Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication?

There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience.

Marijuana As Medicine? provides patients--as well as the people who care for them--with a foundation for making decisions about their own health care. This empowering volume examines several key points, including:

• Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss.
• The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health.
• The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments.

Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients.

In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use.

Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and students--in short, anyone who wants to learn more about this important issue.

Contents

• THE NATIONAL ACADEMIES
• ACKNOWLEDGMENTS
• PREFACE
• I. MARIJUANA, MEDICINE, AND SCIENCE
  • 1. INTRODUCTION
  • 2. CAN MARIJUANA HELP?
    • A BRIEF HISTORY OF MEDICAL MARIJUANA
    • USERS' VIEWS
    • CANNABINOID SCIENCE
    • FOLLOWING LEADS FROM BASIC RESEARCH
  • 3. HOW HARMFUL IS MARIJUANA?
    • WHERE THERE'S SMOKE, THERE'S HARM
    • THE ROLE OF CANNABINOIDS
    • MARIJUANA ABUSE
    • THE PHYSIOLOGY OF USE AND ABUSE
    • MARIJUANA USE AND DEPENDENCE
    • PSYCHOLOGICAL HARMS
    • MEDICAL MARIJUANA: A DANGER TO SOCIETY?
    • WEIGHING MARIJUANA'S HARMS
• II. MEDICAL MARIJUANA AND DISEASE
  • 4. MARIJUANA AND PAIN
  • 5. MARIJUANA AND AIDS
    • NAUSEA AND VOMITING
    • AIDS WASTING SYNDROME
    • PAIN
    • EFFECTS ON MOOD
    • REDUCING MARIJUANA'S RISKS
  • 6. MARIJUANA AND CANCER
    • CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING
    • MALNUTRITION
    • HARDLY A MAGIC BULLET
  • 7. MARIJUANA AND MUSCLE SPASTICITY
    • MULTIPLE SCLEROSIS
    • TOWARD BETTER TREATMENTS
  • 8. MARIJUANA AND NEUROLOGICAL DISORDERS
    • MOVEMENT DISORDERS
    • EPILEPSY
    • ALZHEIMER'S DISEASE
  • 9. MARIJUANA AND GLAUCOMA
• III. MEDICAL MARIJUANA IN CONTEXT
  • 10. PHARMACEUTICALS FROM MARIJUANA
    • THE DRUG-APPROVAL PROCESS
    • SCHEDULING OF CONTROLLED SUBSTANCES
    • THE MARINOL STORY
    • PROSPECTS FOR NOVEL CANNABINOID MEDICATIONS
    • PROSPECTS FOR MEDICAL MARIJUANA USE
  • 11. LEGAL ISSUES
    • FROM MEDICINE TO ILLICIT DRUG
    • A MEDICAL NECESSITY?
    • MEDICAL MARIJUANA AND THE STATES' LAWS
    • RESEARCH AND REGULATION
  • 12. MARIJUANA'S MEDICAL FUTURE
    • THE IOM RECOMMENDATIONS
    • OTHER REPORTS ON MARIJUANA AS MEDICINE
    • INTO THE FUTURE

This book was supported by a grant to the Institute of Medicine by the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s), and the Robert Wood Johnson Foundation does not take responsibility for any statements or views expressed.

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 original report were chosen for their special competences and with regard for appropriate balance.

PRINCIPAL INVESTIGATORS AND ADVISORY PANEL FOR IOM REPORT: The following people served as principal investigators and advisors to the 1999 IOM report, Marijuana and Medicine: Assessing the Science Base, on which this book is based: JOHN A. BENSON, JR., co-Principal Investigator, Oregon Health Sciences University School of Medicine, Portland; STANLEY J. WATSON, JR., co-Principal Investigator, University of Michigan, Ann Arbor; STEVEN R. CHILDERS, Wake Forest University, Winston-Salem, North Carolina; J. RICHARD CROUT, Crout Consulting, Bethesda, Maryland; THOMAS J. CROWLEY, University of Colorado, Denver; JUDITH FEINBERG, University of Cincinnati Medical Center, Cincinnati, Ohio; HOWARD L. FIELDS, University of California in San Francisco; DOROTHY HATSUKAMI, University of Minnesota, Minneapolis; ERIC B. LARSON, University of Washington Medical Center, Seattle; BILLY R. MARTIN, Virginia Commonwealth University, Richmond; TIMOTHY VOLLMER, Yale School of Medicine, New Haven, Connecticut