醫療大麻合法化之研究 – 以美國法制為中心

Abstract

本研究聚焦於美國醫療大麻合法化的歷程，從回顧大麻在歷史上的醫療應用出發，強調其在緩解疼痛、控制癲癇以及鎮靜等方面的潛在價值。然而，1961年聯合國《麻醉品單一公約》將大麻列為高度管控的毒品，這一國際法規對其科學研究和臨床應用施加了嚴格限制，使大麻的醫療潛力長期未能充分發揮。 為了回應國際管控制度，美國也將大麻列為《管制物質法》中附件一的物質，視為無醫療價值且需受到最嚴格管制。然而，這一聯邦層面的嚴格管控未能阻止部分州對醫療大麻的探索與嘗試。自1970年代起，一些州開始通過象徵性立法或研究計畫，探討大麻的醫療用途。1996年，加州通過《加州提案215》，成為全美首個合法化醫療大麻的州，允許醫師推薦大麻作為治療特定疾病的輔助工具。這一突破帶動了其他州的效仿，並逐步使州級與聯邦法律之間產生落差。 隨著科學研究的進展與社會態度的轉變，越來越多的州採用患者登記制度、完善供應鏈監管，並累積了大量數據，證明醫療大麻在治療慢性疼痛、癲癇及化療引起的噁心等疾病上的療效。2023年，美國衛生部門建議將大麻從附件一管制物質移至附件三，這是聯邦層面政策態度的一個重大轉變，若實施，將進一步降低研究門檻並推動臨床應用。 相較之下，台灣在醫療大麻合法化方面仍處於起步階段。根據《毒品危害防制條例》，大麻被列為二級毒品，對其製造、販售乃至栽種均處以嚴厲刑罰。儘管2020年釋字第790號對栽種大麻的刑度過重作出違憲宣示，並促使立法機構進行修法，台灣在法規與行政實務上依然將大麻視為高度危險的毒品，阻礙了其醫療應用的發展。然而，隨著2024年衛生福利部首次核准含大麻二酚的藥品Epidyolex，用於罕見癲癇患者的輔助治療，台灣在醫療大麻應用上已邁出第一步。然而，相關研究與應用仍受限於未完善的監管機制與法律框架。 美國的經驗顯示，科學研究與政策制定的協調發展，不僅能累積數據支持，還能促進大眾對醫療大麻的理解，消除對其濫用風險的過度恐懼，最終形成推動合法化的社會共識。台灣若欲借鑒美國模式，需首先放鬆對大麻研究的法規限制，允許科研機構在嚴格監督下進行臨床試驗，積累本土的醫學數據。同時，建立以疾病條件為核心的醫療大麻管理制度，確定特定疾病範疇內的合法使用條件，並配合醫師專業判斷，制定嚴格的處方與配給標準。此外，法制結構的調整亦不可或缺，需重新檢視《毒品危害防制條例》的相關規定，釐清大麻的法律定義與範圍，並考量其醫療價值與社會風險，進行合理的毒品分級與管控。 整體而言，醫療大麻合法化是一個動態不斷變動並修正的議題，需在法制、科學、醫療與社會政策間找到合理的平衡點。當科學證據足以證明大麻對特定病症具有穩定療效，當科學證據充分證明大麻對特定疾病具有穩定療效，且嚴謹的監管制度能有效防範濫用風險時，大麻應逐步從毒品管理中分離，獲得其應有的醫療用途地位。對於台灣而言，如何穿透法律障礙，滿足患者需求，並透過科學數據與公共溝通形成社會共識，將是推動醫療大麻發展的關鍵挑戰。

This study focuses on the process of legalization of medical marijuana in the United States, starting from a review of the historical medical applications of marijuana, emphasizing its potential value in pain relief, epilepsy control, and sedation. However, the 1961 United Nations Single Convention on Narcotic Drugs listed cannabis as a highly controlled drug. This international regulation imposed strict restrictions on its scientific research and clinical application, which has prevented the full realization of cannabis' medical potential for a long time. In response to the international control system, the United States also listed marijuana as a substance in Schedule I of the Controlled Substances Act, which is considered to have no medical value and is subject to the strictest control. However, this strict federal-level regulation has failed to prevent some states from exploring and experimenting with medical marijuana. Since the 1970s, some states have begun exploring the medical use of marijuana through token legislation or research programs. In 1996, California passed Proposition 215, becoming the first state in the United States to legalize medical marijuana, allowing physicians to recommend marijuana as an adjunct to the treatment of specific diseases. This breakthrough led other states to follow suit and gradually created a gap between state and federal laws. As scientific research progresses and social attitudes change, more and more states are adopting patient registration systems, improving supply chain supervision, and accumulating a large amount of data to prove the effectiveness of medical marijuana in treating chronic pain, epilepsy, and chemotherapy-induced nausea. on the therapeutic effect. In 2023, the U.S. health department recommended moving marijuana from Schedule I controlled substances to Schedule III, which is a major shift in policy attitude at the federal level. If implemented, it will further lower the research threshold and promote clinical applications. In contrast, Taiwan is still in its infancy in legalizing medical marijuana. According to the Drug Hazard Prevention and Control Act, marijuana is classified as a Class II drug, and its production, sale, and even cultivation are subject to severe penalties. Although the 2020 Interpretation No. 790 declared the heavy penalties for growing marijuana unconstitutional and prompted the legislature to amend the law, Taiwan still regards marijuana as a highly dangerous drug in its laws and administrative practices, hindering its medical application. develop. However, with the Ministry of Health and Welfare's first approval of the cannabidiol-containing drug Epidyolex in 2024 for use as an adjunct treatment for patients with rare epilepsy, Taiwan has taken the first step in the application of medical marijuana. However, related research and applications are still limited by imperfect regulatory mechanisms and legal frameworks. The experience of the United States shows that the coordinated development of scientific research and policy making can not only accumulate data support, but also promote the public's understanding of medical marijuana, eliminate excessive fear of its abuse risks, and ultimately form a social consensus to promote legalization. If Taiwan wants to learn from the American model, it must first relax regulatory restrictions on marijuana research, allow scientific research institutions to conduct clinical trials under strict supervision, and accumulate local medical data. At the same time, a medical marijuana management system centered on disease conditions should be established to determine the legal conditions of use within the scope of specific diseases, and in conjunction with the professional judgment of physicians, strict prescription and distribution standards should be formulated. In addition, adjustments to the legal structure are also indispensable. It is necessary to re-examine the relevant provisions of the "Drug Hazard Prevention Act", clarify the legal definition and scope of marijuana, consider its medical value and social risks, and carry out reasonable drug classification and control. Overall, the legalization of medical marijuana is a dynamic issue that is constantly changing and being revised, and it is necessary to find a reasonable balance between the legal system, science, medicine and social policies. When scientific evidence is sufficient to prove that marijuana has a stable therapeutic effect on specific diseases, and a rigorous regulatory system can effectively prevent the risk of abuse, marijuana should be gradually separated from drug management and given the status it deserves. Some have medical uses. For Taiwan, how to overcome legal barriers, meet the needs of patients, and form a social consensus through scientific data and public communication will be the key challenges in promoting the development of medical marijuana.