In Memphis, in the years around 1918, a physician named Webb wrote prescriptions for morphine at fifty cents apiece. The record says he wrote more than 4,000 of them in eleven months, and that he did not examine the people who asked. A druggist named Goldbaum filled them. Goldbaum bought thirty times as much morphine from wholesalers as the average retail druggist did, and the record counts 6,500 sales. The Supreme Court heard the case in 1919 and decided that this was not medicine. It was a crime, by a 5-4 vote.
That is where the Court's drug cases start, and I have read them in order. They do not describe a steady march toward anything. The Court backs the government, pulls back, backs the government again, and keeps arguing with itself about the same question: how far can Washington reach into a doctor's office, a hospital ward or a back garden in California?
Who decides what a prescription is
The first fight was over doctors. The 1914 narcotics law taxed and registered the drug trade and barred sales without a physician's prescription. In Webb v. United States (1919) the majority held that an order written to keep a habitual user comfortable, rather than to treat the habit, was not a prescription. Chief Justice White dissented, joined by Justices McKenna, Van Devanter and McReynolds.
Six years later the Court pulled back. In Linder v. United States (1925) a physician had given a patient one morphine tablet and three cocaine tablets. Justice McReynolds, who had dissented in Webb, wrote for the Court that direct control of medical practice in the states is beyond the power of Congress, and that the law could not reach a doctor acting in good faith who gave an addict moderate amounts to relieve the conditions of addiction. The two cases still sit side by side. One says that the government may punish a doctor who sells drugs under cover of the profession. The other says the government cannot decide what good medicine is.
Illness is not a crime
California made it a misdemeanor to "be addicted to the use of narcotics." There was no need to prove that a person had used or held anything. A police officer saw discolorations and scabs on a man's arms, and the statute required at least ninety days in jail. In Robinson v. California (1962) Justice Stewart wrote that a state may not imprison a person for the condition of being addicted, "even though he has never touched any narcotic drug within the State or been guilty of any irregular behavior there." He added that "even one day in prison would be a cruel and unusual punishment for the 'crime' of having a common cold." Justice Frankfurter took no part.
The decision protects the status, not the conduct. A state can still punish possession and sale. What it cannot do is make the sickness itself the offense.
When the paperwork is the trap
Timothy Leary left New York by car in December 1965 for a vacation in Mexico. He was turned back, and a customs officer at the Texas border found marijuana in the car. He was convicted under the Marihuana Tax Act, which required anyone dealing in the drug to register and pay a tax, and made it a crime to deal without having done so. In Leary v. United States (1969) Justice Harlan wrote for the Court that registering would have forced a person to admit to a crime under state law. The privilege against self-incrimination barred the conviction. Congress replaced the statute with the Controlled Substances Act the next year.
Medicine, marijuana and the Commerce Clause
The Controlled Substances Act treats marijuana as a drug with "no currently accepted medical use." California's Compassionate Use Act allowed it for medical purposes, and two cases tested the gap.
The Oakland Cannabis Buyers' Cooperative distributed marijuana to patients. In United States v. Oakland Cannabis Buyers' Cooperative (2001) Justice Thomas wrote for an eight-justice Court that the Act leaves no room for a medical-necessity defense, because Congress had already decided the drug has no accepted medical use. Justice Breyer took no part. Three justices, in a separate opinion by Justice Stevens, agreed with the judgment and declined to join the broader reasoning.
Four years later the question was narrower and the facts were smaller. Angel Raich and Diane Monson used doctor-recommended marijuana for serious medical conditions. Federal agents seized and destroyed all six of Monson's plants. They sued, saying the federal ban could not constitutionally reach marijuana grown and used at home under state law. In Gonzales v. Raich (2005) Justice Stevens wrote for a 6-3 Court that the claim failed under Wickard v. Filburn (1942), the case about a farmer's wheat. Congress may regulate a class of activity that, taken together, affects interstate commerce, even when a particular plant never leaves its owner's property. Justices O'Connor, Thomas and Chief Justice Rehnquist dissented. I find the reasoning less persuasive the closer the facts are to a back garden, but it is the law.
The hospital and the police
In the fall of 1988, staff at the public hospital run by the Medical University of South Carolina worried about rising cocaine use among prenatal patients. A task force of hospital staff, police and local officials wrote a policy for testing the urine of pregnant patients suspected of drug use, with a chain of custody for the samples and procedures for arrests of those who tested positive. In Ferguson v. City of Charleston (2001) Justice Stevens wrote for a 6-3 Court that a hospital's test to gather evidence of criminal conduct for police is an unreasonable search when the patient has not consented. The "special needs" doctrine did not save it.
Drugs and deportation, drugs and doctors
Adrian Moncrieffe, a Jamaican citizen here legally, had 1.3 grams of marijuana in his car. He pleaded guilty in Georgia to possessing it with intent to distribute, and the government said the conviction was an "aggravated felony" that required his deportation. In Moncrieffe v. Holder (2013) Justice Sotomayor wrote for a 7-2 Court that when a conviction does not establish that the offense involved payment or more than a small amount, it cannot be treated as the felony. Federal law itself treats a small amount shared for no payment as a misdemeanor.
The most recent case returns to the doctors. In Ruan v. United States (2022) two physicians were tried for illegally dispensing controlled substances. The federal law makes it a crime to "knowingly or intentionally" dispense "except as authorized." Justice Breyer wrote that once a doctor shows the prescription was authorized, the government must prove that the doctor knew or intended it was not. Justice Alito concurred in the judgment. The decision sends the question of the doctor's state of mind back to the jury, which is where Webb's story began.
What I would take from it
These cases are not a story of liberalization or of crackdown. They are a series of line-drawing exercises: between the doctor and the dealer, between the person and the condition, between the paperwork and the self-incrimination it demands, between a state's decision and Washington's. The government has won most of the arguments about marijuana. Individuals have won most of the arguments about illness and privacy. Anyone who tells you the Court has a drug policy has not read the record.
Sources
- Webb v. United States (1919), Linder v. United States (1925), Robinson v. California (1962), Leary v. United States (1969)
- United States v. Oakland Cannabis Buyers' Cooperative (2001), Ferguson v. City of Charleston (2001), Gonzales v. Raich (2005)
- Moncrieffe v. Holder (2013), Ruan v. United States (2022), Wickard v. Filburn (1942)
Updated October 2026.
This post was rewritten with AI (Claude) and reviewed by an editor before publication.
