Has Medical Marijuana Gone Up in Smoke?

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JUSTIN SULLIVAN/AP

Cancer patient Creighton Frost lights a marijuana cigarette at his home

Monday was not a good day for advocates of medical marijuana.

In a unanimous decision, the Supreme Court upheld the federal government’s challenge of six California distributors who provided medical marijuana to patients with various illnesses including cancer, multiple sclerosis and AIDS. Many advocates and patients claim smoking pot alleviates the worst of symptoms ranging from nausea to muscle tremor.

The federal government and the high court disagree, however, standing by the Controlled Substances Act, which labels marijuana a Schedule 1 drug (along with heroin, PCP and LSD). In the majority opinion, Clarence Thomas cited the CSA, writing that marijuana has "no currently acceptable medical use."

Meanwhile, over the past ten years, voters in at least eight states have thumbed their noses at federal law, approving propositions to allow the distribution and use of marijuana for medicinal purposes. And the federal government has responded with unequivocal language: In 1997, when voters in both California and Arizona had approved the use of marijuana for medical purposes, Clinton drug czar Barry McCaffrey struck back, outlining various federal responses to "illegal drug activities."

Where does Monday’s ruling leave those states? Will the Supreme Court’s decision galvanize medical marijuana advocates? In an attempt to find the bottom line, TIME.com sat down with two experts to discuss the scientific and legal debates surrounding this hot-button issue.

Patricia Reggio, a professor of chemistry and biochemistry at Kennesaw State College in Kennesaw, Georgia, has extensively researched marijuana’s therapeutic potential. Frank Palumbo is the director of the University of Maryland’s Center on Drugs and Public Policy in Baltimore.

TIME.com: At this point, are there proven therapeutic uses for marijuana?

Patricia Reggio: People are not making up the benefits of marijuana; many therapeutic effects, like pain relief and appetite stimulation, are linked to one ingredient in marijuana. That ingredient, called delta 9 THC, is available by prescription under the name Dronabinol. The problem at this point is that Dronabinol is taken orally, and it doesn’t often do much good for patients who are nauseated, and the oral form often doesn’t deliver a whole lot of the drug to the patients’ system. Drug companies are trying to figure out more effective delivery systems, like inhalers and suppositories. The key, of course, is to get as much of the drug into the system as the patient needs — and the lungs just happen to be an excellent delivery system.

Currently, voters in Arizona, Alaska, California, Colorado, Maine, Nevada, Oregon and Washington have approved the use of medical marijuana. Where does this leave those states in terms of law enforcement?

Frank Palumbo:I’m not sure it leaves them in any different position than they were in before. There’s still a federal law that says marijuana is Schedule 1 drug, per the FDA label. The reason marijuana is labeled a Schedule 1 substance is the federal government has determined it has no medical use.

Could we get to a point where a majority of states’ voters approved propositions approving medical use of marijuana?

Palumbo: We could, I suppose. But before that happened, the issue of medical use would probably go back to Congress, where it would be very hotly debated. At the moment, the federal government is digging in its heels over medical marijuana, and a handful of states happen to disagree with their policy.

What would have to happen for marijuana to become a legal, regulated drug?

Palumbo:Even if there were a movement at the federal level to approve marijuana as a regulated drug, the approval process would require a new drug application and lengthy clinical trials, because even though it’s not a new drug, the government would be considering a new use and a new label for it.

As current law stands, could federal prosecutors go after someone who’s using pot to alleviate nausea from chemotherapy?

Palumbo: They could, although it’s not clear how often that sort of thing happens. They probably wouldn’t have any legal problems: Current federal law provides law enforcement officers with plenty of leeway in dealing with what the law considers "drug offenders."