SAN FRANCISCO -- Marijuana probably can play a role as an analgesic, antiemetic, and appetite stimulant for patients suffering Simultaneously from pain, nausea, and appetite loss, Dr. John A. Benson said at a conference on cannabis therapy sponsored by the University of California, San Francisco.
Typically these patients are getting chemotherapy or have AIDS and haven't found relief from any other single agent, said Dr. Benson, professor of medicine and dean emeritus at Oregon Health Sciences University Portland.
But smoked marijuana delivers many of the same harmful substances to the lungs as are in tobacco smoke, and some patients become dependent on smoked marijuana.
An oral synthetic cannabinoid, dronabinol (Marinol) is available by prescription, but its efficacy can be limited in patients with vomiting.
Dr. Benson based his comments on conclusions of an Institute of Medicine panel he cochaired on the medicinal use of cannabinoids, the active ingredients in marijuana. Some of the conclusions in its 1999 report are:
* Cannabinoids may have a natural role in pain modulation, movement control, and memory.
* In cancer patients, the analgesic effectiveness of 10-15 mg of THC (tetrahydrocannabinol, the main psychoactive ingredient) is comparable to 60 mg of codeine.
* Cannabinoids use a different receptor system than opioids to provide analgesia, so adjunctive synergistic therapy is possibile.
* Marijuana used to treat pain should be targeted to chemotherapy patients; patients with postoperative pain (using an opioid adjunct); and patients with spinal cord injury peripheral neuropathic pain, or central poststroke pain. Those with chronic pain and insomnia or patients who have AIDS and neuropathy should also be targeted.
* Oral THC is comparable to Compazine but less effective than metoclopramide in treating chemotherapy-induced vomiting. Marijuana is poorly tolerated as an antiemetic by one-fourth of patients. Antiemesis with oral serotonin receptor antagonists plus dexamethasone taken an hour before chemotherapy works better.
* Cannabinoids don't restore lean body mass in patients with AIDS wasting syndrome but might be useful adjunctive therapy for stimulating appetite and reducing nausea, vomiting, pain, and anxiety.
* The IOM panel was not impressed by claims that cannabinoids can treat glaucoma. The drug reduces intraocular pressure, but the effect lasts 3 hours or less.
* "The lung cancer risks worry us," Dr. Benson said. Chronic marijuana smoking has the same risks as cigarette smoking. Other adverse effects are within the range tolerated for other medications. Driving after smoking is discouraged due to diminished psychomotor performance.
* Troubled adolescents and those with psychiatric disorders are at greatest risk for marijuana dependence.
Among 46% of the U.S. population that has tried marijuana, 9% ever became dependent. That's lower than dependency rates among people who have tried tobacco (32%), alcohol (15%), cocaine (17%), or heroin (23%), and comparable with dependency among anxiolytics (9%).
* Existing data suggest that sanctioning the medical use of marijuana will not increase use among the general population, as feared, he added.
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