Washington ? People who smoke marijuana because their doctors recommend it to ease pain can be prosecuted for violating federal drug laws, the Supreme Court ruled Monday, overriding medical marijuana statutes in 10 states.

The court’s 6-3 decision was filled with sympathy for two seriously ill California women who brought the case, but the majority agreed that federal agents may arrest even sick people who use the drug as well as the people who grow pot for them.

Justice John Paul Stevens, an 85-year-old cancer survivor, said the court was not passing judgment on the potential medical benefits of marijuana, and he noted “the troubling facts” in the case. However, he said the Constitution allows federal regulation of homegrown marijuana as interstate commerce.

The Bush administration has taken a hard stand against state medical marijuana laws, but it was unclear how it would respond to the new prosecutorial power. Justice Department spokesman John Nowacki would not say whether prosecutors would pursue cases against individual users.

In a dissent, Justice Sandra Day O’Connor said the court’s “overreaching stifles an express choice by some states, concerned for the lives and liberties of their people, to regulate medical marijuana differently.”

The women who brought the case expressed defiance.

Cancer patient Christopher Campbell rests at his home in Portland, Ore. Campbell, who has a medical marijuana card, said Monday he would not cease using the drug to quell his pain and improve his appetite. Its not going to stop me, thats

“I’m just going to keep doing what I’m doing. I don’t really have a choice but to, because if I stop using cannabis, I would die,” said Angel Raich of Oakland, Calif., who suffers from ailments including scoliosis, a brain tumor, chronic nausea, fatigue and pain. She says she smokes marijuana every few hours.

Diane Monson, an accountant who lives near Oroville, Calif., has degenerative spine disease and grows her own marijuana plants. “I’m going to have to be prepared to be arrested,” she said.

State laws still stand

The ruling does not strike down California’s law, or similar ones in Alaska, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Vermont and Washington state. However, it may hurt efforts to pass laws in other states because the federal government’s prosecution authority trumps states’ wishes.

John Walters, director of national drug control policy, defended the government’s ban. “Science and research have not determined that smoking marijuana is safe or effective,” he said.

California’s law, passed by voters in 1996, allows people to grow, smoke or obtain marijuana for medical needs with a doctor’s recommendation. Monson and Raich contend that traditional medicines do not provide the relief that marijuana does.

California has been the battleground state for medical marijuana. In 2001, the Supreme Court ruled in a California case that the federal government could prosecute distributors despite their claim that the activity was protected by medical necessity.

Two years later the justices rejected a Bush administration appeal that sought power to punish doctors for recommending the drug to sick patients. That case, too, was from California.

California Atty. Gen. Bill Lockyer said Monday that “people shouldn’t panic … there aren’t going to be many changes.”

Local and state officers handle nearly all marijuana prosecutions and must still follow any state laws that protect patients.

“I think it would look bad if the federal government focused its prosecution authority on a sick person,” said Daniel Abrahamson, with the Drug Policy Alliance. “Individual patients growing for their own purposes have not been the targets of the federal authorities. We hope that it stays that way.”

Looking to Congress

Congress could be the next stop for the debate.

While there are other legal options for patients, Stevens wrote, “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.”

Still, even supporters say it is unlikely Congress would pass a law allowing physicians to prescribe marijuana.

O’Connor was joined in her dissent by two other states’ rights advocates: Chief Justice William H. Rehnquist and Justice Clarence Thomas. While conservatives may not necessarily support medical marijuana, they have pushed to broaden states’ rights in recent years.

O’Connor, who like Rehnquist has had cancer, said she would have opposed California’s medical marijuana law if she were a voter or a legislator. But she said the court was overreaching to endorse “making it a federal crime to grow small amounts of marijuana in one’s own home for one’s own medicinal use.”

Thomas said the ruling was so broad “the federal government may now regulate quilting bees, clothes drives and potluck suppers throughout the 50 states.”

The case was hatched when Monson’s backyard crop of six marijuana plants was seized by federal agents in 2002. She and Raich sued then-U.S. Attorney General John Ashcroft, asking for a court order letting them smoke, grow or obtain marijuana without fear of arrest, home raids or other intrusion by federal authorities.

They claimed protection under the Constitution, which says Congress may pass laws regulating a state’s economic activity so long as it involves “interstate commerce” that crosses state borders.

The case is Gonzales v. Raich, 03-1454.