In 1999, what was then the Institute of Medicine (now the National Academy of Medicine) issued a report that mocked the idea that smoking plant material could ever be considered medicine but cautiously endorsed research into the possible therapeutic utility of either natural or artificial cannabinoids.  A few years later, “drug czar” Barry McCaffrey dismissed the whole idea as “Cheech and Chong medicine.”

Things have changed.

A new National Academies report makes an unequivocal finding:

CONCLUSION 4-1

There is substantial evidence that cannabis is an effective treatment for chronic pain in adults.

It also finds that some patients are replacing opiates with cannabis.

On average, the pain control benefits of cannabis are described as “modest.” And the data are - for reasons the report lays out - still frustratingly inconclusive about which chemical components of cannabis are doing the work and what dosage regimens and routes of administration are most effective. Still, the finding is what it is.   The sound you hear in the background is the gnashing of drug warriors’ teeth.

Pain is the most common indication cited when physicians and other heath practitioners recommend cannabis under state medical-marijuana laws. It is also the hardest symptom to measure objectively, and thus the easiest to fake for someone who merely wants legal permission to get stoned. So whether a state allows medical-marijuana recommendations for pain is one of the key dividers between “tight” versions of medical marijuana, intended to serve genuine patients only, and the “loose” versions (more common west of the Mississippi) that amount to de facto legalization. Advocates of “tightness” have often won the argument  by pointing out that the efficacy of cannabis for pain hadn’t been scientifically demonstrated. It’s going to be much harder to keep a straight face while saying that tomorrow than it was yesterday. And the finding comes just as several new states (including Florida) are in the process of implementing voter-approved medical marijuana laws.

There’s much more to the new report than the pain finding; so far I’ve only skimmed it. But it’s clear that the politics of medical marijuana just took on a new shape.