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This question has particular relevance for residents of Alaska, Oregon, and the District of Columbia. They will be voting on the legalization of marijuana in those jurisdictions will be on the ballot November 4th. The New York Times endorsed legalization, but how do individuals (particularly those working in the addictions field) gather the necessary information to make a reasoned decision?

During the past year, I have been researching voting on the legalization or marijuana, have often been surprised by what I have found, and will share what I have discovered in the next few blogs posts. For those interested in digging deeper on their own, I would recommend an older reference, Licit and Illicit Drugs, written by Edward Brecher for the Consumers Union in 1972, and a more recent one, Marijuana Legalization written by Jonathan P. Caulkins et al. in 2012

First, marijuana is one of the most ancient substances known to man — originating as “cannabis”  in the Far East more than 12,000 years or about as long as alcohol and much longer than opium or cocaine. Medicinal use was first documented in 2,700 BC. Use by the people of Western Europe for any purpose dates back 2,500 years. In the U.S., the plant —then known as “hemp”— was widely cultivated during colonial times for making fabric and rope. George Washington grew it at Mt. Vernon, and notes in his diary suggest that he may have been aware of its psychoactive properties.

In the 19th and first part of the 20th Century, marijuana was a mainstream medication in the U.S. Liquid extracts were manufactured by many of the largest respected pharmaceutical companies. From 1850 to 1942, marijuana was listed in the U.S. Pharmacopeia, the national standard formulary for medication. One of my medical heroes, Sir William Osler, was about as mainstream as you could get. As one of the founders of Johns Hopkins Medical School and the author of a famous textbook of medicine, he was skeptical about medication. In his day, ineffective preparations were often enthusiastically endorsed. Nevertheless, in 1898 — the year he served as president of the Maryland State Medical Society – he wrote that marijuana was “probably the most satisfactory remedy” for migraine headaches.

Recreational use of smoked marijuana plants in the U.S. was not common until the beginning of the 20th Century when they were brought into the country by Mexican immigrants. In the 1920s, it was adopted by jazz musicians, who were often African American. Thus, marijuana was associated with minority populations until its use began to broaden during the later years of Prohibition. However, now we are voting on the legalization of marijuana.

How did the marijuana situation in the U.S. change so dramatically that a respected, mainstream medication became the subject of such controversy? I will summarize those developments in next week’s blog post about voting on the legalization of marijuana. As a clinical community, it’s important that we stay informed about both past and present issues in this ongoing debate.

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