their
remarks. Without objection, it is so ordered.

Our first panel, if you'll stand and raise your right hand, I need to give
you each the oath. Do you swear and affirm the testimony you give today is
the truth, the whole truth, and nothing but the truth so help you God?

Let the record show that each of the witnesses has answered in the
affirmative. I want to welcome Dr. Volkow back and you're recognized four
or five minutes.

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