The medical use of marijuana is surrounded by a cloud of social, political, and religious controversy, which obscures the facts that should be considered in the debate.

This book summarizes what we know about marijuana from evidence-based medicine--the harm it may do and the relief it may bring to patients. The book helps the reader understand not only what science has to say about medical marijuana but also the logic behind the scientific conclusions.

Marijuana and Medicine addresses the science base and the therapeutic effects of marijuana use for medical conditions such as glaucoma and multiple sclerosis. It covers marijuana's mechanism of action, acute and chronic effects on health and behavior, potential adverse effects, efficacy of different delivery systems, analysis of the data about marijuana as a gateway drug, and the prospects for developing cannabinoid drugs. The book evaluates how well marijuana meets accepted standards for medicine and considers the conclusions of other blue-ribbon panels.

Full of useful facts, this volume will be important to anyone interested in informed debate about the medical use of marijuana: advocates and opponents as well as policymakers, regulators, and health care providers.

Contents

• PRINCIPAL INVESTIGATORS AND ADVISORY PANEL
• Reviewers
• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • HOW THIS STUDY WAS CONDUCTED
  • MARIJUANA TODAY
  • MARIJUANA AND MEDICINE
  • WHO USES MEDICAL MARIJUANA?
  • CANNABIS AND THE CANNABINOIDS
  • ORGANIZATION OF THE REPORT
• 2. Cannabinoids and Animal Physiology
  • INTRODUCTION
  • CANNABINOID RECEPTORS
  • THE ENDOGENOUS CANNABINOID SYSTEM
  • SITES OF ACTION
  • CANNABINOID RECEPTORS AND BRAIN FUNCTIONS
  • CHRONIC EFFECTS OF THC
  • CANNABINOIDS AND THE IMMUNE SYSTEM
  • CONCLUSIONS AND RECOMMENDATIONS
• 3. First, Do No Harm: Consequences of Marijuana Use and Abuse
  • THE MARIJUANA “HIGH”
  • DRUG DYNAMICS
  • MARIJUANA USE AND DEPENDENCE
  • LINK BETWEEN MEDICAL USE AND DRUG ABUSE
  • PSYCHOLOGICAL HARMS
  • PHYSIOLOGICAL HARMS: TISSUE AND ORGAN DAMAGE
  • SUMMARY AND CONCLUSIONS
  • REFERENCES
• 4. The Medical Value of Marijuana and Related Substances
  • STANDARDS FOR EVALUATING CLINICAL TRIALS
  • ANALGESIA
  • NAUSEA AND VOMITING
  • WASTING SYNDROME AND APPETITE STIMULATION
  • NEUROLOGICAL DISORDERS
  • GLAUCOMA
  • OTHER REPORTS ON MARIJUANA AS MEDICINE
• 5. Development of Cannabinoid Drugs
  • FEDERAL DRUG DEVELOPMENT POLICY
  • DEVELOPMENT AND MARKETING OF MARINOL
  • MARKET OUTLOOK FOR CANNABINOIDS
  • REGULATION OF AND MARKET OUTLOOK FOR MARIJUANA
  • CONCLUSIONS
• Appendixes
  • APPENDIX A Individuals and Organizations That Spoke or Wrote to the Institute of Medicine About Marijuana and Medicine
  • APPENDIX B Workshop Agendas
  • APPENDIX C Scheduling Definitions
  • APPENDIX D Statement of Task
  • APPENDIX E Recommendations Made in Recent Reports on the Medical Use of Marijuana
  • APPENDIX F Rescheduling Criteria

This study was supported under Contract No. DC7C02 from the Executive Office of the President, Office of National Drug Control Policy.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The principal investigators responsible for the report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.