What Did the 1999 Institute of Medicine (IOM) Report Say Pro or Con Medical Marijuana?

i. Quotes from the IOM report Marijuana and Medicine
ii. Quotes from other sources

I. Quotes from the IOM report Marijuana and Medicine: Assessing the Science Base

Pro medical marijuana Con medical marijuana
"Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harm associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications. Thus, the safety issues associated with marijuana do not preclude some medical uses."
Mar. 1999 IOM(pages 126-127)
"[S]moked marijuana, however, is a crude THC delivery system that also delivers harmful substances."
Mar. 1999 IOM (page 4)
"Until the development of rapid-onset antiemetic drug delivery systems, there will likely remain a subpopulation of patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis.
It is possible that the harmful effects of smoking marijuana for a limited period of time might be outweighed by the antiemetic benefits of marijuana, at least for patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis.
Such patients should be evaluated on a case-by-case basis and treated under close medical supervision."
Mar. 1999 IOM (page 154)
Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease."
Mar. 1999 IOM (page 6)
"The profile of cannabinoid drug effects suggests that they are promising for treating wasting syndrome in AIDS patients. Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana. Although some medications are more effective than marijuana for these problems, they are not equally effective in all patients.

A rapid-onset (that is, acting within minutes) delivery system should be developed and tested in such patients. Smoking marijuana is not recommended. The long-term harm caused by smoking marijuana makes it a poor drug delivery system, particularly for patients with chronic illnesses.

Terminal cancer patients pose different issues. For those patients the medical harm associated with smoking is of little consequence. For terminal patients suffering debilitating pain or nausea and for whom all indicated medications have failed to provide relief, the medical benefits of smoked marijuana might outweigh the harm."
Mar. 1999 IOM (page 159)
"Chronic marijuana smoking might lead to acute and chronic bronchitis and extensive microscopic abnormalities in the cell lining the bronchial passageways, some of which may be premalignant.

These respiratory symptoms are similar to those of tobacco smokers, and the combination of marijuana and tobacco smoking augments these effects."
Mar. 1999 IOM (page 115)
"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..."
*["in those patients who have not responded to standard approved therapy"].
* [The above bracketed and bolded words were suggested to ProCon.org on Feb. 26, 2002 by John A. Benson, Jr., MD, Co-Principal Investigator of the 1999 IOM report.]
Mar. 1999 IOM (page 179)
"The most compelling concerns regarding marijuana smoking in HIV/AIDS patients are the possible effects of marijuana on immunity.

Reports of opportunistic fungal and bacterial pneumonia in AIDS patients who used marijuana suggest that marijuana smoking either suppresses the immune system or exposes patients to an added burden of pathogens.

In summary, patients with preexisting immune deficits due to AIDS should be expected to be vulnerable to serious harm caused by smoking marijuana."
Mar. 1999 IOM (page 117)
"RECOMMENDATION: 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.”
Mar. 1999 IOM (page 179)
"[C]ellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer."
Mar. 1999 IOM (page 119)
"The different cannabinoid receptor types found in the body appear to play different roles in normal 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.
RECOMMENDATION: Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannbinoids appear to have different effects, cannabinoid research should include, but not be restricted to, effects attributable to THC alone.”
Mar. 1999 IOM (pages 70-71)
"High intraocular pressure (IOP) is a known risk factor for glaucoma and can, indeed, be reduced by cannabinoids and marijuana. However, the effect is too short-lived and requires too high doses, and there are too many side effects to recommend lifelong use in the treatment of glaucoma. The potential harmful effects of chronic marijuana smoking outweigh its modest benefits in the treatment of glaucoma."
Mar. 1999 IOM (pages 177)

II. Quotes from other sources

Pro medical marijuana Con medical marijuana
The Honorable Alex Kozinski, US Ninth Circuit Court Judge, in his Oct. 29, 2002 concurring opinion in Conant v. Walters [309 F. 3d 629 (9th Cir. 2002)]:

"The IOM Report found that marijuana can provide superior relief to patients who suffer these symptoms as a result of certain illnesses and disabilities, in particular metastic cancer, HIV/AIDS, multiple sclerosis (MS), spinal cord injuries and epilepsy, and those who suffer the same symptoms as side effects from the aggressive treatments for such conditions.

As a consequence, the IOM Report cautiously endorsed the medical use of marijuana."
Oct. 29, 2002 Alex Kozinski
Voth, MD, an internist in Topeka, KS, noted in a Apr. 1, 1999 editorial posted to the website of the Institute of Global Drug Policy:

"As one of the final reviewers of the Institute of Medicine evaluation of marijuana, and as a physician who has studied this issue for over twenty years, I am aggravated by the inaccurate portrayal of marijuana that the media has generally set forth.

The IOM summary should be seen as a victory for opponents of smoked marijuana. It supported research into naturally occurring or synthetic cannabinoids, but it also stated that any research using any form of THC should culminate in the development of non-smoked forms of THC...

Furthermore, the study should serve as a death knell for the ballot initiatives and state laws allowing the prescribing of marijuana to virtually any patient...

The IOM findings are consistent with previous evaluations by the American Medical Association and the National Institutes of Health. They are a long way from wide support for the use of marijuana. If anything, the headlines should say, 'Smoked marijuana as a medicine is dead.'"

Apr. 1, 1999 Eric Voth
Andrew Weil, MD, stated in a June 6, 2002 article published in the San Francisco Chronicle:

"The Institute of Medicine, in a report commissioned by the White House "drug czar," concluded in 1999 that there is convincing evidence of marijuana's value in relieving nausea, weight loss, and other symptoms caused by diseases such as AIDS, cancer and multiple sclerosis, as well as the harsh drugs often used to treat these conditions.

The institute concluded that for some patients the potential benefits clearly outweigh the risks, and that ways should be found to make marijuana available to them."
June 2, 2002 Andrew Weil
The National Multiple Sclerosis Society had this to say about the IOM Report:

"A report issued March 17, 1999 by the National Academy of Sciences/Institute of Medicine on the medical uses of marijuana, which was commissioned by the White House, concluded that smoked cannabis does not have a role in the treatment of MS.

However, there is the possibility that specific compounds derived from marijuana may possibly reduce some MS symptoms, particularly MS-related spasticity."
May 2001 National Multiple Sclerosis Society
Ethan Russo, MD, clinical neurologist, researcher and author, wrote ProCon.org on Dec. 31, 2002:

"Even the Institute of Medicine recognized the rationale behind smoked cannabis in terminal patients. Suitable alternative delivery systems are now available.

Smoking is a rapid and easily titrated form of cannabis delivery, but modern techniques such as vaporization, sublingual and nebulized cannabis-based medicine extracts offer other choices to the clinical cannabis patient without the risks of smoking."
Dec. 31, 2002 Ethan Russo
The US DEA stated in its Apr. 25, 2005 press release "Marijuana: The Myths Are Killing Us":
"In 1999 the Institute of Medicine (IOM) undertook a landmark study reviewing the alleged medical properties of marijuana. Advocates of so-called medical marijuana frequently tout this study, but the study's findings decisively undercut their arguments.

In truth, the IOM explicitly found that marijuana is not medicine and expressed concern about patients' smoking it because smoking is a harmful drug-delivery system.

The IOM further found that there was no scientific evidence that smoked marijuana had medical value, even for the chronically ill, and concluded that 'there is little future in smoked marijuana as a medically approved medication.'

In fact, the researchers who conducted the study could find no medical value to marijuana for virtually any ailment they examined, including the treatment of wasting syndrome in AIDS patients, movement disorders such as Parkinson's disease and epilepsy, or glaucoma.

The IOM found that THC (the primary psychoactive ingredient in marijuana) in smoked marijuana provides only temporary relief from intraocular pressure (IOP) associated with glaucoma and would have to be smoked eight to 10 times a day to achieve consistent results. And there exists another treatment for IOP, as the availability of medically approved once- or twice-a-day eye drops makes IOP control a reality for many patients and provides round-the-clock IOP reduction.

For two other conditions, nausea and pain, the report recommended against marijuana use, while suggesting further research in limited circumstances for THC but not smoked marijuana."
Apr. 25, 2005 DEA