What Did the 1999 Institute of Medicine (IOM) Report Say Pro or Con Medical Marijuana?
General Reference (not clearly pro or con)
The Institute of Medicine stated in the Preface of its Mar. 1999 report titled "Marijuana and Medicine: Assessing the Science Base":
"In January 1997, the White House Office of National Drug Control Policy (ONDCP) asked the Institute of Medicine to conduct a review of the scientific evidence to asses the potential health benefits and risks of marijuana and its constituent cannabinoids. That review began in August 1997 and culminated in this report...
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... As a result, roughly equal numbers of persons and organizations opposed to and in favor of the medical use of marijuana were heard from."
"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.”
"[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)