I have a confession.
I like Ethan Nadelmann.
For almost seventeen years, Nadelmann was the executive director of the Drug Policy Alliance, which advocates for cannabis legalization and reduced penalties on other drugs. He retired in April 2017, after demolishing his opponents, at least on the marijuana front.
Nadelmann didn’t join the legalization movement to get rich—or high. He lives in a modest one-bedroom apartment with a view of an airshaft on Manhattan’s Upper West Side. By his own account, he uses cannabis a couple of times a week. (He has a little stash of THC-infused chocolates in his dresser. He politely offered me one after our last interview. I politely declined.)
Nadelmann’s tried most other drugs, too. Given his position, he felt almost a responsibility to understand their psychoactive and addictive qualities firsthand, he says. But Nadelmann never fell in love with drug culture or hedonism in general. A divorcé with one grown daughter, he’s spent the last two decades in a cross-country relationship with Marsha Rosenbaum, another Drug Policy Alliance wonk. Keith Stroup’s biggest backer was Hugh Hefner. Nadelmann’s was George Soros, who has donated tens of millions of dollars to support legalized cannabis.
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Born in 1957, Nadelmann grew up in Westchester County, north of New York City. He came of age during the first wave of marijuana legalization and went to college at McGill, in Montreal, before transferring to Harvard. He graduated in 1979 and entered a joint law-PhD program, also at Harvard. He planned to specialize in international law, with a focus on the Middle East. But the drug war grabbed his interest.
By 1981, Ronald Reagan had taken the White House. Cannabis use was declining, but cocaine use was still rising, thanks in part to falling prices. In a 1982 survey, 9 percent of men aged 18 to 25 said they had used cocaine in the last month. Abuse, addiction, and overdose followed. In response, the Reagan Administration pressed to destroy coca plants in the highland jungles of South America and block traffickers as they moved cocaine north. The administration was internationalizing the American drug war, trying to block supply at the source.
Nadelmann decided to write his PhD thesis about that effort. He focused on the way the State Department and Drug Enforcement Administration worked with foreign law enforcement agencies. He received surprising cooperation from the DEA, which hired him as a consultant to write a classified report about its practices.
Just as Nadelmann was seeing the drug war from the inside, crack took off—first in New York, Miami, and Los Angeles, then everywhere. Crack is cocaine that’s been cooked with baking soda and water into a smokable pellet. Inhaling its fumes through a glass pipe produces a brief, intense euphoria. A journalist who smoked it described it in The New Republic as offering “the head rush of marijuana . . . with the clarity induced by a noseful of powder cocaine.” A single small “rock” of crack cost only $5 or $10, making it cheap enough for poor people to try. Crack was an immediate hit, in the worst way. Its spread provoked a surge in violence caused both by the drug itself and turf battles between dealers.
Crime in the United States had been rising for decades, but crack supercharged it. In 1983, the United States had 1.25 million murders, assaults, and robberies—a rate of 538 violent crimes per 100,000 people, far higher than that of other rich countries. By 1991, the rate rose another 40 percent, to 1.9 million violent crimes. Almost 25,000 people were murdered that year, the highest total ever recorded in United States, nearly half the number of American soldiers who died in the entire Vietnam War. New York City alone had 2,154 killings.
Meanwhile, the AIDS epidemic was spreading. Along with gay men, heroin users were its main victims. But the Reagan White House would hardly acknowledge that AIDS existed, much less try to prevent it by giving addicts clean needles as AIDS activists wanted.
To Nadelmann, the explosion in crack-related violence, the spread of heroin-fueled HIV, and the hundreds of thousands of marijuana arrests every year all proved the same point: the American war on drugs was an insane mistake. He remembers telling two hundred intelligence analysts at a conference at Bolling Air Force Base in Washington, DC, in June 1987 that prohibition would inevitably end in failure. “I was nearly booed off the stage,” he said.
In April 1988, he went public with his concerns in a Foreign Policy magazine article, “U.S. Drug Policy: A Bad Export.” The next year, he wrote in the journal Science that the United States should consider legalization.
But Nadelmann was swimming upstream—not just on the issues of heroin and cocaine, but cannabis, too. NORML had never recovered from its collapse, and Republicans made mincemeat of Democrats who suggested that penalties for drug trafficking or dealing were tough enough already. The aggressive policies continued under George H. W. Bush, who became president in 1989. “The drug war [was] just going crazy,” Nadelmann recalls. “It was like McCarthyism on steroids.”
By then, Nadelmann was a professor at Princeton University. In the summer of 1992, Soros asked him to lunch. Already a billionaire investor, Soros would soon become famous for “breaking” the British pound—and in the process making a $1 billion profit. Soros had supported anti-Communist movements in Eastern Europe and the Soviet Union. Now that the Soviet Union had fallen, he wanted to expand his “open society” efforts to the West. He thought liberalizing drug policy might be a good place to start.
At lunch, Nadelmann sketched out a three-part strategy: decriminalizing marijuana, reducing penalties for other drugs, and increasing access to needles and drug treatment. While the media focuses on his role in marijuana legalization, he considered all three equally important, he says. “It’s always about ending the broader drug war.”
Soros liked Nadelmann’s vision. In 1994, with Soros’s backing, Nadelmann started the Lindesmith Center, named after Alfred Lindesmith, a sociologist who questioned whether drugs were as addictive as they seemed. Nadelmann also toned down his public rhetoric about legalizing drugs. (In 1993, he had said he hoped that within a few years “the right to possess and consume drugs may be as powerfully and as widely understood as the other rights of Americans.”)
The crime wave in the United States had just crested. Drug arrests were still rising. In 1992, Bill Clinton had beaten George H. W. Bush to become the first Democratic president since Carter. But Clinton had won in part by making sure the Republicans couldn’t portray him as weak on crime. In January 1992, as governor of Arkansas, he’d famously supported the execution of a mentally impaired inmate named Ricky Ray Rector.
Nadelmann prepared to dig in for a long fight.
Then Proposition 215 took off from San Francisco and landed in his lap.
Prop 215 was the first medical marijuana initiative. It offered California voters the chance to change the state’s laws so that anyone 18 or older could use marijuana with a physician’s authorization. Initiatives are democracy at its most pure. Voters vote yes or no on them directly. They don’t exist on the national level, only in some states. California is among the states where they are most frequently used.
The 1970s wave of marijuana decriminalization hadn’t made much of the notion of marijuana as medicine. In Marihuana Reconsidered, Lester Grinspoon devoted only one thirteen-page chapter to the idea. But studies in the 1980s showed cannabis might help epilepsy and chemotherapy-related nausea. The studies were mostly small—more hypothesis generating than hypothesis testing. Still, they raised the question of whether marijuana might have medicinal uses.
Then AIDS activists in San Francisco began using marijuana to treat AIDS-related wasting. Ultimately, clinical trials would show cannabis was at best marginally helpful for the syndrome, which largely disappeared anyway after pharmaceutical companies introduced effective anti-HIV medicines. But at the time, activists said denying patients the chance to smoke as they were dying of AIDS was unfair and inhumane. They didn’t want to legalize marijuana for recreational use, only medical purposes, they said.
The argument gained traction, especially in Northern California, one of the epicenters of the AIDS epidemic—and of cannabis use. But Nadelmann was reluctant to push a ballot initiative with uncertain prospects. A down vote would add to the narrative that marijuana was unpopular and should remain prohibited.
Still, Prop 215’s backers were aggressive, so Nadelmann paid for a private statewide poll to see if the initiative had a chance statewide. To his surprise, it did. He brought the results to Soros. At the time, Soros didn’t favor fully legalized marijuana, Nadelmann says. But Soros did like the idea of medical marijuana. He spent $550,000 to back the initiative.
Peter Lewis, the billionaire chairman of Progressive Insurance, and George Zimmer, the founder of Men’s Wearhouse, together added another $760,000, at Nadelmann’s urging. (While Soros was interested in drug reform for ideological reasons, marijuana was a personal issue for Lewis and Zimmer, who were regular smokers.) The three men accounted for almost two-thirds of the $2 million of the financing behind the initiative.
And on November 5, 1996, as Clinton swept to his second presidential term, Prop 215 won approval in California—clearing the way for medical marijuana in the state, and ultimately across the country.
The long-term importance of Prop 215 is hard to overstate. It spurred a chicken-and-egg reevaluation of marijuana’s risks. In their wisdom, more than five million California voters had declared marijuana medicine. It couldn’t be medicine if it was dangerous, could it? And it couldn’t be dangerous if it was medicine, could it?
Marijuana’s late-1970s association with cocaine had destroyed the legalization movement. The rebranding of cannabis as medicine helped undo that link. Plus, by 1990, cocaine use was declining sharply. Firsthand experience with the drug’s dangers had turned Americans away from it. For the first time in a decade, cannabis advocates could put daylight between the two drugs.
The cocaine epidemic changed the dynamics around marijuana in a second, more subtle way. In the late 1970s, parents groups had proved a surprisingly effective counterweight to the cannabis lobby. They’d begun as volunteer organizations for parents upset about marijuana’s effects on their children. But after Reagan became president, they became politicized. As the federal government increased spending on antidrug efforts, it wanted more control of the groups. And Nancy Reagan saw antidrug campaigns as a way to improve her image.
By the mid-1980s, “Just Say No,” Nancy Reagan’s pet phrase, had become the movement’s motto. In 1987, her staff forced the nonprofit foundation behind Just Say No to accept a Procter & Gamble marketing executive as its director. The next year, the company sent 48 million homes a Just Say No pledge card—plus coupons for discounts on P&G products.
The corporate takeover hurt the legitimacy of the antidrug movement, while the rise of crack made parents groups seem out of touch. They came off as suburban Republicans hyperfocused on marijuana at a time when smokable cocaine was ravaging inner cities. The effect was to hollow out the ground-level opposition to cannabis, opening the way for Nadelmann and the next generation of advocates.
But for a while, the antimarijuana campaign still had momentum. Cannabis use plunged through the 1980s. By 1991, only one in four high school seniors said they had ever tried the drug, down from one in two in 1979. The number of Americans of any age who reported having used marijuana in the last year bottomed at 17 million in 1992, down from 33 million in 1979.
Yet arrests for marijuana, which had fallen along with use during the 1980s, suddenly began to rise. After bottoming at 290,000 in 1991, they reached 734,000 by 2000. The increase occurred mostly in arrests for possession rather than sale—users rather than dealers.
Several factors drove the crackdown. Police forces became aggressive about targeting minor crimes. They were following the “broken windows” theory, which held that failing to check low-level lawbreaking created an impression of disorder and allowed more serious crimes to flourish. In addition, police officers simply had more time to go after marijuana smokers. The number of officers in the United States rose by more than 100,000 during the decade, a nearly 20 percent increase, even as the crack epidemic waned.
“Police are now taking opportunities to make more marijuana arrests than they were when they were focused on crack cocaine,” a criminology professor told the Washington Post in 2005.
The arrests rarely led to jail time, and almost never for simple possession. A 2005 paper from a liberal group called the Sentencing Project found that despite the huge number of arrests, fewer than 28,000 people in 2003 were incarcerated in federal or state prisons for marijuana offenses. Another 4,600 were held in county jails, for a total of 32,500 prisoners, out of almost 2.1 million nationally.
Many of those prisoners were traffickers who had moved pounds or even tons of marijuana. Even then, sentences could be surprisingly short. In 1994, for example, Vincent Capece was caught helping to smuggle $17 million of marijuana across the United States. Though he already had a record of drug offenses, he received a thirty-three-month sentence.
Even so, the arrests became a political issue. Civil libertarians and liberal groups focused on the fact that African Americans were arrested two to three times as often as whites, though the two groups had similar rates of marijuana use. (The groups skimmed over the fact that “similar” didn’t mean the same; federal surveys showed that African Americans used marijuana somewhat more than whites, and those black people who did use tended to be heavier smokers. A 2016 paper in the journal Drug and Alcohol Dependence that was based on federal surveys covering more than 340,000 people showed that black people were almost twice as likely to report marijuana abuse or dependence as whites.)
The arrest gap provided an important way for marijuana’s strongest advocates—who were overwhelmingly white and liberal—to approach the black community. African American leaders had seen the damage that alcohol and tobacco did in inner cities. They feared reducing restrictions on cannabis would cause similar problems, and many saw it as a gateway drug.
Cannabis supporters argued the arrests were the real problem. In a 2004 report, NORML argued:
It doesn’t matter that many people arrested for marijuana possession do not spend time in jail beyond the time required for processing and arraignment before a magistrate; what matters is that any person arrested by police for marijuana possession can be sentenced to the maximum penalty allowed by law . . . marijuana laws are subjectively enforced and prosecuted.
In other words, black teenagers passing a joint in Harlem might be arrested and jailed, while white kids hitting a bong in Central Park would only be warned. The difference was unfair and racist, the advocates said. The argument didn’t convert older black leaders overnight, but it gained traction among younger ones.
The racial disparity in arrests mattered less at first to most white people. To win them over, marijuana supporters argued that the crackdown on marijuana wasted money and the time of police officers who should focus on violent crimes. In reality, spending on marijuana arrests and post-arrest processing made up only about $4 billion of the $110 billion that the United States spent on police and courts in 2001, according to the Sentencing Project paper.
Still, the legalizers had found an issue that resonated. After 2000, the overall crime rate continued its long decline. Yet marijuana arrests rose, peaking at 872,000 in 2007. The disconnect fueled a sense among voters that the war on marijuana had gone too far.
Meanwhile, advocates continued their slow work—writing opinion pieces, highlighting the cost and racial disparities of the drug war, and offering grants to local pro-cannabis organizations. In July 2000, Nadelmann merged the Lindesmith Center with the Drug Policy Foundation—a Washington-based reform organization. The new group was called the Drug Policy Alliance. Soros would be its most important backer. Ultimately, he gave more than $100 million to the DPA and a related group that funded medical marijuana and legalization ballot initiatives. By 2010, he supported full legalization, and he wrote an opinion piece saying so in the Wall Street Journal.
Soros declined my request for an interview, but a spokeswoman for his Open Society Initiative, his philanthropic arm, wrote:
George Soros has been committed to drug policy reform since the early-1990s. He has seen how prohibitionist policies have disproportionally harmed the most marginalized populations and failed to protect society’s most vulnerable people.
Nadelmann and Soros were not alone in their efforts.
In January 1995, a 25-year-old named Rob Kampia started the Marijuana Policy Project. As its name suggested, the MPP focused solely on cannabis. While Nadelmann saw the drug war as an intellectual and moral failure, the issue was more personal for Kampia. He had served ninety days in jail after being caught growing plants as an undergraduate at Penn State.
Like the original legalizers, Kampia liked to party, though he says alcohol was his drug of choice. (In 2010, the Washington City Paper published an article called “The Breast Massage Will Happen,” a scathing investigation into Kampia’s sexual harassment of MPP staffers.)
Whatever his personal demons, Kampia’s single-minded focus on marijuana attracted the interest of Peter Lewis. “Peter’s legalization mission was exactly the same as mine,” Kampia told me. “It was to regulate marijuana like alcohol in the United States.” Lewis cared less about Nadelmann’s other drug-related projects, and the two men didn’t particularly get along. So, Lewis backed MPP instead of the DPA. Before his death in November 2013 Lewis gave MPP more than $40 million to fund medical marijuana and legalization initiatives, Kampia says.
Kampia was less guarded than Nadelmann, more willing to make aggressive claims about marijuana’s medicinal properties. “If I had children, I would actually encourage them to use marijuana not just as a substitute for alcohol but because it has certain anticancer properties,” he told me. Some legalizers would accept or even prefer a tightly regulated marijuana market, with high taxes, state-owned dispensaries with limited hours, or both. Kampia favors a fully free market, with low costs and wide availability. “You want marijuana to be significantly more available than alcohol or pills.”
Still, Kampia and Nadelmann were colleagues more than rivals. Rather than competing to lead medical marijuana ballot initiatives, they divided them up by state. Each group led more than a dozen successful initiatives, helping draft the exact ballot language, fund-raising and gathering signatures, and paying for ads and campaign events.
Kampia always saw medical initiatives as a step to legalization. “[Only] six percent of all marijuana users use it for medical purposes,” he said. “Medical marijuana is a way of protecting a subset of society from arrest.”
Even more than the rise in arrests, medical marijuana had traction as an issue for advocates. Through the 1990s, Gallup polls showed that about only 25 percent of Americans favored legalizing marijuana. That figure perked up slightly in 1999, to 29 percent—while 69 percent opposed legalization.
But when it came to medical marijuana, Gallup found the numbers were reversed: 73 percent of Americans in 1999 favored “making marijuana legally available for doctors to prescribe in order to reduce pain and suffering.” Only 25 percent opposed the idea.
By 2000, Alaska, Colorado, Oregon, Nevada, and Washington had all followed California and okayed medical marijuana. The idea appealed to Americans’ sense of compassion; if marijuana could help sick people, why shouldn’t they have it?
Yet the very wording of the Gallup question suggested the confusion around the issue. Even now, doctors cannot prescribe marijuana, because the FDA has never approved cannabis to treat any medical condition. Marijuana simply isn’t a prescription drug in the way that physicians use the term. In modern medicine, a drug is usually a single chemical compound, like aspirin, taken as a pill or as an injection. (These days, some drugs are “biologics,” complex molecules grown from specially engineered cells. But those biologics have even less in common with marijuana than ordinary chemical pharmaceuticals do.)
On the other hand, cannabis is a plant that contains many different chemicals, some of which work at cross purposes, like THC and CBD. Further, different strains have different levels of cannabinoids, so they can’t be easily compared. Marijuana can be cooked and eaten or smoked in a cigarette—a method of use that the FDA could never condone. It can also be inhaled through a vaporizer as nearly pure THC.
The FDA generally approves pharmaceuticals only after years of closely controlled clinical trials. Doctors prescribe them at a set dose to treat a particular disease: take antibiotics for your sore throat for a week. Even drugs meant as long-term treatments, like medicines for diabetes, require patients to get new prescriptions when they finish their supply.
In contrast, medical marijuana laws allowed doctors to authorize patients to use cannabis for many different diseases, including nebulous conditions like insomnia or anxiety. (California’s law allowed doctors to recommend it for any medical condition they saw fit.) Those authorizations lasted a year, and once a patient received one, he could use it to buy cannabis anytime he wished, for any reason.
In selling Prop 215 and later ballot initiatives, advocates promoted the idea that medical marijuana would be used as medicine. Posters featured a green leaf over a red cross, and slogans like “You’ve just been told you have terminal cancer. Now the bad news. Your medicine is illegal.”
As the Los Angeles Times wrote in November 1996:
The human face of Proposition 215, the medical marijuana initiative on Tuesday’s ballot, is benign and sympathetic. It’s right there in the backers’ TV commercials: A breast cancer survivor who uses marijuana to ease nausea, a doctor who prescribes it to ailing patients, the widow of a cancer patient who used marijuana.
Mary Jane Rathbun—yes, Mary Jane was her real name—was the campaign’s most prominent face. Rathbun had become known in San Francisco for the marijuana-laced brownies that she cooked for AIDS patients. In July 1992, sheriff’s deputies in Sonoma County, north of San Francisco, arrested her as she mixed marijuana into brownie batter. The charges were later dropped, but the arrest made “Brownie Mary” a celebrity across the state.
Spokespeople like Brownie Mary promoted the idea that medical marijuana would be used by genuinely sick people after careful discussions with their doctors. The reality was different. Most physicians didn’t want to write medical marijuana authorizations, for both medical and legal reasons. The Drug Enforcement Administration initially tried to stop physicians from writing them at all, leading marijuana advocates to sue. After a 2002 decision against the government in the federal appeals court that covered California, the DEA backed off. Still, the issue was murky.
Aside from the potential legal jeopardy, many doctors thought medical marijuana was a bad idea. After seeing the dangers of tobacco, they didn’t want to encourage smoking. Many knew the scientific evidence for using cannabis was weak. And doctors tend to be conservative when it comes to unproven treatments; the cardinal rule of medicine is first, do no harm.
As a result, a relative handful of cannabis-friendly doctors wrote most authorizations. California has more than 100,000 physicians; in 2011, NORML’s list of doctors willing to write authorizations included about 1,500 names.
For the so-called pot doctors, medical marijuana cards became a volume business. At first, receiving an authorization in California cost $100 to $200 and required a serious consultation. But prices and standards dropped over time. Meanwhile, seriously ill people who wanted to discuss marijuana with their own doctors couldn’t always do so. A 2010 article in Mother Jones highlighted the absurdity:
Recently, my wife and I had a contest. She’d ask her rheumatologist if he would write her a prescription for medical marijuana to treat her arthritis. I’d go online, find a doc, and see if I could get pot prescribed for a vague, undocumented medical problem. Then we’d see who’d be the first to join the ranks of California’s 500,000 medical marijuana users.
After a $70, ninety-second “examination” in San Francisco with a “stooped, white-haired man in a rumpled pullover—the doctor,” the writer had his authorization. Meanwhile, his wife’s rheumatologist said he couldn’t help and referred her to her general practitioner, who also refused:
“I very rarely write letters for medical marijuana, and then it’s only for advanced cancer,” the doc explained. “I am not willing to write a letter for a relatively healthy 34-year-old.”
Later, the Mother Jones writer found his way to the International Cannabis and Hemp Expo:
My medical marijuana card got me into a “patient consumption area” staffed by busty women in tight-fitting nurse outfits . . . As the refrain of “We Gotta Get High” hit the speaker, an employee of a San Jose–based dispensary wearing a nametag that said “Dr. Herb Smoker, MD” offered me a hit.
California didn’t keep a mandatory registry of its patients, but surveys showed they were mostly white, under 45, and had been regular cannabis users before getting a medical card. Pain was a far more frequent reason for authorization than cancer or other serious illnesses. By 2014, some physicians charged as little as $30 for an authorization. Even medical marijuana supporters complained that the process was a joke.
The situation was similar elsewhere. In Oregon, which kept detailed data on authorizations, 10 of the state’s 10,000 physicians accounted for 76 percent of all the authorizations written during the first decade of the program. One accounted for more than 35 percent.
At least in California and Oregon, patients had to see an actual physician for an authorization. Other states had even looser rules. The most stunning example was Arizona, where “naturopaths” could also write authorizations. Though they call themselves doctors, naturopaths do not attend regular medical schools or complete residencies in hospitals. They cannot practice surgery. Most states do not allow them to prescribe drugs.
Like Oregon, Arizona kept detailed statistics on which doctors wrote prescriptions (at least through the fiscal year ended June 30, 2015). During that year, about 78,000 Arizona residents received medical marijuana cards.
In 2015, Arizona had 30 times as many medical doctors as naturopaths. But the naturopaths accounted for nearly all the authorizations. The 23 busiest wrote 60 percent of all the authorizations in Arizona. Meanwhile, 98 percent of physicians didn’t write a single authorization.
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Despite the obvious loopholes it provided for recreational use, the medicalization of marijuana proved the crucial bridge to full legalization.
Not because the number of people authorized to use medical cannabis has ever been particularly high. The registries show that it is less than 1 percent of the population in most medical marijuana states, and more than 3 percent in only one state, Maine.
But medical legalization created a community of dispensaries and growers with a financial interest in full legalization. And it produced a stalemate between state and federal laws that allowed that community to flourish. Neither George W. Bush or Barack Obama wanted the spectacle of drug agents raiding medical marijuana dispensaries and dragging “budtenders” out in handcuffs.
Meanwhile, the backdoor protection the authorizations offered for recreational use increased pressure on voters in medical states to take the last step. With some justification, proponents of full legalization argued that dropping the fig leaf would result in better regulation and higher taxes.
Even in states that hadn’t passed medical marijuana laws, everyone heard the same chorus: marijuana is medicine, marijuana is medicine, marijuana is medicine. No matter that the medical claims far outstripped the available evidence, and that when good studies were conducted, they were almost universally disappointing.
You might not be shocked to learn that Rob Kampia is wrong about cannabis and cancer, according to the National Academy of Medicine. In its 2017 report, NAM found essentially no evidence that cannabis or cannabinoids can help cancer of any kind. Worse, it found some evidence that cannabis use is associated with testicular cancer—and that mothers who smoke are more likely to have children who develop leukemias and brain cancer.
But it’s not just cancer.
The National Academy’s report also found no evidence that cannabis is useful for a whole alphabet of diseases it’s supposed to help: dementia, epilepsy, glaucoma, irritable bowel syndrome, ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease), or Parkinson’s disease. It found almost no evidence that marijuana can treat anxiety or posttraumatic stress disorder—and some evidence that the drug worsens those conditions.
The only conditions cannabis or cannabinoids have been proven to treat are chemotherapy-associated nausea and spastic muscles associated with multiple sclerosis, the report said. (Since the report appeared, CBD, the nonintoxicating compound in marijuana, has been shown to treat seizures associated with two rare forms of epilepsy, and the FDA has approved it for that condition.)
Smoking cannabis also seems to produce moderate pain relief. But the pain studies don’t usually compare the degree of relief to standard pain relievers like ibuprofen, only to a placebo. More recently, a 1,500-patient, four-year study in Australia threw doubt on that finding, too.
Cannabis’s general uselessness as medicine shouldn’t surprise anyone who thinks through the issue. The human body is incredibly complicated. Hundreds of thousands of biomedical researchers worldwide spend their lives trying to figure out how diseases damage the body and how to stop them. Why would a single plant treat conditions as different as dementia, irritable bowel syndrome, and cancer? Even if it did, why would it treat them better than the compounds that scientists have discovered and refined over the last century? We don’t pretend that garlic or nightshade cure diseases better than more modern medicines, so why do we do so for marijuana?
As Dr. David Gorski, a cancer surgeon and researcher, wrote on the blog Science-Based Medicine in 2015:
I believe that marijuana should be legalized, regulated, and taxed, just like alcohol and tobacco. If marijuana is going to be approved for use as medicine rather than for recreational use, however, the standards of evidence it must meet should be no different than for any other drug, and for the vast majority of indications for which it’s touted medical cannabis doesn’t even come close to meeting that standard.
But aside from a few killjoys like Gorski, the same professional skeptics who insist guardian angels aren’t watching us all, the idea of marijuana as a cure-all has no real opponents. At a time when Americans are hopelessly divided on issues from abortion to race relations, medical marijuana stands out for its nearly unanimous support. A 2017 national poll found that 94 percent of Americans supported “allowing adults to legally use marijuana for medical purposes if their doctor prescribes it.”
Thirty states have now legalized medical marijuana, including Oklahoma, among the reddest of red states, in June 2018. Support for full recreational legalization remains weaker than for medical marijuana. But it too has climbed steadily, and now ranges over 60 percent in most polls, a figure high enough that politicians are paying attention. For the first time, some serious Democratic presidential hopefuls have called for legalization.
More surprisingly, John Boehner—a Republican who adamantly opposed legalization as Speaker of the House—announced in April 2018 that he had joined the board of a cannabis company, Acreage Holdings. “My thinking on cannabis has evolved,” he said. (Boehner cannot be accused of being overly concerned about the risks of smoking, at least. He’s a two-pack-a-day cigarette smoker. Paul Ryan, his successor as speaker, complained Boehner’s office reeked of stale cigarettes after Ryan took it over.)
Even having a Republican in the White House probably won’t turn the tide. Attorney General Jeff Sessions vehemently opposes cannabis. But his boss doesn’t seem to care.
“Trump—on marijuana policy he’s the best president who’s ever existed on his stated intent,” Kampia said. “He has not ever contradicted himself on the issue of having states determine their policies without federal interference.”
Kampia thinks full national legalization is all but certain. Nadelmann agrees.
“I don’t think it’s really stoppable,” he said. “The public support is so high . . . The broader question of issues like when and how marijuana is going to get legalized is not really an interesting question right now.”
Instead, the debate will shift to issues like when and how the records of people who were arrested for marijuana should be expunged, Nadelmann said. The industry’s commercial structure and attitude toward regulation will also be big issues. Nadelmann retired from DPA in part because he felt the next generation of advocates should lead those debates.
“The marijuana industry occupies a unique place in American history,” Nadelmann said. “A movement driven by concerns for human rights, racial justice, and good public policy has resulted in the emergence of an industry that will be worth tens of billions of dollars a year.”
For twenty-five years, marijuana legalizers have trounced their opponents by endlessly repeating two myths, that cannabis is effective medicine and that American prisons are filled with black people arrested for marijuana possession.
I’m sure advocates like Nadelmann and Kampia believe that marijuana is a relatively safe drug, illegal mainly because of American racism, and that the link between cannabis and mental illness is government propaganda to frighten kids. They’ve pounded that message over and over.
They’ve won and won and won.
They’ve been so busy winning they haven’t noticed the proof they’re wrong piling up.