Tài liệu Marijuana and Medicine: Assessing the Science Base ppt

LINK DOWNLOAD MIỄN PHÍ TÀI LIỆU "Tài liệu Marijuana and Medicine: Assessing the Science Base ppt": http://123doc.vn/document/1043336-tai-lieu-marijuana-and-medicine-assessing-the-science-base-ppt.htm

Consultant
MIRIAM DAVIS
Section Staff
CHARLES H. EVANS, JR., Head, Health Sciences Section
LINDA DEPUGH, Administrative Assistant
CARLOS GABRIEL, Financial Associate
iv
Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the Institute of Medicine in making
the published report as sound as possible and to ensure that the report
meets institutional standards for objectivity, evidence, and responsive-
ness to the study charge. The review comments and draft manuscript re-
main confidential to protect the integrity of the deliberative process. The
committee wishes to thank the following individuals for their participa-
tion in the review of this report:
JAMES C. ANTHONY, Johns Hopkins University
JACK D. BARCHAS, Cornell University Medical College
SUMNER H. BURSTEIN, University of Massachusetts Medical School
AVRAM GOLDSTEIN, Stanford University
LESTER GRINSPOON, Harvard Medical School
MILES HERKENHAM, National Institute of Mental Health, National
Institutes of Health, Bethesda, Maryland
HERBERT D. KLEBER, Columbia University
GEOFFREY M. LEVITT, Venable Attorneys at Law, Washington, D.C.
KENNETH P. MACKIE, University of Washington
RAPHAEL MECHOULAM, The Hebrew University of Jerusalem
CHARLES P. O’BRIEN, University of Pennsylvania
JUDITH G. RABKIN, Columbia University
v
vi REVIEWERS
ERIC G. VOTH, International Drug Strategy Institute, Topeka, Kansas
VIRGINIA V. WELDON, Washington University
While the individuals listed above provided constructive comments
and suggestions, it must be emphasized that responsibility for the final
content of this report rests entirely with the authoring committee and the
Institute of Medicine.
Preface
Public opinion on the medical value of marijuana has been
sharply divided. Some dismiss medical marijuana as a
hoax that exploits our natural compassion for the sick; oth-
ers claim it is a uniquely soothing medicine that has been
withheld from patients through regulations based on false
claims. Proponents of both views cite “scientific evidence”
to support their views and have expressed those views at
the ballot box in recent state elections. In January 1997, the
White House Office of National Drug Control Policy
(ONDCP) asked the Institute of Medicine to conduct a review of the scien-
tific evidence to assess the potential health benefits and risks of marijuana
and its constituent cannabinoids. That review began in August 1997 and
culminates with this report.
The ONDCP request came in the wake of state “medical marijuana”
initiatives. In November 1996, voters in California and Arizona passed
referenda designed to permit the use of marijuana as medicine. Although
Arizona’s referendum was invalidated five months later, the referenda
galvanized a national response. In November 1998, voters in six states
(Alaska, Arizona, Colorado, Nevada, Oregon, and Washington) passed
ballot initiatives in support of medical marijuana. (The Colorado vote will
not count, however, because after the vote was taken a court ruling deter-
mined there had not been enough valid signatures to place the initiative
on the ballot.)
vii
viii PREFACE
Information for this study was gathered through scientific workshops,
site visits to cannabis buyers’ clubs and HIV/AIDS clinics, analysis of the
relevant scientific literature, and extensive consultation with biomedical
and social scientists. The three 2-day workshops—in Irvine, California;
New Orleans, Louisiana; and Washington, D.C.—were open to the public
and included scientific presentations and individual reports, mostly from
patients and their families, about experiences with and perspectives on
the medical use of marijuana. Scientific experts in various fields were se-
lected to talk about the latest research on marijuana, cannabinoids, and
related topics. (Cannabinoids are drugs with actions similar to THC, the
primary psychoactive ingredient in marijuana.) In addition, advocates for
and against the medical use of marijuana were invited to present scien-
tific evidence in support of their positions. Finally, the Institute of Medi-
cine appointed a panel of nine experts to advise the study team on techni-
cal issues.
Public outreach included setting up a Web site that provided infor-
mation about the study and asked for input from the public. The Web site
was open for comment from November 1997 until November 1998. Some
130 organizations were invited to participate in the public workshops.
Many people in the organizations—particularly those opposed to the
medical use of marijuana—felt that a public forum was not conducive to
expressing their views; they were invited to communicate their opinions
(and reasons for holding them) by mail or telephone. As a result, roughly
equal numbers of persons and organizations opposed to and in favor of
the medical use of marijuana were heard from.
Advances in cannabinoid science over the past 16 years have given
rise to a wealth of new opportunities for the development of medically
useful cannabinoid-based drugs. The accumulated data suggest a variety
of indications, particularly for pain relief, antiemesis, and appetite stimu-
lation. For patients who suffer simultaneously from severe pain, nausea,
and appetite loss, such as those with AIDS or who are undergoing che-
motherapy, cannabinoid drugs might offer broad-spectrum relief not
found in any other single medication.
Marijuana is not a completely benign substance. It is a powerful drug
with a variety of effects. However, the harmful effects to individuals from
the perspective of possible medical use of marijuana are not necessarily
the same as the harmful physical effects of drug abuse.
Although marijuana smoke delivers THC and other cannabinoids to
the body, it also delivers harmful substances, including most of those
found in tobacco smoke. In addition, plants contain a variable mixture of
biologically active compounds and cannot be expected to provide a pre-
PREFACE ix
cisely defined drug effect. For those reasons, the report concludes that the
future of cannabinoid drugs lies not in smoked marijuana but in chemi-
cally defined drugs that act on the cannabinoid systems that are a natural
component of human physiology. Until such drugs can be developed and
made available for medical use, the report recommends interim solutions.
John A. Benson, Jr.
Stanley J. Watson, Jr.
Co-Principal Investigators

Acknowledgments
This report covers such a broad range of disciplines—
neuroscience, pharmacology, immunology, drug abuse,
drug laws, and a variety of medical specialties, including
neurology, oncology, infectious diseases, and ophthalmol-
ogy—that it would not have been complete without the
generous support of many people. Our goal in preparing
this report was to identify the solid ground of scientific
consensus and to steer clear of the muddy distractions of
opinions that are inconsistent with careful scientific analy-
sis. To this end we consulted extensively with experts in each of the disci-
plines covered in this report. We are deeply indebted to each of them.
Members of the Advisory Panel, selected because each is recognized as
among the most accomplished in their respective disciplines (see page iii),
provided guidance to the study team throughout the study—from helping
to lay the intellectual framework to reviewing early drafts of the report.
The following people wrote invaluable background papers for the re-
port: Steven R. Childers, Paul Consroe, Howard Fields, Richard J. Gralla,
Norbert Kaminski, Paul Kaufman, Thomas Klein, Donald Kotler, Richard
Musty, Clara Sanudo-Peña, C. Robert Schuster, Stephen Sidney, Donald
P. Tashkin, and J. Michael Walker. Others provided expert technical com-
mentary on draft sections of the report: Richard Bonnie, Keith Green,
Frederick Fraunfelder, Andrea Hohmann, John McAnulty, Craig Nichols,
John Nutt, and Robert Pandina. Still others responded to many inquiries,
provided expert counsel, or shared their unpublished data: Paul Consroe,
Geoffrey Levitt, Raphael Mechoulam, Richard Musty, David Pate, Roger
xi
xii ACKNOWLEDGMENTS
Pertwee, Clara Sanudo-Peña, Carl Soderstrom, J. Michael Walker, and
Scott Yarnell. Miriam Davis, consultant to the study team, provided ex-
cellent written material for the chapter on cannabinoid drug development.
The reviewers for the report (see page iv) provided extensive, con-
structive suggestions for improving the report. It was greatly enhanced
by their thoughtful attention. Many of these people assisted us through
many iterations of the report. All of them made contributions that were
essential to the strength of the report. At the same time, it must be empha-
sized that responsibility for the final content of report rests entirely with
the authors and the Institute of Medicine.
We would also like to thank the people who hosted our visits to their
organizations. They were unfailingly helpful and generous with their
time. Jeffrey Jones and members of the Oakland Cannabis Buyers’ Coop-
erative, Denis Peron of the San Francisco Cannabis Cultivators Club, Scott
Imler and staff at the Los Angeles Cannabis Resource Center, Victor
Hernandez and members of Californians Helping Alleviate Medical Prob-
lems (CHAMPS), Michael Weinstein of the AIDS Health Care Founda-
tion, and Marsha Bennett of the Louisiana State University Medical Cen-
ter. We also appreciate the many people who spoke at the public
workshops or wrote to share their views on the medical use of marijuana
(see Appendix A).
Jane Sanville, project officer for the study sponsor, was consistently
helpful during the many negotiations and discussion held throughout the
study process. Many Institute of Medicine staff members provided greatly
appreciated administrative, research, and intellectual support during the
study. Robert Cook-Deegan, Marilyn Field, Constance Pechura, Daniel
Quinn, and Michael Stoto provided thoughtful and insightful comments
on draft sections of the report. Others provided advice and consultation
on many other aspects of the study process: Clyde Behney, Susan Fourt,
Carolyn Fulco, Carlos Gabriel, Linda Kilroy, Catharyn Liverman, Dev
Mani, and Kathleen Stratton. As project assistant throughout the study,
Amelia Mathis was tireless, gracious, and reliable.
Deborah Yarnell’s contribution as research associate for this study was
outstanding. She organized site visits, researched and drafted technical
material for the report, and consulted extensively with relevant experts to
ensure the technical accuracy of the text. The quality of her contributions
throughout this study was exemplary.
Finally, the principal investigators on this study wish to personally
thank Janet Joy for her deep commitment to the science and shape of this
report. In addition, her help in integrating the entire data gathering and
information organization of this report was nothing short of essential. Her
knowledge of neurobiology, her sense of quality control, and her unflag-
ging spirit over the 18 months illuminated the subjects and were indis-
pensable to the study’s successful completion.
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
xiii