If You Are Strongly in Favor of Marijuana Decriminalization, It Is Hypocritical to Oppose Medical Marijuana

New York Gov. Andrew Cuomo speaks during a news conference announcing an agreement with legislative leaders on New York's Sec
New York Gov. Andrew Cuomo speaks during a news conference announcing an agreement with legislative leaders on New York's Secure Ammunition and Firearms Enforcement Act in the Red Room at the Capitol on Monday, Jan. 14, 2013, in Albany, N.Y. (AP Photo/Mike Groll)

Governor Cuomo,

In your 2013 State of the State Address, you said:

[There are] roughly 50,000 arrests in New York City for marijuana possession [every year]... Of those 50,000 arrests, 82 percent are black and Hispanic... These arrests stigmatize, they criminalize, they create a permanent record. It's not fair, it's not right, it must end and it must end now... Stop stigmatizing these young people, making it harder to find a job, making it harder to get into school, making it harder to turn their lives around.

I applaud you for your support of the decriminalization of marijuana in NY State. But when it comes to supporting the bill in Albany to allow for the use of marijuana for medical purposes by those who have been authorized its use by a doctor, you have not raised your voice in support and have fallen back on the federal government's position. I find this quite hypocritical. When you stand for marijuana decriminalization, you support the idea that a New Yorker should not be treated as a wrong-doing social outcast when they carry in their possession a certain amount of marijuana. But your position is antithetical to the federal law which calls for up to one year in prison and a fine of $1,000 for possessing any amount of marijuana-zero tolerance. With a third possession offence under federal law, one can be charged with a felony, be sentenced to a mandatory minimum of 90 days in prison or a maximum of five years, and be fined up to $5,000. For cultivating one marijuana plant, one can face up to five years in federal prison. This is severe stigmatization that you clearly do not endorse given your support of stopping New York state from following along with the utter folly of the United States Criminal Code.

Although you significantly diverge with the federal government's view of the threat level those who possess marijuana pose to society, you somehow fall in lockstep with their view that marijuana has no currently accepted medical use in treatment and no standard of safety for use under medical supervision -- the criteria for placement in Schedule I. On April 9, 2012, you said at a press conference in Utica:

My position has been that there are tremendous risks here, also. I understand the benefits, but there are also risks and I think the risks outweigh the benefits at this point. I understand there's more research and there's more evidence and it can always be re-evaluated.

Governor Cuomo, if you do not believe the federal government's judgment about the severe criminality of the act of marijuana possession, why do you trust their position on the medical use of marijuana? Do you think that the federal government's assessment of risks and benefits of marijuana is going to be "fair" and "right"? What if you found out that the federal government's judgment that marijuana's risks outweigh any benefits was actually a purely politically motivated one? We have proof from recordings from the White House Oval Office that then-President Richard Nixon attempted to sabotage and predetermine the outcome of the national commission that had been set up by Congress to recommend what level of risk marijuana should be handled with in federal law. Nixon privately told the commission chair, former Pennsylvania Governor Raymond Shafer, that it was "terribly important" that they not come out with a report that was "soft on marijuana." Strategizing for political expediency over factual review and nuance, Nixon called for obfuscation: "I think there's a need to come out with a report that is totally, uh, uh, oblivious to some obvious, uh, differences between marijuana and other drugs, other dangerous drugs..." Nixon further warned Shafer: "Keep your Commission in line." The Commission did not listen to Nixon and recommended in 1972 that marijuana be removed from the same category as heroin and that no crime should be made of its possession or non-commercial exchange. Somehow, Governor Cuomo, Governor Shafer understood 40 years ago what you do not today -- the federal government is more interested in politics than science when it comes to marijuana. The federal government later blocked in 1988 an attempt to change the scheduling of marijuana when a DEA judge recommended, after two years of careful evidentiary review, that it be rescheduled to Schedule II with painkillers and anesthetics. They denied another petition in 2011, which is under appeal.

You see, New York State is no stranger to the medical use of marijuana. The New York Department of Health conducted a large scale taxpayer funded cooperative clinical trial whose results were published in 1988. The central question addressed in the study was how effective inhaled marijuana was in preventing nausea and vomiting due to chemotherapy in patients who failed to respond to previous anti-nausea therapy based on patient self-report. Patients undergoing chemotherapy were allowed to use marijuana distributed through three centers: North Shore Hospital, Columbia Memorial Hospital, and a triad of the Upstate Medical Center, St. Joseph's Hospital and Jamestown General Hospital. The program provided marijuana therapy to 208 patients through 55 practitioners. Of those, data on 199 patients were evaluated and published. These patients had received a total of 6,044 government supplied marijuana cigarettes provided to patients during 514 treatment episodes. The New York State Department of Health report on this study concluded that approximately 93% of marijuana inhalation treatment episodes were effective or highly effective when compared with other anti-emetics. No serious adverse side effects were reported. No patient receiving marijuana required hospitalization or any other form of medical intervention.

Yes, these trials are older now, but what they found has been confirmed in more recent randomized controlled clinical trials of inhaled cannabis, which have repeatedly found definite medical benefit for patients suffering from muscle spasms, appetite loss, and chronic pain - a fact acknowledged in an American Medical Association Council on Science and Public Health report in 2009. Some of these trials were even conducted in New York state's finest academic medical centers.

See, it is hypocritical to dissent from the federal position on marijuana criminalization and at the same time endorse their out-of-touch position on marijuana's medical utility and safety. Respectfully, Governor, what makes you think that their position on marijuana can be trusted at all? To not support medical marijuana is like saying science and compassion for patients can wait until we let the federal government sort out and acknowledge their mistakes. But the sick should not have to wait for that. To use your words, "It's not fair, it's not right, it must end and it must end now."

Sunil Aggarwal, MD, PhD
House Staff, Physical Medicine and Rehabilitation
Large Academic Medical Center in New York City