Introduction
On February 19 and 20, 1997, the National Institutes of Health (NIH) held a
meeting
concerning the potential medical uses of marijuana. Recent (November 1996)
ballot
initiatives in California and Arizona had sparked a public health and policy
debate on the
medical utility of marijuana and the desirability of allowing healthcare
providers to prescribe, and
patients to receive, marijuana for medicinal purposes.
For some years the principal psychoactive ingredient of marijuana,
delta-9-tetrahydrocannabinol
(9-THC), has been
available to healthcare providers in an oral form as dronabinol (trade name
Marinol) for the treatment of emesis associated with cancer chemotherapy and for
appetite stimulation
in the treatment of AIDS wasting syndrome. The current debate centers primarily
on the potential
for other treatment indications and the claims that, when smoked, marijuana
offers therapeutic
advantages over the currently available oral form. As the Federal Government's
principal biomedical
research agency, the NIH believed that the public debate could benefit from an
impartial examination
of all the data available to date concerning these issues. As the claims for
benefits were wide
ranging, 10 major components of the NIH participated in the planning for the
conference.
The NIH planning group focused the meeting on the following four questions
concerning
marijuana as a potential therapeutic agent:
Question 1 - What research has been done previously and what is
currently known about the
possible medical uses of marijuana?
Question 2 - What are the major unanswered scientific questions?
Question 3 - What are the diseases or conditions for which marijuana
might have potential as a
treatment and that merit further study?
Question 4 - What special issues have to be considered in conducting
clinical studies of the
therapeutic uses of marijuana?
The meeting was formatted as a scientific workshop. It was not an attempt to render a consensus. Therefore, it was structured so that speakers with experience in the relevant therapeutic areas would present to a group of eight expert consultants who possessed broad expertise in clinical studies and therapeutics and who had no public positions on the potential use of marijuana as a therapeutic agent. Each presentation was followed by a session for questions and answers from the Expert Group. The second day was allotted for the public to present their views and for discussion by the Expert Group. This report represents a compilation of the views of the Expert Group. Since this report was not intended as a general review of the literature on marijuana and THC, only a few selected references from among the thousands that exist are cited. Each of the members in the Expert Group chose those references relevant to their own contributions to the report.
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