WASHINGTON (CNN) - The Supreme Court sidestepped Monday the politically explosive debate over whether federal drug laws trump the use of so-called legalized "medical marijuana."
The decision leaves unclear how local districts must comply if a state law, passed by referendum, allowing the limited use of medical marijuana conflicts with the federal government's tough anti-narcotic stance.
The justices Monday rejected appeals from two California counties, which have balked at accommodating Proposition 213, which legalized cannabis for pain-suffering patients with a prescription.
At issue is whether the federal Controlled Substances Act - which prohibits pot possession for any purpose - supersedes state medical laws, when it comes to enforcement and liability for local districts. A California appeals court found federal oversight was limited since it was designed "to combat recreational drug use, not to regulate a state's medical practices."
If the Supreme Court ever decides to tackle the issue, observers believe the justices will likely insist the Obama administration weigh in with its views of the state-federal tug-of-war.
California is one of 13 states legalizing pot to be grown, distributed, sold and taken for personal "medicinal" use. Users include former television host Montel Williams, who has multiple sclerosis.
San Diego and San Bernardino counties refused to issue identification cards for such patients, prompting a lawsuit from individuals and marijuana advocacy groups. The ACLU is representating the lead plaintiff, the National Organization for the Reform of Marijuana Laws (NORML).
Many ill Californians who use it say marijuana can help provide relief in the treatment of cancer, AIDS, chronic pain, glaucoma, and arthritis, among other ailments. It is most commonly smoked for such purposes.
The voluntary use of identification cards was designed to ensure certified patients and their doctors were not arbitrarily arrested for pot possession or distribution. The state Compassionate Use Act and Medical Marijuana Program Act require counties to provide applications for those who request the cards.
The federalism conflict has been tying up courts for years, and those on both sides of the issue have urged the high court to issue definitive ruling on the overall constitutionality of state medical marijuana laws.
The Supreme Court has previously said federal narcotics laws do not conflict with state autonomy, but that drug enforcement agents retain the power to arrest those who sell or use marijuana, even for state-sanctioned medical use.
After California's referendum passed in 1996, "cannabis clubs" sprung up across the state to provide marijuana to patients. They were eventually shut down by the state's attorney general.
The U.S. Supreme Court ruled in 2001 that anyone distributing medical marijuana could be prosecuted, despite claims their activity was a "medical activity."
The Drug Enforcement Agency (DEA) began raids that same year against patients using the drug and their caregivers in California. Among those arrested was Angel Raich, who has brain cancer, and Diane Monson, who grew cannabis in her garden to help alleviate chronic back pain.
"I need to use cannabis every two hours," Raich, a mother from Oakland, told CNN four years ago. "If I don't medicate every two hours, I become debilitated."
Shortly aftreward, 6-3 high court majority rejected an appeal from Raich, saying the federal government can prohibit the backyard cultivation of pot for personal use, because such use has broader social and financial implications.
The court's ruling turned on the long-standing issue of the federal government's power to regulate trade, illegal or otherwise. "The case," wrote Justice John Paul Stevens, "comes down to the claim that a locally cultivated product that is used domestically rather than sold on the open market is not subject to federal regulation. Given the [federal anti-drug] Act's findings and the undisputed magnitude of the commercial market for marijuana," federal power held sway in such cases.
Stevens also noted patients could pursue an appeal on individual due process claims, which were not an issue before the Court then. "But perhaps even more important than these legal avenues is the democratic process, in which the voices of voters allied with these (California women) may one day be heard in the halls of Congress," he added.
A federal appeals court two years ago rejected Raich's latest appeal on her due process rights, noting "Although changes in state law reveal a clear trend towards the protection of medical marijuana use, we hold that the asserted right has not yet gained the traction on a national scale to be deemed fundamental."
The same San Francisco-based court last month upheld a 10-year mandatory minimum federal sentence for Bryan Epis, convicted of drug conspiracy. He said he was growing 458 marijuana plants for legal use by himself and fellow patients. Prosecutors said he was a simple drug dealer looking to profit from illegal narcotics.
The current high court cases are San Diego County v. San Diego NORML (08-887); San Bernardino County v. California (08-897).