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Institute of Medicine (USA) accepts evidence of medical benefit but calls for more research, including raw or smoked marijuana for terminally ill.

In the USA, the Institute of Medicine recently published a detailed review of the scientific basis of therapeutic uses of cannabis (marijuana), following a commission from the White House Office of National Drug Control Policy (ONDCP). The report runs to over 200 pages plus appendices and references, reviewing relevant scientific papers published since 1975. Their report echoed the conclusions of the BMA and House of Lords, calling for more research and clinical trials to determine the efficacy and safety of standardised cannabinoid preparations including, but not limited to, THC. The Institute's conclusions and recommendations included:

"Cannabinoids (are) likely to have a natural role in pain modulation, control of movement and memory"

"The different cannabinoid receptor types found in the body appear to play different roles in normal human physiology. In addition, some effects of cannabinoids appear to be independent of those receptors. The variety of mechanisms through which cannabinoids can influence human physiology underlies the variety of potential therapeutic uses for drugs that might act selectively on different cannabinoid systems."

"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.

"Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems."

"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. In addition,psychological effects can complicate the interpretation of other aspects of the drug effect."

"Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trials."

"Present data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs, and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids."

"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:

  • failure of all approved medications to provide relief has been documented;

  • the symptoms can reasonably be expected to be relieved by rapid onset cannabinoid drugs;

  • such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness;

  • and 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."

'Until a non-smoked, rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as e-of-1 clinical trials, in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system, and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions.'

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