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Institute of Medicine

  




Index



A

Addiction, see Craving; Dependence; Tolerance; Withdrawal symptoms

Adjunctive therapy, general, 4, 10, 145, 153, 157, 167, 172, 247
     see also Pain, treatment of

Administration of drugs, see Drug delivery

Adolescents, 6, 15, 16, 90, 91, 96, 97, 98, 99, 101, 102, 104, 123, 126

Affinity, receptors, 42, 44, 46, 51
     defined, 42(footnote)

African Americans, 173

Age factors, 9, 16, 22, 92-93, 94, 95, 100, 117
     adolescents, 6, 15, 16, 90, 91, 96, 97, 98, 99, 101, 102, 104, 123, 126
     children, 96, 97, 101, 124-125, 139, 149, 167, 210
     clinical trials, 139, 142
     prenatal exposure, effects of, 124-125
     see also Elderly persons

Agonists, receptor, 34, 37, 38, 39, 43-47, 54, 56-57, 58, 64, 70
     glaucoma, 176-177
     listed, 44
     market considerations, 209, 210, 212
     neurological disorders, 166, 167, 168
     see also SR 141716A; SR 144528

AIDS, viii, 16, 18, 21, 22, 23, 107, 115-117, 120-121, 145, 178, 252

AIDS wasting, 4, 8, 23, 154-158, 159, 177, 204-205, 207, 209, 234, 246, 248
     clinical trials, 8, 156, 213, 245
     defined, 154
     individual patient account, 27-28
     smoking of marijuana, 27-28, 156

Alaska, vii, 17

Alcohol use and abuse, 6, 88, 90, 92, 95, 96, 97, 100, 101, 117, 254
     nausea and vomiting, 147

Alternative medicine, general, 19, 20, 180, 215, 216, 217-218, 254-255

Alzheimer's disease, 173, 204, 205, 209

American Medical Association, 180, 244-255 (passim)

Amotivational syndrome, see Motivation

Amphetamines, 21, 88, 240

Analgesia, see Pain, treatment of

Anandamide, 34, 41, 43-47, 48, 54, 194

Animal studies, 3, 35, 36-81, 88, 89, 91, 111, 120, 122-123, 125, 140, 145, 195, 199, 212, 246
     movement disorders, 164-165, 167, 170
     relevance of, general, 36

Anorexia, see Appetite; Wasting syndrome

Anorexia nervosa, 159

Antagonist, receptor, 34, 37, 39, 44, 55, 58, 70
     market considerations, 205, 210, 211
     nausea and vomiting, 151, 152-153

Antiemesis, see Vomiting

Antigens, 59, 64, 66, 120

Anxiety, 4, 10, 36, 84, 90, 109, 127, 142, 153, 165, 168, 203
     see also Dysphoria; Euphoria; Sedation

Appetite, viii, 3, 4, 10, 21, 23, 142, 144, 156-159 (passim), 173, 205, 209, 245, 248
     see also Nausea; Vomiting; Wasting syndrome

Arachidonic acid, 46, 47, 57

Arachidonyl glycerol (2-AG), 43, 45, 46, 47, 64, 65

Arizona, vii, 1, 17, 18, 104(footnote)

Arthritis, 28-29

Attitudes
     patients, 27-29, 153, 205-206
     physicians, prescribing marijuana, 152, 202
     risk perception, 104

B

Barbiturates, 143, 172

Basal ganglia, 48-52, 164-166, 168

B cells, 62, 64, 65, 66, 112
     see also Lymphocytes, general

Benzodiazepines, 3, 70, 161, 164, 168

Blood pressure
     hypertension, 48, 84, 86, 90, 121, 158, 175
     hypotension, 121, 150, 151, 175

Brain, general, 3, 35, 36-37, 48-49, 69, 70, 92, 170
     basal ganglia, 48-52, 164-166, 168
     cannabinoid receptors, 37-65, 69-70
     cerebellum, 46, 49, 50, 51, 53, 121, 122
     endogenous cannabinoid system, 43-51, 70
     globus pallidus, 49, 52, 53, 167
     hippocampus, 45-46, 49, 53
     putamen, 49, 52, 53, 166
     striatum, 46, 51, 53
     substantia nigra, 49, 51, 52, 53, 167, 168
     thalamus, 46, 49, 51, 52, 53, 55, 165, 167, 169
     see Neurons, general

British Medical Association, 180, 244-255 (passim)

Bronchi, 113-114, 115, 119

Buyers' clubs, see Cannibis buyers' clubs

C

Cachexia, 145, 154, 155, 158
     see also AIDS wasting; Appetite; Wasting syndrome

Caffeine, 88

California, vii, 1, 16, 17, 18, 101-102, 104, 204, 207

Canada, 150

Cancer
     smoking of marijuana as cause, 5, 114, 115, 117-121, 237
     treatment of, 22, 23, 142, 145, 154, 158, 159, 204-205; see also Chemotherapy

Cannabidiol (CBD), 3, 36-37, 47, 60-61, 66, 122, 166, 171-172, 214

Cannabinoids, general, vii, viii-ix, 2-4
     defined, 2, 25-26, 194
     defined substances, 4
     standards, general, 19, 213, 216, 217
     see also THC

Cannabinol, 25, 37, 64, 66, 110
     see also THC

Cannibis buyers' clubs, viii, 16, 20, 21, 22, 207
     defined, 20

Cardiovascular system, 121-122, 251
     see also Blood pressure

Case studies, 15, 27-29, 117, 119-120, 254
     individual patient accounts, 27-29
     single-patient clinical trials, 139, 162

CBD, see Cannabidiol

Cellular biology, 5, 25, 35-59, 69-70, 118-119, 120-121
     see also Genetics; Immune system; Receptors; Signal transduction

Cerebellum, 46, 49, 50, 51, 53, 121, 122

Cesamet, see Nabilone

Chemotherapy, viii, 4, 16, 23, 144, 146-153 (passim), 177, 205, 207, 234, 245, 247, 248

Children, 96, 97, 101, 124-125, 139, 149, 167, 210
     see also Adolescents

Chronic obstructive pulmonary disease, 114-115

Clinical studies, 15, 30, 34-35, 137, 206, 233-234
     glaucoma, 177, 251
     movement disorders, 166, 169-170
     smoking of marijuana, 9-10

Clinical trials, 7-8, 9-10, 34, 137, 141, 142-143, 203, 209, 211, 218
     age factors, 139, 142
     AIDS wasting, 8, 156, 213, 245
     animal studies vs, 36
     epilepsy, 170-172, 173
     Investigational New Drugs, 195, 196
     movement disorders, 167, 168
     nausea and vomiting, 7-8, 142, 145-154, 179, 245, 247
     pain, 7-8, 141-145, 179
     psychological effects, 5, 10, 109, 149
     recommendations, 4, 5, 7-8, 9-10, 178, 179-180, 215, 245-255 (passim)
     regulatory requirements, 195, 196, 200, 202, 208, 211, 213, 218, 256-257
     single-patient trials, 139, 162
     spasticity, 160-164, 165, 249
     standards for, 7-8, 10, 138-139, 179-180

Cocaine, 3, 20, 70, 88, 90, 95, 102, 240

Colorado, vii, 1

Codeine, 143, 241

Cognitive effects, 49, 83-84, 89, 105, 106-107, 108, 124-125
     disorientation, 4, 142, 203
     memory, 35, 49, 53, 56, 84, 89, 106, 144, 173, 212
     see also Psychological effects

Connecticut, 17

Controlled Substance Act, 16-17, 102, 198-204 (passim), 210, 213-219 (passim)
     scheduling, 17, 102, 194, 198-213 (passim), 216-217, 218, 240-241, 256-257

Convulsions, see Seizures

Cost factors, 9, 16, 206-207, 243
     antiemetics, 151, 152
     drug development, 195, 196, 203, 206, 217-218

CP 47,497, 210

CP 55,244, 210

CP 55,940, 44, 46, 56, 201

Craving, 9, 90, 91-92

CT-3, 67, 209

Cytokines, 62, 66, 67, 112, 120, 157

D

DEA, see Drug Enforcement Administration

Delivery modes, see Drug delivery

Department of Health and Human Services, 199, 200, 201, 217
     see also National Institutes of Health

Dependence, 6, 9, 57-59, 70, 84, 86, 237
     animal research, 35
     criteria, 87
     legal issues, 16
     marijuana as a gateway drug, 6-7, 9, 20-21, 98-101
     predictors of, 93-98, 99, 100, 101, 126
     see also Craving; Tolerance; Withdrawal symptoms

Depression, 22, 23, 29, 84, 95, 105, 155, 159
     fluoxetine, 48
     see also Dysphoria

Diagnostic and Statistical Manual of Mental Disorders, 84, 87

Diarrhea, 24, 155

District of Columbia, 17

Dizziness, 27, 121, 150, 158, 203

Dopamine, 58, 88, 92, 167, 168

Dosage factors, 137, 245, 248, 256
     affinity, 42(footnote)
     AIDS wasting, 156, 157, 158
     caffeine, 88
     cardiovascular effects, 121
     CBD, 36, 60-61
     cognitive effects, 107
     glaucoma treatment, 176, 177, 251
     immune system effects, 60-63, 64-67, 68
     morphine, 37
     multiple sclerosis treatment, 163
     neurological disorder treatment, 166, 169
     overdosing, 37, 109, 206
     pain treatment, 102, 142, 143, 149
     psychological effects, 84, 85, 105
     psychomotor effects, 51, 53, 85
     reproductive effects, 122, 125
     respiratory effects, 113
     THC, 88, 89, 91, 122, 142, 176, 203, 206, 215, 255
      anxiety, 36, 142, 149
      glaucoma treatment, 176, 177, 251
      pain treatment, 102, 142, 143, 149
      psychoactive doses, 85
      vomiting, 147, 154
     vomiting, 147, 151, 152, 154
     see also Dependence; Tolerance

Dronabinol, see Marinol

Drug Awareness Warning System, 102-103

Drug delivery, 7, 9, 151, 197, 199, 217, 239, 242, 245
     inhalation, 7, 9, 57, 94, 150, 154, 165, 175, 197, 203, 206, 215(footnote), 216, 242, 247, 251, 255; see Smoking, marijuana
     injection, 39, 54, 57, 66, 67, 68, 85, 88, 94, 100, 122, 150, 151, 152, 159, 174, 175, 203
     oral, 4, 9, 16, 57, 84, 89, 91, 121, 122, 142, 148-156 (passim), 163, 164, 165, 171, 174, 175, 202, 203, 205, 206, 207, 215, 242, 247, 249, 251
     suppositories, 206
     topical, 175, 176, 251

Drug Enforcement Administration (DEA), 137, 198-202, 203-204, 208, 213, 214, 217

Dysphoria, 5, 84, 126, 150, 159, 203
     see also Anxiety; Depression

Dystonia, 166, 168, 245, 250

E

Economic factors
     access and availability, general, 9, 194-198, 206-208, 213-214
     health insurance, 207
     malnutrition, 154, 155
     private investment, 178, 195-219
     public investment, 4, 137, 178, 211, 214, 218
     see also Cost factors

Efficacy, 9, 11, 14, 19, 20, 30, 54, 57, 88, 107, 108, 126, 144, 179, 217, 243, 256
     defined, 4-5
     regulatory requirements, 197, 212, 215
     see also Clinical studies; Clinical trials

Elderly persons, 21
     clinical trials, 139
     psychological effects, 4, 175

Emesis, see Vomiting

Emotional factors, see Psychological effects

Endorphins (endogenous opioids), 35, 43

Epidemiological Catchment Area Program, 97

Epilepsy, 29, 170-173, 177, 245, 250-251

Euphoria, 5, 16, 83-84, 85, 87, 88, 89, 92, 108, 144, 150, 203

Eye diseases, see Glaucoma

F

Federal government, 194-202
     see also Department of Health and Human Services; Drug Enforcement Administration; Food and Drug Administration; Legal issues and legislation; Public investment

Fluoxetine, 48

Food and Drug Administration, 17, 20, 137, 138, 149, 156, 194-198, 199, 200, 202-203, 204, 205, 208, 209, 213, 215, 216, 217, 257

Food and Drug Administration Modernization Act, 197(footnote)

Food, Drug, and Cosmetic Act, 194, 213, 215, 256

Foreign countries, see International perspectives; specific countries

France, 69

Funding, see Public investment

G

Gamma-aminobutyric acid (GABA), 50

Gateway theory, 6-7, 9, 20-21, 98-101

Gender factors, 20, 22, 94, 95, 115, 170-171

Genetics, 5, 38, 42, 69, 118-119, 120
     dependence, 94, 97-98
     drug development, 19-20
     gene regulation, 37, 38
     reproductive system effects, 122-125
     transduction, 37, 38, 40-41, 43, 57; see also Agonists, receptor
     see also Cellular biology; Receptor binding; Receptors

Glaucoma, 9, 22, 24, 173-177, 234, 251-252
     agonists, receptor, 176-177
     dose effects, 176, 177, 251
     intraocular pressure, 175, 176, 251-252
     smoking of marijuana, 174, 175, 177, 251

Globus pallidus, 49, 52, 53, 167

H

Hallucinations, 84, 90, 106

Headaches, 151
     see also Migraine headaches

Health insurance, 207

Heart, see Cardiovascular system

Herbal medicine, general, see Alternative medicine, general

Heroin, 88, 90, 92, 95, 99, 100, 240

Hippocampus, 45-46, 49, 53

Hispanics, 94-95

Historical perspectives, 118
     antiemetics, 151
     legal issues, 16-18
     medicinal uses of marijuana, 16-19
     research on marijuana, 33-34, 244-255

HIV, see AIDS

Hormones, 37, 48, 58-59, 66, 122, 123, 155, 157

HortaPharm, 214-215, 218

HU-210/HU-211, 44, 60, 64, 66, 67, 176, 201, 209, 211, 250

Huntington's disease, 49, 166, 198

Hyperalgesia, 54, 56, 141

Hypertension, 48, 84, 86, 90, 121, 158, 175

Hypotension, 121, 150, 151, 175

I

Immune system, 5, 37, 42, 51, 59-68, 70, 109-111, 112-113, 116-117, 120, 156, 158, 212, 233, 236, 245, 248, 252
     antigens, 59, 64, 66, 120
     cytokines, 62, 66, 67, 112, 120, 157
     dose effects, 60-63, 64-67, 68
     infections, 66-67, 112-113, 155, 236
     inflammatory/antiinflammatory effects, 67-68, 112-113, 142, 155, 209
     leukocytes, 59, 62, 64, 109-111, 120
     lymphocytes, general, 59, 62, 64, 112, 118, 155
      B cells, 62, 64, 65, 66, 112
      T cells, 59, 62, 64-65, 66, 112
     macrophages, 66, 112-113, 121
     multiple sclerosis, 160
     see also AIDS

Inactivation, 36, 46, 47, 48, 212

Infections, 66-67, 112-113, 155, 236
     see also AIDS; Receptors

Inflammatory/antiinflammatory effects, 67-68, 112-113, 142, 155, 209

Information dissemination, see Public information

Insurance, see Health insurance

International perspectives, 180, 244-255
     exporter of marijuana for research, 214-215, 218
     marijuana laws, 103-104
     seizure treatment, 171
     Single Convention on Narcotic Drugs, 217
     see also specific countries

Internet, viii, 16, 245

Intraocular pressure, see Glaucoma

Investigational New Drug applications (FDA), 195, 196, 198, 206, 213

Israel, 209

L

Legal issues and legislation, 14, 16-18, 86, 126, 206-207, 215-216
     Controlled Substance Act, 16-17, 102, 198-204 (passim), 210, 213-219 (passim)
      scheduling, 17, 102, 194, 198-213 (passim), 216-217, 218, 240-241, 256-257
     Food and Drug Administration Modernization Act, 197(footnote)
     Food, Drug, and Cosmetic Act, 194, 213, 215, 256
     foreign/international, 103-104, 217
     Marijuana Tax Act, 16
     National Organization for the Reform of Marijuana Legislation, 17, 18, 200, 213
     Orphan Drug Act, 198, 205, 211
     patent law, 208-210
     Prescription Drug User Fee Act, 195
     referenda, vii, 1, 17, 18
     Single Convention on Narcotic Drugs, 217
     state legislation, 17, 18, 102-103, 200, 206-207
     see also Regulatory issues

Lethargy, see Motivation

Leukocytes, 59, 62, 64, 109-111, 120

Levonantradol, 44, 57, 142, 148, 149, 210

Ligands, 37, 39, 40-41, 42, 45, 53, 64, 194
     see also Agonists, receptor; Antagonist, receptor; Receptor binding

Lipophilic substances, 25, 39, 175, 206

Louisiana, 17

LSD, 240

Lungs, 5, 111-115, 117, 118, 119, 126, 236, 253

Lymphocytes, general, 59, 64, 112, 118, 155
     B cells, 64, 65, 66, 112
     T cells, 59, 64-65, 66, 112

M

Macrophages, 66, 112-113, 121

Malnutrition, see Appetite; Nutrition

Marijuana, general
     active constituents, 36-37
     defined, 2, 24-25
     prevalence of use, 92-93, 137

Marijuana and Health, 2, 33

Marijuana Tax Act, 16

Marinol (dronabinol), 16, 44, 137, 149, 156, 158, 173, 194, 195, 240, 248
     development of, 193-194, 195, 197, 202-208, 210, 211, 216, 218

Medical Use of Cannabis, 244-245

Memory, 35, 49, 53, 56, 84, 89, 106, 144, 212
     Alzheimer's disease, 173

Men, see Gender factors

Metabolic processes, 36-37, 65, 110, 203
     starvation, 154-155

Methadone, 92, 240

Methodology
     drug development, 19-20, 137, 193-219, 238-239, 255; see also Drug Enforcement Administration; Food and Drug Administration
      costs of, 195, 196, 203, 206, 217-218
     other research, 20-22, 24, 119-121, 162, 163, 213-214
      recommendations by non-committee organizations, 244-257
     psychological research, 104-105
     study at hand, 15-16, 225-243
     see also Case studies; Clinical studies; Clinical trials

Migraine headaches, 22, 23, 143-144, 209, 213

Minority groups, see Racial/ethnic factors

Mood effects, 21, 69, 84, 89, 92, 99, 105, 108, 143, 144, 153, 154, 161, 165, 248
     see also Anxiety; Depression; Dysphoria; Euphoria; Sedation

Morphine, 37, 41, 55, 240

Motivation, 58, 105, 107-108, 158, 168, 237, 254

Motor effects, see Movement disorders; Psychomotor effects

Movement disorders, 4, 160, 165-170, 177, 233, 245, 249-250
     animal studies, 164-165, 167, 170
     Parkinson's disease, 49, 167, 168, 198, 209
     seizures, 22, 29, 90, 170-173, 177, 245, 250-251
     Tourette's syndrome, 167-168
     see also Basal ganglia; Psychomotor performance; Spasticity

Mucositis, 144

Multiple sclerosis, 9, 22, 23, 143, 160-161, 162, 163, 170, 198, 209, 245
     individual patient account, 28

Muscle spasticity, see Spasticity

N

Nabilone, 44, 148, 149, 161, 162, 163, 174, 202, 246, 248, 249

Naloxone, 37, 92

National Cancer Institute, 202

National Household Survey on Drug Abuse, 104

National Institute of Drug Abuse, 213-214

National Institutes of Health, 178, 180, 194-195, 202, 213-214, 215, 244-255 (passim)

National Organization for the Reform of
      Marijuana Legislation, 17, 18, 200, 213

Nausea
     antagonist, receptors 151, 152-153
     clinical trials, 7-8, 142, 145-154, 245, 247
     opioids, 140
     palliation, 3, 4, 7-8, 9, 10, 16, 21, 23, 27, 29, 142, 144, 145-154, 159, 164, 202, 205, 207, 234, 245, 247, 248
     withdrawal symptoms, 6, 90, 127
     see also Appetite; Vomiting

Netherlands, 103-104, 180, 214, 244, 245, 246, 249-255 (passim)

Neurology and neurological disorders, 233, 234, 242, 245, 246, 251
     Alzheimer's disease, 173, 204
     dizziness, 27, 121, 150, 158, 203
     glaucoma, 173-176 (passim)
     seizures, 22, 29, 90, 170-173, 177, 245, 250-251
     see Brain; Movement disorders; Multiple sclerosis; Spasticity; Spinal cord

Neurons, general, 2, 37, 38, 46, 47, 48, 49-50, 53, 55, 167, 211

Neuroprotection, 47, 67, 70, 176, 209, 211

Neurotransmitters, 37, 38, 43, 48, 50, 53, 54, 88, 147, 168, 211
     dopamine, 58, 88, 92, 167, 168
     see also Endorphins; Gamma-aminobutyric acid; Serotonin

Nevada, vii, 1, 17

New drug applications (FDA), 195-197, 203, 215, 257

New Hampshire, 17

Nicotine, 3, 70, 88, 90, 92, 96, 97, 100
     see also Tobacco

Norway, 104

Nutrition, 154-156, 158
     anorexia nervosa, 159
     see also Appetite; Wasting syndrome

O

Office of National Drug Control Policy, vii, 1

Ohio, 17

Older persons, see Elderly persons

Opioids, 3, 35, 37, 43, 53, 54, 55, 58, 69, 70, 88, 92, 102, 233, 246
     heroin, 88, 90, 92, 95, 99, 100, 240
     morphine, 37, 41, 55, 240
     pain treatment, 140, 142

Oregon, vii, 1, 17

Orphan Drug Act, 198, 205, 211

P

Pain, treatment of, viii, 3, 4, 7, 9, 10, 11, 20-22, 23, 24, 28-29, 84, 159, 164, 210, 233, 234, 241, 245-247
     clinical trials, 7-8, 141-145, 179
     dose effects, 102, 142, 143, 149
     hyperalgesia, 54, 56, 141
     market for, 210, 212
     neurophysiology of, 35, 53-56, 70
     sedation, 5, 10, 109, 127, 140, 144, 145, 150, 161, 164, 168, 241
     standards of analgesic usefulness, general, 140-141
     usefulness of analgesics, general, 140-141

Pain, types of, 141-145, 166
     acute, 54, 67-68, 141-142
     chronic, 8, 21, 22, 23, 30, 53, 54, 67-68, 138, 142-143
     definitional issues, 139-140, 141
     depression, 22, 23, 29, 48, 84, 95, 105, 155, 159
     dysphoria, 5, 84, 126, 150, 159, 203
     inflammatory/antiinflammatory effects, 67-68, 112-113, 142, 155, 209
     surgical, 142, 145, 247
     withdrawal, 3, 6, 35, 58-59, 70, 84, 86, 87, 89-91, 127, 143-144

Paranoia, 84, 105

Parkinson's disease, 49, 167, 168, 198, 209
     see also Substantia nigra

Peer review, 9, 15

Performance, see Psychomotor performance

Pharmaceutical companies, see Private sector

Political and social factors, vii, 1, 2, 6-7, 13-15, 17-19, 92, 93, 94, 98, 99, 202, 234
     National Organization for the Reform of Marijuana Legislation, 17, 18, 200, 213
     see also Legal issues and legislation; Referenda

Polycyclic aromatic hydrocarbons, 117, 119

Potency, 41, 46, 214-215

Pregnancy, 122-125, 126, 139, 145

Prescription Drug User Fee Act, 195

Private sector, 178, 195-219

Prostaglandins, 44, 46, 176

Prozac, see Fluoxetine

Psychiatric disorders, see Schizophrenia

Psychological effects, 3, 4-5, 44, 54, 65, 83-92, 101, 104-109, 126, 233, 237, 253-254
     anorexia nervosa, 159
     anxiety, 4, 10, 36, 84, 90, 109, 127, 142, 153, 165, 168, 203
     clinical trials, 5, 10, 109, 149
     dependence predictors, 95-96, 99, 100, 101, 126
     depression, 22, 23, 29, 48, 84, 95, 105, 155, 159
     dose effects, 84, 85, 105
     DSM-IV, 84, 87
     dysphoria, 5, 84, 126, 150, 159, 203
     elderly patients, 4, 175
     euphoria, 5, 16, 83-84, 88, 92, 108, 150, 203
     hallucinations, 84, 90, 106
     mood disorders, general, 23, 24
     motivation, 58, 105, 107-108, 158, 168, 237, 254
     paranoia, 84, 105
     receptor physiology, 35
     schizophrenia, 105, 106, 159, 253
     seizures, impacts of, 172
     smoking of marijuana, 5-6, 10-11, 104-109
     withdrawal, 3, 6, 35, 58-59, 70, 84, 86, 87, 89-91, 127, 143-144
     see also Cognitive effects

Psychomotor performance, 5, 85, 89, 107, 108, 125-126, 254
     dizziness, 27, 121, 150, 158, 203
     dose effects, 51, 53, 85
     movement disorders
     physiology of, 35, 49, 51-53, 55
     see also Spasticity

Public information, viii, 101
     Internet, viii, 16, 245

Public investment, 4, 137, 178, 211, 214, 218

Putamen, 49, 52, 53, 166

R

Racial/ethnic factors, 94-95, 173

Receptor binding, 37, 39-45, 64, 194, 211
     affinity, 42, 44, 46, 51
     ligands, 37, 39, 40-41, 42, 45, 53, 64, 194
     potency, 41, 46
     see also Agonists, receptor; Antagonist, receptor

Receptors, 2, 3, 33, 34, 35, 37-65, 69-71, 86, 110, 144, 159, 169, 172, 176-177
     anandamide, 34, 41, 43-47, 48, 54, 194
     brain, 41, 49, 51-59
     immune system, 59-64
     nausea and vomiting, 146, 147, 152, 153
     serotonin, 48, 151, 152-153, 159, 205

Referenda, vii, 1, 17, 18

Regulatory issues, 14, 211, 213-218
     clinical trials, 195, 196, 200, 202, 208, 211, 213, 218, 256-257
     THC, 200-208, 214-215
     see also Drug Enforcement Administration; Food and Drug Administration; Legal issues and legislation; Standards

Reproductive system effects, 122-125, 126, 139, 145, 253

Research methodology, see Methodology

Respiratory system, 5-6, 10, 88, 113-115, 119-120, 127, 146, 236, 253
     see also Lungs

S

Scheduling, 17, 102, 194, 198-213 (passim), 216-217, 218, 240-241, 256-257

Schizophrenia, 105, 106, 159, 253

Sedation, 5, 10, 109, 127, 140, 144, 145, 150, 161, 164, 168, 241

Seizures, 22, 29, 90, 170-173, 177, 245, 250-251
     types of, 170

Serotonin, 48, 151, 152-153, 159, 205

Side effects, general, 9, 27, 28, 127, 138, 140, 151, 203, 243, 246
     marijuana use, 34, 145, 150, 152, 158, 161, 170, 172, 173, 177
     see also Anxiety; Chemotherapy; Memory; Nausea; Sedation; Vomiting

Signal transduction, 37, 38, 40-41, 43, 57
     see also Agonists, receptor; Cellular biology

Single Convention on Narcotic Drugs, 217

Sleep, 6, 27, 37, 49, 83, 90, 127, 160, 164, 165

Smoking, marijuana, 2, 4, 5, 7-8, 47, 83, 85, 91, 104, 111-127, 177-178, 216, 254-255
     AIDS wasting, 27-28, 156
     carcinogenic effects, 5, 114, 115, 117-121, 237
     defined, 2
     glaucoma, 174, 175, 177, 251
     individual patient accounts, 27-29
     movement disorders, 167
     physiological effects, 5-6, 10-11, 104-109
     spasticity, 161, 163
     tolerance, 57, 89
     vomiting, control of, 150, 152, 153, 154, 179, 247
     wasting syndrome, 27-28, 156, 159

Smoking, tobacco, see Tobacco

Social factors, see Political and social factors

Spasticity, 23, 24, 143, 169, 245, 249
     clinical trials, THC, 160-164, 165, 249
     multiple sclerosis, 9, 22, 23, 28, 143, 160-161, 162, 163, 198
     smoking of marijuana, 161, 163

Spinal cord, 49, 54, 55-56,
     injury, 23, 145, 159-160, 161, 163-164, 198, 245, 249

Spleen, 46, 59, 64, 66

SR 141716A, 34, 44, 57-58, 65, 69

SR 144528, 34, 44

Standards
     analgesic usefulness, general, 140-141
     cannabinoid drugs, 19, 213, 216, 217
     clinical trials, 7-8, 10, 138-139, 179-180
     DSM-IV, 84, 87

State-level action
     legislation, 17, 18, 102-103, 200, 206-207
     referenda, vii, 1, 17, 18
     see also specific states

Striatum, 46, 51, 53

Substantia nigra, 49, 51, 52, 53, 167, 168

T

Tardive dyskinesia, 166, 168

Taxes, 16

T cells, 59, 62, 64-65, 66, 112, 120
     see also Lymphocytes, general

Tetrahydrocannabinol, see Marinol; THC

Thalamus, 46, 49, 51, 52, 53, 55, 165, 167, 169

THC, viii, 2, 3, 4, 5, 10, 25, 26, 36-37, 39, 41, 71, 85, 88, 107, 109, 127, 177, 212, 234, 246, 247, 255
     analogues, 44
     Alzheimer's disease, 173
     cardiovascular system, 121-122
     dependence, 57-59
     dose effects, 88, 89, 91, 122, 142, 176, 203, 206, 215, 255
      anxiety, 36, 142, 149
      glaucoma treatment, 176, 177, 251
      pain treatment, 102, 142, 143, 149
      psychoactive doses, 85
      vomiting, 147, 154
     endogenous cannabinoids and, 43-48
     epilepsy, 170
     glaucoma, 174-175, 176-177, 251-252
     immune system, 59-68 (passim), 110, 117
     levonantradol, 44, 57, 142, 148, 149, 210
     Marinol (dronabinol), 16, 44, 137, 149, 156, 158, 173, 194, 195, 240, 248
      development of, 193-194, 195, 197, 202-208, 210, 211, 216, 218
     pain treatment, 7-8, 102, 141-145, 149, 179
     regulatory issues, 200-208, 214-215
     reproductive system effects, 122-125
     spasticity, clinical trials, 160-164, 165, 249
     tolerance, 56-57, 89, 121
     vomiting, clinical trials, 148-150, 153

Tobacco, viii, 5, 6, 95, 96, 97, 111-112, 113-114, 117, 118-119, 123
     see also Nicotine

Tolerance, 3, 56-57, 70, 84, 86, 88-89, 121, 126-127, 233, 237
     analgesics, usefulness of, 140
     defined, 86, 87
     smoking of marijuana, 57, 89
     THC, 56-57, 89, 121
     see also Dependence

Tourette's syndrome, 167-168

2-AG, see Arachidonyl glycerol

U

Unimed Pharmaceuticals, Inc., 202-205

United Kingdom, 180, 209, 211, 218, 244-255 (passim)

V

Vermont, 17

Virginia, 17

Vomiting, 3, 4, 10, 21, 23, 27, 29, 202, 205, 207, 210, 234, 248
     antagonists, receptors, 151, 152-153
     clinical trials, 7-8, 142, 145-154, 179, 245, 247
     cost of antiemetics, 151, 152
     dose effects, 147, 151, 152, 154
     drug delivery route, 148-154 (passim), 179, 247
     smoking of marijuana, 150, 152, 153, 154, 179, 247
     THC, 148-150, 153
     see also Nausea

W

Washington, D.C., see District of Columbia

Washington State, vii, 1, 17

Wasting syndrome, 9, 23, 24, 28-29, 144, 154-159, 234, 248
     Alzheimer's disease, 173
     definitions, 153-154
     smoking of marijuana, 27-28, 156, 159
     see also AIDS wasting; Appetite

WIN 55,212, 42, 44, 64, 65, 88

Wisconsin, 17

Withdrawal symptoms, 3, 6, 35, 58-59, 70, 84, 86, 89-91, 127, 143-144
     defined, 86, 87

Women, see Pregnancy; Reproductive system effects

World Health Organization, 244-255 (passim)

World Wide Web, see Internet



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