Source: Flickr user Carlos Gracia

The wait is nearly over and a little more than one week from now residents in a number of states will go to the polls to decide whether or not marijuana should be either legalized on a recreational level or for medical purposes.

Looking at the nation as a whole, how marijuana is perceived is dramatically changing. Even a decade ago the percentage of those favoring approval was a mere 34% according to Gallup. As of last year this number had surged to 58% and marked the first time in history that more Americans favored legalization than didn't favor it.

Will medical marijuana be approved in this state?
At the moment there are roughly two dozen states which have approved the use of marijuana for medical purposes, most often as a relief aid for chronic or severe pain, or to treat nausea. Florida is one such state that will be making this crucial decision to approve or deny in just a matter of days -- and as such, perhaps it's only fitting that Harris Poll conducted a survey on more than 2,000 Floridians on behalf of Miami Jewish Health Systems to gauge their opinion on marijuana's benefits versus risks.

Source: Flickr user Katherine Hitt

Specifically, Harris polled 2,060 Floridians and posed to them a yes or no question as to whether they believed the benefits of utilizing medical marijuana to treat pain outweighed the risks. The findings of the study showed that 68% of respondents believed medical marijuana's benefits were indeed superior to whatever risks were present. These results were consistent across gender lines, with those respondents in the 55-64 age bracket being the most in favor (74%) of legalizing medical marijuana as a treatment for pain.

Interestingly enough, however, Dr. Fernando Branco, the Medical Director of the Rosomoff Comprehensive Rehabilitation Center at Miami Jewish Health Systems, expressed concern with the studies' findings. While acknowledging that marijuana has been effective as a treatment for abating nausea associated with cancer treatments and in patients with AIDS, Dr. Branco was quite clear in his belief that medical marijuana's benefits may be overstated and that the public as a whole might be misled.

Dr. Branco pointed out in an Associated Press article that physical and psychological dependence are common with marijuana usage, lending to a high propensity for addiction. As Dr. Branco said, "The use of marijuana for pain would be similar to alcohol use. Some patients will say that alcohol helps them 'forget' their pain, but it does not mean I would be in favor of alcohol use to treat pain." 

Weighing the benefits against the risk
So who's right? That's a touchy subject and it really depends who you ask. There are studies on both sides of the question that demonstrate what appear to be clear benefits for medical marijuana, as well as long-term studies which suggest a number of risks involved with its use.

On one hand medical marijuana has been empirically shown to lower healthcare costs by reducing opioid overdose deaths in states where medical marijuana has been legalized. An abstract published in JAMA Internal Medicine earlier this year showed that not only did medical marijuana lead to a 24.8% reduction in mean opioid overdose mortality rates in the 13 states that were analyzed between 1999 and 2010, but the effect of this reduction only grew stronger as time passed. The implication here is that medical marijuana leads to fewer overdoses than opioids for treating pain, fewer overdose-related deaths, and could save the healthcare system millions, if not billions. 

Source: Michigan Municipal League via Flickr

Conversely, other studies on marijuana's long-term effects found many of the similarities that Dr. Branco described above. A study released in early September from the National Drug and Alcohol Research Centre in Australia tracked 3,765 adolescents who were younger than age 17 until they hit the age of 30 and noted that regular marijuana users were 60% less likely to finish high school or get a college degree, were 18 times more likely to become dependent on marijuana, were seven times more like to attempt suicide, and were eight times more likely to try other illicit drugs at some point later in life. 

As I said, it really just depends on what data you choose to follow, though admittedly with marijuana remaining a schedule 1 drug there's not a significant amount of long-term data on its effects for researchers to sift through.

The medical marijuana debate is a big deal for these companies
Why is this such a big deal? Over the past couple of years we've seen a major push by pharmaceutical companies in developing drugs based on cannabinoids found in the cannabis plant, so legalization on a state-by-state basis, or even better a federal approval, could clear a path for these developing drugs to be pharmaceutical superstars.

Source: GW Pharmaceuticals

The biopharmaceutical company at the forefront is GW Pharmaceuticals (NASDAQ:GWPH). GW has discovered roughly five dozen different cannabinoids and is attempting to effect biologic change through a natural cannabinoid receptor system found in our bodies. Thus far the company has only one approved drug outside the U.S. known as Sativex, which treats spasticity associated with multiple sclerosis.

However, there are multiple potential uses for GW's cannabinoids beyond spasticity-associated MS. In the U.S., for example, GW is in the midst of running three late-stage studies of Sativex as a treatment for cancer pain, and the more statewide approvals marijuana sees the better chance GW would have of seeing Sativex take off in the U.S. Additionally, GW is researching cannabinoid-based drugs that'd treat both adult and pediatric epilepsy, type 2 diabetes, ulcerative colitis, and even schizophrenia.

Source: Insys Therapeutics

GW isn't alone, either. Insys Therapeutics (NASDAQ:INSY) is also developing an oral version of dronabinol -- a synthetic formulation of THC that would act faster and have more flexible dosing than the generic version of dronabinol currently being marketed -- as a second-line treatment for chemotherapy-induced nausea and vomiting which is currently under review by the U.S. Food and Drug Administration.

Marijuana's ultimate fate is anyone's guess
Although we have no clue right now what will ultimately happen with GW and Insys' cannabinoid-based pipelines, we will have some improved clarity in a little over a week with regard to medical marijuana's fate in yet another state.

Of course, even these state-by-state approvals come with the drawback that marijuana remains a schedule 1 drug according to the Drug Enforcement Agency. For now the U.S. government has kept its distance and allowed individual states to manage their own marijuana law enforcement, but it's also likely implied that any breakdown in the regulation of the growing or disbursement process on a state level could result in a more hands-on approach from the federal government.

In other words, while it would appear that marijuana is gaining momentum, and that it could possess positive therapeutic benefits, the risk of federal intervention, or even additional studies that refute some of the benefits provided by marijuana, could halt the drug in its tracks. As an investor this is something you'll want to keep in mind as we head into midterm elections week.