Dr. Hepler
Thank you for sharing the full affidavit of Dr. Robert S. Hepler, a key figure in the Randall v. United States case and in early federal cannabis research. Below is a concise summary and analysis of the affidavit, followed by a citation-style format you can use for footnoting in legal, academic, or advocacy documents.
🔍 Summary of the Affidavit of Robert S. Hepler, M.D.
Filed in support of Robert C. Randall in Randall v. United States (1976–1978)
1. Professional Background
Dr. Hepler is a board-certified ophthalmologist since 1967, trained at UCLA and Boston Eye and Ear Infirmary.
A faculty member at UCLA School of Medicine for over a decade with extensive experience treating glaucoma.
Began federally sanctioned cannabis research in 1970; expanded to glaucoma patients in 1974.
2. Nature and Dangers of Glaucoma
Glaucoma is defined as increased intraocular pressure (IOP), which can cause irreversible damage to the optic nerve.
Chronic open-angle glaucoma, the type afflicting Randall, is progressive and can lead to tunnel vision and ultimately central blindness.
Management depends on maintaining IOP within a "safe range" via medication or surgery.
3. Limitations of Conventional Medications
Drugs fall into three main categories:
Miotics (e.g., pilocarpine, phospholine iodide) – can cause blurred vision, headache, and even retinal detachment.
Epinephrine compounds – cause eye discomfort and systemic issues like rapid heart rate and hypertension.
Carbonic anhydrase inhibitors (e.g., Diamox) – systemic oral drugs with significant gastrointestinal and neurological side effects.
Randall was resistant to all these, showing no sustained IOP control despite maximum dosages during a 12-day hospital trial.
4. Marijuana’s Therapeutic Role
Dr. Hepler tested both smoked and oral marijuana in 12 glaucoma patients; 7 showed significant IOP reduction.
In Randall’s case, high doses of smoked marijuana reduced IOP effectively for full test days.
Side effects were minimal: mild euphoria, increased heart rate, and very rare panic reactions (none observed in Randall).
5. Randall’s Case
By 1975, Randall had lost central vision in one eye and had severe peripheral loss in the other.
Randall’s IOP during hospitalization fluctuated between 15 and 36 mmHg, with safe range typically between 10–20 mmHg.
Marijuana consistently lowered his IOP when all other medications failed.
Randall’s own self-treatment observations (e.g., halos disappearing after smoking) were validated by Hepler’s testing.
6. Medical and Ethical Conclusions
Marijuana was the only effective therapy for Randall short of risky surgery.
If marijuana were legal, Dr. Hepler would prescribe it as part of Randall’s glaucoma management.
The risk of blindness far outweighed the mild and manageable side effects of cannabis use.
Cannabis should be considered medically necessary to preserve Randall’s remaining vision.
📌 Key Legal and Policy Implications
Medical Necessity: Dr. Hepler’s testimony forms a scientific foundation for the successful use of the medical necessity defense in Randall’s federal case.
Federal Acknowledgment: The study used federally supplied marijuana through the National Institute on Drug Abuse (NIDA).
Precedent-setting Evidence: Demonstrates early federal acknowledgment (1970s) of cannabis efficacy for glaucoma.
📚 Citation for Legal/Policy Documents
Hepler, R.S. (1978). Affidavit of Robert S. Hepler, M.D., Randall v. United States, U.S. District Court for the District of Columbia. Filed in support of plaintiff Robert C. Randall.
Key testimony: Dr. Hepler confirmed that marijuana was the only effective therapy for Randall’s glaucoma after all other medications failed, and that its therapeutic benefits outweighed known risks. He concluded that if legal, he would have prescribed cannabis as part of Randall’s regular treatment.
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
Robert C. Randall, Plaintiff,
V.
United States, et. al. Defendants
AFFIDAVIT OF ROBERT S. HEPLER. M.D.
State of California
County of Los Angeles ) ss.
I, Robert S. Hepler, M.D., Professor of Ophthalmology at the School of Medicine, University of California in Los Angeles, being duly sworn, hereby make oath that, to wit:
1. I became a board-certified ophthalmologist in 1967. I received my medical degree from UCLA, where I also completed my internship and ophthalmology residency fellowship at the Boston Eye and Ear Infirmary of Massachusetts General Hospital and spent an additional year at the University of California in San Francisco. During both years, I studied neuro-ophthalmology. I have held an appointment at the UCLA Medical School for 11 years and during this period I have had substantial experience in diagnosing and treating glaucoma.
2. In layman’s terms, glaucoma may be described as an imbalance of pressure within the eye. A normal eye is almost perfectly round. The eye must remain round in order to keep the curvature and clarity of the cornea standardized so that rays of light can be focused in a regular manner upon the retina. The roundness of the eye is maintained by pressure within the eye, referred to as intraocular pressure (IOP). This pressure results from the production of fluid from one of the structures inside the eye, the ciliary body, at a limited rate, this being matched by the outflow channels. If too much fluid is produced, or if drainage of the fluid is impaired in some manner, excess pressure will result. Such an increase in pressure constitutes the condition known as glaucoma.
3. There are two major types of glaucoma. Closed-angle glaucoma results when, for some reason, the angle of the portion of the eye which houses the outflow chambers narrows or closes, preventing fluid drainage and thereby increasing IOP. This condition occasionally occurs suddenly and can be quite painful. The other, more prevalent form of glaucoma is referred to as open-angle (also called chronic simple glaucoma). In this type of glaucoma, although the angle housing the outflow chambers remains open, the inadequate drainage of fluid results from the malfunctioning of outflow chambers themselves.
4. Open-angle glaucoma may be a serious disease. Once it has been diagnosed, the successful management of the disease requires sustained close cooperation between the patient and the physician. The ultimate prognosis for severe cases, particularly in younger patients, is blindness.
5. Unchecked increases in IOP result in damage to the optic nerve. Such damage usually is first manifested in loss of peripheral vision. L:oss of peripheral vision impairs the patient’s ability to see to the left and right when looking straight ahead. Severe loss of peripheral vision results in tunnel vision. Also, loss of peripheral vision may visually change the true shape and color of large objects. If IOP remains uncontrolled, it will result eventually in loss of central vision. Loss of central vision results in the inability of a patient to read or define small objects. The loss of central vision is referred to by laymen as blindness. The final result of increased IOP may be total loss of sight.
6. Whether glaucoma is being adequately managed can be determined by the periodic comparison of the results of three tests: (a) Intraocular eye pressure can be measured, (b) the extent of sight loss can be charted, and (c) the extent of nerve head damage can be directly observed.
a) Intraocular eye pressure is measured by a process called Tonometry. One mechanism to measure IOP, the Schiotz Tonometer, is relatively simple to operate and may provide an accurate IOP reading. The Schiotz Tonometer process can be used by a trained non-professional in order to provide for the taking of frequent IOP by someone who is usually available to the patient at home. Intraocular pressure is calibrated in terms of millimeters of mercury. Normal eye pressure for most individuals is between 10 and 20mm.
b) The extent of sight loss can be measured by a visual field examination. This examination discloses the amount of sight loss from the outer periphery to the center. Visual field results are usually charted in graph form.
c) The extent of nerve head damage can be determined by examining the nerve disc and viewing the damage to the optic nerve.
7. A glaucoma patient whose IOP remains in the safe range, whose visual field examination does not show progressive sight loss, and whose optic disc examination does not show any additional damage is successfully managing the disease.
8. The conventional medications for the treatment of glaucoma are divisible into three families: (a) miotics; (b) Epinephrine; and (c) carbonic anhydrase inhibitors. The prescription of medication for glaucoma patients usually follows a set pattern. Short-acting miotics are first prescribed, followed by Epinephrine, carbonic anhydrose inhibitors and, finally, long-acting miotics. The order of progression is determined by the relative safety (i.e. known side effects) of each drug family. A patient progresses to the next drug family. A patient progresses to the next drug family when a tolerance to the previous drug develops. Frequently, a patient will be prescribed a combination of drug families in order to attempt successful management of IOP.
a) Miotics are subdivided into short-acting and long-acting subfamilies. Short-acting miotics are usually the initial drug family choice for glaucoma treatment and include Carbachol and Pilocarpine. Short-acting miotics may blur vision but are generally safe. Prolonged use, however, may cause cataracts. Long-acting miotics (such as Phospholine Iodide) usually are not employed until after drugs in the other families have proven ineffective. Drugs in this subfamily, for most patients, cause blurring vision because of accomodative myopia. Also, commonly reported side-effects include headache, brow-ache, ocular pain, spasm of the eyelid muscles, and the development of cysts in the pupillary margin of the iris. These drugs significantly increase the incidence of cataracts and, infrequently, cause detachment of the retina. At toxic levels these agents interfere with central nervous system functions and can cause ataxia (loss of muscular coordination), confusion, convulsion and coma. Both muscular paralysis and death due to respiratory failure have been reported as a result of toxic level dosages.
b) Agents from the second family, Epinephrine Compounds, may be used alone or in combination with a short-acting miotic. Epinephrine Compounds can make the eyes red and uncomfortable. They also can produce systemic effects, including tachycardia (rapid beating of the heart). Hypertension, palpitation, sweating and tremors.
c) The third family is the carbonic anhydrose inhibitors, Diamox and Daranide. While the other families of antiglaucoma drugs are applied topically to the eye, this family is taken orally and has a direct systemic effect and commonly causes anorexia (substantially diminished appetite), weight loss, gastric distress, vomiting, nausea, diarrhea, and a general sense of fatigue. Headache and dizziness frequently are reported. Incidental reactions include skin rashes, drug fever, bone marrow depletion and acidosis (depletion of alkali from body fluids). Prolonged use is associated with renal stones (in rare instances patients have died from acute renal failure), dysphoria, thought disorientation, severe depression, impotence, and rapid mood shifts. In patients with asthma or other pulmonary disorders the drugs may contribute to acute respiratory failure.
9. It is not unusual for chronic open-angle glaucoma patients to develop tolerances to all of these conventional medication families. Such a tolerance exists when the medication fails to lower the patient’s IOP to a safe range even when the highest allowed dosage level has been used.
10. Since the prescription of marijuana is not presently a legal alternative, once tolerances have developed to conventional medications, the only option available to save sight is surgery. Surgery, because of the inherent risks, is recommended only after the failure of all known medications to control the patient’s IOP.
11. The usual surgical procedures enlarge the mechanism which drains the fluid from the eye. The risks of such procedures include a significant chance that the opening will not be made large enough and, therefore, it will not be effective in reducing IOP to the safe range, or that it will be too large and, therefore, will reduce IOP beneath the safe range. The possibility of unsuccessful surgery is increased in patients with sharply fluctuating IOP because of the inability to determine the extent to which the mechanism should be enlarged. Other risks of the surgery include hemorrhages from delicate vessels, the occurrence of infections which may be extremely difficult to treat, and resulting cataracts which themselves may necessitate additional surgery. Moreover, even as a patient grows older that pressure levels will change necessitating repeated surgery. Repeated surgery is complicated by the thinning of eye tissue and the presence of scar tissue caused by the original surgery. Hence the surgical alternative should be postponed until all known medical alternatives have been proven inadequate in controlling the patient’s IOP. This is particularly true in young patients and in patients with sharply fluctuating IOP.
12. The risks of surgery are also increased if the patient has central vision in only one eye. Complications caused by surgery in this eye could result in central blindness.
13. On December 7 and 8, 1975 I conducted my first extensive examination of Robert Randall’s eyes. This examination supported his previous diagnoses of advanced, severe open-angle glaucoma. Robert Randall’s right eye had lost all central vision but retained some peripheral vision. The left eye was 20/20 centrally but had suffered severe loss of peripheral vision. In layman’s terms, Robert Randall was blind in his right eye and had lost the ability in his left eye to see from side to side when looking straight ahead.
14. The only way of preserving central vision in Robert Randall’s left eye is to control his IOP within a safe range. A delicate balance exists in this eye. Very little additional damage can be tolerated in this eye without the resulting loss of central vision.
15. Elevated IOP, above the safe range, even for short time periods, could cause further irreversible nerve head damage in Robert Randall’s eyes. Such damage could result in the event loss of central vision in his left eye. In laymen’s terms he would then be blind in both eyes.
16. Robert Randall remained in the hospital for tests conducted by myself and other members of my staff from December 7, 1975 through December 18, 1975. During this time, Phospholine Iodide, pilocarpine, epinephrine and diamox (one drug from each family discussed in paragraph 8) were administered. None of these conventional drugs proved effective in controlling his IOP.
17. During this time Robert Randall’s eye pressure was observed to fluctuate from 15 to 36 mm.
18. I began experimenting with the effects of marijuana on the eye in 1970 as part of a larger government-authorized research program. These early experiments were intended to examine pupilary reaction and other ocular effects. These tests were conducted on 70 normal subjects. Most of the normal subjects showed a decrease in IOP which averaged 30%.
19. In 1974 my tests were expanded to include glaucoma patients, of whom 12 were tested. A majority of those tested showed a decrease in IOP. In 7 glaucoma patients there was a significant reduction of IOP.
20. In these tests both smoked marijuana and oral marijuana were used. The marijuana was furnished by the federal government through the National Institute for Drug Abuse.
21. Robert Randall was one of the twelve I tested. He remained hospitalized for these tests from December 7, 1975 to December 18, 1975.
22. Prior to my prescription of marijuana for Robert Randall, I thoroughly examined him as I described in paragraphs 13-15 and I unsuccessfully tried to reduce his elevated IOP with the conventional medications described in paragraph 16. As an additional prerequisite to admission to the program, Robert Randall was administered a standard test to assess personality traits. He also was interviewed by a staff psychiatrist. The purpose of the test and interview was to eliminate from the program persons with any significant psychopathology. After these preliminaries, Robert Randall was admitted to the program.
23. Beginning on December 9, 1975 Robert Randall was given a small dosage of marijuana. He received a similar dosage on December 10, 1975. A small dosage of oral THC was administered on December 11, 1975. On December 12, 1975 he was administered a large dosage of smoked marijuana. For the remainder of the test he was given large dosages of smoked marijuana.
24. The large dosages of smoked marijuana effectively reduced Robert Randall’s IOP into the safe range over an entire test day.
25. During my research, I have observed the following side effects of the use of marijuana: slightly accelerated heart rate, a minor effect on the respiratory system and a mild “high.” In addition, in some older patients without any experience in smoking marijuana, an occasional panic reaction results. The panic reaction is psychological and contributing factors, in addition to the marijuana induced high, probably include fear of the drug, fear of the disease, and the hospital environment. Such reactions were not observed in patients who were not marijuana-naive. These were the only side effects I discovered even in patients who continued to smoke marijuana for 90 days.
26. Robert Randall did not suffer any panic reaction to the drug.
27. My tests showed no indication that there is a tolerance effect on the eye pressure lowering phenomenon of marijuana.
28. At some point during these tests, Robert Randall explained his self-discovery of marijuana’s therapeutic effect and his self medication with the substance. He explained that his “halos” disappeared and that his blurred vision cleared some 30 minutes to an hour after smoking marijuana. “hHalos” are rings which form around lights in the vision of one whose IOP has increased above the safe range. Blurred vision also is a result of high IOP. The disappearance of “halos” and the clearing of blurred vision would indicate that high IOP was being reduced. Robert Randall’s explanation of self-treatment with marijuana was consistent with the results I discovered during my tests.
29. Based upon my general knowledge as a practicing neuro-ophthalmologist, my 7 years of research with marijuana, my 3 years of marijuana research concentrating particularly on its effects on glaucoma patients, and my examination and treatment of Robert Randall during December 1975, I have reached the following conclusions:
While abstaining from marijuana, and while being treated with conventional drugs, Robert Randall’s IOP has been observed to fluctuate between 15 and 36mm.
Robert Randall has lost central vision in his right eye and cannot stand much more damage to his left eye without also losing its central vision. The loss of central vision, in laymen’s terms, constitutes blindness.
It is not unusual for chronic open-angle glaucoma patients to develop tolerance to conventional medications used to reduce eye pressure. No conventional medication has been observed which can consistently lower Robert Randall’s eye pressure to a safe range during an entire day.
In Robert Randall’s case, marijuana in combination with conventional medications, lowers his eye pressure to within a safe range.
The safety risk (observed side-effects) of using marijuana to treat glaucoma appears to be no greater than risks associated with the more conventional medications, and is insignificant when compared with the certain result of allowing IOP to escalate uncontrolled.
The treatment of glaucoma patients, and particularly Robert Randall (because of his youth, loss of central vision in one eye and sharply fluctuating IOP), with known medications, including marijuana, may be preferable to surgery.
The only known alternative to preserve the sight of Robert Randall which avoids the significant risks of surgery is to include marijuana as part of his prescribed medical regimen.
If marijuana could be legally prescribed, and if I were Robert Randall’s personal physician, I would prescribe that drug for him as part of his regular glaucoma maintenance program.
