Last update: 1 October 2008
The situation with respect to cannabis laws in the USA is extremely complex. Quite simply, however, cannabis use, possession, cultivation, and sale are illegal under federal law under the Controlled Substances Act (CSA) of 1970. Cannabis is listed as Schedule I, a category for drugs that are deemed dangerous, addictive and have no recognized medical use. Challenges to this law, whether legislative or through litigation are frequently mounted, but none have succeeded to date.
Four surviving patients in the Compassionate Use Investigational New Drug Program have exemptions from this law, and receive cannabis directly from the government for their medical conditions.
State and local laws vary widely in the USA. Possession of small amounts may result in a fine or lesser penalty in some areas while others deal more harshly with such offenses (see links below).
Medicinal use of cannabis is allowed under state law under certain conditions and restrictions in the following 12 states: Alaska, Hawaii, Washington, Oregon, California, Montana, Colorado, New Mexico, Maryland, Rhode Island, Vermont and Maine. Legislative bills and voter ballot initiatives are under consideration elsewhere. Detailed information on American laws is available on the web sites of NORML and MPP, including State by State Laws.
Synthetic dronabinol is available by prescription as Marinol® under Schedule III of the CSA and is indicated as treatment for nausea associated with cancer chemotherapy or treatment of HIV/AIDS wasting. Costs are very high, with averages per capsule from online pharmacies of:
2.5 mg = $5.65
5 mg = $11.59
10 mg = $21.64
A semi-synthetic cannabinoid, nabilone (Cesamet®) is in CSA Schedule II, requiring monthly written prescriptions without refills, for treatment of nausea associated with cancer chemotherapy. Average price of Cesamet is $20 per 1 mg capsule.
Sativex oromucosal cannabis-based medicine remains Schedule I and illegal to possess in the USA except for patients enrolled in FDA-approved clinical trials for cancer pain.
Even clinical research on cannabis is severely restricted by existing laws and policies.
Under Conant vs. Gonzalez, the US 9th Circuit Court of Appeals (Western States) ruled that physicians may discuss clinical cannabis usage with patients without risk of arrest or sanctions on their licenses to practice medicine. Since this has not been appealed or adjudicated elsewhere, it is the effective law of the land.
In Ashcroft vs. Raich, the US Supreme Court asserted federal control over the legal status of cannabis, but did not strike down existing state laws on medicinal usage. In essence, this creates a mismatch under existing laws in that medical cannabis is legal in certain states under certain conditions, but remains illegal under federal law in all 50 states.
Confusion and contradictions abound. In some areas of the USA, cannabis usage may appear legal de facto, while in truth, anyone possessing cannabis can be arrested anywhere at any time. Incremental changes in municipal and state laws continue, but federal reform efforts have fallen short in every instance. Public opinion polls typically endorse medicinal usage of cannabis by margins of 60% or more.
Legal availability of whole cannabis prescription medicines is anticipated several years hence.