FindLaw > Criminal Law Summaries > United States v. Oakland Cannabis Buyers' Cooperative

Controlled Substances Act – Medical Necessity Defense for Marijuana

Case: United States v. Oakland Cannabis Buyers' Cooperative

Issue: Is the common law defense of medical necessity available under the federal Controlled Substances Act as an exception to that Act’s prohibition of the manufacture and distribution of marijuana?

Facts: In 1996, California voters enacted an initiative that allowed for the possession and use of marijuana by seriously ill patients for medical purposes. The Compassionate Use Act of 1996 created an exception to California drug law prohibiting the possession and cultivation of marijuana. The prohibitions do not apply to a patient or primary caregiver who possesses or cultivates marijuana for the patient’s medical purposes upon the approval or recommendation of a physician. Respondent Oakland Cannabis Buyers Cooperative (“the Cooperative”) was organized to dispense medical marijuana to qualified patients. In 1998, the United States sued the Cooperative in the United States District Court for the Northern District of California to enjoin the Cooperative’s manufacture and distribution of marijuana on the ground that, although legal under California law, the Cooperative’s acts violated the federal Controlled Substances Act. Specifically, the United States argued that the Cooperative violated the Controlled Substances Act’s prohibitions against the manufacture, distribution, and possession (with intent to distribute or manufacture) a controlled substance. The District Court granted a preliminary injunction.

Rather than appeal the injunction, the Cooperative openly violated it. The United States initiated contempt proceedings in the District Court and the Cooperative asserted a medical necessity defense, arguing that marijuana relieves severe pain and other debilitating symptoms. The District Court rejected this argument and held the Cooperative in contempt. It later denied a motion by the Cooperative to modify the injunction to allow distributions that were medically necessary.

The Cooperative appealed both the contempt order and its denied motion to the United States Court of Appeals for the Ninth Circuit, but before a ruling was reached, the Cooperative voluntarily purged its contempt by promising it would comply with the preliminary injunction. The appeal of the contempt order was, therefore, moot, but the District Court’s refusal to modify the injunction still presented a justiciable issue. Reaching the merits, the Ninth Circuit reversed and remanded, holding that the medical necessity defense was a legally cognizable defense “that likely would apply in the circumstances.” The Ninth Circuit additionally held that the District Court had erred in its belief that it had no authority to issue an injunction that was more limited in scope than the Controlled Substances Act itself. Because district courts retain broad equitable discretion, the District Court should have weighed the public interest and considered factors such as the serious harm of depriving patients of marijuana. The Ninth Circuit instructed the District Court to consider on remand the criteria for a medical necessity exemption and, in the event that the District Court modified its injunction, to set forth such criteria in the modified order. The United States petitioned for certiorari. The Supreme Court granted certiorari, “[b]ecause the [Ninth Circuit’s] decision raises significant questions as to the ability of the United States to enforce the Nation’s drug laws.”

Holding: “[M]edical necessity is not a defense [under the federal Controlled Substances Act] to manufacturing and distributing marijuana. The Court of Appeals erred when it held that medical necessity is a legally cognizable defense.... It further erred when it instructed the District Court on remand to consider the criteria for a medical necessity exemption, and, should it modify the injunction, to set forth those criteria in the modification order.”

Reasoning: Noting that it is an open question whether federal courts ever have authority to recognize a necessity defense not provided by statute, the Court, through Justice Thomas, declined to reach that issue, because, “[i]n this case, to resolve the question presented, we need only recognize that a medical necessity exception for marijuana is at odds with the terms of the Controlled Substances Act.” In the case of the Controlled Substances Act, the Court observed that “the statute reflects a determination that marijuana has no medical benefits worthy of an exception (outside the confines of a Government-approved research project). Whereas some other drugs can be dispensed and prescribed for medical use [under the Act] the same is not true for marijuana. Indeed, for purposes of the Controlled Substances Act, marijuana has no currently accepted medical use at all.”

The structure of the Act supports this conclusion. “The statute divides drugs into five schedules, depending in part on whether the particular drug has a currently accepted medical use. The Act then imposes restrictions on the manufacture and distribution of the substance according to the schedule in which it has been placed. Schedule I is the most restrictive schedule. The Attorney General can include a drug in Schedule I only if the drug has no currently accepted medical use in treatment in the United States, has a high potential for abuse, and has a lack of accepted safety for use under medical supervision. Under the statute, the Attorney General could not put marijuana into Schedule I if marijuana had any accepted medical use.” (Even though it was Congress, rather than the Attorney General, which had placed marijuana in Schedule I, the Court found this to be a distinction without a difference.)

The Court also rejected the Cooperative’s argument that although a drug placed in Schedule I may not have achieved general acceptance as medical treatment, it nevertheless may have medical benefits to a particular class of patients. The Court refused to “parse the statute in this manner,” stating that it is clear from the text of the Act that “Congress had made a determination that marijuana has no medical benefits worthy of an exception.”

The Court summarily refused the Cooperative’s invitation to construe the Controlled Substances Act to include a medical necessity defense, in order to avoid allegedly difficult constitutional questions. “[T]he canon of constitutional avoidance has no application in the absence of statutory ambiguities.”

The Court conceded that federal district courts, when acting in equity, have discretion in fashioning injunctive relief, unless a statute provides otherwise. The Court nevertheless rejected the Cooperative’s argument that, to sustain the Ninth Circuit’s judgment, the Court “need only reaffirm that federal courts, in the exercise of their equity jurisdiction, have discretion to modify an injunction based upon a weighing of the public interest.” The mere fact that a district court has discretion does not necessitate the conclusion that the District Court here, when considering whether it could modify the injunction, could consider any and all factors that might relate to the public interest, the convenience of the parties or the medical needs of patients. “On the contrary, a court sitting in equity cannot ignore the judgment of Congress, deliberately expressed in legislation.” An equity court’s choice, unless there is statutory language to the contrary “is simply whether a particular means of enforcing the statute should be chosen over another permissible means; [the equity court’s] choice is not whether enforcement is preferable to no enforcement at all.” The Ninth Circuit erred in considering public interest factors in connection with the medical properties of marijuana. Because the Controlled Substances Act does not allow for a medical necessity defense for the use of marijuana, the District Court may not consider evidence of medical necessity as a public interest factor.

Other Opinion: In a concurring opinion Justice Stevens, joined by Justices Souter and Ginsburg, stated that “[l]est the Court’s narrow holding be lost in its broad dicta, let me restate it here: [W]e hold that medical necessity is not a defense to manufacturing and distributing marijuana.” The Court, Stevens said, “takes two unwarranted and unfortunate excursions that prevent me from joining its opinion. First, the Court reaches beyond its holding, and beyond the facts of the case, by suggesting that the defense of necessity is unavailable for anyone under the Controlled Substances Act.” Because necessity was raised in this case as a defense to distribution, the Court need not provide an opinion on whether the defense is available to anyone other than distributors. More notably, Stevens opined that whether the medical necessity defense might be available to a seriously ill patient is an open question. “Second, the Court gratuitously casts doubt on whether necessity can ever be a defense to any federal statute that does not explicitly provide for it, calling such a defense into question by a misleading reference to its existence as an open question.” Stevens also complained that the case before the Court “does not require us to rule on the scope of the District Court’s discretion to enjoin, or to refuse to enjoin, the possession of marijuana or other potential violations of the Controlled Substances Act by a seriously ill patient for whom the drug may be a necessity.”

Comment: Justice Thomas expressly declined to consider any constitutional questions implicated by the Controlled Substances Act, such as whether the Act exceeds Congress’ Commerce Clause powers, because these claims were not addressed by the Ninth Circuit.