Proc Assoc Am Physicians. 1999 Mar-Apr; 111(2): 159-65.

Making sense of medical marijuana.

Rosenthal MS, Kleber HD.

Phoenix House Foundation, New York, USA.

The case for marijuana's medical use is primarily from anecdotal clinical reports, human studies of delta-9-tetrahydrocannabinol, and animal studies on constituent compounds. The authors believe that while a key policy issue is to keep marijuana out of the hands of children, its use for medicinal purposes should be resolved by scientific research and Food and Drug Administration (FDA) review. Weighed against possible benefits are increased risks such as cancer, pulmonary problems, damage to the immune system, and unacceptable psychological effects. More study is needed to determine the efficacy of marijuana as an antiemetic for cancer patients, as an appetite stimulant for AIDS and cancer patients, as a treatment for neuropathic pain, and as an antispasmodic for multiple sclerosis patients. If this new research shows marijuana to have important medical uses, FDA approval could be sought. However, the better response is accelerated development of delivery systems other than smoking for key ingredients, as well as the identification of targeted molecules that deliver beneficial effects without intoxicating effects. If the National Institutes of Health conducts research on marijuana, we would propose parallel trials on those indications under careful controls making marijuana available to appropriate patients who fail to benefit from standard existing treatments. This effort would begin after efficacy trials and sunset no later than 5 years. If this open-trial mechanism is adopted, the compassion that Americans feel for seriously ill individuals would have an appropriate medical/scientific outlet and not need to rely on referenda that can confuse adolescents by disseminating misleading information about marijuana effects.