Medical Marijuana in Three Countries: The Advantages of Federalism

Last week Ha'aretz ran a story about medical marijuana in Israel (the country where THC was first isolated, back in 1964). It provides some interesting contrasts with the situation in the United States. Unlike here, where 13 states recognize cannabis as a legitimate medicine but the national government continues to forbid all uses of the plant, the decisions in Israel have been made centrally and by regulation, as opposed to ballot initiative or statute. In 1999, three years after California voters approved America's first medical marijuana initiative, the Israeli Health Ministry began allowing patients to use the drug. But there was no legal way for patients to obtain marijuana if they were not up to the task of growing their own. In 2001 one of the first patients with a prescription for marijuana was arrested and tried for buying it from a dealer. Four years ago, the Israeli government finally authorized cultivation of medical marijuana, but until recently it was limited to a single operation. As the number of marijuana prescriptions continued to rise (it's expected to hit 1,200 this fall), it became clear that more suppliers would be needed. This year an entrepreneur with expertise in growng many different varieties of cannabis opened a second legal pot farm, and the Health Ministry plans to license three or four more.

While Israel's policy is more rational than the American policy at the federal level, which elevates anti-drug orthodoxy above science and the interests of patients, it has the quirks you'd expect from a centrally planned system. In the whole country, only one doctor is allowed to prescribe marijuana, forcing patients to wait needlessly. For six years there was no legal supplier at all, and for another four years only one. Controversy continues over whether the national health care system should cover cannabis, whether patients should pay anything out of pocket, and if so how much—all issues that ultimately will be decided for the entire country by Health Ministry bureaucrats.

In California, by contrast, any doctor can recommend cannabis to his patients, and privately run medical marijuana dispensaries have proliferated, based mainly on the legal premise that the people running them are "primary caregivers" for their customers and therefore allowed to provide cannabis to them. Last fall the California Supreme Court rejected that rationale, so it looks like dispensaries from now on will have to follow a patient-run cooperative model (since patients are allowed to grow their own cannabis). Meanwhile, of course, the federal government has periodically raided dispensaries and arrested their operators. But despite the murky legal status of the dispensaries, medical marijuana is more readily available to patients in California than it is in Israel, where it has the national government's blessing. The same should soon be true in New Mexico and Rhode Island, which recently authorized medical marijuana suppliers.

The Ha'aretz story reminded me of an encounter I had during a trip to Toronto last week. A woman at the conference I attended showed me her medical marijuana license, a laminated card that looks like a driver's license and signifies that she has the Canadian government's permission to use cannabis for symptom relief. Although that license reflects a more enlightened approach than our federal government taken, she immediately complained that in Canada there's only one legal source of medical marijuana: the national health bureaucracy. In the U.S., she said, "people have more freedom."

Legislation approved yesterday would make New Hampshire the 14th state to allow medical use of cannabis, with the supply coming from state-licensed "compassion centers." Gov. John Lynch, a Democrat, says he has not decided yet whether to sign the bill.

[Thanks to Bruce Mirken at the Marijuana Policy Project for the Ha'aretz link.]