Synopsis of ASAM’s Recommendations – Legalization of Marijuana

American Society of Addiction Medicine, ASAM

White paper on State-Level Proposals to Legalize Marijuana

“ASAM opposes proposals to legalize marijuana anywhere in the United States …”

“ASAM asserts that the anticipated public health costs of marijuana legalization are significant and are not sufficiently appreciated by the general public policy makers. Physicians and other health professionals must become more aware of the anticipated undesirable outcomes of marijuana legalization and encourage public education on these facts. ASAM’s conclusion that marijuana legalization would not be in the interest of public health is based on the following:

  • Marijuana is neither safe nor harmless. Marijuana contains psychoactive cannabinoids which produce a sense of pleasure in many users and a sense of discomfort and even paranoid thoughts in other users. Cannabinoids interact with the brain circuits in comparable ways to opioids, cocaine and other addictive drugs.
  • Substance use disorders resulting from marijuana use are a serious and widespread health problem.
  • Marijuana use is associated with adverse health consequences, including damage to specific organs and tissues and impairments in behavioral and neurological functioning. Among these are acute impairments in the performance of complex tasks such as driving a motor vehicle.
  • Marijuana-related crashes, deaths and injuries are currently a major highway safety threat in the United States.
  • Legalization of marijuana would likely lead the general public and, in particular, young people, to view marijuana as less harmful than it is now viewed. Decreases in ‘perceived harm’ associated with marijuana would result in increased rates of marijuana use and increased rates of marijuana-related substance use disorders, including addiction.
  • Marijuana use is associated with increased rates and worsening symptoms of psychosis. Population-wide increases in availability of and access to high-potency marijuana would be associated with increased rates of marijuana use and could result in increased rates of psychotic illnesses.
  • Increased incidence and prevalence and marijuana-related substance use disorders, including marijuana addiction, would lead to increased demand for treatment services. Today treatment systems are inadequate for meeting the current treatment needs in our nation.
  • Revenues projected to be generated from taxation of legal marijuana would be far lower than the costs associated with increased marijuana use and would unlikely to be targeted to these needs, as tobacco and alcohol revenues are not targeted to the health costs of the use of these drugs.”

Synopsis of ASAM’s Recommendations – Medical Marijuana

The Role of the Physician in “Medical” Marijuana

“ASAM asserts that cannabis, and cannabis-based medications, and cannabis delivery devices should be subject to the same standards that are applicable to other prescription medications and medical devices and that these medications or devices should not be distributed or otherwise provided to patients unless and until such medications or devices have received marketing approval from the Food and Drug Administration.

“ASAM recommends its members and other physician organizations and their members reject responsibility for providing access to cannabis and cannabis-based medications until such time that these materials receive marketing approval from the Food and Drug Administration.

“ASAM rejects smoking as a means of drug delivery since it is inherently unsafe.

“ASAM supports the need for federal regulatory standards for drug approval and distribution. ASAM recognizes that states can enact limitations that are more restrictive but rejects the concept that states could enact more permissive regulatory standards. ASAM discourages state interference in the federal medication approval process.

“ASAM rejects a process whereby State and local ballot initiatives approve medicines because these initiatives are being decided by individuals not qualified to make such decisions [based upon a careful science-based review for safety and efficacy, standardization and formulation for dosing, or provide a means for a regulated, closed system of distribution for marijuana which is a CNS drug with abuse potential].”


Synopsis of Robert L. DuPont, M.D., The Campaign to Normalize Marijuana Use in the United States: Effects of “Medical Marijuana” and Drug Legalization Efforts

“The term ‘medical marijuana’ connotes that the drug is not only safe but therapeutic. Hidden from view is the fact that ‘medical marijuana’ is the same marijuana bought on the street. No real medicine is brought to an open legal market by ballot initiative or legislation. All legitimate medicines are subject to stringent scientific evaluation by the Food and Drug Administration (FDA) and once approved as safe for use, they are made available through professional pharmacies by prescription. ‘Medical marijuana,’ a federally scheduled drug of abuse, is available at so-called dispensaries and on the mere ‘recommendation’ of a physician. The physician does not recommend a specific dose, quantity or duration of marijuana use. … No real medicine is available in this way.”

“The CBS News poll results are not surprising considering the evolving pattern of increasing marijuana use nationally among adults and youth who ignore the harmful effects of marijuana use and the current reality of ‘medical marijuana.’ Marijuana has serious negative health effects, including abuse and dependence and remains the most widely abused illegal drug in the country. Over 60% of the 7.1 million Americans who suffered from an illegal drug-related substance use disorder in 2010 abused or were dependent on marijuana. Additionally, ‘medical marijuana’ states are home to twice the number of residents who meet criteria for marijuana abuse or marijuana dependence than residents living in states without these laws.”


Synopsis of Testimony of Robert L. DuPont, M.D., Marijuana and Medicine: The Need for a Science-Based Approach, Senate Judicial Proceedings Committee, State of Maryland

“It is interesting to me that the ‘medical marijuana ‘ advocates are loudly and consistently opposed to using purified chemicals instead of smoked marijuana. They are also loudly and consistently opposed to any delivery system except smoking, despite the known toxicity of smoking. They pose as concerned about patient welfare. They want to be seen as compassionate. How can it be explained that the only form of this “medicine” they support is smoked marijuana even though everyone who has studied this issue has concluded, as the IOM committee did, that smoking is inherently an unreliable and toxic route of administration for any medicine?

“I can think of only one explanation: they are not interested in medicine at all. They are using the ‘medical marijuana’ issue as a Trojan horse to legitimize the use of marijuana in this country, and throughout the world. Since the widely-shared public health goal is to reduce marijuana (and other drug) use it should not be surprising that many people, including myself, object to labeling smoked marijuana as a medicine.

“Burning leaves is not a modern drug delivery system, period. ‘Medical marijuana’ is an oxymoron.”


Synopsis of the National Comprehensive Cancer Network’s position on Cannabinoids in the Treatment of Chemotherapy-Induced Nausea and Vomiting

“Because of medical and legal concerns, the use of marijuana is not recommended for management of CINV and is not a part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Antiemesis.

Marijuana is not a completely benign substance. Its use has been reported to be associated with adverse effects on the cardiovascular, respiratory, and central nervous systems. Marijuana smoke contains more carcinogens than cigarette smoke, which may lead to lung cancer and is an important risk factor in the development of respiratory disease. Use may also be associated with an increased risk of head and neck cancer, atrial fibrillation, myocardial infarction, stroke and chronic bronchitis. Marijuana also has immunosuppressive properties that may be detrimental to patients with cancer. Children whose mothers smoked marijuana during pregnancy may have an increased risk of developing leukemia.”