MOVEMENTS AND THE
OF THE MEDICAL IN CANNABIS
How can organizations use strategic frames to develop support for illegal
and stigmatized markets? Drawing on interviews, direct observation, and
the analysis of 2,497 press releases, I show how pro-cannabis activists used
distinct framing strategies at different stages of institutional development to
negotiate the moral boundaries surrounding medical cannabis, diluting the
market’s stigma in the process. Social movement organizations rst estab-
lished a moral (and legal) foothold for the market by framing cannabis as
a palliative for the dying, respecting moral boundaries blocking widespread
exchange. As market institutions emerged, activists extended this frame to
include less serious conditions, making these boundaries permeable.
Social Movements, Stakeholders and Non-Market Strategy
Research in the Sociology of Organizations, Volume 56, 53–82
Copyright © 2018 by Emerald Publishing Limited
All rights of reproduction in any form reserved
54 CYRUS DIOUN
Keywords: Stigma; morals; frames; social movements; economic
Over the past two decades, organizational scholars have combined theories of
collective action found in social movement studies with theories of structure
found in economic and organizational sociology, yielding a dynamic theory
of contentious markets (Fligstein & McAdam, 2012; King & Pearce, 2010).
Social movement organizations and social movement-like entrepreneurs play
a central change-making role in these theories, performing cultural and insti-
tutional “work” by constructing frames, mobilizing resources, and targeting
the state and society in order to build, contest, and recongure market insti-
tutions. While an extensive literature has developed showing how rms in
industries can act like social movements by taking part in collective action
(Carroll & Swaminathan, 2000; Fligstein, 1996), only recently have scholars
begun to explore how social movements outside of markets inuence market
dynamics (King & Soule, 2007).
Social movement organizations can shape the meaning of markets by
using frames strategically. Frames are “schemata of interpretation” that
allow actors to “locate, perceive, identify, and label” the world around them
(Goffman, 1974, p. 21; see also Benford & Snow, 2000; Snow, 2004; Snow,
Rochford, Worden, & Benford, 1986). Framing is a process of theorization
in which actors highlight problems and propose solutions, drawing upon cul-
turally resonant symbols to suggest cause-and-effect relationships (Strang &
Meyer, 1993; Oliver & Johnston, 2000).
Meaning making is often rooted in social norms regarding morality.
Social movement organizations can act as moral entrepreneurs and support
or challenge a market by making normative claims to its moral legitimacy
or lack thereof (Becker, 1963).1 Examples include the Women’s Christian
Temperance Union’s mobilization to make alcohol illegal in the early
20th-century United States (Hiatt, Sine, & Tolbert, 2009) and environmental-
ists’ valorization of wind energy (Sine & Lee, 2009). Activists can construct
moral boundaries that segregate offending products from reputable com-
merce, blocking exchange (Walzer, 1983), or take a commodity and elevate it
on moral grounds (Weber, Heinze, & DeSoucey, 2008).
Negotiating Moral Boundaries 55
While studies describe how social movements can stigmatize and challenge
the legitimacy of existing organizations and markets (Hiatt & Park, 2013;
Hiatt, Grandy, & Lee, 2015; Weber, Rao, & Thomas, 2009), few studies
have uncovered the processes by which movements do the opposite, namely
destigmatize taboo exchange. A burgeoning literature on organizational
stigma has emerged that shows how stigmatization affects both organiza-
tional performance and worker identities (e.g., Tracey & Phillips, 2016), yet
few studies have examined how stigmatized organizations, markets, and prac-
tices become legitimate (Hampel & Tracey, 2017). This elision points to a gap
in the literature on movements and markets, which has largely ignored how
social movements co-evolve with markets over time (Sine & Lee, 2009).
This chapter illustrates how social movements can construct and deploy
frames strategically to dilute a market’s stigma, incrementally negotiating
the moral boundaries surrounding the market through the use of different
framing strategies. During political campaigns to legalize an illegal and stig-
matized market, social movements can strategically emphasize a restrictive
framing of the market, highlighting a morally deserving subset of consumers.
Activists use these claims to garner support among the general public and
policymakers who believe such a product should be separated from market
exchange. Once activists gain a legal foothold for the market, they can extend
their initial frame to make moral boundaries more permeable and the market
I test this process model using a longitudinal data set of 2,487 social move-
ment press releases published in 49 states between 1996, the year California
passed the rst law legalizing medical cannabis in the United States, and 2013,
the year before the rst recreational cannabis markets opened in Colorado
and Washington. During this 18-year period, medical cannabis transformed
from a universally prohibited product into an industry that was legal in
20 states, giving rise to 12 active markets that together yielded over $1.4
billion in revenue in 2013 (ArcView Market Research, 2014). Leveraging
these data, as well as interviews with movement activists and observation
of social movement organization conferences and meetings, I demonstrate
how activists strategically deployed different frames regarding what consti-
tuted legitimate medical use at different stages of legalization and market
I nd that social movement organizations employed distinct strategic
framing practices in response to changes in the market’s opportunity struc-
ture and institutional context. During political campaigns to legalize medi-
cal cannabis, social movement organizations restricted their denition of
56 CYRUS DIOUN
cannabis’s medical use to a subset of morally deserving participants, the
seriously ill and dying. Following the successful legalization of medical can-
nabis, activists extended their framing of cannabis’s medical use to include
less serious illnesses such as pain and insomnia, helping enlarge the market’s
To develop this argument, I rst describe the case of medical cannabis
markets in the United States, drawing upon interviews with activists and
entrepreneurs to outline two distinct conceptions of cannabis’s medical use,
one restrictive and one expansive. Next, I connect theories of movements
and markets with theories of morals, markets, and organizational stigma to
outline a number of hypotheses describing how social movements can use
specic frame alignment strategies to negotiate moral boundaries blocking
exchange, diluting the market’s stigma in the process. Finally, I describe my
data and measures and explain my ndings.
From Compassion to Wellness:
Framing the Medical in Cannabis Markets
Cannabis (commonly known as marijuana) is a owering herb that has
been used as a medicine, intoxicant, and spiritual aid for over ve millennia
(Bostwick, 2012). When a person consumes cannabis, cannabinoids (such as
THC and CBD) enter the bloodstream and bind to receptors in regions of the
brain that coordinate and regulate movement, learning, memory, and higher
brain functions, such as pleasure and judgment (Ameri, 1999; Iversen, 2003).
The National Institute on Drug Abuse describes this process:
After inhaling marijuana smoke, an individual’s heart begins beating more rapidly, the
bronchial passages relax and become enlarged, and blood vessels in the eyes expand, mak-
ing the eyes look red. The heart rate…may increase by 20 to 50 beats per minute… As
THC enters the brain, it causes a user to feel euphoric…by acting in the brain’s reward
system… A marijuana user may experience pleasant sensations, colors and sounds may
seem more intense, and time appears to pass very slowly. The user’s mouth feels dry, and
he or she may suddenly become very hungry and thirsty. (Volkow, 2005: p. 3)
Users can interpret the meaning of cannabis’s physiological and psy-
choactive effects in a number of different ways. This is because cannabis
is a pleiotropic substance that can have multiple, often ambiguous effects,
providing a broad canvas for the social construction of cannabis’s qualities
and consequences, which may vary across time and cultures (Becker, 1953;
Molina-Holgado et al., 2002; Pacher & Ungvári, 2008).
Negotiating Moral Boundaries 57
Medical professionals in the United States rst recognized canna-
bis as a medicine in 1850 when they included it in the third edition of The
Pharmacopeia of the United States, a list of sanctioned medicinal prepara-
tions. At the time, cannabis was described as a legitimate treatment for a
variety of illnesses, including “neuralgia, gout, rheumatism, tetanus, hydro-
phobia, epidemic cholera, hysteria, mental depression, insanity, and uterine
hemorrhage” (Wood & Bache, 1851, p. 311). Cannabis was sold during the
late 19th and early 20th century until moral entrepreneurs crusaded for its
prohibition. Prohibitionists described cannabis as a menace to youth that
caused madness, violence, and licentious behavior (Anslinger & Cooper, 1937;
Rowell & Rowell, 1939; Stanley, 1931). During this time, market opponents
rebranded cannabis as “marijuana,” a slang term used by Mexican farmwork-
ers who had recently immigrated to the Western United States eeing the
Mexican Civil War (Bonnie & Whitebread, 1970). By linking the owering
herb to a stigmatized minority group and playing on the public’s xenophobic
fears, prohibitionists created what Goffman (1963) calls a “courtesy stigma,”
that is, a stigma by association. These campaigns to stigmatize cannabis were
successful. The federal government outlawed cannabis in 1937, and medical
professionals removed cannabis from the Pharmacopeia in 1947.
During the half century following the prohibition of cannabis, both prohi-
bitionists and consumers primarily conceptualized cannabis as an intoxicant
used for pleasure. This framing, often described as “recreational,” depicted
the act of using cannabis as “getting high” and portrayed cannabis users as
“potheads” living outside the norms of traditional society (Suchman, 1968).
In 1970, the US government codied the recreational intoxicant framing
when it enacted the Controlled Substances Act (CSA), which classied can-
nabis as a Schedule 1 narcotic with “no currently accepted medical value”
and “high potential for abuse” (21 USC § 812). This classication prohibited
the prescription of cannabis for medical use and blocked research into its
Cannabis prohibition remained relatively unchallenged until the AIDS
epidemic created an opportunity for activists and entrepreneurs to leverage
a new, morally legitimate framing of cannabis use. Prior to the emergence of
effective anti-retrovirals in the mid-1990s, many AIDS patients suffered from
wasting syndrome (cachexia), a complication of AIDS that caused extreme
nausea, leading to rapid weight loss (Grinspoon, Bakalar, & Doblin, 1995).
AIDS patients battling wasting syndrome found that the antiemetic proper-
ties of cannabis helped them eat, maintain weight, and live longer (Werner,
2001). During this period, gay rights and AIDS activists who were prominent
in the black market for cannabis developed a new organizational form, the
58 CYRUS DIOUN
cannabis buyer’s club, where sick patients could buy cannabis even though it
remained illegal under local, state, and federal law.
At the same time, activists and market pioneers developed moral legitimacy
and legal support for the emerging medical cannabis market in California by
framing cannabis as a compassionate palliative for the seriously ill and dying.
The compassionate frame relied on moral claims, imploring the general pub-
lic to have sympathy for the suffering of the terminally ill. Rather than chal-
lenge the prevailing view that cannabis was a recreational intoxicant, activists
and entrepreneurs carved out a morally legitimate subset of users, the seri-
ously ill and dying, who could righteously claim access to cannabis despite its
intoxicating qualities (Dioun, 2017).
Activists who helped legalize the rst medical cannabis markets in the con-
temporary United States conrm that they used the compassionate frame to
win support for their cause. Dennis Peron – the founder of the rst medical
cannabis buyer’s club in San Francisco and the co-author of initiatives to
legalize medical cannabis use in San Francisco and California – describes the
strategic act of framing during the early years of the market:
To get the answer you want you got to ask the right questions, you got to frame it right.
So I framed it in such a way, cannabis is medicine that helps people [who are] sick and
dying. (Interview May 18, 2012)
Peron purposefully distanced himself and the medical cannabis market from
the more common recreational intoxicant framing of cannabis. Peron explains,
“I realized I had to get away from the potheads … they had so much baggage …
I had to put it aside for the greater goals” (Interview May 18, 2012).
The public supported medical cannabis use if it was limited to the seriously
ill and dying. The Columbia University Center for Addiction and Substance
Abuse (CASA, 1996) surveyed 800 likely voters in October 1996, just before
Californians voted on The Compassionate Use Act to legalize medical can-
nabis. The CASA survey found that a majority of respondents supported
medical cannabis legalization, but only if it was limited to the seriously ill and
dying. California voters passed The Compassionate Use Act by a wide margin
(55.6% – 44.4%), suggesting that social movement framing of cannabis as a
compassionate palliative resonated with the public.
Between 1996 and 2013, laws allowing the medical use of cannabis
spread to 20 states and the District of Columbia. At the same time, the
number of AIDS deaths per year decreased as public health campaigns and
more effective anti-retroviral medications lessened the severity of the AIDS
crisis in the United States. As AIDS became less deadly, medical canna-
bis markets proliferated, and the composition of these markets changed to
Negotiating Moral Boundaries 59
include patients with less serious illnesses such as chronic pain and insom-
nia (Colorado Department of Public Health, 2012; Reinarman, Nunberg,
Lanthier, & Heddleston, 2011).
As medical cannabis markets grew larger and more widespread, a new, more
expansive framing of cannabis’s legitimate medical use, the wellness frame,
emerged. This frame was congruent with the shifting demographics of the
patient population, expanding cannabis’s medical use to include less serious ill-
nesses. Steve DeAngelo, the Executive Director of Harborside Health Center,
the nation’s largest medical cannabis provider, describes the wellness frame:
Now I dene wellness very broadly, right? I mean, I think that people are using it to
manage their cancer tumors or their pain or their nausea or their MS [multiple sclerosis].
They’re using it for wellness purposes. So are people who are using it for anxiety or insom-
nia or depression. So are people who are using it for libido, or just to enjoy a meal a little
bit more, or to get creative inspiration … not to get recreation, but to make the transition
from the work day to the leisure day and thereby be able to do recreational activities more
easily … Those for me are all wellness issues. (Interview May 31, 2012)
DeAngelo’s denition of wellness does not abandon the compassionate fram-
ing, which described cannabis as a palliative for the seriously ill and dying; he
maintains that cannabis helps patients suffering from terminal and debilitat-
ing illnesses such as cancer and multiple sclerosis. At the same time, DeAngelo
adds less serious conditions such as anxiety, pain, and lack of libido as rea-
sons for cannabis’s medical use and even includes non-medical uses such as
creativity and enjoyment in the wellness frame, normalizing a broad deni-
tion of medical cannabis without calling it “recreational.”
How did compassion give way to wellness? Did social movements strategi-
cally restrict or expand their denition of cannabis’s medical use at differ-
ent stages of legalization and market development? In the following section,
I draw upon theories of movements and markets, moral boundaries, and
organizational stigma to propose a process by which social movements (and
rms acting like social movements) can use frames strategically to dilute mar-
ket stigma and develop support for morally and legally contested markets.
Morally and Legally Contested Markets
Firms in morally and legally contested markets are more likely to fail than
rms in legal and reputable markets, because taboo and illegal markets
60 CYRUS DIOUN
lack sociopolitical legitimacy and state support (Aldrich & Fiol, 1994; Sine,
Haveman, & Tolbert, 2005). When the state prohibits a market, it blocks the
development of institutions such as property rights, governance structures,
and rules of exchange, limiting the size and stability of the market (Campbell &
Lindberg, 1990). It also increases the cost of exchange by actively prosecut-
ing market participants (Beckert & Wehinger, 2012). Even if a market is legal,
social stigma can prevent sellers from operating openly, restricting their abil-
ity to market “unmentionable” products and making it harder to nd buyers
and connect with capital (Wilson & West, 1981, 1992).
While social stigma and legal obstruction are powerful normative and
regulatory forces that can inhibit market growth, these social and legal clas-
sications are not immutable, but rather contingent on the market’s political
and cultural context. Different categories of exchange ranging from the sale
of humans (slavery) to the sale of political favors (corruption) are “blocked”
because they lack moral legitimacy (Walzer, 1983). At the heart of blocked
exchange is the Durkheimian concept of segregating the sacred from the
profane such that the sacred cannot be commensurate with the profane via
normal market exchange (Durkheim, 1912). The sacred does not necessarily
refer to something that is religious or spiritual. Rather, the sacred describes
“something ‘set apart,’ regardless of whether it is distinct because it is exalted
or because it is fouled” (Rossman, 2014, p. 44; see also Douglas, 1966). Moral
boundaries separating the sacred from profane are ubiquitous. However,
what is considered taboo varies across societies and over time, inviting schol-
ars to investigate when and how moral boundaries are created, contested, and
negotiated (Fourcade & Healy, 2007).
Organizational theorists have joined economic sociologists and focused
their attention on how morals shape markets by studying organizational
and categorical stigma (Vergne, 2012). Organizational stigma is “a collec-
tive stakeholder group-specic perception that an organization possesses a
fundamental, deep-seated aw that deindividuates and discredits the organi-
zation” (Devers, Dewett, Mishina, & Belsito, 2009, p. 155). There are two
primary types of stigma that affect organizations: event stigma and core
stigma (Hudson, 2008). An organization is marked with event stigma when
it transgresses a social norm once, gaining the stigma for a specic viola-
tion, for example, when Arthur Anderson committed accounting fraud dur-
ing the Enron scandal. In these cases, organizations can attempt to distance
themselves from the stigmatizing event through symbolic decoupling or by
separating from the organizational unit or employee that caused the infrac-
tion (Boeker, 1992; Elsbach & Sutton, 1992). In contrast, core stigma refers
to organizations that are stigmatized for their essential qualities: who they
Negotiating Moral Boundaries 61
are and what they do. For example, cigarette companies, abortion provid-
ers, nuclear power plants (Piazza and Perretti 2015), and gay bathhouses
(Hudson & Okhuysen 2009) are stigmatized for selling products or services
that are viewed as immoral or damaging. In these cases, organizations do not
acquire stigma from a single act, but rather are marked as immoral because
the organization’s core attributes are connected to a stigmatized category.
Scholars have shown how organizations can prevent stigma through the
defensive adoption of certain rhetoric and practices (Carberry & King, 2012).
Organizations can also manage the consequences of stigma through impres-
sion management techniques such as hiding their business’s purpose (Hudson
& Okhuysen, 2009) and straddling multiple categories (Vergne, 2012). Yet
there is little evidence of the process by which organizations rid themselves
of core stigma and normalize exchange. This may be because organizational
accounts of destigmatization rarely draw on theories of framing that are
prominent in social movement studies.
Framing the Morality of Markets
Most studies of the relationship between social movements and markets con-
ceptualize the relationship as antagonistic – value-rational social movement
organizations oppose the negative impact and externalities of instrumentally
rational economic actors (e.g., Gamson & Modigliani, 1989). In these cases,
social movement organizations construct and deploy morally charged frames
in order to stigmatize specic organizations or industries for their negative
effects on society (Galvin, Ventresca, & Hudson, 2004; Weber et al., 2009).
Recently, scholars have shown how market proponents can use strategic frames
and moral suasion to develop legitimacy for markets by valorizing normal
“amoral” markets and destigmatizing morally contested markets (Hampel &
Tracey, 2017; Lounsbury, Ventresca, & Hirsch, 2003). Such framing can trans-
form a commodity into a morally elevated cause by imbuing it with meaning.
For example, environmental activists framed grass-fed beef, an unpopular and
discounted product, in terms of authenticity and sustainability, transforming
it into a highly valued symbol of environmental care (Weber et al., 2008). In
doing so, activists united consumers and producers with a shared understand-
ing of a product that was evaluated based on moral taste.
Organizations hoping to win support for an illegal or stigmatized market
often stress how the market solves a social problem, benets society, or helps
a deserving group that has the sympathy of the public (Hampel & Tracey,
2017). For example, sellers of life insurance transformed a practice that
62 CYRUS DIOUN
was originally viewed as a violation of the sanctity of life into a death ritual
that provided security for the deceased’s loved ones (Zelizer, 1978). Similarly,
the “ghoulish” secondary market for life insurance, where the insured party
can monetize their life insurance policy to be traded as a nancial instru-
ment, gained moral legitimacy because market participants framed it as a
product that provided terminally ill consumers consolation and a dignied
death (Quinn, 2008).
While some studies show how collective action can develop moral legiti-
macy for markets, there have been few processual accounts explicating when
and how strategic framing can be used to diminish stigma over time. In the fol-
lowing section, I outline a number of frame alignment processes and describe
how social movement organizations can use distinct framing strategies at dif-
ferent stages of legalization and market development to destigmatize a mor-
ally and legally contested market.
Stage 1: Amplifying Frames, Respecting Moral Boundaries
Social movements do not construct frames in a vacuum, but rather in a cul-
tural context that renders some ideas more legitimate, recognizable, and sen-
sible than others (Koopmans & Statham, 1999; McCammon, Sanders Muse,
Newman, & Terrell, 2007). Savvy social movement organizations craft frames
that resonate by taking part in frame alignment processes that make their
message congruent with the values of potential supporters. Frame alignment
consists of “strategic efforts by social movement organizations to link their
interests and interpretive frames with those of prospective constituents and
actual or prospective resource providers” (Benford & Snow, 2000, p. 624).
Frame amplication is a frame alignment process that involves highlighting
elements of a frame that are more likely to be salient to the target audience.
Activists may foreground one part of the frame, particularly if it resonates
with the political and cultural environment, while de-emphasizing other parts
that are less salient. Frame amplication is a conservative strategy that stig-
matized groups often use because it does not “require potential supporters
to depart from traditional and widely shared values” (Klandermans, 1992,
p. 189; see also Berbrier, 1998). Rather, stigmatized groups construct frames
to meet prevailing pockets of sentiment where they are and highlight areas of
agreement between public opinion and their goals.
I posit that social movement organizations will be more likely to take part
in frame amplication during political campaigns to legalize a morally and
legally contested market. Since these markets lack both legality and legiti-
macy, social movement organizations must win the support of the general
Negotiating Moral Boundaries 63
public to approve a ballot initiative or lobby lawmakers to pass legislation
that legalizes the market. During these periods of heightened political oppor-
tunity, I expect that social movement organizations will highlight elements
of their frames that resonate with prevailing public attitudes that support
moral boundaries separating the taboo market from reputable commerce.
Thus, activists will attempt to make their frames congruent with these atti-
tudes by putting forth a more restrictive framing of the market. In the context
of medical cannabis markets, I hypothesize that during political campaigns to
legalize the market, social movement organizations will be more likely to use
the compassionate frame, which focuses on cannabis’s medical use by those
who are terminally ill or have a debilitating illness, than they will during non-
Stage 2: Extending the Frame to Expand the Market’s Customer Base
Once a market becomes legal through ballot initiative or legislation, there is
an implementation period that takes place between the passage of the law or
ballot initiative and the emergence of state-sanctioned providers. During this
period, state authorities draft rules that will shape the market, specically
its size, by designating who may participate in the market. Social movement
organizations can remain politically active during implementation, lobbying
the state and the public regarding the specics of the regulatory regime. At
this time, market proponents must balance political and economic goals, con-
tinuing to develop political support for the market by aligning their frames
with public sentiment, while at the same time pushing for a large and prot-
able market by dening its potential customer broadly.
To enlarge the size of the market, while at the same time maintaining the
coherence of the original frame, activists can take part in frame extension, a
frame alignment process by which a social movement organization attempts
to enlarge “the boundaries of its primary framework” in order to recruit new
supporters (Snow et al., 1986, p. 472). In the case of a newly legal market,
organizations may attempt to grow the market’s potential customer base by
strategically extending the initial frame, showing how the product can be use-
ful to a variety of consumers, not just the restricted use amplied in the ini-
tial framing of the market. Note that frame extension does not eliminate the
original meaning highlighted in the frame amplication process, but rather
adds additional, more expansive cases of how consumers can legitimately
use the product. Thus, activists will continue to invoke the needs of morally
deserving consumers, while at the same time extending the frame to consum-
ers who have weaker moral claims to the stigmatized product. In the context
64 CYRUS DIOUN
of medical cannabis markets, I hypothesize that during the implementation
period between legalization and the emergence of market institutions, social
movement organizations will continue to describe cannabis as a compassion-
ate palliative for the seriously ill and dying, but will also introduce the more
expansive wellness frame that includes less serious conditions such as insom-
nia, headaches, and chronic pain.
Stage 3: Market Emergence and Frame Transformation
Thus far I have described the rst two stages of legalizing a prohibited prod-
uct: the political push for legalization, and if successful, the political, yet
economically consequential battle for implementation. The nal stage in
this process is the emergence of a legal market. While rms often operate
in illegal markets before legalization and during implementation, the emer-
gence of a market with state-sanctioned institutions marks a distinct phase
because the market no longer has an existential need for support from the
social movement. If social movement organizations continue to use strategic
frames in support of the market even after the market has developed legal
and institutional support, then this suggests that social movement organiza-
tions are continuing to attempt to shape the meaning of the market.
Once the need to justify the market to the public and relevant authori-
ties becomes less intense, I suspect that social movement organizations
will attempt to remove the moral boundaries surrounding the market and
develop support for a larger market. Social movement organizations will
continue their use of a more expansive frame and discontinue their use of a
restrictive frame that reies the moral boundaries surrounding the market.
Thus, frame extension will give way to frame transformation, the wholesale
reconguration of an extant frame, as a new, more expansive meaning fully
displaces the old, restrictive meaning. In the context of medical cannabis
markets, I hypothesize that following the emergence of a legal market, social
movement organizations will be less likely to deploy press releases that solely
emphasize the seriously ill and dying and will instead focus on cannabis’s
efcacy for less serious illnesses.
DATA AND MEASURES
The dataset consists of press releases created and distributed between 1996
and 2013 by two of the largest and most inuential pro-cannabis social
movement organizations in the United States, the National Organization for
Negotiating Moral Boundaries 65
the Reform of Marijuana Laws (NORML) and Americans for Safe Access
(ASA). Founded in 1970, NORML’s (2013) mission is:
To move public opinion sufciently to legalize the responsible use of cannabis by adults,
and to serve as an advocate for consumers to assure they have access to high quality can-
nabis that is safe, convenient and affordable.
NORML denes responsible use to include both medical and recrea-
tional use. In 2013, NORML had 150 local chapters, 6 million website vis-
its, 123,000 email subscribers, over 482,000 Facebook likes, and 2,000 media
interviews (St. Pierre, 2013). ASA was founded in 2002 in response to ongo-
ing federal raids of medical cannabis providers. ASA describes itself as “the
country’s leading medical cannabis advocacy group” with a mission to bring
“the patient’s voice to the table” and “to ensure safe and legal access to can-
nabis for therapeutic uses and research” (Americans for Safe Access (ASA),
2013a; Duncan, 2012). In 2013, ASA had over 50,000 members.
Using a Python script, I collected the text of all press releases relevant to
the United States included in NORML’s news release archive and ASA’s press
release archive in March and April of 2014 (ASA, 2014; NORML, 2014).
Tables 1 and 2 present the distribution of press releases by state, organization,
and year. These tables show that the NORML corpus included 2,105 press
releases published over 18 years (1996–2013), and the ASA corpus included
382 press releases published over 12 years (2002–2013). Press releases were
published in 49 states and the District of Columbia.
I have focused on press releases to study framing processes because they
are strategic acts of communication that organizations carefully craft to inu-
ence public opinion and policymakers. If NORML and ASA are strategically
framing the medical use of cannabis, distinct frames should appear in their
press releases. To contextualize press releases, I interviewed 17 pro-cannabis
social movement activists and entrepreneurs, including members of both
NORML and ASA. I also observed 15 hours of pro-cannabis social move-
ment organization conferences and chapter meetings between 2013 and 2014.
These interviews and observations helped me construct the criteria and key-
words for the compassionate and wellness frames that I operationalize below.
To capture how social movement organizations framed medical cannabis, I
used computational methods for text analysis to measure how narrowly or
broadly social movement organizations described what constituted legitimate
66 CYRUS DIOUN
medical use. I developed a dictionary of keywords associated with the more
restrictive compassionate frame and the more expansive wellness frame in the
following manner.2 First, I used a Python script to create a frequency table of
every unigram (single word) and bigram (two consecutive words) in the cor-
pus. I then marked every word in the table that referred to a specic medical
condition (e.g., AIDS, depression, and anxiety) or a more general description
of an illness (e.g., terminal illness, seriously ill, and dying). Next, I located
every medical keyword in the corpus, reading each press release to understand
the context in which NORML or ASA mentioned the medical condition.3
I constructed a framing variable with three mutually exclusive outcomes:
no medical frame, compassionate frame, and wellness frame. To measure the
use of the compassionate frame, I constructed the dummy variable compas-
sionate, coded 1 if the press release mentioned a terminal illness or debilitating
Table 1. Distribution of Press Releases by State.
State Frequency State Frequency
AK 16 MO 17
AL 3 MS 1
AR 8 MT 25
AZ 28 NC 17
CA 587 ND 6
CO 58 NE 1
CT 19 NH 26
DC 23 NJ 45
DE 4 NM 20
FL 41 NV 21
Federal (National) 794 NY 85
GA 10 OH 23
HI 34 OK 16
IA 6 OR 42
ID 5 PA 21
IL 30 RI 25
IN 8 SC 4
Il 1 SD 12
KS 2 TN 4
KY 21 TX 17
LA 11 UT 2
MA 62 VA 16
MD 73 VT 21
ME 20 WA 66
MI 61 WI 12
MN 15 WV 2
Negotiating Moral Boundaries 67
disease but did not mention a less serious medical condition and 0 otherwise.
To measure the use of the wellness frame, I constructed the dummy variable
wellness, coded 1 if the press release included a less serious medical condition,
such as chronic pain, anxiety, gastrointestinal problems, or eating disorders
or specied how cannabis could be used to prevent disease and 0 otherwise.
Since the wellness frame is an extension of the compassionate frame, social
movement press releases that included both serious illnesses and less serious
illnesses were coded 1 for the wellness dummy and 0 for the compassionate
dummy. Table 3 shows a frequency table of medical conditions associated with
the compassionate or wellness frames in the corpus of 2,487 press releases.
Note that references to the terminally ill and dying (9.53%) were the most com-
mon keywords associated with the compassionate frame and that chronic pain
(7.08%) was the most common keyword associated with the wellness frame.
To assess whether different phases of institutional development were asso-
ciated with specic framing strategies, I created three mutually exclusive
Table 2. Distribution of Press Releases by Organization and Year.
Year ASA NORML Total
1996 0 178 178
1997 0 111 111
1998 0 105 105
1999 0 116 116
2000 0 147 147
2001 0 108 108
2002 14 103 117
2003 30 110 140
2004 34 111 145
2005 20 97 117
2006 25 110 135
2007 22 118 140
2008 21 88 109
2009 40 112 152
2010 45 131 176
2011 35 127 162
2012 40 108 148
2013 56 125 181
Total 382 2,105 2,487
68 CYRUS DIOUN
dummy variables, which each represent a distinct stage of legalization
and institutional development at the state level. To measure the relation-
ship between political campaigns to legalize medical cannabis and activist
framing strategies, I created the dummy variable medical campaign period,
coded 1 if the press release was published during the 180 days preced-
ing a vote on a ballot initiative to legalize medical cannabis and 0 other-
wise.4 Similarly, to measure the association between implementation and
Table 3. Medical Condition Frequency in Press Corpus.
Medical Condition # of Press Releases % of Corpus Frame
Terminally ill/seriously ill/dying 237 9.53 Compassionate
Chronic pain 195 7.84 Wellness
HIV/AIDS 190 7.64 Compassionate
Cancer/lymphoma 176 7.08 Compassionate
Multiple sclerosis 121 4.87 Compassionate
Spasms/spasticity 76 3.06 Compassionate
Epilepsy/seizures 44 1.77 Compassionate
Nausea 42 1.69 Wellness
Insomnia/sleep disorder 33 1.33 Wellness
Prevents cancer 24 0.97 Wellness
Nerve damage 23 0.92 Compassionate
Anxiety 23 0.92 Wellness
Crohn’s disease 23 0.92 Wellness
Depression 21 0.84 Wellness
Alzheimer’s 19 0.76 Compassionate
Diabetes 18 0.72 Wellness
Hepatitis 17 0.68 Wellness
Neuroprotectant 17 0.68 Wellness
ALS/Lou Gehrig’s 16 0.64 Compassionate
Inammation 16 0.64 Wellness
Stroke 15 0.60 Compassionate
Migraines/headaches 13 0.52 Wellness
PTSD 12 0.48 Wellness
Parkinson’s 11 0.44 Compassionate
Inammatory bowel/irritable bowel 10 0.40 Wellness
Hypertension 9 0.36 Wellness
Schizophrenia 8 0.32 Compassionate
Spinal cord injury 8 0.32 Compassionate
Quadraplegic/paraplegic 7 0.28 Compassionate
Obesity 5 0.20 Wellness
Eating disorders/anorexia 4 0.16 Wellness
Tourrette’s/movement disorder 3 0.12 Compassionate
Prevents Alzheimers 2 0.08 Wellness
Sickle cell anemia 2 0.08 Wellness
Negotiating Moral Boundaries 69
framing, I created the dummy variable implementation period, coded 1 if a
press release was published following the passage of a ballot initiative or
state law authorizing medical cannabis but before a legal market emerged
and 0 otherwise. Finally, to see how providers framed medical cannabis
once a state-sanctioned market opened, I created the dummy variable mar-
ket period, coded 1 if state-legal providers were operating and 0 otherwise.
All three of these dummy variables use the reference period, when medical
cannabis was neither legal nor at the center of a political campaign, as
Secular trends, discursive opportunities, and coercive threat could each
explain why social movement organizations used more restrictive or expan-
sive frames in their press releases. I have included the variable time, operation-
alized as the number of days since the beginning of the study period (January
1, 1996), to control for secular changes in the environment that might have
affected the frames used by social movement organizations. If secular trends
over time were associated with greater acceptance of cannabis, then I would
expect to nd that time was positively associated with the use of the wellness
frame and negatively associated with the use of the compassionate frame.
Time was scaled (divided by 365) to make the interpretation of coefcients
more intuitive (change per year). Interactions between implementation period
and time (implementation × time) and market period and time (market × time)
measured whether the effects of implementation period and market period
increased or decreased over time.
The AIDS epidemic made the public more sympathetic to the plight of
medical cannabis users and receptive to the compassionate frame (CASA,
1996). To control for the discursive opportunity provided by the AIDS epi-
demic, I created the variable AIDS deaths, the number of AIDS deaths per
year per capita in the United States between 1995 and 2012, using the Center
for Disease Control’s (CDC) Annual Surveillance Reports (CDC, 2002, 2003,
2005, 2009, 2014). This variable reects the number of AIDS deaths per
100,000 US residents. I lagged this variable one year because it is an annual
measure. To control for the political opportunity provided by campaigns to
legalize cannabis for recreational use, I created the dummy variable recrea-
tional campaign, coded 1 if the press release was published during the 180
days preceding a vote on a ballot initiative legalizing cannabis for recreational
purposes and 0 otherwise.
70 CYRUS DIOUN
Coercive threat from the federal government may have affected organiza-
tional framing strategies. During periods of increased enforcement actions,
activists might have attempted to shield the market through impression man-
agement techniques, framing medical cannabis in morally acceptable ways. To
control for coercive threat, I constructed the variable federal raids, a count of
the number of federal raids of medical cannabis providers each year nation-
wide. This information was collected by ASA and published in the report
What’s The Cost? The Federal War on Patients (ASA, 2013b). I lagged this
variable one year because these numbers were collected annually. Conversely,
organizations may have been less likely to shield the market during periods
of decreased threat. For most of the study period, federal policy prohibited
medical cannabis, rejecting state laws supporting medical cannabis markets.
But during a 20-month period between October 19, 2009, and June 29, 2011
(Cole, 2011; Ogden, 2009), the federal government changed its policy so that
it would no longer devote federal resources to prosecute medical cannabis
providers operating in accordance with state law. To control for the effect of
easing state-federal tensions, I constructed the dummy variable federal defer-
ence, coded 1 during this period and 0 otherwise.
I also controlled for organizational differences in framing strategies with
the dummy variable Americans for Safe Access, coded 1 if ASA published
the press release and coded 0 if NORML published the press release. Longer
press releases were more likely to cover a broader range of topics, including
the medical uses of cannabis, so I created the variable word count to control
for press release length.
Plan of Analysis
I used a multinomial logistic regression model to predict the occurrence of
the compassionate frame or wellness frame in a press release as compared to
the baseline (no medical frame). As a robustness check, I modeled the aver-
age marginal effects of explanatory and control variables on the probability
of social movement organizations using each medical frame in their press
release, meaning the effect of a one-unit change of each regressor on the
conditional mean of the outcome variable. This allowed for the comparison
of effects between groups, samples, and periods of time, rendering the inter-
pretation of interaction effects more meaningful (Cameron & Trivedi, 2009;
Mood, 2010). I also conducted a robustness check excluding press releases
that were not associated with any specic state (national) or the District
Negotiating Moral Boundaries 71
Table 4 presents descriptive statistics and a correlation table for all observa-
tions. Twenty-six percent of press releases included either the compassionate
(14.2%) or wellness (11.8%) frame. Most variables were weakly or moderately
correlated except time, which had a strong positive correlation with federal
raids (+0.84) and a strong negative correlation with AIDS deaths (–0.70). The
variance ination factor was 6.85, below the cut-off of 10 commonly used in
social science research, indicating that collinearity was not a major concern
(Belsley, Kuh, & Welsch, 1980).
Tables 5 and 6 present the results of a multinomial logistic regression
model for predictors of the compassionate frame (Table 5) and the wellness
frame (Table 6). These tables compare each specic outcome (compassion-
ate or wellness) to the reference group (no medical frame). All results were
exponentiated to show the relative risk ratio of each medical frame vis-a-vis
the baseline of no medical frame. Relative risk is the ratio of the cumulative
incidence rate among those exposed to the treatment compared to the rate
among those not exposed.
Table 5 shows that ASA and NORML were more likely to use the com-
passionate frame during political campaigns to legalize medical cannabis
(medical campaign period) and during the implementation phase following
legalization (implementation period). The effects of medical campaign period
and implementation period were large, positive, and statistically signicant.
Press releases published during political campaigns to legalize medical can-
nabis were 3.1 times as likely to include the compassionate frame as press
releases published during the reference period. Press releases published
during implementation were 2.5 times as likely to include the compassion-
ate frame as press releases published during the reference period. However,
once a state-sanctioned market emerged (market period), ASA and NORML
were neither more nor less likely to use the compassionate frame as during
the reference period. Together, these ndings suggest that social movement
organizations began to amplify parts of the medical frame that were morally
acceptable to the public during campaigns to legalize medical cannabis and
maintained this framing during the implementation phase. However, they
discontinued their increased use of the compassionate frame once a state-
legal market emerged.
A review of the variables that controlled for alternate explanations shows
that neither discursive opportunities nor coercive threats were signicantly
associated with the use of the compassionate frame, but that ASA was more
likely to use this frame than NORML. This is not surprising, as ASA is
Table 4. Descriptive Statistics and Correlation Table.
1 2 3 4 5 6 7 8 9 10 11 12 13 14
N2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487
Mean 7.181 0.014 29.040 0.117 0.154 316.578 9.415 0.013 0.192 1.922 0.169 2.275 0.142 0.118
SD 3.899 0.116 30.299 0.321 0.361 159.301 5.374 0.114 0.394 4.546 0.375 5.174 0.349 0.323
Min 4.825 0 0 0 0 21 0.008 0 0 0 0 0 0 0
Max 19.400 1 92 1 1 1,071 17.997 1 1 17.978 1 17.959 1 1
1 AIDS deaths 1.000
2 Recreational campaign −0.062 1.000
3 Federal raids −0.457 0.013 1.000
4 Federal deference −0.190 0.270 0.077 1.000
5 ASA −0.191 0.075 0.225 0.099 1.000
6 Word count −0.133 0.047 0.201 0.026 0.578 1.000
7 Time −0.709 0.111 0.842 0.355 0.281 0.215 1.000
8 Medical campaign 0.177 −0.014 −0.047 −0.031 −0.049 −0.030 −0.107 1.000
9 Implementation −0.122 −0.031 0.012 0.081 −0.029 −0.107 0.055 −0.048 1.000
10 Implement × time −0.179 −0.024 0.197 0.174 0.000 −0.077 0.256 −0.036 0.868 1.000
11 Market −0.209 0.233 0.297 0.133 0.403 0.226 0.338 −0.052 −0.220 −0.191 1.000
12 Market × time −0.212 0.255 0.344 0.156 0.375 0.228 0.378 −0.051 −0.214 −0.186 0.974 1.000
13 Compassionate 0.119 −0.028 −0.131 −0.076 0.063 0.139 −0.161 0.074 0.018 −0.040 −0.039 −0.048 1.000
14 Wellness −0.048 −0.032 0.023 −0.017 0.117 0.161 0.035 −0.010 0.040 0.029 0.021 0.003 −0.149 1.000
Negotiating Moral Boundaries 73
dedicated to defending the medical use of cannabis, while NORML supports
both medical and recreational use. As expected, press release length (word
count) was associated with an increase in the relative risk that a social move-
ment press release included the compassionate frame. Finally, the use of the
compassionate frame decreased over time. Each additional year in the study
period was associated with a 9.1% decrease in the relative risk of including
the compassionate frame in a press release, suggesting a secular decrease in
the use of the more restrictive frame over time.
Table 6 shows that social movement organizations were neither more nor
less likely to use the wellness frame in press releases published during cam-
paigns to legalize medical cannabis (medical campaign period) than during
the reference period, but were more likely to use the wellness frame during
implementation (implementation period) and following the emergence of
a legal market (market period). The effects of implementation and market
emergence were large, positive, and statistically signicant. Press releases pub-
lished during the implementation period were 2.8 times as likely to include
the wellness frame as press releases published during the reference period.
Press releases published during the market period were 14.6 times as likely
to include the wellness frame as press releases published during the refer-
ence period. However, the effect of market period decreased with time.
Table 5. Multinomial Logistic Models Predicting the
Variables 1 2 3 4
AIDS deaths 0.983 0.976 0.993 0.997
Recreational campaign 0.512 0.512 0.513 0.616
Federal raids 0.998 0.998 0.997 0.998
Federal deference 0.744 0.742 0.716 0.730
Americans for safe access 1.562* 1.574* 1.513* 1.584*
Word count 1.004*** 1.004*** 1.004*** 1.004***
Time 0.884*** 0.884*** 0.903** 0.909*
Medical campaign period 2.911** 3.113** 3.076**
Implementation period 2.381** 2.540**
Implementation × time 0.951 0.940
Market period 1.948
Market × time 0.935
N2,487 2,487 2,487 2,487
Notes: * p < 0.05; ** p < 0.01; and *** p < 0.001; two-tailed t-tests.
74 CYRUS DIOUN
Following market emergence, each additional year was associated with a
19.5% decrease in the relative risk of including the wellness frame in a press
release, suggesting that while social movement organizations escalated their
use of the wellness frame following the emergence of a legal market, they
used the wellness frame with decreasing frequency as the market matured.
Table 6 shows little support for alternate arguments that secular trends,
discursive opportunities, or variation in levels of federal threat were associ-
ated with the wellness frame. None of the controls except document length
(word count) were associated with this more expansive frame, suggesting
that social movement organizations did not respond to opportunities or
threats with the wellness frame and that neither ASA nor NORML were
more likely to use the more expansive frame. While Table 5 shows that time
was associated with a decrease in the compassionate frame, Table 6 does
not show that time was associated with an increase in the wellness frame,
indicating that there was not a secular trend toward a more expansive fram-
ing over time.
In summary, Tables 5 and 6 suggest social movement organizations rst
used frame amplication to develop public support for legalizing medical
cannabis by highlighting aspects of cannabis’s medical use that were congru-
ent with the socially constructed moral boundaries surrounding the market.
Once activists helped develop legal support for the market, social movement
Table 6. Multinomial Logistic Models Predicting the Wellness Frame.
Variables 1 2 3 4
AIDS deaths 0.959 0.958 0.973 0.989
Recreational campaign 0.169 0.169 0.178 0.248
Federal raids 0.996 0.996 0.995 0.997
Federal deference 0.773 0.772 0.734 0.800
Americans for safe access 1.313 1.317 1.277 1.178
Word count 1.003*** 1.003*** 1.003*** 1.004***
Time 0.983 0.983 0.998 1.014
Medical campaign period 1.453 1.560 1.532
Implementation period 2.223* 2.816**
Implementation × time 0.972 0.948
Market period 14.660***
Market × time 0.805***
N2,487 2,487 2,487 2,487
Notes: * p < 0.05; ** p < 0.01; and *** p < 0.001; two-tailed t-tests.
Negotiating Moral Boundaries 75
organizations shifted to a strategy of frame extension, interspersing their
use of the restrictive compassionate frame and the expansive wellness frame
to make these moral boundaries more permeable. Finally, once a state-legal
market emerged, social movement organizations continued to support the
market through strategic framing, dramatically increasing their use of the
wellness frame while discarding the compassionate frame, resulting in a frame
transformation. However, as state-authorized markets grew older, social
movements decreased their use of the wellness frame, indicating that while
social movements may continue to support a market through strategic fram-
ing after the market opens, this support may decrease over time. Robustness
checks estimating average marginal effects show similar results, as do robust-
ness checks estimating these models for the subset of data excluding national
This study shows how social movement organizations used distinct fram-
ing strategies at different stages of institutional development to destigma-
tize medical cannabis markets. NORML and ASA performed cultural and
institutional work redening the legitimate medical use of cannabis by stra-
tegically deploying different medical frames to negotiate the moral bounda-
ries surrounding cannabis. By showing how social movement organizations
sequenced their framing strategies to develop support for the market – rst
respecting moral boundaries through frame amplication and then making
boundaries permeable through frame extension and frame transformation –
this study demonstrates how organizations can incrementally dilute stigma
and develop support for the normalization of a taboo market. But do organi-
zations always follow this strategic process when attempting to legalize and
legitimate an illegal and taboo market?
Anecdotal evidence from a number of different campaigns to destigma-
tize morally and legally contested markets suggests that organizations often
attempt to win support for a contested product or practice by emphasizing
how the market will benet a subset of sympathetic and worthy individuals.
For example, advocates of euthanasia restrict their framing of the right to
die to those who are terminally ill or have illnesses that cause constant suf-
fering. Lotteries, a form of gambling, are often justied because the proceeds
go toward schools or other public services. Proponents of legalized prostitu-
tion point to how regulation will protect sex workers from exploitation and
76 CYRUS DIOUN
trafcking. These examples suggest that this study’s ndings are generalizable
to other morally and legally contested markets. Organizations will attempt to
develop support for morally repugnant products and practices by amplifying
frames that highlight how the market is restricted to a set of worthy individu-
als who are unlikely to be perceived as transgressing the moral boundaries
that separate the offending market from reputable commerce.
However, not all organizations will extend and transform frames following
legalization because in some cases, unrestrained commerce may undermine
the values that helped give rise to the market (Lee, Hiatt, & Lounsbury, 2017;
McInerney, 2014). In these cases, organizations may ght market expansion
and maintain more restrictive frames as bulwarks against full normaliza-
tion. The generalizability of these ndings should be conditioned on whether
expansion of the market is aligned with social movement values.
Alternately, social movement organizations may move on to other battles
or cease to exist once they develop support for a morally and legally con-
tested market. In these cases, social movement organizations would no longer
take part in strategic framing in support for the market. As medical cannabis
remains illegal at the federal level, it may be that social movements continue
to play a role in state-legal medical cannabis markets because of the ongoing
threat of federal prohibition.
While movements may support or oppose market expansion, depend-
ing on their values, it is safe to assume that most market participants will
desire a larger and more protable market once it has gained legitimacy and
legal support. Industry actors and trade associations are likely to extend and
transform frames following legalization and market emergence. Therefore,
these ndings may be more generalizable to the universe of market partici-
pants that engage in collective action than the universe of social movement
I could not rule out a number of alternate explanations due to data limita-
tions. Social movement scholars often describe the discursive battles taking
place between movements and countermovements. Social movement organi-
zations’ framing strategies are often contingent on the frames used by their
opponents. It has been challenging to obtain reliable strategic messaging data
from opponents to medical cannabis over the 18-year study period. This is
in part because much of the opposition to medical cannabis legalization has
come from the state and collective bodies, such as state-level and local unions
that represent law enforcement and correctional guards.5 It has been difcult
to develop a corpus to show how the countermovement has framed cannabis
across all 50 states. Including movement–countermovement dynamics may
shed light on how social movements strategically negotiate moral boundaries
Negotiating Moral Boundaries 77
surrounding a market. Future research should explore how movement–coun-
termovement dynamics co-evolve with legalization and the development of
Finally, this study has practical implications for social movement organiza-
tions, rms in contested industries, and policymakers attempting to persuade
the public with regard to a controversial issue. In order to transform percep-
tion of a maligned category, product, or practice, actors must rst under-
stand the moral environment in which they are operating and frame their
message so as to gain a foothold for their institution-building project. Once
actors gain a degree of moral legitimacy for a contested product or practice,
they can use this foothold as a foundation for transformative change.
Special thanks to Heather Haveman, Laura Stoker, Neil Fligstein, Mike
Hout, Jens Beckert, Dave Harding, Cristina Mora, Kim Voss, Cybelle Fox,
Sarah Brothers, and Gillian Gualtieri, as well as participants in the Berkeley-
Stanford Organization Behavior Conference and Berkeley’s CCOP work-
shop and the anonymous reviewers/editors at Research in the Sociology of
Organizations for their helpful comments. Also, thanks to Amazon Web
Services and Github, as well as the Berkeley URAP program for their gener-
ous grants and support. All mistakes and omissions are my own.
1. Moral legitimacy refers to “a positive normative evaluation…about whether the
activity is ‘the right thing to do’…as dened by the audience’s socially constructed
value system” (Suchman, 1995, p. 579; see also Aldrich & Fiol, 1994).
2. This approach “assumes that frames manifest themselves by the presence or
absence of certain keywords and concepts” (Fiss & Hirsch, 2005, p. 35).
3. NORML and ASA included medical conditions in their press releases in one
of the three ways: They (1) described cannabis’s efcacy for treating a medical condi-
tion; (2) explained how a law or ballot initiative would allow for (or unfairly prohibit)
certain medical uses; or (3) highlighted the plight of a patient with a specic illness.
4. Most efforts to legalize cannabis have gone through the public ballot initiative
process, where voters decide whether or not to allow for legal medical cannabis use.
During the study duration, 16 states voted on legalizing medical cannabis with 12
ballot initiatives passing and four failing. I chose the 180-day cutoff because in most
states, relevant state authorities must approve a ballot initiative four to six months
78 CYRUS DIOUN
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while Oregon’s cutoff is 165 days).
5. The federal government appears to have accepted the compassionate framing
of cannabis’s medical use. In the 2011 Cole Memo, the Department of Justice stated
that its hands-off approach to medical cannabis markets was restricted to “individuals
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