Edith Cowan University Research Online Theses: Doctorates and Masters Theses 2015 Medical cannabis in the United States: Policy, politics and science Jelica Grbic Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Alternative and Complementary Medicine Commons, and the Bioethics and Medical Ethics Commons Recommended Citation Grbic, J. (2015). Medical cannabis in the United States: Policy, politics and science. https://ro.ecu.edu.au/ theses/1619 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/1619 Edith Cowan University Research Online Theses: Doctorates and Masters Theses 2015 Medical cannabis in the United States: Policy, politics and science Jelica Grbic Edith Cowan University Recommended Citation Grbic, J. (2015). Medical cannabis in the United States: Policy, politics and science. Retrieved from http://ro.ecu.edu.au/theses/1619 This Thesis is posted at Research Online. http://ro.ecu.edu.au/theses/1619 Edith Cowan University Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorize you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. Where the reproduction of such material is done without attribution of authorship, with false attribution of authorship or the authorship is treated in a derogatory manner, this may be a breach of the author’s moral rights contained in Part IX of the Copyright Act 1968 (Cth). Courts have the power to impose a wide range of civil and criminal sanctions for infringement of copyright, infringement of moral rights and other offences under the Copyright Act 1968 (Cth). Higher penalties may apply, and higher damages may be awarded, for offences and infringements involving the conversion of material into digital or electronic form. USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. Medical Cannabis in the United States: Policy, Politics and Science Jelica Grbic, BSc (Hons) Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy (Public Health) Principal Supervisor: Dr. David Ryder Associate Supervisor: Prof. Perilou Goddard Faculty of Health, Engineering and Science School of Exercise and Health Sciences EDITH COWAN UNIVERSITY December 2014 USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. Medical Cannabis in the United States iii Abstract Historically, cannabis has been used as a pharmaceutical drug for a variety of conditions including rheumatism, depression, convulsions, and malaria. Since the 1970s, randomised, controlled clinical trials have shown cannabis to be effective in the treatment of debilitating medical conditions including nausea and vomiting resulting from cancer chemotherapy, wasting syndrome associated with HIV/AIDS, and chronic pain. Despite scientific evidence, as of 2011, when the material for this thesis was collected, only 17 states of the United States (U.S.) and the District of Columbia had enacted medical cannabis laws allowing patients with specific medical conditions to use cannabis without being criminally prosecuted. This thesis examines two components of the medical cannabis policy: the medical cannabis policy process in five representative states of the U.S., and the factors influencing the formation of such a process. The first part of the thesis chronologically documents the passing, attempts to pass, and failure to pass medical cannabis policies in five U.S. states; two with a current medical cannabis law; one where attempts to pass a law have been made, but a law has not yet been passed; and two states where no or few attempts at passing a medical cannabis law have been made. The second part of the thesis used a questionnaire to elicit the factors influencing policies as perceived by three groups. Group one comprised individuals directly involved in the medical cannabis policy process in at least one of the five states referred to above and group two comprised individuals participating in research in the alcohol and other drug field. Group four comprised members of the International Society for the Study of Drug Policy (ISSDP). The study found that, despite the expectation that the same rules would apply to cannabis as other medicine, the medical cannabis process appears to be less medically and more politically driven, with Medical Cannabis in the United States iv scientific evidence having limited influence. The results suggest that there are a number of interlinking factors which played a role in the passing or failure to pass medical cannabis laws in U.S. states, and the level of influence of these factors can vary according to context or conditions placed on them. Three major themes emerged in relation to the factors influencing policy: the role of scientific evidence, the political process, and the interaction between factors. It is hoped that this thesis will be viewed as an observation of the medical cannabis process, not only from the researcher’s point of view but from the views of those who participated in the process, researched the process, or observed the changes in medical cannabis laws over the years. Medical Cannabis in the United States v Declaration I certify that this thesis does not, to the best of my knowledge and belief: (i) incorporate without acknowledgement any material previously submitted for a degree or diploma in any institution of higher education; (ii) contain any material previously published or written by another person except where due reference is made in the text; or (iii) contain any defamatory material. I also grant permission for the Library at Edith Cowan University to make duplicate copies of my thesis as required. Signature: Date: Medical Cannabis in the United States vi Some sections of this thesis have already been presented as a conference paper: Grbic, J., Ryder, D., & Goddard, P. (2010, March). Factors influencing medical cannabis policy development in the U.S. and their implications. Paper presented at the International Society for the Study of Drug Policy Conference, Santa Monica, CA. Medical Cannabis in the United States vii Acknowledgements It is with immense gratitude that I acknowledge the support of my Principal Supervisor, Dr David Ryder. I could not imagine doing this thesis without his unwavering support, guidance, and encouragement. He has pushed me to do better, motivated me, and, most importantly, inspired me. I was also very fortunate to have Prof Perilou Goddard as my Associate Supervisor; I could not have asked for a wittier or more professional one. With her enthusiasm, encouragement, and sound advice, this thesis kept growing and improving. Thank you to the School of Exercise, Biomedical and Health Sciences for giving me a scholarship which made this thesis possible. Thank you to all those who took the time to participate in this research project; their willingness to share their knowledge is much appreciated. I would also like to thank the International Society for the Study of Drug Policy for providing me with a scholarship to present at their 2010 Annual Conference in Santa Monica. I am indebted to the many people I met there who very kindly provided me with valuable feedback and support. I am especially grateful to Prof Alex Stevens, Dr Martin Iguchi, and Mr David McDonald. My sincerest thanks goes to those not mentioned here by name, but who, through one way or another, contributed to this thesis. On a more personal note, I would like to thank those who kept me from drowning in this process; a small gesture of kindness, sharing a joke, or just a smile makes a big difference. A big thank you goes to my brothers, who many times challenged my commitment but continued supporting me. To my dear parents, without whose unconditional support this would have been impossible, I dedicate this thesis. Medical Cannabis in the United States viii Table of Contents ABSTRACT ............................................................................................................................... III DECLARATION .......................................................................................................................... V ACKNOWLEDGEMENTS .......................................................................................................... VII LIST OF ABBREVIATIONS ............................................................................................................ CHAPTER 1- INTRODUCTION .................................................................................................... 1 PARTICIPANTS IN THE UNITED STATES POLICY MAKING .......................................................................... 2 THE ROLE OF THE SCIENTIFIC EVIDENCE ............................................................................................... 3 Barriers to research utilisation. ............................................................................................. 5 Improving the use of scientific evidence. .............................................................................. 6 POLICY TRANSFER AND LEARNING .....................................................................................................