Contents

Executive Summary, 1

1. Introduction, 13

How This Study Was Conducted, 15

Marijuana Today, 16

Marijuana and Medicine, 19

Who Uses Medical Marijuana? 20

Cannabis and the Cannabinoids, 24

Organization of the Report, 30

2. Cannabinoids and Animal Physiology, 33

Introduction, 33

Cannabinoid Receptors, 39

The Endogenous Cannabinoid System, 43

Sites of Action, 48

Cannabinoid Receptors and Brain Functions, 51

Chronic Effects of THC, 56

Cannabinoids and the Immune System, 59

Conclusions and Recommendations, 69

3. First, Do No Harm: Consequences of Marijuana Use and Abuse, 83

The Marijuana »High», 83

Drug Dynamics, 84

Marijuana Use and Dependence, 92

Link Between Medical Use and Drug Abuse, 101

Psychological Harms, 104

Physiological Harms: Tissue and Organ Damage, 109

Summary and Conclusions, 125

4. The Medical Value Of Marijuana and Related Substances, 137

Standards for Evaluating Clinical Trials, 138

Analgesia, 139

Nausea and Vomiting, 145

Wasting Syndrome and Appetite Stimulation, 154

Neurological Disorders, 159

Glaucoma, 173

Summary, 177

Other Reports on Marijuana as Medicine, 180

5. Development of Cannabinoid Drugs, 193

Federal Drug Development Policy, 194

Development and Marketing of Marinol, 202

Market Outlook for Cannabinoids, 208

Regulation of and Market Outlook for Marijuana, 213

Conclusions, 218

Appendixes

 A. Individuals and Organizations That Spoke or Wrote to the Institute of Medicine About Marijuana and Medicine, 225

B. Workshop Agendas, 232

C. Scheduling Definitions, 240

D. Statement of Task, 242

E. Recommendations Made in Recent Reports on the Medical Use of Marijuana, 244

F. Rescheduling Criteria, 256

Index, 259

(24 de setiembre de 2010)