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Published Online: 20 March 2009

IOM Report Still Sets Standard on Medical Marijuana

Publication: Psychiatric News
Volume 44, Number 6
https://doi.org/10.1176/pn.44.6.0010a
In an area where ideology may sometimes trump evidence, the 10-year-old Institute of Medicine report titled “Marijuana and Medicine: Assessing the Science Base” still appears to be the clearest statement of scientific understanding about the therapeutic potential of marijuana. The report came to a number of conclusions, including the following:
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Cannabinoids likely have a natural role in pain modulation, control of movement, and memory. The natural role of cannabinoids in immune systems is likely multifaceted and remains unclear.
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The brain develops tolerance to cannabinoids.
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Animal research demonstrates the potential for dependence, but this potential is observed under a narrower range of conditions than with benzodiazepines, opiates, cocaine, or nicotine; withdrawal symptoms can be observed in animals but appear to be mild.
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Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances.
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The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria, can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others.
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Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease.
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A distinctive marijuana withdrawal syndrome has been identified, but it is mild and short-lived.
The report concluded that short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions:
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Failure of all approved medications to provide relief has been documented.
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The symptoms can reasonably be expected to be relieved by rapid-onset cannabinoid drugs.
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Such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness.
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Treatment involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use.
“Marijuana and Medicine: Assessing the Science” is available online for purchase at<www.iom.edu/?id=12668>.▪

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Psychiatric News
Volume 44 • Number 6 • March 20, 2009
Pages: 10

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Published online: 20 March 2009
Published in print: March 20, 2009

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