The U.S. Supreme Court heard arguments Monday in a case that will determine whether federal drug officials can crack down on patients who grow and smoke marijuana even in states where the law allows its medical use.

The case centers on just two patients in California, one of 10 states with laws allowing patients to use marijuana under a doctor’s supervision to treat the symptoms of chronic health problems. But the court’s ruling is likely to have implications across the nation, say activists who vow to press ahead with more legalization efforts.

Attorneys for one patient, Diane Monson, argued that agents acted illegally in August 2002 when they seized six marijuana plants she cultivated under California’s medical marijuana law. Monson’s doctor has said that he recommended she smoke the drug because all other alternatives failed to help chronic severe back pain and spasms caused by a degenerative spine disease.

A second patient, Angel McClary Raich, also joined with two anonymous growers in suing the government to protect her access to medical marijuana. Raich said in court papers that marijuana has been “a miracle” in easing nausea, vomiting, and weight loss caused by the chemotherapy she receives to treat a brain tumor.

The patients’ lawyers faced off with attorneys from the Bush administration over whether federal agents have the authority to raid the patients’ personal marijuana supplies. Federal law bars the sale or use of marijuana in nearly all cases, though the patients and their advocates maintain that the government’s jurisdiction is limited to illegal interstate drug sales and does not include private, noncommercial use allowed under state law.

Raich and Monson are like thousands of patients who say that marijuana helps them ease difficult symptoms and side effects that traditional drugs can’t treat.

A 1999 Institute of Medicine report concluded that marijuana's active components are potentially effective in treating chemotherapy-induced nausea and helping AIDS and cancer patients gain weight by stimulating the appetite. The drug has also been shown to reduce eye pressure in glaucoma patients and ease some forms of chronic pain. But the Institute of Medicine report does not support using marijuana for glaucoma.

“There is no doubt that marijuana does reduce pain. The big question is whether marijuana is better than other drugs,” says Steven Childers, PhD, a professor of pharmacology at Wake Forest University who was a member of the panel that authored the report.

The report also stressed that smoking was not a safe or effective way to administer marijuana because it is carcinogenic and cannot deliver a consistent dose of marijuana’s active ingredients. Childers added that most doctors he knows support allowing terminally ill patients to use marijuana, since the benefits of the drug are likely to outweigh the risks.

But federal drug officials have warned that allowing states to legalize marijuana undermines their ability to enforce drug laws. John Walters, head of the White House Office of National Drug Control Policy, has repeatedly warned that medical legalization sends a mixed message to youths who are considering trying drugs.

Supporters of the Bush administration’s case also say that voter initiatives in California and other states sidestep drug safety regulation usually reserved for the FDA. Allowing voters to choose which drugs to approve could cause a return to the pre-FDA days when traveling salesmen sold bogus “snake oil” treatments to vulnerable patients, says David Evans, a lawyer who helped author an amicus brief for the Drug Free America Foundation in support of the federal government.

“We would have 50 different standards in 50 different states and we would have no trust in our medical system,” he tells WebMD.

Eric E. Sterling, executive director of the Criminal Justice Policy Foundation, said state laws are necessary because the federal government has balked at widespread evidence that marijuana is safe. “We wouldn’t be in this place if bureaucrats hadn’t rejected science.”

Review boards overseeing government research grants are “excited” about the potential of marijuana to treat disease symptoms, said Childers, who serves on several such panels. The challenge is studying the drug in a way that reliably measures the drug dose that patients get and its side effects.

“So many people have so many agendas that it’s really hard to separate the medicine from the politics,” he said.

More States Targeted

Legalization advocates say they will continue to target state legislatures and election ballots regardless of how the court rules on the case. Even if the government prevails, groups will still push medical marijuana legalization in legislatures in Rhode Island, Connecticut, New York, and Illinois in the coming year, says Rob Kampia, executive director of the Marijuana Policy Project, the largest group backing legalization.

If the government wins, Kampia says, federal agents are likely to conduct sporadic raids on large-scale growing operations as they have done in most cases in California and elsewhere. “You’re not going to see the feds sweeping up and down the West Coast arresting cancer patients.”

If the legalization activists prevail, “then we are going to fly through legislatures passing bills everywhere, because the federal menace will have been removed,” he says.

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: Ashcroft v. Raich, U.S. Supreme Court Docket No. 03-1454. Steven Childers, PhD, professor of pharmacology, Wake Forest University. David Evans, attorney, Drug Free America Foundation. Eric E. Sterling, executive director, Criminal Justice Policy Foundation. Rob Kampia, executive director, Marijuana Policy Project.