Editor’s Note
This essay opens Medical Marijuana at 50, a year-long series marking the fiftieth anniversary of the medical marijuana movement. Rather than beginning with legislation or advocacy, the series begins where the movement itself began: with one patient, one illness, and a legal system unprepared to recognize either.
Episode 1 establishes the historical, medical, and legal ground on which everything that follows will unfold.
🎧 Listen to the Episode here, read by the author Alice O’Leary Randall
Before Medical Marijuana Had a Name
🖋️ The medical marijuana movement did not begin in a moment of altruistic inspiration. It was not Judy Garland and Mickey Rooney dancing with their friends toward the barn to “put on a play!” It was born of desperation and necessity. I know this because I was there, fifty years ago.
In the mid-1970s, Robert Randall was going blind from glaucoma. When he discovered that smoking marijuana seemed to help him see better, he dismissed it as fanciful. It was the 1970s, and marijuana had no medical use. At least that’s what the government told us.
From today’s enlightened vantage point, a quarter of the way into the 21st century, it is almost impossible to imagine a time when there was no medical marijuana. But there was a time, 50 years ago, when making an argument for medical marijuana got you nothing but laughter and scorn.
There was a time before medical marijuana had a name.
The Beginning
On an August afternoon in 1975, Robert and I returned home from a road trip to find our Washington, D.C., apartment ransacked, with a search warrant on the kitchen table instructing us to turn ourselves in. A quick look around our apartment confirmed the police had confiscated all our marijuana, including four plants growing on our sundeck.
The details of our arrest are not particularly important to the story. What is important is the desperation we felt in that moment. The arrest did not occur in the abstract space of youthful indiscretion or political dissent. It arrived in the middle of one man’s medical drama, and it could end in his blindness.
That distinction mattered. It would come to matter more than anything else.
Illness Before Ideology
Robert’s glaucoma was diagnosed in 1972, after he began seeing halos around lights and experienced periodic whiteouts. He had a long history of visual distortions, dating back to high school, where it was attributed to eye strain. When the diagnosis finally came, so did a grim prognosis: blindness within five to seven years.
He tried everything medicine offered. Different drops and pills. The eyes were already so damaged that surgery was ruled out. Some of the medications worked briefly, then stopped. Others failed outright.
By accident, Robert noticed that when he smoked marijuana, the pressure in his eyes eased. When he didn’t, his vision worsened again. At first, he dismissed the pattern as simply an offshoot of being “stoned.” But the effect persisted, and he began keeping records and observations. Soon it was undeniable. Smoking marijuana was helping Robert see better.
He told no one except me, and I laughed. In the 1970s, there was no medical marijuana.
The Lexography of Medical Marijuana
The Merriam-Webster Dictionary[i] dates the origin of the term “medical marijuana” to 1976 and the case of U.S. v. Randall. That timing tells you how thoroughly federal policy had erased cannabis as a medicine from public language.
Despite 5,000 years of recorded medical use in history, the U.S. federal government removed cannabis from the U.S. Pharmacopeia in 1942. In 1970, the newly minted Controlled Substances Act placed marijuana in Schedule 1 and defined it as having “no accepted medical use.”
But it soon became apparent to me that Robert could see better when we had marijuana. So we did everything we could to keep supplies available, including growing four plants in a secluded area of our sun deck. We thought we had stumbled on something completely unknown and feared that revealing our secret would have disastrous results for Robert.
But this “secret” knowledge created a trap. Robert knew that telling his ophthalmologist would implicate the physician in a crime. Marijuana was contraband. There were no exceptions. The doctor might feel obliged to report Robert to the authorities. At the very least, he would likely refuse to treat Robert if he continued using the illegal substance. Silence became not a preference but a form of self-preservation.
At that stage, our thinking extended no further than what Robert would later call his “personal orbit.” We did not imagine a broader fight. We were simply trying to preserve Robert’s fragile eyesight.
Then came the arrest.
When the State Enters the Room
We had returned home on a Sunday. On Monday morning, after a sleepless night, I called a lawyer I knew, and he agreed to take the case. He accompanied us through the mechanics of arrest—turning ourselves in, booking, fingerprints, and arraignment. It was a humbling experience.
As we walked out of the courthouse, the lawyer turned to Robert and asked a question we had been dreading: how did we intend to pay for the case?
Robert stumbled into an explanation about his glaucoma and his need for marijuana. The lawyer listened politely and graciously stifled a laugh.
“Prove it, Bobby. Just prove it,” the lawyer said.
That simple phrase would reorganize the coming year and, eventually, our lives. Failure, as the saying goes, was not an option. Failure would mean a criminal record and likely future arrests because we would continue to buy illegal marijuana—Robert’s sight depended on it.
Proving What Could Not Be Said
What followed was a crash course in cannabis history, facilitated by our residency in Washington, D.C., which offered unparalleled resources. Robert began by heading to NORML’s headquarters — the National Organization for the Reform of Marijuana Laws. NORML was our first ally in the fight of our lives, and their support in these early years was immeasurable.
Robert returned home with a few clippings and a list of contacts within the National Institute on Drug Abuse (NIDA), which, he learned, must report each year to Congress on the status of marijuana research. NORML provided the most recent report. From it, we learned not only that others knew marijuana lowered intraocular pressure, but that the federal government was funding research into cannabis eyedrops! We were stunned.
What the Government Already Knew
The NIDA Marihuana Research Monograph was critical to our success, revealing the existence of ongoing cannabis and glaucoma research that bolstered our ability to “Prove it.” Project 50 has scanned my well-worn desk copy of the 1976 edition of the NIDA Monograph, and it is available on the P50 Google Drive.
While Robert pursued these leads, I headed to the Library of Congress, just eight blocks from our apartment, and discovered how and why marijuana had become illegal in 1937. Prior to that, cannabis had been used legally and extensively in medicine.
It was an exciting time as we began to assemble our newfound knowledge. We began to see a possible path forward, a path that could help us “Prove it!”
Within a month of our arrest, Robert contacted the four glaucoma researchers mentioned in the NIDA 1974 Report to Congress. All were helpful in terms of sharing knowledge. Only two, however, had permission to test marijuana on humans: Dr. Mario Perez-Reyes and Dr. Robert Hepler.
Perez-Reyes was located in Raleigh, N.C., and agreed to see Robert on the day after Thanksgiving in 1975. Dr. Perez-Reyes was a clinical pharmacologist, not an ophthalmologist, and we later discovered that it was questionable whether he had permission to test an actual glaucoma patient. Nevertheless, from our perspective, he was a godsend.
The doctor explained the experiment carefully. Robert would receive intravenous delta-8 THC[ii]. His eye pressure would be measured. He would be asked repeatedly to report how he felt.
What happened surprised everyone.
After receiving what would normally be a highly psychoactive dose, Robert reported feeling nothing unusual. He was not high. He was lucid. But when Perez-Reyes measured his eye pressure, it had dropped dramatically — from dangerous levels into the normal range.
Robert had unknowingly demonstrated something critical: he required a higher therapeutic dose to control his glaucoma than most people needed to feel intoxicated. The implication was obvious and unsettling. The very dose that preserved his sight would be used to discredit him as a “drug abuser”.
The evidence was real. The danger was real, too.
The North Carolina data was never introduced in court. The lawyers feared it might jeopardize both the case and the researcher. Still, it was an early confirmation of what Robert already understood: the science was on his side, even if the law was not.
California Dreaming
It was Robert Hepler’s study at UCLA that offered our greatest hope. Hepler, a board-certified ophthalmologist, had spent much of the 1970s looking into the eyes of people who had just smoked marijuana and recording what he found. He was a part of the UCLA Marijuana Research Project, which had been established to study the basic physiological effects of marijuana, part of the President’s National Commission on Marihuana and Drug Abuse, also known as the Shafer Commission.
Hepler demonstrated that the plant’s ability to lower intraocular pressures was consistent and easily measured. The finding was so conclusive that in 1971, he sent a letter to the Journal of the American Medical Association (JAMA) reporting his observations and offering this tantalizing sentence, “The possible implications, including the mechanism of action, and even possible therapeutic action in the treatment of glaucoma, are obvious.”[iii]
Hepler amended his research protocol and was given permission to test his hypothesis on a few patients with glaucoma, but he was beginning to wrap up that study when Robert called him in October 1975.[iv]
Hepler was intrigued by Robert’s case and invited him to UCLA for testing. In December 1975, Robert was on his way to UCLA. For ten days, Hepler tried every possible glaucoma medication, as well as capsules of delta-9 THC, and federally-legal cannabis rolled into neat cigarettes. The results were undeniable. It was only when cannabis was added to Robert’s regular regimen of glaucoma medications that his ocular pressures lowered into the safe range. There was really no doubt about it.
Hepler established that Robert required between 5 and 10 marijuana cigarettes of at least 2% THC content daily. This conclusion was helpful when negotiations began for Robert to receive federal supplies of marijuana. It was a script that would last for 25 years.
Validation But Still …
Just after Christmas, in the early days of 1976, Robert and I sat across from our lawyer as he read the compiled report on the UCLA studies. Hepler sent Robert home with a large stack of raw data, which Robert then spent the Christmas holidays meticulously compiling and preparing a report. The lawyer took his time reading, then looked up in awe. “Bob, this is history.”
We had proved it!
Watching our lawyer move from skeptic to convert was a moment of validation we both needed. Before the arrest, we had told no one about Robert’s use of marijuana to treat his glaucoma. It was not our goal to start a movement; it was to save Robert’s eyesight. There was no interest on Robert’s part or mine to become advocates for something that seemed quite fanciful in the mid-1970s.
The arrest snapped us out of that reverie. After learning that the federal government had known since 1971 that marijuana could possibly treat glaucoma, we decided to fight the charges. What other choice did we have? At that point, our silence would make us complicit in an enormous lie perpetuated in the nation’s drug code that categorized cannabis as a drug with “no accepted medical use.” That was wrong.
Some friends began to pull away as they learned about our ambition. As we began sharing our new knowledge with friends, it was clear that some found it tedious at best, delusional at worst. One friend pulled me aside to say that Robert’s constant use of marijuana was worrisome, and maybe we should get some help. A family member, whose occupation was counseling those with alcohol addiction, wrote a sweet letter of concern that cautioned me against enabling Robert’s drug use by feeding his thoughts of marijuana as a medicine.
But with the UCLA data, the die was cast. Watching our lawyer absorb that data and relishing his response, there was little doubt we were on the right path. We had proved it to the lawyer; surely the judge would see things the same way?
Proof Without Permission
Enthusiasm makes heavy lifting easier, and we had a lot of heavy lifting ahead of us. Robert’s personal ophthalmologist, Dr. Ben Fine, was impressed with the Hepler findings, and he clearly had Robert’s best interests at heart, but he was also worried about his standing in the ophthalmic community. Before agreeing to sign an affidavit that detailed Robert’s ocular health while under Dr. Fine’s care, the ophthalmologist insisted that Robert check in to the Wilmer Eye Clinic at Johns Hopkins University, one of the most respected ophthalmology centers in the country.
Wilmer’s role was not to explore marijuana’s effect on Robert’s glaucoma; they did not have permission to do so. It was to confirm failure.
Essentially, Wilmer replicated the Hepler study but without the marijuana. Every conventional medication in every combination was tried. None worked.
Wilmer could not offer relief. What it provided instead was something colder and more consequential: proof that Robert was running out of time. It strengthened the UCLA findings and gave us cumulative proof that conventional medications were ineffective against Robert’s glaucoma.
But there was a bright spot during Robert’s time at Wilmer, a moment that moved Robert beyond concern for himself. For several days, he shared his hospital room with Vincent Mustachio. Vince was in his fifties, from West Virginia, and facing his second cryogenic surgery in a last attempt to slow the glaucoma that was ravaging his eyesight.
Vince was the first person with glaucoma that Robert had ever met. He peppered the man with questions about the disease and treatments Vince had used. To Robert’s utter amazement, before he revealed why he was at Wilmer, Vince began to tell Robert about the night he had smoked some marijuana with a group of young men behind the industrial plant where they made glass products. “It was kinda interesting, that marijuana. But, believe it or not, it reduced the pressure. Usually, the pressure gets so bad at night that I wake up with a headache. The night I smoked marijuana, I woke up feeling just fine.”
Robert was gobsmacked. He asked the older man why he didn’t continue using marijuana, and Vince said he “didn’t like the high.” But Robert wondered how Vince would have felt about marijuana if his doctor had prescribed it rather than sneaking off to the parking lot with some “young guys.”
Robert’s medical experience at Wilmer was miserable and unsuccessful. And so was Vince’s. Vince became an ally in those early days, and we would learn that the surgery was not successful. Robert would later reflect that “Hopkins opened my eyes. I did not want to be like Vince, but more importantly, I did not want there to be other Vinces.”[v]
Two Tracks, No Map
By early 1976, two parallel processes were underway to resolve our dilemma.
One was the criminal case, inching forward through motions and delays. The second was a petition to the federal government for legal access to federal supplies of marijuana for medical treatment.
The court date was finally set: July 20, 1976. Our lawyers were prepared to present a unique argument in open court — that Robert was not guilty by reason of medical necessity, a defense rooted in common law. Essentially, necessity holds that a person can be excused from committing a crime because they had no other choice. To obey the law would bring greater harm than to break it.
The data from UCLA was irrefutable—Robert needed marijuana to keep from going blind. Necessity seemed like a reasonable approach, but medical necessity had never been argued as a defense for committing a crime.
In the same week as the trial, The National Observer published a long piece that captured Robert in a singular moment in time, teetering on a precipice—not victorious, not defeated, but suspended in uncertainty. It was a marvelous piece of reporting, written by Daniel St. Albin Greene. It presented Robert’s point of view and also that of the federal government as it tried to determine how to handle this unusual and unexpected request from a private citizen to access federal supplies of marijuana for medical purposes. Robert was careful to insist he did not want to be seen as either a hero or a symbol. “I’m simply a human being placed in this situation because of a convoluted law.”
It was a position Robert would maintain throughout his life: patient first, always, and never eager to become an activist.
“Obviously I have a very high stake in getting access to marijuana,” he reflects in his verdant, second-floor living room. “At the same time, I’m totally cognizant of the broader implications. I’d be happy if other people with glaucoma would petition the Government, too, or at least make their views known. It’s time for marijuana to be discussed rationally.”
— Robert Randall, The National Observer, July 24, 1976
The National Observer article was reprinted by other newspapers throughout the country, and the two-day trial was covered by the CBS Evening News. Dr. Hepler was present and testified to Robert’s need for marijuana. The government had no comeback except the law itself, which was beginning to look a bit shaky with respect to classifying cannabis as having no medical use. Final arguments were given. Our attorney, John Karr, spoke eloquently about Robert’s need for marijuana. The judge thanked everyone and said he would have his decision “soon.”
We were about to learn that “soon” in the judicial world may have a different meaning than it did in our world. We were kept in a suspended state for almost four months, waiting for the decision.
But there were other things to distract us.
September 1976: Almost Lost
The parallel track involved petitioning the federal government for permission to use their marijuana in treating Robert’s glaucoma. It was the logical extension of Hepler’s study since he had used federal marijuana to prove Robert’s need for the drug. In May 1976, our attorneys filed a petition with the Food and Drug Administration (FDA), the National Institute on Drug Abuse (NIDA), and the Drug Enforcement Administration (DEA). The two larger agencies, FDA and DEA, passed it off to the new kid on the block, NIDA, which was formed just two years earlier, in 1974. No one knew what to do with this request from a private citizen. The system was designed to handle threats from corporations, academia, and non-profit associations. No one ever expected Robert.
NIDA was still finding its footing as an agency, and that worked to our advantage. There was sympathy for Robert’s plight and a genuine desire to help.
The biggest problem was finding an ophthalmologist who would agree to monitor Robert’s use of marijuana. His personal physician had been supportive but drew the line at becoming the nation’s first marijuana doctor. Robert contacted many other ophthalmologists in the D.C. area, as did NIDA, with the help of the National Eye Institute (NEI), but none were willing to assume responsibility for this unique method of glaucoma care.
By late summer, the strain became unbearable.
A proposed workaround in which NIDA held the research papers in-house collapsed abruptly. Weeks of negotiation evaporated in a single reversal. As upper management at NIDA and the FDA became aware of what was happening, the pace slowed considerably.
Money was short. Bills piled up. Finding marijuana became more difficult. The criminal case was unresolved. The petition, seemingly, had failed. It was the lowest point of the year.
Suddenly, the story turned.
In early October, a young ophthalmologist, Dr. John Merritt, made inquiries at the National Eye Institute (NEI) about how to establish a research project on marijuana and glaucoma. The Howard University professor was particularly interested in glaucoma in the black population, where the incidence of the disease is five times higher than in whites.[vii] NEI quickly contacted NIDA, which contacted Dr. Merritt and explained Robert’s situation. Dr. Merritt was willing to monitor Robert’s use of marijuana as part of his research reporting. It was an utterly sublime moment of success.
A thorny issue was Robert taking marijuana home. DEA, and some individuals at the FDA, felt he should use the marijuana only in Merritt’s office. But Dr. Hepler had demonstrated that Robert required 5-10 marijuana cigarettes a day spaced about 3-4 hours apart, seven days a week. The idea of Robert returning to Merritt’s office each time he needed to medicate was idiotic. It was also the opening salvo in Robert’s long battle to be seen as a patient, not a research subject.
DEA pivoted to demands that Robert get a 750 lb safe to secure his medicine, which is one of the regulations for a Schedule I drug. Robert simply refused.
Of course, the real issue was control. That would come roaring back in the months ahead. But for the moment, there was only joy that legal access appeared to be secured.
Quiet Access, Then Judgment
On November 12, 1976, without announcement or ceremony, Dr. Merritt handed Robert a small plastic case of government-issued marijuana cigarettes. There were no cameras. No reporters. Robert took a cab home, the marijuana case stuck awkwardly in his pocket, stunned by the quiet of the moment.
There were still some minor details of Merritt’s study to clear with the FDA, so he asked Robert to “play it cool” and not call the press about what had happened. Robert understood. He was grateful and respected everything that Merritt had done for him.
During the next two weeks, Robert would travel to Howard University 2 or 3 times a week. Merritt needed to convince himself that Hepler’s findings were accurate, so Robert once again had to endure round after round of tests.
On the day before Thanksgiving, Robert was once again at Merritt’s office, where he was being tested with delta-9 THC capsules. Robert did not like the synthetic, which he had first used in Hepler’s study, but he knew Merritt had to see the results. The pill made Robert anxious to a degree that was uncomfortable for him. As the pill began to really kick in, Robert received a call from our lawyer—the Court decision was in.
Robert finally managed to get to the lawyers’ offices several hours later, still buzzing from the THC. He was handed the decision and shown to a quiet room. He sat down and began to read.
I was at home, already fielding phone calls as the word got out. Finally, the one call I wanted came through. Robert’s calm voice belied his feelings. He had read the decision and declared it a “masterpiece”. His voice cracked, and the next words struggled to get out, tight with emotion. “We won!”
The Necessity Defense
Robert’s defense was based in common-law necessity that dates back to the Magna Carta of 1215. With Necessity, a defendant argues that illegal actions were necessary to prevent a more serious harm from occurring. It is rarely successful as a defense. In the 20th century there were about five published opinions supporting medical necessity beginning with U.S. v. Randall in 1976. See a list of cases below.
Not only had we won, but the case made legal history by establishing the concept of medical necessity. It was the first time necessity was successfully expanded into a right-to-health argument. In the coming years, the defense would be used by other medical cannabis patients, some successfully, but not all. And it would expand into the complicated issue of needle-exchange and AIDS patients.
But on the day in November 1976, all we could see was the present moment, and Judge Washington’s words were repeated over and over again as Robert spoke to members of the press. “Penalizing a person who acted rationally to avoid a greater harm,” the judge wrote, “served neither justice nor reason.”[viii]
Snow fell lightly outside our apartment. Friends arrived with champagne. Reporters called. The story spread quickly.
But inside, there was only relief — and exhaustion.
The medical marijuana movement, which would become our life’s work, was just beginning to take shape, but for now, the story ended where it had started: with one patient, one body, and a law that had finally been forced to see him. ❖
Endnotes
[i] Merriam-Webster Online Dictionary. https://www.merriam-webster.com/dictionary/medical%20marijuana
[ii] Delta-8 THC is one of many ingredients in cannabis. It has many of the same properties as Delta-9 THC but is less psychoactive. Nevertheless, it is psychoactive.
[iii] Marihuana Smoking and Intraocular Pressure, JAMA, September 6, 1971, Vol 217, No 10. https://bit.ly/4bwrmJn.
[iv] Had we been arrested even a month later, we likely would have missed the opportunity to have Robert tested at UCLA. Hepler was literally beginning to shut down his research for the UCLA program when Robert first called in October 1975. Robert would be the last glaucoma patient tested.
[v] Randall, R. C., & O’Leary, A. M. (1998). Marijuana Rx: The Patients’ Fight for Medicinal Pot (p. 75). Thunder’s Mouth Press. The original 1998 publication is out-of-print. However, an updated and digital version of the book, prepared by Project 50, is available on my website for free! Click here!
[vi]Burns, C. (1976, April 19). Fight to legalize pot to save eyes. The Melbourne Age. https://bit.ly/3NolS9C
[vii] African Americans and glaucoma. Glaucoma Research Foundation. (2025, February 20). https://glaucoma.org/articles/african-americans-and-glaucoma
[viii] U.S. v. Randall (1976). Judge James A. Washington’s historic decision established the concept of medical necessity and paved the way for the medical marijuana movement. Find the complete decision here.
Medical Necessity Cases
Published 20th-century cases recognizing medical necessity as a defense.
United States v. Randall, No. 76-686 (D.C. Super. Ct. Nov. 24, 1976) Charges dismissed on medical necessity grounds for a glaucoma patient using cannabis.
State v. Diana, 24 Wash. App. 908, 604 P.2d 1312 (1979) Recognizing medical necessity defense and remanding; subsequent proceedings resulted in relief for defendant.
Jenks v. State, 582 So. 2d 676 (Fla. Dist. Ct. App. 1991) Reversing convictions where trial court improperly barred medical-necessity defense.
People v. Bordowitz, 588 N.Y.S.2d 507 (N.Y. Crim. Ct. 1991) Acquittal of AIDS activists distributing sterile syringes under public-health necessity.
People v. Cezar, 588 N.Y.S.2d 519 (N.Y. Crim. Ct. 1991) Dismissal/relief recognizing necessity in syringe-exchange context.
Thanks for the sharing this important history!
Highlighting it in my newsletter this week...
Thank you for your kind comments. Episode 2 will post this Saturday. I hope you enjoy it.