SAN FRANCISCO – The U.S. Supreme Court on Tuesday refused to let the Justice Department punish doctors in California and other states for recommending marijuana to their ill patients.

The justices, in declining without comment to review a lower-court decision favoring the doctors, handed a major victory to medical-marijuana advocates in the nine states that allow patients to smoke pot with a doctor’s recommendation.

“My goodness, this is so incredible,” said California cancer patient Angel Raich, who smokes medical marijuana with a doctor’s recommendation every two hours that she is awake. “Hopefully, there’ll be more doctors now that will feel safer in recommending cannabis to patients that need it.”

The ruling was a setback for the Bush administration, which had sought to punish doctors who recommend marijuana – or who simply discuss the drug’s benefits – by revoking the all-important federal licenses they need to write prescriptions.

A ruling in favor of the federal government would have gutted the state marijuana laws, which generally depend on a patient’s ability to get a doctor’s recommendation. The nine states are Alaska, Arizona, California, Colorado, Hawaii, Maine, Nevada, Oregon and Washington.

Nevertheless, it is still illegal under federal law to grow, sell or possess marijuana, and federal prosecutors can still go after cultivators, dealers and users, just as they have done in raids on “cannabis clubs” and other locations in California over the past few years.

In fact, the U.S. Supreme Court ruled against medical marijuana clubs in 2001, declaring there is no medical exception to the federal law against marijuana.

Still, Dr. Frank Lucido of Berkeley, Raich’s physician, said the justices’ move Tuesday “takes some of the fear and intimidation factor out of doctors performing their practice.”

Even some supporters of these laws had expected the Supreme Court to step into the case. They said the court’s refusal to intervene could encourage other states to consider passing medical marijuana laws.

“It finally definitively puts to rest these federal threats against doctors and patients,” said Graham Boyd, an American Civil Liberties Union attorney representing patients, doctors and other groups in the case.

Patients with cancer, AIDS, glaucoma and other illnesses say marijuana relieves pain, stimulates appetite and wards off nausea.

The justices let stand a decision last October by the 9th U.S. Circuit Court of Appeals, which held that doctors have a constitutional right to speak candidly with their patients about marijuana.

“An integral component of the practice of medicine is the communication between doctor and a patient. Physicians must be able to speak frankly and openly to patients,” the 9th Circuit said at the time.

In their appeal, federal prosecutors argued that doctors who recommend marijuana are interfering with the drug war and circumventing the government’s judgment that the illegal drug has no medical benefit.

The conflict began after California voters passed the nation’s first medical marijuana law in 1996. The Clinton administration said doctors who recommended marijuana would lose their federal licenses to prescribe medicine, could be excluded from Medicare and Medicaid programs, and could face criminal charges if they help patients actually obtain marijuana.

Seven California doctors and some of their patients sued during the Clinton administration, and the Bush administration continued the fight.

The case pitted the First Amendment free-speech rights of doctors against government authority to discourage illegal drug use.

Some California doctors and patients, in court papers, compared doctor information on pot to physicians’ advice on “red wine to reduce the risk of heart disease, Vitamin C, acupuncture, or chicken soup.”

The administration argued that public heath – not free speech – was at stake.

“The provision of medical advice – whether it be that the patient take aspirin or Vitamin C, lose or gain weight, exercise or rest, smoke or refrain from smoking marijuana – is not pure speech. It is the conduct of the practice of medicine. As such, it is subject to reasonable regulation,” the administration said.