The Politics of Pot and Pain

How doctors built the case for medical marijuana.

Marijuana leaves. 
National Journal
Peter Hecht
Add to Briefcase
See more stories about...
Peter Hecht
April 3, 2014, 5 p.m.

Don­ald Ab­rams knew that Mark Henry was go­ing to die. It was 1986 when the two met. Ab­rams, one of the world’s lead­ing AIDS doc­tors, was de­liv­er­ing a lec­ture in Maui. The speech had been set up in hon­or of Henry’s former part­ner, who had been the first per­son on the is­land to die of the dis­ease. Henry, who had HIV him­self, sought out Ab­rams at the lec­ture. Ab­rams’s ex­per­i­ences told him that Henry’s de­teri­or­a­tion would be rap­id and ex­cru­ci­at­ing. Yet that know­ledge didn’t stop him from de­vel­op­ing a re­la­tion­ship with Henry. It didn’t stop the two men from va­ca­tion­ing to­geth­er, from laugh­ing to­geth­er, or from draw­ing close to each oth­er.

Ab­rams was a Stan­ford Uni­versity-edu­cated hem­at­o­lo­gist and on­co­lo­gist. He’d be­gun his work on AIDS in 1979 when an un­ex­plain­able pro­gres­sion of young gay men with swollen glands began show­ing up at the Kais­er Found­a­tion Hos­pit­al in San Fran­cisco. Lee Wilkin­son, the hos­pit­al’s chief hem­at­o­lo­gist, summoned Ab­rams, a 29-year-old openly gay med­ic­al res­id­ent. “Hey, Duck,” Wilkin­son said, in­vok­ing the Dis­ney char­ac­ter nick­name he had be­stowed on the prom­ising young doc­tor. “Can you take a look at this?”

Ab­rams ordered lab tests on the men’s lymph nodes. The res­ults offered noth­ing from which to draw con­clu­sions. So he found him­self cau­tion­ing the men on un­healthy life­styles. “Stop hav­ing so many sexu­al part­ners,” he lec­tured. “Stop tak­ing drugs. Move out of the fast lane.”

At the ur­ging of Wilkin­son, Ab­rams moved on to the hem­at­o­logy and on­co­logy train­ing pro­gram at the Uni­versity of Cali­for­nia (San Fran­cisco). There, he star­ted en­coun­ter­ing more young gay men with new, more-severe symp­toms. By 1981, doc­tors at the uni­versity were see­ing the first cases of Ka­posi’s sar­coma, a haunt­ing, sys­tem­ic af­flic­tion that left pa­tients splotched with le­sions. Ab­rams began fo­cus­ing on a strange “gay can­cer” that would be­come known as Ac­quired Im­mune De­fi­ciency Syn­drome. He no­ticed many of the men had swollen glands. “How long have you had those?” Ab­rams asked. About two years, they told him, sug­gest­ing a troub­ling pro­gres­sion of the symp­toms Ab­rams had noted in 1979.

Ab­rams ap­plied for a grant to study lymph­aden­o­pathy syn­drome, hop­ing to find clues about the first symp­toms of ill­nesses lead­ing to dia­gnoses of AIDS. He ex­amined 200 gay men with swollen glands who had yet to de­vel­op Ka­posi’s sar­coma or pneumo­cystis, the ravaging pneu­mo­nia that would sig­nal their rap­id de­cline. He took lymph node spe­ci­mens to the UC San Fran­cisco labor­at­ory of Har­old Var­mus, a No­bel Prize-win­ning re­search­er. They began study­ing what would be iden­ti­fied as a ret­ro­vir­us that at­tacked cells and altered the body’s DNA and its abil­ity to fend off dis­ease.

In 1983, Ab­rams moved to San Fran­cisco Gen­er­al Hos­pit­al. There, on­co­lo­gist Paul Vol­berd­ing and in­fec­tious-dis­ease spe­cial­ist Con­nie Wofsy es­tab­lished the world’s first AIDS in­pa­tient ward, Ward 5B, with Ab­rams as their protégé. For a time, the trio knew every AIDS pa­tient in San Fran­cisco. That year, a French re­search­er, Luc Montag­ni­er, would be widely cred­ited with dis­cov­er­ing the vir­us that led to AIDS. Ab­rams later be­came one of three re­search­ers to name it the Hu­man Im­mun­ode­fi­ciency Vir­us, or HIV. Soon the rate of HIV dia­gnoses and the num­ber of AIDS pa­tients were skyrock­et­ing. All too soon, Ab­rams re­called, “we didn’t know every­body any­more.” San Fran­cisco be­came a death camp for men wast­ing away, dis­figured, stig­mat­ized with a gay dis­ease. Over two dec­ades, 19,000 city res­id­ents would per­ish from AIDS.

Still, Ab­rams let him­self fall in love with Mark Henry. When the two men met, Henry had just had an epis­ode of AIDS-re­lated pneu­mo­nia. Ab­rams knew nearly every­one with the dis­ease died with­in 12 months after a pneumo­cystis out­break.

By 1986, phys­i­cians were pre­scrib­ing a new an­ti­vir­al drug called AZT for the treat­ment of AIDS. Ab­rams be­lieved the tox­icity of AZT out­weighed its thera­peut­ic be­ne­fits. Henry didn’t take the drug. Yet Ab­rams watched his part­ner sur­vive through 1986, then 1987, then 1988, and in­to 1989. Throughout this time, Henry smoked marijuana. Ab­rams, who as an un­der­grad at Brown Uni­versity pre­ferred pot to booze, joined him. Ul­ti­mately, the weed made the doc­tor feel para­noid, so Ab­rams cur­tailed his use. But Henry did not. He went on to out­live fel­low AIDS pa­tients in one sup­port group, then a second, then a third.

When he died in 1989, Mark Henry had sur­vived three times longer after pneumo­cystis than the av­er­age for AIDS pa­tients. Ab­rams didn’t know for sure if there was a med­ic­al be­ne­fit to the marijuana Henry had used. The doc­tor also had no ink­ling that, years later, he would be­come Cali­for­nia’s most renowned re­search­er on med­ic­al marijuana — and that clin­ic­al tri­als in the Golden State would chal­lenge the fed­er­al gov­ern­ment and health-re­search or­tho­doxy by help­ing es­tab­lish the med­ic­al ef­fic­acy of pot. Still, it was not lost on Ab­rams just how long Henry had man­aged to live — and he used can­nabis “every freakin’ day.”


Twenty-five years after Henry’s death, med­ic­al marijuana is leg­al in 20 states. In 2012, Col­or­ado and Wash­ing­ton be­came the first states to leg­al­ize marijuana for non­med­ic­al reas­ons. Re­cently, Pres­id­ent Obama said of pot dur­ing an in­ter­view with The New York­er: “I don’t think it is more dan­ger­ous than al­co­hol.”

Yet with the tide of his­tory seem­ingly on the side of leg­al­iz­a­tion, it’s easy to for­get that the ques­tion of wheth­er pot can be le­git­im­ately used for med­ic­al reas­ons re­mains a fraught polit­ic­al sub­ject. The fed­er­al gov­ern­ment still clas­si­fies marijuana as a Sched­ule I drug with no ac­cep­ted med­ic­al use. And last year, the gov­ern­ment’s po­s­i­tion on marijuana re­ceived a cru­cial en­dorse­ment from the U.S. Court of Ap­peals for the Dis­trict of Columbia Cir­cuit. A group called Amer­ic­ans for Safe Ac­cess had sued the Drug En­force­ment Ad­min­is­tra­tion over marijuana’s 42-year-long clas­si­fic­a­tion as a Sched­ule I drug, and the court ended up sid­ing with the status quo. “There is ser­i­ous de­bate in the United States over the ef­fic­acy of marijuana for med­ic­al uses,” Seni­or Cir­cuit Judge Harry Ed­wards wrote in his ma­jor­ity opin­ion — be­fore con­clud­ing that “sub­stan­tial evid­ence” sup­ports the gov­ern­ment’s claim that stud­ies af­firm­ing ac­cep­ted med­ic­al use of marijuana “do not ex­ist.” In oth­er words, as far as the D.C. Cir­cuit and the fed­er­al gov­ern­ment were con­cerned, the work of Don­ald Ab­rams — and oth­er doc­tors who had spent many years ex­plor­ing the med­ic­al be­ne­fits of marijuana — nev­er happened.

To be sure, Ab­rams and his peers in the med­ic­al pro­fes­sion were hardly the only people work­ing to change the dis­cus­sion sur­round­ing marijuana over the last two dec­ades. Throughout the coun­try, but es­pe­cially in Cali­for­nia, there has been no short­age of act­iv­ists, politi­cians, in­tel­lec­tu­als, and en­tre­pren­eurs who pushed so­ci­ety to ad­opt a dif­fer­ent view of pot. Yet of all these groups, it is ar­gu­ably the doc­tors — spe­cific­ally those steeped in the re­search on med­ic­al marijuana — whose work has offered the most dir­ect chal­lenge to the fed­er­al gov­ern­ment’s cur­rent stance on can­nabis.


By 1990, an­guish over the un­solved epi­dem­ic of AIDS and HIV was ex­plod­ing in­to rage in San Fran­cisco. That year the city hos­ted the In­ter­na­tion­al AIDS Con­fer­ence, only to have the event dis­rup­ted by act­iv­ists from ACT UP, the AIDS Co­ali­tion to Un­leash Power. Wear­ing “Si­lence=Death” shirts, they blew pier­cing whistles, threw chairs, and dir­ec­ted shouts of “Shame!” at con­fer­ence par­ti­cipants, in­clud­ing Don­ald Ab­rams and oth­er AIDS doc­tors and re­search­ers. Ac­cord­ing to the act­iv­ists, people were dy­ing be­cause of a con­spir­acy of gov­ern­ment ob­struc­tion, be­cause of a lack of fund­ing for AIDS treat­ments, and be­cause of the con­tin­ued fail­ure of re­search­ers to find a cure.

By then, an­oth­er move­ment was at­tach­ing it­self to the cause of AIDS and gay rights — marijuana. That same year, nar­cot­ics of­ficers raided the apart­ment of Den­nis Per­on, a pot deal­er who sup­plied weed to sick people in the gay com­munity. Po­lice roughed up Per­on’s lov­er, le­sion-wracked and skelet­al-thin AIDS suf­fer­er Jonath­an West. An en­raged Per­on would later de­scribe an of­ficer put­ting a boot on West’s neck and taunt­ing him: “Know what AIDS means? As­shole in Deep Shit.” In 1991, Per­on mar­shaled his fury to win 80 per­cent voter sup­port for San Fran­cisco’s Meas­ure P, an ad­vis­ory meas­ure call­ing on the state to leg­al­ize marijuana as medi­cine.

Per­on also found an ally in Mary Jane Rath­bun, an ec­cent­ric Ir­ish-Cath­ol­ic sep­tua­gen­ari­an with a pas­sion for bak­ing and for pot. She partnered with him to set up the San Fran­cisco Can­nabis Buy­ers Club, which went on to provide marijuana to thou­sands of gay men with AIDS. They would later cowrite a book, Brownie Mary’s Marijuana Cook­book and Den­nis Per­on’s Re­cipe for So­cial Change.

It was at San Fran­cisco Gen­er­al Hos­pit­al where Don­ald Ab­rams and fel­low AIDS doc­tors got to know “Brownie Mary.” For years, she was an ever-present vo­lun­teer in an out­pa­tient clin­ic in a con­ver­ted pe­di­at­rics ward on the sixth floor of the hos­pit­al’s build­ing No. 80. “Ward 86” be­came Amer­ica’s most fam­ous AIDS clin­ic. There, Rath­bun shuttled sick young men she dubbed her “kids” from the clin­ic to ra­di­ology. She also brought them fresh-baked goods in­fused with marijuana, be­com­ing a me­dia darling in the pro­cess.

In 1992, Ab­rams ar­rived in Am­s­ter­dam for an In­ter­na­tion­al AIDS Con­fer­ence. He flipped on the tele­vi­sion in his hotel room. CNN In­ter­na­tion­al was broad­cast­ing a break­ing story from the Bay Area: Brownie Mary had been ar­res­ted with two and a half pounds of weed, raided by po­lice as she was craft­ing her con­fec­tions at a friend’s home in Sonoma County. Soon the City of San Fran­cisco — which un­der the voter-ap­proved Meas­ure P now of­fi­cially con­sidered marijuana a le­git­im­ate source of symp­tom re­lief for AIDS, can­cer, and oth­er ill­nesses — staged a “Brownie Mary Day.” The Sonoma County dis­trict at­tor­ney later dropped the charges.

Brownie Mary’s mes­sage el­ev­ated AIDS and pot as an in­ter­na­tion­al story. It reached a frus­trated med­ic­al-marijuana re­search ad­voc­ate named Rick Dob­lin in North Car­o­lina. Dob­lin was pre­par­ing to re­sume his doc­tor­al stud­ies in pub­lic policy at Har­vard after com­plet­ing his Har­vard mas­ter’s de­gree with a thes­is on med­ic­al marijuana. He had foun­ded a group called the Mul­tidiscip­lin­ary As­so­ci­ation for Psy­che­del­ic Stud­ies, which ad­voc­ated re­search on al­tern­at­ive medi­cines, in­clud­ing marijuana and the drug known as Ec­stasy.

Dob­lin had no med­ic­al de­gree. But for two years he had shopped around a re­search pro­tocol for study­ing marijuana’s ef­fect­ive­ness in re­vers­ing the naus­ea and loss of ap­pet­ite that led to wast­ing syn­drome and starved AIDS pa­tients in­to hol­low-eyed hu­man forms. After Dob­lin saw Brownie Mary on tele­vi­sion, he wrote a let­ter “to whom it may con­cern” at San Fran­cisco Gen­er­al Hos­pit­al’s AIDS pro­gram. The let­ter, ur­ging someone there to take on the re­search pro­ject, was routed to Ab­rams. The doc­tor fol­lowed up, and Dob­lin made an in­stant im­pres­sion. Dob­lin in­sisted that ground­break­ing marijuana re­search “should come from Brownie Mary’s in­sti­tu­tion.” Ab­rams was be­mused by the thought of be­com­ing the Brownie Mary Re­search In­sti­tute. But he was in­spired by the study idea, which made him think of Henry. It re­minded him of how pot had seemed to keep his lov­er alive and func­tion­ing for so long.

By 1992, Ab­rams was work­ing with San Fran­cisco’s Com­munity Con­sor­ti­um, a group of phys­i­cians set­ting up com­munity-based clin­ic­al tri­als to ex­plore treat­ments with AIDS and HIV pa­tients. Des­pite be­ing in­trigued, Ab­rams was skep­tic­al of Dob­lin’s plan to in­vest­ig­ate the medi­cin­al ef­fect­ive­ness of marijuana brownies. He didn’t see a way to stand­ard­ize can­nabis doses in brownies, par­tic­u­larly over a mul­ti­week clin­ic­al-re­search tri­al. But Dob­lin in­sisted that some kind of study of marijuana’s ef­fect on wast­ing syn­drome needed to hap­pen. Dob­lin con­tac­ted the Food and Drug Ad­min­is­tra­tion about sup­port­ing a clin­ic­al tri­al and got a pos­it­ive re­sponse. He ar­ranged with a Dutch med­ic­al-marijuana firm to grow can­nabis for the re­search.

The same year, the pre­scrip­tion drug Marin­ol — con­tain­ing a syn­thet­ic­ally pro­duced ver­sion of marijuana’s psy­cho­act­ive delta 9-tet­rahy­drocan­nabin­ol (THC) con­stitu­ent — had been ap­proved for treat­ment of people with HIV wast­ing syn­drome. But pa­tients of phys­i­cians at Com­munity Con­sor­ti­um re­por­ted that swal­low­ing Marin­ol left them zoned out for hours. Many re­por­ted they pre­ferred smoking pot be­cause they could reg­u­late their dose through the num­ber and spa­cing of hits from a joint. The Com­munity Con­sor­ti­um’s board de­cided to back a study to as­sess sep­ar­ate groups of wast­ing pa­tients — who either smoked marijuana or took Marin­ol — for changes in im­mune-sys­tem levels, body weight, and body com­pos­i­tion. Re­search re­view boards from UC San Fran­cisco and the state of Cali­for­nia signed off on the study.

But in try­ing to pur­sue the re­search, Ab­rams re­calls that he ran in­to a series of road­b­locks in the fed­er­al gov­ern­ment — at the Drug En­force­ment Ad­min­is­tra­tion, the Na­tion­al In­sti­tute on Drug Ab­use, and the Na­tion­al In­sti­tutes of Health. NIH, for in­stance, re­viewed the study but ef­fect­ively killed it by not at­tach­ing a re­search score, an ac­tion crit­ic­al to rank­ing the tri­al for po­ten­tial gov­ern­ment fund­ing. Two peer re­view­ers ques­tioned why re­search­ers wanted to test a “tox­ic” sub­stance such as pot. An­oth­er sug­ges­ted that wast­ing pa­tients re­dis­cov­er­ing their ap­pet­ites might de­vel­op high cho­les­ter­ol, clogged ar­ter­ies, and re­duced sup­pres­sion of tu­mor cells. Ab­rams was in­cred­u­lous. People with wast­ing syn­drome didn’t live re­motely long enough for any of that to oc­cur.


In Novem­ber 1996, three months after the NIH helped kill Ab­rams’s study, Cali­for­nia voters passed Pro­pos­i­tion 215, which made the state the first in the coun­try to leg­al­ize med­ic­al marijuana. Though it made no ref­er­ence to med­ic­al re­search, Cali­for­nia’s his­tor­ic vote seemed to cry out for stud­ies on pot’s ef­fect­ive­ness for those suf­fer­ing from AIDS/HIV, can­cer, an­or­ex­ia, spas­ti­city, and pain.

After Pro­pos­i­tion 215’s pas­sage, Ab­rams at­ten­ded meet­ings with the San Fran­cisco De­part­ment of Pub­lic Health to dis­cuss how to make the law op­er­a­tion­al for people who needed can­nabis. At one meet­ing, he met an ACT UP mem­ber wor­ried about the re­cent death of an AIDS pa­tient who had been tak­ing Ec­stasy. The drug had blocked the liv­er’s meta­bol­ism of pro­tease in­hib­it­or drugs, height­en­ing the pa­tient’s vul­ner­ab­il­ity to the dis­ease. By then, an es­tim­ated 11,000 gay men in San Fran­cisco were us­ing marijuana for AIDS or HIV. The ACT UP act­iv­ist wanted to know wheth­er pot, too, could in­ter­fere with life-sav­ing an­ti­ret­ro­vir­al drugs.

Ab­rams had an epi­phany. He could study the risk of pot for pa­tients on pro­tease in­hib­it­ors. In oth­er words, in­stead of try­ing to in­vest­ig­ate wheth­er pot was med­ic­ally use­ful, he would — as a way of at least mov­ing the sci­ence on pot for­ward — in­vest­ig­ate wheth­er it was med­ic­ally harm­ful when used with anti-AIDS drugs. He wrote up a re­search pro­tocol for a clin­ic­al tri­al on the po­ten­tial in­ter­ac­tion between marijuana and the AIDS-fight­ing med­ic­a­tions, ar­guing that the con­nec­tion was “wor­ri­some since many HIV-in­fec­ted pa­tients con­tin­ue to smoke marijuana as an ap­pet­ite stim­u­lant or to de­crease naus­ea.”

In Au­gust 1997, after a peer re­view by spe­cial­ists Ab­rams had sug­ges­ted — in clin­ic­al phar­ma­co­logy, im­mun­o­logy, vir­o­logy, en­do­crino­logy, and HIV medi­cine — the Na­tion­al In­sti­tute on Drug Ab­use and oth­er gov­ern­ment agen­cies signed off on the pro­ject. With $1 mil­lion in fund­ing awar­ded for the re­search, Ab­rams ac­cep­ted de­liv­ery from NIDA of 1,400 gov­ern­ment joints, plus a re­search sup­ply of the syn­thet­ic THC drug Marin­ol. The pot was stored at San Fran­cisco Gen­er­al Hos­pit­al in a locked freez­er equipped with a burg­lar alarm.

On May 12, 1998, the first pa­tients were en­rolled in the study. One group daily smoked three marijuana joints that con­tained 3.95 per­cent THC and had been prepped in a hu­mid­i­fi­er. An­oth­er group smoked can­nabis-fra­grant placebo joints with the THC re­moved. A third group took or­al ap­plic­a­tions of Marin­ol. The 16-mem­ber re­search team led by Ab­rams mon­itored the weight, cell counts, and vir­al health of the pa­tients.

The study con­cluded that use of can­nabin­oids — the nat­ur­al THC in pot or syn­thet­ic THC in Marin­ol — neither in­creased the vir­al load of in­di­vidu­als with HIV in­fec­tion nor in­terfered with their pro­tease in­hib­it­or drugs. An­ec­dot­ally, the re­search­ers noted that pa­tients giv­en Marin­ol were more leth­ar­gic and spent more time in bed, while those smoking pot were more act­ive. The re­search, Ab­rams wrote, failed to demon­strate “clin­ic­ally sig­ni­fic­ant in­ter­ac­tions with can­nabin­oids that would war­rant dose ad­just­ments of pro­tease in­hib­it­ors.” He de­livered the con­clu­sion that marijuana was safe for people with HIV. It didn’t in­ter­fere with anti-AIDS drugs. And there was something more: Pa­tients us­ing marijuana and Marin­ol saw in­creased pro­duc­tion of healthy cells, with mar­gin­ally high­er levels for the pot smokers. People in the marijuana group also put on an av­er­age of 7.7 pounds in 21 days, com­pared to 7 pounds for the Marin­ol group and 2.9 pounds for the placebo group.

Des­pite the res­ults, no lead­ing med­ic­al re­search journ­al was eager to pub­lish the study. Ab­rams was re­jec­ted by the pres­ti­gi­ous journ­al The Lan­cet, by The New Eng­land Journ­al of Medi­cine, and by The Journ­al of the Amer­ic­an Med­ic­al As­so­ci­ation. Ul­ti­mately, after an ini­tial deni­al, the An­nals of In­tern­al Medi­cine of the Amer­ic­an Col­lege of Phys­i­cians in­ter­viewed Ab­rams on his study. In 2003, the journ­al pub­lished his re­search.

Clin­ic­al evid­ence of the ef­fic­acy of can­nabis with HIV pa­tients was now part of ac­cep­ted med­ic­al lit­er­at­ure. Still, in the study and with the me­dia, Ab­rams was polit­ic about the con­clu­sions. He wrote that the find­ings meant “placebo-con­trolled stud­ies of the ef­fic­acy of smoked marijuana could be con­sidered in the fu­ture.” He called for more re­search.

After the death of Mark Henry, Ab­rams had found a new life part­ner in Clint Wern­er. They began a re­la­tion­ship in 1994 and later mar­ried. Years after Ab­rams’s clin­ic­al tri­al on can­nabis and pa­tients with HIV in­fec­tion, Wern­er re­vealed the doc­tor’s in­tern­al sense of tri­umph. What Ab­rams mostly re­frained from broad­cast­ing, Wern­er, a nat­ur­al-foods chef de­voted to the di­et­ary pre­ven­tion of dis­ease, all but shouted out. “The clin­ic­al tri­al was a Tro­jan horse, fi­nally al­low­ing re­search­ers to get the data they had been seek­ing for years,” Wern­er wrote in his book Marijuana Gate­way to Health. Ab­rams’s “true pur­pose” in the study, Wern­er wrote, “had been to as­cer­tain wheth­er marijuana helped im­prove the ap­pet­ite of AIDS pa­tients — and it did.” Ab­rams’s hus­band con­cluded with a flour­ish: “Sci­ence had spoken. THC really did cause the munchies.”


After Don­ald Ab­rams’s break­through clin­ic­al tri­al, state As­sembly­man John Vas­con­cel­los sought to make med­ic­al can­nabis re­search a fully fun­ded pri­or­ity of the state. Vas­con­cel­los cham­pioned le­gis­la­tion call­ing for cre­ation of a Cali­for­nia Cen­ter for Medi­cin­al Can­nabis Re­search. Its mis­sion would be to provide an­swers — af­firm­at­ive, neg­at­ive, or both — to the ques­tion, “Does marijuana have thera­peut­ic value?”

Vas­con­cel­los set out to de­vel­op the concept in con­sulta­tion with some of the top med­ic­al and re­search pro­fes­sion­als in the Uni­versity of Cali­for­nia sys­tem. He also needed polit­ic­al help in or­der to get his idea through the Le­gis­lature. A self-de­scribed “old-time lib­er­al,” Vas­con­cel­los found an un­ex­pec­ted ally dur­ing the 1998 elec­tion sea­son in a law-and-or­der con­ser­vat­ive, Dan Lun­gren, the state’s at­tor­ney gen­er­al. Lun­gren, who had been an ar­dent op­pon­ent of Pro­pos­i­tion 215, was run­ning for gov­ernor that year. He drew a Re­pub­lic­an primary chal­lenge from Den­nis Per­on, the pro-med­ic­al-marijuana act­iv­ist. With no shot at win­ning, Per­on served as an ant­ag­on­ist to re­mind people that Lun­gren op­posed the will of voters on med­ic­al marijuana. Look­ing to find middle ground on pot for the Novem­ber gen­er­al-elec­tion race against Demo­crat Gray Dav­is, Lun­gren en­dorsed re­search on the med­ic­al use of can­nabis. Vas­con­cel­los saw a polit­ic­al op­por­tun­ity. He reached out to the at­tor­ney gen­er­al. Their staffs began draft­ing le­gis­la­tion for un­pre­ced­en­ted med­ic­al-marijuana stud­ies.

In 1999, by the time the le­gis­la­tion — Sen­ate Bill 847 — reached the floor, Vas­con­cel­los had moved to the state Sen­ate. Lun­gren was gone from the at­tor­ney gen­er­al’s of­fice and had been de­feated in the gov­ernor’s race. But his en­dorse­ment helped pry loose cru­cial Re­pub­lic­an votes. Vas­con­cel­los needed 27 votes — a two-thirds ma­jor­ity of the 40-mem­ber Sen­ate — to pass the ap­pro­pri­ation. With no votes to spare, Vas­con­cel­los offered pro­ced­ur­al cov­er to three Re­pub­lic­an sen­at­ors — Jim Brulte, Tim Leslie, and Pete Knight — who were skit­tish about be­ing the 27th vote on a pro-marijuana bill. The GOP trio agreed to shout “aye” in uni­son so that no in­di­vidu­al got the blame as Cali­for­nia law­makers voted to spend $8.7 mil­lion in state tax dol­lars to study weed. In 2000, the Cen­ter for Medi­cin­al Can­nabis Re­search was born.

Re­search pro­pos­als began stream­ing in by 2001. Over the next dec­ade, the cen­ter — headquartered at the Uni­versity of Cali­for­nia (San Diego) — would ap­prove and over­see 15 Cali­for­nia clin­ic­al stud­ies, in­clud­ing sev­en tri­als dir­ectly test­ing pot’s ef­fect on re­search sub­jects. The cen­ter es­tab­lished an ex­haust­ive peer-re­view pro­cess and used the le­gis­lat­ive clout of the most pop­u­lous state in the na­tion to win re­search ap­prov­al from mul­tiple fed­er­al agen­cies. The cen­ter’s dir­ect­or, Ig­or Grant, a renowned neuro­psy­chi­at­rist at UC San Diego, didn’t con­duct any re­search him­self; he saw to it that the cen­ter handled all re­search ap­plic­a­tions and that his clini­cians didn’t have to fight the gov­ern­ment to do can­nabis work. Mean­while, he de­man­ded rig­or­ous, mod­ern tri­als that could be pub­lished in med­ic­al-re­search lit­er­at­ure. He figured there was no point in wast­ing Cali­for­nia tax money on stud­ies “that wouldn’t see the light of day.”

One of those ap­ply­ing for a re­search grant, Barth Wil­sey — a pain-man­age­ment phys­i­cian at the Uni­versity of Cali­for­nia (Dav­is) — sought fund­ing for a study on wheth­er can­nabis provided re­lief for people with neuro­path­ic pain from spin­al cord in­jur­ies, dia­betes, strokes, and oth­er con­di­tions caus­ing life-dis­rupt­ing dis­com­fort from nerve dam­age or in­jury. Earli­er in his ca­reer, Wil­sey was a fel­low in pain man­age­ment at UC San Fran­cisco, see­ing pa­tients in a small clin­ic in the city. People com­ing in would tell him they turned to marijuana when noth­ing else seemed to work. Wil­sey, a li­censed acu­punc­tur­ist, was in­ter­ested in al­tern­at­ive ther­apies.

Mark Wal­lace, an an­es­thesi­olo­gist and pain spe­cial­ist at UC San Diego, pro­posed a study in which healthy sub­jects would smoke marijuana and re­search­ers would study the an­al­ges­ic ef­fects of can­nabis after in­ject­ing cap­saicin, the hot in­gredi­ent in chili pep­pers, in­to their skin. Jody Corey-Bloom, dir­ect­or of the UC San Diego Mul­tiple Scler­osis Cen­ter, set out to see if marijuana could re­lieve spas­ti­city in MS pa­tients whose use of phar­ma­ceut­ic­als of­ten failed to al­le­vi­ate their suf­fer­ing. Don­ald Ab­rams and Ron El­lis, a UC San Diego neur­o­lo­gist, worked to see if pot could quell tingling and shoot­ing pains that would start in the feet of AIDS and HIV pa­tients and move to their fin­gers and hands, dis­rupt­ing their abil­ity to sleep, to ex­er­cise, and, of­ten, to cope.

In sep­ar­ate, over­lap­ping stud­ies between 2002 and 2006, pa­tients with neuro­path­ic pain from HIV smoked pot un­der the su­per­vi­sion of Ab­rams’s nine-mem­ber re­search team at UC San Fran­cisco’s Gen­er­al Clin­ic­al Re­search Cen­ter and El­lis’s eight-mem­ber team at the UC San Diego Med­ic­al Cen­ter. In San Fran­cisco, 55 pa­tients, mostly men with HIV in­fec­tion for 14 years, smoked three marijuana ci­gar­ettes or placebo joints a day in five-day tri­als. In sur­veys for chron­ic pain dur­ing the tri­als, can­nabis was found to re­duce the sub­jects’ pain by an av­er­age of 34 per­cent — double the rate of the marijuana placebo. Tests in which brushes were stroked against the sub­jects’ skin showed pot could quell shoot­ing pain sen­sa­tions in HIV pa­tients, for whom things as be­nign as pulling a bed­sheet over their toes could trig­ger light­ning bolts of agony. However, Ab­rams’s team failed to show sim­il­ar be­ne­fits of marijuana in cases of acute pain such as might be ex­per­i­enced after an in­jury or sur­gery.

In San Diego, re­search sub­jects were giv­en placebo joints or three po­tency levels of marijuana. El­lis’s team mon­itored 28 HIV sub­jects as they toked on marijuana or the pot placebos over two-week peri­ods, with a two-week break with no marijuana use al­lowed between each new re­search stage. Not­ably, El­lis also had all sub­jects con­tin­ue tak­ing their phar­ma­ceut­ic­al pain med­ic­a­tions dur­ing the study. He found they still got a boost from can­nabis, with the pot group re­port­ing pain re­lief at two and a half times the fre­quency of the placebo group.

El­lis also meas­ured impair­ment. He tested people’s abil­ity to con­nect ran­dom let­ters and num­bers on a page, and he had them op­er­ate a driv­ing ma­chine, in which they were to avoid sim­u­lated traffic obstacles and fol­low lights and signs. In both tests, pa­tients scored worse after smoking can­nabis than be­fore.

In­deed, re­search­ers did not shy away from ac­know­ledging down­sides of pot. One of El­lis’s ori­gin­al 34 en­rolled re­search sub­jects had to be ex­cused when he de­veloped an in­tract­able cough from smoking pot. An­oth­er sub­ject, who had nev­er be­fore used marijuana, gave re­search­ers a scare. After smoking his first joint, he star­ted star­ing in­to space and stopped re­spond­ing to ques­tions. The man was in a cata­ton­ic state, “at­tend­ing to what was go­ing on in his head,” El­lis ob­served. He came to in a couple of hours with no memory of what had happened. He was dropped from the study.

At UC Dav­is, Wil­sey found something he wasn’t count­ing on. In out­pa­tient ses­sions of three to 21 days, Wil­sey and his sev­en-mem­ber team mon­itored 32 pa­tients with nerve in­jur­ies as they smoked marijuana with 7 per­cent or 3.5 per­cent THC or toked on THC-free placebo joints. Sub­jects in both marijuana groups found sig­ni­fic­ant re­lief from chron­ic pain. What sur­prised Wil­sey is that they got the same re­lief with the lower can­nabis dose as with the high­er dose, only with less impair­ment.

Corey-Bloom re­por­ted that MS pa­tients giv­en can­nabis showed mod­est cog­nit­ive impair­ment. However, her study on 30 pa­tients also demon­strated that smoking marijuana could re­duce pain­ful, of­ten dis­abling symp­toms of spas­ti­city.

At UC San Diego, the res­ults of Wal­lace’s study us­ing the in­gredi­ent in hot chili pep­pers pro­duced com­pel­ling evid­ence of can­nabis’s ef­fect­ive­ness with pain while also stir­ring ques­tions about marijuana dos­ing. Wal­lace had healthy re­search sub­jects smoke marijuana joints with 2 per­cent, 4 per­cent, and 8 per­cent THC, then in­jec­ted cap­saicin in­to one of each sub­ject’s fore­arms five minutes af­ter­ward, and in­to the oth­er fore­arm 45 minutes af­ter­ward. When the sub­jects were in­jec­ted after five minutes, pot had no sig­ni­fic­ant ef­fect in re­du­cing the cap­saicin-in­duced pain. When in­jec­ted after 45 minutes, sub­jects tak­ing the 2 per­cent THC dose re­por­ted little or no pain re­duc­tion. But people smoking 4 per­cent THC re­por­ted sig­ni­fic­ant re­lief. And people smoking can­nabis with 8 per­cent THC found their pain ac­tu­ally in­creased. For Wal­lace, the res­ults were sig­ni­fic­ant. His clin­ic­al tri­al had re­vealed ex­pos­ure levels where marijuana was both ef­fect­ive and not.


There were more stud­ies as well — an at­tempt to fig­ure out wheth­er pa­tients with pain­ful neuro­pathy could get re­lief from marijuana without get­ting stoned; a tri­al that tested wheth­er smoking joints or con­sum­ing can­nabis by va­por­iz­ing de­livered medi­cin­al ef­fects more ef­fi­ciently; a study to find out if can­nabis could be a suit­able co­ther­apy for pa­tients tak­ing opi­ate drugs.

The doc­tors who con­duc­ted all these stud­ies were not act­iv­ists; their goal was not to em­brace the polit­ic­al marijuana cause. Nev­er­the­less, in Feb­ru­ary 2010, when Ig­or Grant and the Uni­versity of Cali­for­nia re­search­ers gathered at the state Cap­it­ol to present their pre­lim­in­ary find­ings, their an­swer to the state-man­dated ques­tion — does marijuana have thera­peut­ic value? — was yes.

“As a res­ult of this pro­gram of sys­tem­at­ic re­search, we now have reas­on­able evid­ence that can­nabis is a prom­ising treat­ment,” Grant an­nounced. At the time, he re­frained from point­ing out that the res­ults flew in the face of the U.S. gov­ern­ment’s clas­si­fic­a­tion of marijuana as a Sched­ule I drug with no ac­cep­ted med­ic­al use. But in 2012, with the Cali­for­nia clin­ic­al tri­als com­pleted and the last stud­ies be­ing pub­lished, Grant let it be known that the Sched­ule I clas­si­fic­a­tion “is com­pletely at odds with ex­ist­ing sci­ence” and “seems in­tel­lec­tu­ally dis­hon­est.”

Every clin­ic­al study by the Cen­ter for Medi­cin­al Can­nabis Re­search showed po­ten­tial med­ic­al be­ne­fits from can­nabis. Yet the Cali­for­nia tri­als didn’t in­clude any­where close to suf­fi­cient num­bers of pa­tients to meet FDA stand­ards for eval­u­at­ing marijuana’s po­ten­tial as a pre­scrip­tion med­ic­a­tion. Moreover, na­tion­al drug-ab­use and ad­dic­tion sur­veys said marijuana — though it presen­ted less per­ceived danger than oth­er sub­stances — could be ad­dict­ive, with 9 per­cent of users de­vel­op­ing an un­healthy pot de­pend­ency. With­in the med­ic­al com­munity, there re­mains a di­vide between phys­i­cians who have stud­ied the po­ten­tial be­ne­fits of marijuana and those who spe­cial­ize in ad­dic­tion. The lat­ter group, not sur­pris­ingly, is more skep­tic­al about pot.

Grant cau­tioned that a sig­ni­fic­ant body of med­ic­al lit­er­at­ure raised le­git­im­ate con­cerns over pot’s danger for people sus­cept­ible to schizo­phrenia or oth­er psychot­ic ill­nesses and over its po­ten­tial harms for teen­agers, whose brains were still de­vel­op­ing. The gov­ern­ment pot used in the stud­ies also wasn’t even close to the bot­tom-shelf in­tens­ity of de­sign­er weed strains sold at many Cali­for­nia med­ic­al-marijuana dis­pens­ar­ies, mean­ing re­search­ers didn’t test what was ac­tu­ally on the mar­ket. They also didn’t have the op­tion of look­ing at new niche marijuana strains bred with low-THC and high con­cen­tra­tions of can­na­bi­d­i­ol, or CBD, a can­nabis con­stitu­ent be­lieved to de­liv­er an­al­ges­ic be­ne­fits without impair­ment.

Still, Grant and his re­search teams were able to char­ac­ter­ize marijuana as a prom­ising ther­apy that offered re­lief to people for whom oth­er treat­ments failed. It was an im­port­ant junc­ture in a sci­entif­ic jour­ney, one that Mark Henry had helped in­spire Don­ald Ab­rams to go on many years ago.


Peter Hecht is a seni­or writer for The Sac­ra­mento Bee and the au­thor of Weed Land: In­side Amer­ica’s Marijuana Epi­cen­ter and How Pot Went Le­git, from which this piece is ad­ap­ted.

What We're Following See More »
Trump to Nominate Linda McMahon to Head SBA
5 hours ago
House Dems Introduce Legislation to Investigate Russian Hacking of Elections
10 hours ago

"On Wednesday afternoon, Rep. Eric Swalwell, (D-Calif.), a Democrat on the House intelligence committee, and Rep. Elijah Cummings (D-Md.), the senior Democrat on the House government oversight committee, announced they were introducing legislation to create a bipartisan commission to investigate any attempt by the Russian government or persons in Russia to interfere with the recent US election. The commission they propose is modeled on the widely-praised 9/11 Commission."

Senate Sends Medical Cures Bill to Obama’s Desk
10 hours ago
Colorado Electors Sue State for Right to Vote Third Party
11 hours ago

"Two Colorado presidential electors Tuesday filed a lawsuit in federal court challenging a state law that requires them to vote for the winner of the state’s popular vote," in this case Hillary Clinton. They say they want to "vote for a third-party candidate to keep Trump from receiving 270 electoral votes," and work with other faithless electors around the country to "shift their Democratic votes to a consensus pick."

Oklahoma AG Pruitt to Get the Nod for EPA Chief
11 hours ago

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.