Dr. Merritt
Thank you for sharing the full Affidavit of Dr. John C. Merritt, one of the most critical expert medical statements in the Randall v. United States case and in the early history of federally sanctioned medical cannabis use.
Here is a summary and analysis of the affidavit’s key elements, along with citations and footnotes suitable for inclusion in reports, legal arguments, or policy briefs.
Summary: Affidavit of Dr. John C. Merritt, M.D.
Filed in support of Robert C. Randall, U.S. District Court, 1978
✅ Credentials and Medical Authority
Dr. Merritt is a licensed, board-certified ophthalmologist educated at Howard University and trained at leading institutions including the University of Illinois and the Bascom Palmer Eye Institute. He served as Assistant Professor of Surgery at Howard University and later joined the University of North Carolina Hospital in Chapel Hill.
→ His credentials affirm his authority on glaucoma diagnosis and treatment.
👁️ Randall’s Diagnosis and Condition
Dr. Merritt began treating Robert Randall on September 9, 1976 and diagnosed him with chronic open-angle glaucoma, a condition characterized by elevated intraocular pressure (IOP) which, if uncontrolled, leads to permanent optic nerve damage and blindness.
Despite aggressive use of conventional glaucoma medications (Phospholine Iodide, Glaucon, and Diamox), Randall’s IOP could not be consistently maintained within a safe range of 10–20 mm Hg, and his vision was deteriorating.
“Treatment with conventional medications alone will not prevent Robert Randall’s blindness.” —¶5
🌿 Federal Approval and Cannabis Efficacy
In September 1976, Dr. Merritt obtained federal approval (IND from FDA; registration from DEA; marijuana supplied by NIDA) to investigate cannabis as a treatment for glaucoma. His findings:
Smoked marijuana combined with conventional drugs stabilized Randall’s IOP within safe limits.
No progression of optic nerve damage or visual field loss occurred during 14 months of cannabis therapy.
Randall used 8–10 marijuana cigarettes daily, with each containing .9g and ≥2% THC, alongside Glaucon and Phospholine Iodide.
“Marijuana… proved itself an effective therapeutic agent in this instance.” —¶8
⚖️ Government Interference and Ethical Concerns
Dr. Merritt criticizes the federal system’s bureaucratic and unethical interference, noting that:
Research controls disrupted effective doctor-patient treatment.
Agencies tried to eliminate Randall’s take-home supply.
Randall was pressured to sign a consent form agreeing to unknowingly receive a placebo, which posed a serious risk to his vision.
“The federal agencies… can assert themselves into the doctor-patient relationship to a medically unwise extent.” —¶7
🚫 Alternatives and Risk of Blindness
Surgical intervention, while an option, posed significant risks and should only be used as a last resort. According to Merritt:
Even a three-week disruption in Randall’s marijuana supply could lead to irreversible blindness.
Randall’s condition was stable but fragile, and continuation of cannabis therapy was medically necessary.
“In my opinion marijuana is… the only treatment… capable of maintaining his remaining sight.” —¶17
Key Takeaways
Dr. Merritt's affidavit is the most authoritative early medical validation of smoked cannabis as a treatment for glaucoma.
The federal government knowingly approved and supplied cannabis for a research program that it then obstructed.
Randall’s case demonstrated that marijuana was essential to prevent blindness, and that denial of access constituted medical harm.
This testimony helped establish the legal precedent for marijuana’s medical necessity defense in court.
Chapter 3
AFFIDAVIT OF JOHN C. MERRITT, M.D.
State of North Carolina
County of Orange ss.
I, John C.. Merritt, M.D., Robert Randall’s personal physician from September 9, 1976 until January 20, 1978, being duly sworn, hereby make oath that, to wit:
I am a licensed, board-certified ophthalmologist. I received my medical degree from Howard University College of Medicine. I completed my internship at the University of Illinois Hospitals, Chicago, Illinois and my residency in ophthalmology at the University of Illinois, Eye and Ear Infirmary, Chicago, Illinois. I received a one-year fellowship in Pediatric Ophthalmology at the Bascom Palmer Eye Institute of the University of Miami, Florida. Until January 1978 I was engaged in a private practice located at Howard University Hospital, Washington, D.C. and was an Assistant Professor in Surgery at the College of Medicine. I am now on the staff at the University of North Carolina Hospital, Chapel Hill, North Carolina.
On September 9, 1976 Robert Randall became my private patient. A thorough ocular examination showed that Robert Randall had chronic open-angle glaucoma. This disease is characterized by elevated intraocular pressure (IOP) which if uncontrolled results in damage to the optic nerve. IOP within a range of 10 to 20mm. is considered safe and should not cause damage to the optic nerve. The examination of Robert Randall revealed substantial damage to the optic disc of both eyes as a result of uncontrolled IOP. Visual field examination revealed a marked loss of sight in the right eye, particularly within the central field. Visual acuity (a measure of visual sharpness, ability to distinguish contours) has ranged from 20/200 (legally blind) to 20/60 depending on the patient's routine of conventional medication. Visual acuity in the left eye is correctable to 20/20, but with diminished peripheral vision.
For a period of two months, September to November 1976, I examined Robert Randall while he was on a routine of conventional glaucoma control medicines. These medications included: Phospholine Iodide at .06%, Glaucon at 2.0% and occasional use of Diamox. These drugs, even when employed at their highest permitted dosages, were not capable of reducing Robert Randall’s elevated IOP to within the safe range throughout the course of the day. These drugs, therefore, were ineffective in treating his disease. Treatment with conventional medications alone will not prevent Robert Randall’s blindness.
A number of the conventional medications which are normally used to treat glaucoma may cause a variety of troubling and potentially serious side effects.
Robert Robert provided me with a detailed medical history which included opinions of Dr. Fine of Washington, D.C. and controlled studies performed by Dr. Robert S. Hepler of the Jules Stein Eye Institute (UCLA) and Dr. Gary Diamond of the Wilmer Eye Institute (Johns Hopkins University Hospital). My findings, summarized below, were consistent with those of all three doctors:
Robert Randall has chronic open-angle glaucoma and this disease already has destroyed significant areas of his vision due to elevated IOP.
Conventional glaucoma medicines, even when deployed at very high dosages, are not effective in providing this patient with adequate relief.
A continued routine of conventional glaucoma drugs will result in marked progression in the disease and would eventually render the patient blind.
6. In September of 1976, I received permission from the federal government to conduct experimentation on whether marijuana would prove to be an effective therapeutic agent for the treatment of glaucoma. I received an Investigational Exemption for a New Drug (IND) from the Food and Drug Administration and was registered by the Drug Enforcement Administration. The National Institute on Drug Abuse exerted control over the research program and provided me with the marijuana for it.
7. Enrolling a patient in a program solely designed to research a drug is an ineffective, cumbersome and possibly dangerous means of providing the patient with a drug crucial to sight retention. Whether the doctor conducting the research views the person in question as a research subject or as a patient can, especially in this instance, be determinative of sight retention. In research, “control” of the subjects may be a premium consideration, such control may result in hospitalization for an extended period of time and the elimination of, or severe limitation on, take home supply of the drug. None of these “control” related considerations is necessary from the treatment perspective; in addition to being burdensome, in an unfunded program, the research subject must pay for hospitalization and doctor visits necessary only to further research, not patient treatment. Moreover, research with marijuana is tightly controlled by the federal government. The federal agencies involved in the control of such research can assert themselves into the doctor-patient relationship to a medically unwise extent. In Robert Randall’s situation the agencies on several occasions attempted to eliminate or substantially limit his take home supply of the drug. In addition the agencies conditioned his continued supply upon his signing of a consent form which required his consent to treatment with a placebo without his knowledge.
8. In November 1976, I placed Robert Randall on a routine of conventional medications and marijuana in smoked form. Marijuana in smoked form employed in combination with conventional medications proved itself an effective therapeutic agent in this instance. For fourteen months Robert Randall remained on this routine. Under the three primary criteria of glaucoma assessment this method of therapy showed itself valid and effective:
The patient’s elevated IOP is responsive to marijuana and has been held within a safe range by the routine described above.
Direct examination of the optic disc of both eyes revealed no progression of nerve head damage.
Visual field examinations conducted in October 1976, April 1977 and December 1977 are indistinct and reveal that no progression in sight loss has occurred during the 14 months marijuana was used in combination with conventional medications.
9. The results of my studies on other glaucoma patients confirm that marijuana is an effective and safe medication that reduces IOP to within safe levels.
10. Robert Randall’s need for marijuana has remained relatively stable throughout the year although seasonal fluctuations in dosages may occur.
11. Robert Randall requires between 8 and 10 marijuana cigarettes at .9 grams per cigarette with at least 2% delta-9 THC present, per day, employed in combination with two conventional drugs, Glaucon 2% and Phospholine Iodide .06%, both employed twice daily.
12. During the fourteen months of tests Robert Randall made weekly visits to my office for checkups. During this time, I observed no untoward physical effects of the drug. During this time I never witnessed him in a state of intoxication. The “high” associated with marijuana smoking does not appear to effect Mr. Randall in any significant way. He tolerates the drug well, displays no symptoms of adverse side effects, and is able to function in a normal manner while employing the substance.
13. Although surgery is an alternative method of controlling IOP, I advise against it in Robert Randall’s case, and believe that medicated control of IOP is to be preferred generally. Surgical techniques for the control of IOP are imprecise and would expose Robert Randall to significant risks. Complications related to glaucoma surgery may themselves produce blindness. Surgery is generally considered a last resort and is undertaken only when all medications have been proven ineffective when taken in maximum tolerable amounts.
14. The use of marijuana, in combination with conventional drugs (which are ineffective when employed alone), provides Robert Randall with important therapeutic relief and the use of marijuana has prevented the continued deterioration of his vision. Robert Randall’s condition, while fragile, is now stable. Considering his past medical history and the delicate state of his present ocular health, however, a disruption in his present medical management could generate severe and irreversible damage to his sight. The unavailability of the drug for as short a period as three weeks could cause permanent damage to his sight.
15. As long as adequate IOP control, optic disc and visual field stability are retained and no untoward side effects develop, a continuation of Robert Randall’s present medical routine, which includes marijuana, is warranted.
16. I left Washington, D.C. on January 20, 1978 to take a position at the University of North Carolina School of Medicine. Therefore, on that date, I concluded both my Washington based research and my physician-patient relationship with Robert Randall. As a result of the termination of this program, Robert Randall no longer has access to a legal supply of marijuana.
17. In my opinion marijuana is both a safe and an effective means of treating Robert Randall’s glaucoma, and is the only treatment (other than surgery, which because of attendant risks, should not be considered so long as marijuana is effective) capable of maintaining his remaining sight.
18. Any licensed or certified ophthalmologist would be able to administer and monitor Robert Randall’s use of marijuana in the context of a total course of glaucoma management.
19. If I were still Robert Randall’s personal physician, I would request this court allow me to prescribe marijuana as a vital component to his medical regimen designed to maintain his sight.
