A recent survey of 1,746 patients at nine medical marijuana evaluation clinics in California indicates that "the patient population has evolved from mostly HIV/AIDS and cancer patients to a significantly more diverse array." University of California at Santa Cruz sociologist Craig Reinarman and his colleagues, who report their results in the Journal of Psychoactive Studies, say "this trend toward increasing therapeutic uses is bringing marijuana back to the position it held in the U.S. Pharmacopeia prior to its prohibition in 1937."
Reinarman et al. found that "relief of pain, spasms, headache, and anxiety, as well as to improve sleep and relaxation, were the most common reasons patients cited for using medical marijuana." The top three reasons physicians gave for recommending marijuana were "back/spine/neck pain" (31 percent), "sleep disorders" (16 percent), and "anxiety/depression" (13 percent). Although those may sound like easy-to-fake symptoms, four-fifths of the patients reported trying other, doctor-prescribed medications (most commonly opioids) before marijuana. They could have been malingering then too, of course, and it may be easier to get a recommendation for marijuana than it is to get a prescription for Vicodin or Valium. But on the whole, it does not look like allowing the medical use of marijuana has fundamentally changed the nature of the doctor-patient relationship. Doctors do, after all, commonly prescribe psychoactive pharmaceuticals to treat not only pain but also sleep disorders, anxiety, and depression—all with the government's blessing. If some people find that marijuana works better for these purposes, there is no rational reason to prevent them from using it.
"While it is true that the great majority of our respondents had used marijuana recreationally," Reinarman et al. write, "over two-ﬁfths...reported that they had not been using it recreationally prior to trying it for medicinal purposes." The authors are keenly aware of the widepread impression that a large portion of California's medical marijuana patients are using phony or exaggerated ailments as an excuse to get high. They note that it is hard to measure the extent of such "diversion" and that the phenomenon is not limited to marijuana. More fundamentally, they suggest that the distinction between medical and nonmedical use of drugs is becoming increasingly difficult to draw:
Beyond the spread of [medical marijuana], Prozac and other SSRI-type antidepressants, for example, are often prescribed for patients who do not meet DSM criteria for clinical depression but who simply feel better when taking it. Such "cosmetic psychopharmacology"...is likely to grow as new psychiatric medications come to market. The line between medical and nonmedical drug use has also been blurred by performance enhancing drugs such as steroids, so-called "smart drugs" that combine vitamins with psychoactive ingredients, and herbal remedies like mahuang (ephedra) available in health food stores.
These examples suggest that despite the best intentions of physicians and law makers, much drug use does not ﬁt into two neat boxes, medical and nonmedical, but rather exists on a continuum where one shades into the other as patients' purposes shift to suit situational exigencies in their health and their daily lives. It is not clear where a border line between medical and nonmedical marijuana or other drug use might be drawn nor how it might be effectively policed.
If you believe the government has no business drawing or policing this line, it is hard to get worked up about people who fake their way to a medical marijuana recommendation. But as I argued back in 1993, reformers could pay a price if all the talk about relieving the suffering of cancer and AIDS patients is perceived as a cover for recreational use. Politicians in other states commonly cite the California example as a reason to block medical use or restrict it to a short list of conditions. Then again, the perception that California's current law encourages dishonesty (much as the medical and religious exceptions to alcohol prohibition did) may strengthen support for outright legalization, which last fall attracted support from 46 percent of California voters.