INDEX

A

Addiction

clinical studies, 47-48

craving, 52, 53, 54

epidemiological studies, 47-48, 54, 57-58

gateway theory, 5, 62-65, 67-68

mental illness, 61

tolerance, 11, 48, 49, 50, 52-53, 78

withdrawal, 11, 41, 48, 49, 51-54

see also Dependence

Adolescents, 51-52, 54, 65, 66

attitudes, 66-67

dependence, 56

gateway theory, 63

peer pressure, 54, 55, 63

Africa, 15

African Americans, 56

glaucoma, 125

Age factors, 11

AIDS, 86

cellular biology of, 90

clinical trials, 74

elderly persons, 45, 74, 95, 125

gateway theory, 63

glaucoma, 124-125

prevalence of marijuana use, 54, 56, 73

side effects of medication, general, 19-21

smoking of marijuana by patients, 90, 93, 161, 185

see also Adolescents;

Children

AIDS, 3, 4, 5, 7, 10, 19-20, 43, 44-45, 86-94, 160, 164, 176-177, 185

age factors, 86

clinical studies, 75, 84, 87-94, 134, 135, 178-179

Marinol, 88, 89-90, 91, 92, 134, 135, 145

AIDS wasting, 8, 87-88, 101, 150, 166, 185

clinical studies, 84, 89-90, 93, 171

Marinol, 27, 144, 145, 147

patients' views, 19-21

smoking of marijuana, 90, 93, 161, 185

THC, 108, 109, 111-113

Alaska, 4, 164

Alcohol use, 39, 56, 58, 60, 61

gateway theory, 62-63, 64



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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy INDEX A Addiction clinical studies, 47-48 craving, 52, 53, 54 epidemiological studies, 47-48, 54, 57-58 gateway theory, 5, 62-65, 67-68 mental illness, 61 tolerance, 11, 48, 49, 50, 52-53, 78 withdrawal, 11, 41, 48, 49, 51-54 see also Dependence Adolescents, 51-52, 54, 65, 66 attitudes, 66-67 dependence, 56 gateway theory, 63 peer pressure, 54, 55, 63 Africa, 15 African Americans, 56 glaucoma, 125 Age factors, 11 AIDS, 86 cellular biology of, 90 clinical trials, 74 elderly persons, 45, 74, 95, 125 gateway theory, 63 glaucoma, 124-125 prevalence of marijuana use, 54, 56, 73 side effects of medication, general, 19-21 smoking of marijuana by patients, 90, 93, 161, 185 see also Adolescents; Children AIDS, 3, 4, 5, 7, 10, 19-20, 43, 44-45, 86-94, 160, 164, 176-177, 185 age factors, 86 clinical studies, 75, 84, 87-94, 134, 135, 178-179 Marinol, 88, 89-90, 91, 92, 134, 135, 145 AIDS wasting, 8, 87-88, 101, 150, 166, 185 clinical studies, 84, 89-90, 93, 171 Marinol, 27, 144, 145, 147 patients' views, 19-21 smoking of marijuana, 90, 93, 161, 185 THC, 108, 109, 111-113 Alaska, 4, 164 Alcohol use, 39, 56, 58, 60, 61 gateway theory, 62-63, 64

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy Alternative medicine, general, 11 historical perspectives, 13-14, 24 Alzheimer's disease, 121-122, 145, 150 American Medical Association, 17, 158, 178-179, 180 Amotivational syndrome, 60-61, 178-179 Anandamide, 29, 35, 141 Animal studies, 13, 53, 150 cannabinoids, general, 43-44 carcinogenic effects of smoking marijuana, 42-43 dystonia, 117 historical perspectives, 15-16 Huntington's disease, 117 immune system, 35, 44 muscle spasticity/multiple sclerosis, 35, 107, 110, 112 pain palliation, 33, 51, 79 psychomotor behavior, 31 in regulatory process, 134, 136 reproductive system, 45-46 smoking of marijuana, 42-43, 51 tolerance, 50-51 withdrawal, 52 Anorexia, see Appetite; Wasting syndrome Antioxidants, 31, 151 Anxiety, 11, 24, 58, 61, 62, 96, 113, 174, 183 clinical trials, 74, 84, 87, 91, 92, 93, 109, 119, 143 THC, 108, 109, 111-113 tobacco smokers, 41 withdrawal, 52 Appetite, 174 Alzheimer's disease, 122, 145 cancer and, 101-102 clinical studies, 75, 93, 176 megestrol acetate, 89, 101-102 patients' views, 20, 23, 96 withdrawal, 51 see also AIDS wasting Arizona, 4, 164 Attitudes adolescents, 66-67 amotivational syndrome, 60-61, 178-179 illegality of marijuana, 24-25, 42 parental, 55 patients, 19-25, 87, 95-96, 100, 103-104, 108-109, 164 peer pressure, 54, 55, 63 physicians, 21 public opinion, 24-25, 42, 62, 149 users of marijuana, general, 19, 54; see also “patients” supra B Bakalar, James, 19, 74-75 Birth weight, 38, 46 Black persons, see African Americans Brain, 59-60, 96-97, 115-116, 118 Alzheimer's disease, 121-122 cannabinoid receptors, 28, 31, 32, 51, 77-78, 83, 98, 107, 109, 117-118, 131-132, 152, 176, 181 Marinol, 143 serotonin, 29, 88, 98, 100 cognitive functions, general, 47, 59-60, 92, 119, 143; see also Psychological effects; “memory” infra craving, 53, 54 epilepsy, 120-121, 134 headaches, 19, 22, 23, 77, 83, 164 pain, general, 77-78 memory, 31, 32-33, 50, 51, 59, 61, 84, 119, 121-122, 152, 176 multiple sclerosis, 107 muscle spasticity, 107 reward system, 53 Britain, see United Kingdom Bronchi, 40-41 Buyers' clubs, see Cannabis buyers' clubs

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy C Cachexia, see AIDS wasting; Appetite; Wasting syndrome California, 4, 19, 65, 66-67, 86, 93, 95, 147, 164-169 Canada, 6, 113, 116, 171-172 Cancer, 91, 95-105, 164 animal studies, 42-43 appetite of patients, 101-102 clinical studies, 42, 81, 82, 84, 98-102, 134, 164, 171 National Cancer Institute, 136, 144 pain palliation, 81, 82, 95-96, 98 prostate cancer, 42, 101 smoking of marijuana as cause, 38, 41-43, 47, 67, 153-154, 183 smoking of marijuana as palliative, 95-96, 98 smoking of tobacco as cause, 41 THC, 81, 82, 91, 96, 98-102 treatment of, 3, 4, 7, 8, 10, 164; see also Chemotherapy wasting syndrome, 101-102, 171 Cannabidiol, 27, 31, 151 epilepsy, 121 Huntington's disease, 117 Cannabinoids, general, 8-9, 10, 25-31, 103, 142, 174, 175, 181-183 animal studies, 43-44 cellular processes, 27-36, 131; see also Receptors and receptor binding clinical trials, 43-44, 175, 178-179 glaucoma, 124, 127, 128 immune system, 28, 34-35, 43, 44, 176 nervous system, 28, 29, 30, 31-34, 119-120, 121, 122 novel medications, 148-153 pain, 79, 83-84, 176, 181-182 reproductive system, 44, 45-46 side effects, 24, 25, 28, 67 see also Drug delivery; Marinol; THC Cannabis buyers' clubs, xii, Carcinogens, 41, 183 Cardiovascular system, 44, 45, 47, 127-128 hypertension, 11, 48, 102 withdrawal, 52 Case studies (single-patient trials), 74, 93, 95, 107, 109, 177 Cellular biology, 13, 17, 25, 27-36, 42, 43-45, 131 AIDS wasting, 90 glaucoma, 124 multiple sclerosis, 107 smoking effects, 40-41, 42-45 THC, 28, 29, 30, 181 see also Genetics; Immune system; Receptors and receptor binding Centers for Disease Control and Prevention, 88 Cesamet, see Nabilone Chemotherapy, 8, 95-101, 102 clinical studies, 75, 97-101, 164 Marinol, 27, 88, 144, 145, 147 patients' views, 19, 21-22 Children clinical trials, 47 gateway theory, 63 peer pressure, 54, 55, 63 see also Adolescents China, 14, 17 Chronic obstructive pulmonary disease, 41 Clinical studies, 6, 13, 24, 25, 73-128 (passim), addiction, 47-48 age factors, 74 AIDS, 75, 84, 87-94, 134, 135, 178-179 AIDS wasting, 84, 89-90, 93, 171 Alzheimer's disease, 122

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy anxiety, 74, 84, 87, 91, 92, 93, 109, 119, 143 appetite, 75, 93, 176 barriers to, 24-25, 42, 73, 169-171 cancer, chemotherapy, 75, 97-101, 164 cancer, marijuana as cause, 42 cancer, other, 81, 82, 84, 134, 171 cannabinoids, general, 43-44, 175, 178-179 children, cognitive function, 47, 74 cognitive effects, 47, 60 dependence, 56, 134 dosage factors, 84, 135 dystonia, 116-117 epilepsy, 121, 134, 178-179 federal government, general, 24-25 Food and Drug Administration, 134, 143-144, 152, 179 funding, 24-25, 73, 93, 134, 143-144, 171 glaucoma, 24, 127, 135, 171 Marinol, 88, 89-90, 91, 122, 143-145 muscle spasticity/multiple sclerosis, 24, 83, 107, 108-113, 119, 171, 178-179, 183-184 nausea, 24, 33-34, 73-74, 75, 87-88, 93, 97, 104, 164, 176, 178-179 neuropathy, general, 24, 83, 107, 108-113, 115, 117, 119-122, 178-179 pain, 24, 36, 75, 79-85, 93, 102-104, 171, 176, 178-179, 184 placebo effects, 74, 108-109 psychological effects, 24 regulatory process, 24-25, 42, 73, 134-138, 141, 169-171 respiratory effects, 39, 40 single-patient trials, 74, 93, 95, 107, 109, 177 smoking of marijuana, 39, 40, 42, 80, 83, 85, 90, 93, 161, 171, 178-179, 180, 183 smoking of tobacco, 40 state sponsorship, 19, 24-25, 73, 160, 163-164 THC, 74, 75, 79-83, 88, 89-90, 91, 98-101, 108-113, 117, 119, 122, 127, 128, 143-145, 151; see also “Marinol” supra tolerance, 50 Tourette's syndrome, 119 vomiting, 33-34, 87-88, 97-101, 104, 176, 178-179 wasting, 24, 178-179; see also “AIDS wasting” supra withdrawal, 51-52 Cocaine, 5, 8, 39, 53, 61, 64, 140 Codeine, 17, 65, 79, 82-83, 141, 158 Cognitive effects, 59-60, 92, 119, 143 children of marijuana smokers, 47 clinical trials, 47, 60 see also Memory; Psychological effects Colorado, 4 Compassionate Use Program, 4, 23, 124, 160, 164, 170 Comprehensive Drug Abuse Prevention and Control Act, 158 Controlled Substances Act, 18-19, 65, 138-139, 140-141, 149, 151, 158-159, 163, 169, 184 Cost factors, see Economic factors Craving, 52, 53, 54 CT-3, 150 D Delivery modes, see Drug delivery Department of Health and Human Services, 54, 139, 169, 170 Centers for Disease Control and Prevention, 88

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy National Cancer Institute, 136, 144 National Institute on Drug Abuse, 160, 170-171 National Institutes of Health, general, 134, 160, 169, 170, 171, 178-179 Public Health Service, 160 see also Food and Drug Administration Dependence, 11, 47-48, 49, 54-58, 91, 140, 141 clinical studies, 56, 134 drug delivery methods and, 146-147 gateway theory, 64 see also Addiction; Craving; Tolerance; Withdrawal Depression, 59, 87, 91 Alzheimer's disease, 122 gateway theory, antidepressants, 64 patients' views, 19, 20 withdrawal, 52 Dermal delivery of drugs, 146 Dexanabinol, see HU-211 Diagnostic and Statistical Manual of Mental Disorders, Diarrhea, 14, 16, 20 Diet, see Appetite District of Columbia, 4, 164, 166 Dosage factors, 11, 12, 31, 34, 51, 53, 58-59, 176 clinical studies, 84, 135 overdoses, 50 see also Tolerance Dronabinol, see Marinol Drug delivery, 11-12, 146-147, 148, 161, 162, 169, 174, 179 dependence and, 146-147 dermal, 146 inhalation, 11, 12, 92-93, 101, 103, 113, 127, 137, 143, 146, 153-154, 157, 176, 179, 183-184; see also Smoking of marijuana; Tobacco injection, 51, 80-81, 116, 143 oral, 11, 12, 92, 146, 176; see also Marinol; THC Drug Enforcement Administration, 133, 139, 140, 142, 144, 145, 154, 159 Dysphoria, 24, 59, 67 see also Anxiety; Depression; Paranoia Dystonias, 116-117 E Economic factors cannabinoid-based drug development, 131, 133-155 health insurance, 147 Marinol, 134-135, 137, 140-141, 142-148, 149, 150, 152 Orphan Drug Act, 138, 144, 149 patents, 149, 151, 152, 154 see also Funding Elderly persons, 45, 74, 95, 125 Emotional factors, see Psychological effects Epidemiological Catchment Area Program, 57-58 Epidemiological studies, xii addiction, 47-48, 54, 57-58 amotivational syndrome, 61 gateway theory, 63-64 reproductive effects, 46 smoking, effects of, 39 Epilepsy, 120-121, 134 clinical trials, 121, 134, 178-179 Euphoria, 50, 53, 58, 59, 84, 91, 176 Europe, 15, 17, 116, 154 France, 150 Netherlands, 65, 66, 151, 152, 154 United Kingdom, 10, 143, 150, 151, 178-179, 180, 183-184 Eye diseases, see Glaucoma

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy F Federal government, 4, 156-157 clinical studies, 24-25 Drug Enforcement Administration, 133, 139, 140, 142, 144, 145, 154, 159 see also Department of Health and Human Services; Food and Drug Administration; Funding; Legal issues and legislation Fertility, 46 Food and Drug Administration (FDA), 4, 133, 134-138, 140, 152, 153-153, 169 clinical trials, 134, 143-144, 152, 179 Investigational new drug applications (INDs), 134, 136, 138, 144, 146, 153, 171 Marinol, 8, 88, 142, 143-146, 159, 176 New drug applications (NDAs), 135-137, 153 Food, Drug, and Cosmetic Act, 134 Foreign countries, see International perspectives; specific countries France, 150 Funding clinical studies, 24-25, 73, 93, 134, 143-144, 171 Orphan Drug Act, 138, 144, 149 G Gateway theory, 5, 62-65, 67-68 Gender factors dependence, 55-56 epilepsy, 121 see also Pregnancy Genetics, 43, 56-57 see also Cellular biology; Immune system; Receptors and receptor binding Glaucoma, 3, 4, 7, 23, 124-128, 135, 159-160 African Americans, 125 age factors, 124-125 clinical trials, 24, 127, 135, 171 Great Britain, see United Kingdom Grinspoon, Lester, 19, 74-75 H Hallucinations, 59, 61, 118 Headaches, 19, 22, 23, 77, 83, 164 Health insurance, 147, 149 Herbal medicine, general, see Alternative medicine, general Heroin, 5, 8, 17, 28, 50, 51, 64, 140 Historical perspectives, 6-7, 9-10, 13-19, 60, 131-132 alternative medicine, general, 13-14, 24 drug delivery, 11-12 glaucoma, 124, 128 legalization, 65-67 Marinol, 144-147 pain relievers, 15, 16, 17-18, 151-152 see also Legal issues and legislation HIV, see AIDS HU-211, 128, 150, 151 Huntington's disease, 32, 116, 117-118, 138 Hypertension, 11, 48, 102 I Immune system, 178-179 animal studies, 35, 44 cannabinoids, general, 28, 34-35, 43, 44, 176 inflammation, 35, 149, 150 multiple sclerosis, 107

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy smoking of marijuana, 35, 44-45, 92 THC, 34, 44 see also AIDS; Infections India, 14, 16 INDs, see Investigational new drug applications Infections, 35, 43, 44 history of marijuana, 14 see also AIDS; Immune system Inflammation, 35, 149, 150 Inhalation, drug delivery, 11, 12, 92-93, 101, 103, 113, 127, 137, 143, 146, 153-154, 157, 176, 179, 183-184 see also Smoking of marijuana; Tobacco Injection, drug delivery, 51, 80-81, 116, 143 Insurance, see Health insurance Intellectual property, see Patents International perspectives, 86 Canada, 6, 113, 116, 171-172 Europe, general, 15, 17, 116, 154 France, 150 gateway theory, 65 historical, 14-16, 65, 66 legalization, 66 multiple sclerosis, 113 Netherlands, 65, 66, 151, 152, 154 United Kingdom, 10, 143, 150, 151, 178-179, 180, 183-184 United Nations Single Convention on Narcotic Drugs, 169-170 World Health Organization, 178-179 Internet, state legislation, 163 Investigational new drug applications (INDs), 134, 136, 138, 153, 171 Marinol, 144, 146 L Legal issues and legislation, 8, 17, 48, 62, 65, 68, 131, 156-172 Cannabis buyers' clubs, xii, Compassionate Use Program, 4, 23, 124, 160, 164, 170 Comprehensive Drug Abuse Prevention and Control Act, 158 Controlled Substances Act, 18-19, 65, 138-139, 140-141, 149, 151, 158-159, 163, 169, 184 Food, Drug, and Cosmetic Act, 134 gateway theory, 64 litigation, 4, 137, 159-160, 161-163, 165, 166, 168 Marijuana Tax Act, 17, 158 National Organization for the Reform of Marijuana Legislation (NORML) , 19, 142, 158-159, 163 Netherlands, 65, 66, 154, 180 Orphan Drug Act, 138, 144, 149 religious prohibitions, 15 research barriers, 24-25, 42, 73, 169-171 state legislation, xi, state litigation, 4, 137, 159-160, 161-163, 165, 166, 168 state referenda, 19, 66-67, 95, 131, 164-165, 169 see also Regulatory issues Levonantradol, 80-81, 98, 100 Litigation, 4, 137, 159-160, 161-163, 165, 166, 168 LSD, 8, 19, 140 Lungs, 38-39, 41-42, 43, 44-45, 67

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy M Maine, 4 Malnutrition, see Appetite; Wasting syndrome Marihuana: The Forbidden Medicine, Marijuana and Medicine: Assessing the Science Base, Marijuana Policy Project, 163, 165-166 Marijuana Tax Act, 17, 157-158 Marinol (dronabinol), 8, 12, 27, 91, 92, 157, 176 AIDS patients, 88, 89-90, 91, 92, 134, 135, 145 AIDS wasting, 27, 144, 145, 147 Alzheimer's disease, 122 chemotherapy and, 27, 88, 144, 145, 147 clinical studies, 88, 89-90, 91, 122, 143-145 economics of, 134-135, 137, 140-141, 142-148, 149, 150, 152 Food and Drug Administration, 8, 88, 142, 143-146, 159, 176 historical perspectives, 144-147 multiple sclerosis, 146 nausea and vomiting, 27, 88, 89-90, 144, 145, 147 patients' views, 21 regulatory issues, 134-135, 137, 140-141, 142-148, 149, 150, 152, 159 Mass media, 6 Megestrol acetate, 89, 101-102 Memory, 31, 32-33, 50, 51, 59, 61, 84, 119, 152, 176 Alzheimer's disease, 121-122 Men, see Gender factors Mental illness, 61, 64 see also Psychological effects Methadone, 53, 140 Methodology basic research, 13 other research, 7 study at hand, xi-xii, see also Animal studies; Case studies (single-patient trials); Clinical studies Migraine, see Headaches Monitoring the Future, 65 Mood effects, 50, 54, 59, 91-92, 102, 112, 145 see also Anxiety; Depression; Dysphoria; Euphoria; Sedation Mortality, 43 Motivation, amotivational syndrome, 60-61, 178-179 Movement disorders, see Psychomotor performance; Spasticity Multiple sclerosis, 3, 4, 10, 86, 106, 107-113, 150 animal studies, 35, 107, 110, 112 clinical studies, 24, 83, 107, 108-113, 119, 171, 178-179, 183-184 Marinol, 146 pain, 106, 107-108, 112 patients' views, 19, 23 THC, 108, 109, 111-113 Muscle spasticity, see Spasticity N Nabilone, 98, 100, 109, 111, 112-113, 142-143, 180 National Cancer Institute, 136, 144 National Comorbidity Survey, 57-58 National Institute on Drug Abuse, 160, 170-171 National Institutes of Health, 134, 160, 169, 170, 171, 178-179 National Organization for the Reform of Marijuana Legislation (NORML) , 19, 142, 158-159, 163 Nausea, 25, 78 neurology, cellular processes, 31, 32, 33-34, 96, 97

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy palliation, 10, 62, 78, 87, 96, 174, 177, 182, 185 clinical studies, 24, 33-34, 73-74, 75, 87-88, 93, 97, 104, 164, 176, 178-179 Marinol, 27, 88, 89-90, 144, 145, 147 patients' views, 19-20, 21-23, 87 THC, 33-34, 82, 88, 98-101, 102 withdrawal, 52 see also Appetite; Vomiting Netherlands, 65, 66, 154, 180, 183 Neurology and neurological disorders, 7, 20, 31-34, 115-122, 149, 150, 151 Alzheimer's disease, 121-122, 145, 150 antioxidants, 31, 151 cannabinoids, general, 28, 29, 30, 31-34, 119-120, 121, 122 clinical trials, 24, 83, 107, 108-113, 115, 117, 119-122, 178-179 epilepsy, 120-121, 134, 178-179 Huntington's disease, 32, 116, 117-118, 138 memory, 31, 32-33, 50, 51, 59, 61, 84, 119, 121-122, 152, 176 nausea and vomiting, 31, 32, 33-34, 96, 97 neurotransmitters and receptors, 28, 29, 30, 118-119 antioxidants, 31, 151 serotonin, 29, 88, 98, 100 Parkinson's disease, 32, 116, 118, 138, 150 seizures, 4, 120-121 spinal cord, 4, 31, 33, 75, 84, 106, 107, 112, 150, 178-179 Tourette's syndrome, 116, 118-119 see also Brain; Cognitive effects; Multiple sclerosis; Pain; Psychomotor performance Nevada, 4-5, 164 New drug applications (NDAs), 135-137, 153 Nicotine, 36, 41, 48, 53, 54, 63, 146 see also Tobacco NORML, see National Organization for the Reform of Marijuana Legislation Norway, 66 Nutrition, see Appetite; Wasting syndrome O Office of National Drug Control Policy, xi, Opiates, 17-18, 28, 33, 36, 78, 84, 184 codeine, 17, 65, 79, 82-83, 141, 158 gateway theory, 64, 65 heroin, 5, 8, 17, 28, 50, 51, 64, 140 Oral drug delivery, 11, 12, 92, 146, 176; see also Marinol; THC Oregon, 4, 5, 164, 166 Orphan Drug Act, 138, 144, 149 P PAHs, see Polycyclic aromatic hydrocarbons Pain, 4, 10, 11, 25, 77-85, 90-91, 96, 150, 174, 176, 177 animal studies, 33, 51, 79 brain, 77-78 cancer, 81, 82, 95-96, 98 cannabinoids, general, 79, 83-84, 176, 181-182 cellular processes, 28, 31, 33, 51 clinical studies, 24, 36, 75, 79-85, 93, 102-104, 171, 176, 178-179, 184 gateway theory, 64, 65 headaches, 19, 22, 23, 77, 83, 164 historical perspectives, 15, 16, 17-18, 151-152

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy inflammation, 35 Marinol, 143 multiple sclerosis, 106, 107-108, 112 opiates, 17-18 patients' views, 19-20, 22, 23, 95-96 smoking of marijuana, 22, 23, 80, 83, 85, 91, 161, 177 spinal cord injuries, 106, 107, 112 surgical, 17, 78-79, 80-81, 84 THC, 79-83, 91, 181 see also Nausea Paranoia, 24, 59 Parkinson's disease, 32, 116, 118, 138, 150 Patents, 149, 151, 152, 154 Peer pressure, 54, 55, 63 Placebo effect, 74, 108-109 Political and social factors, 7, 38, 62-67, 156 dependence, 49, 54 legalization of use, xi, Marijuana Policy Project, 163, 165-166 market forces, 149 mass media, 6 National Organization for the Reform of Marijuana Legislation (NORML) , 19, 142, 158-159, 163 peer pressure, 54, 55, 63 public opinion, 24-25, 42, 62, 149 religion, perceptions of marijuana, 14, 15, 16 see also Legal issues and legislation Polycyclic aromatic hydrocarbons, 41-42 Pregnancy, 38, 43, 44, 46, 47, 67, 74 birth weight, 38, 46 Prostate cancer, 42, 101 Psychological effects, 3, 5, 38, 50, 54, 58-62, 89, 91, 100, 113, 127, 143, 174 amotivational syndrome, 60-61, 178-179 dysphoria, 24, 59, 67; see also Anxiety; Depression euphoria, 50, 53, 58, 59, 84, 91, 176 gateway theory, 64, 65 hallucinations, 59, 61, 118 marijuana psychosis, 61 mood effects, 50, 54, 59, 91-92, 102, 112, 145; see also Anxiety; Depression; Dysphoria; Euphoria paranoia, 24, 59 placebo effects, 74, 108-109 psychiatric disorders, general, 56, 61, 64, 67 schizophrenia, 61, 178-179 sedation, 58, 78, 81, 82, 84, 112, 116, 174, 176 withdrawal, 11, 41, 48, 49, 51-54 Psychomotor performance, 31-32, 51, 59, 60, 62, 67, 107, 115-120, 176 dystonias, 116-117 Huntington's disease, 32, 116, 117-118, 138 Parkinson's disease, 32, 116, 118, 138, 150 Tourette's syndrome, 116, 118-119 see also Multiple sclerosis; Spasticity Public Health Service, 160 Public opinion, 24-25, 42, 62, 149 R Race/ethnicity, 56 glaucoma, 124-125 Receptors and receptor binding, 27-34, 36, 51, 77-78, 83, 98, 107, 109, 117-118, 131-132, 152, 176, 181 Marinol, 143

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy neurotransmitters and receptors, 28, 29, 30, 118-119 antioxidants, 31, 151 serotonin, 29, 88, 98, 100 Regulatory issues, 68, 134-154 animal studies, 134, 136 clinical trials, 24-25, 42, 73, 134-138, 141, 169-171 Investigational new drug applications (FDA), 134, 136, 138, 144, 146, 153, 171 Marinol, 134-135, 137, 140-141, 142-148, 149, 150, 152, 159 New drug applications (FDA), 135-137, 153 research barriers, 24-25, 42, 73, 169-171 side effects, 143, 149 THC, 139-140, 142, 151; see also “Marinol” supra see also Drug Enforcement Administration; Food and Drug Administration; Legal issues and legislation; Standards Religious factors, 14, 15, 16 Reproductive system effects, 44, 45-46 birth weight, 38, 46 pregnancy, 38, 43, 44, 46, 47, 67, 74 prostate cancer, 42, 101 THC, 45-46 Research methodology, see Methodology Respiratory system, 42, 47, 174, 183 bronchi, 40-41 chronic obstructive pulmonary disease, 41 clinical studies, 39, 40 lungs, 38-39, 41-42, 43, 44-45, 67 see also Smoking of marijuana; Tobacco S Schizophrenia, 61, 178-179 Sedation, 58, 78, 81, 82, 84, 112, 116, 174, 176 Seizures, 4, 120-121 Serotonin, 29, 88, 98, 100 Side effects, general, 10, 11, 24, 117, 118, 120, 184 age factors, 19-21 AIDS medication, 19-21 cannabinoids, general, 24, 25, 28, 67 regulatory issues, 143, 149 smoking, immediate adverse reactions, 24, 43, 92, 164 THC, 59, 60, 81-82, 92, 101, 143 see also Anxiety; Chemotherapy; Memory; Nausea; Psychological effects; Sedation; Vomiting Sleep, 14, 51, 104, 106, 108, 112, 113, 143 Smoking of marijuana, xii, adverse reactions, immediate, 24, 43, 92, 164 age factors, patients, 90, 93, 161, 185 AIDS patients, 90, 93, 161, 185 animal studies, 42-43, 51 cancer, as cause of, 38, 41-43, 47, 67, 153-154, 183 cancer patients, palliation, 95-96, 98 cellular effects, 40-41, 42-45 children of smokers, cognitive effects, 47 clinical studies, 39, 40, 42, 80, 83, 85, 90, 93, 161, 171, 178-179, 180, 183 economic factors, 147-148 epidemiological studies, 39

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy federal law allowing, 4, 23, 124, 160, 164, 170 gateway theory, 62-63 immune system effects, 35, 44-45, 92 movement disorders, 119 multiple sclerosis, 108 pain palliation, 22, patients' views, 20-23, 24, 103-104 during pregnancy, 38, 43, 44, 46, 47, 67, 74 tobacco smokers who smoke marijuana, 39 tolerance, 50 vomiting, antiemetic effects, 98, 100-101, 103 Smoking of tobacco, see Tobacco Social factors, see Political and social factors Spasticity, 106-113, 138, 164, 182 animal studies, 35, 107, 110, 112 clinical studies, 24, 83, 107, 108-113, 119, 171, 178-179, 183-184 historical perspectives, 17 patients' views, 19 THC, 108, 109, 111-113 see also Multiple sclerosis Spinal cord, 4, 31, 33, 75, 84, 106, 107, 112, 150, 178-179 pain, 106, 107, 112 Standards, see Regulatory issues State-level action clinical studies, 19, 24-25, 73, 160, 163-164 legislation, xi, litigation, 4, 137, 159-160, 161-163, 165, 166, 168 referenda, 19, 66-67, 95, 131, 164-165, 169 see also District of Columbia; specific states Substance abuse, see Addiction; Dependence Surgical procedures glaucoma, 127 pain, 17, 78-79, 80-81, 84, 184 T Taxation, 17, 157-158 Tetrahydrocannabinol, see Marinol; THC THC, 8, 10, 27, 47, 53, 59, 60, 67, 151, 152, 174, 180, 183-184 AIDS wasting, 89, 91, 96 Alzheimer's disease, 122 anxiety, 74, 75, 81-82, 91, 109, 113 cancer patients, 81, 82, 91, 96, 98-102 cellular processes, 28, 29, 30, 181 chemistry of, 26, 27, 28 clinical studies, 74, 75, 79-83, 88, 89-90, 91, 98-101, 108-113, 117, 119, 122, 127, 128, 143-145, 151 Marinol, 88, 89-90, 91, 122, 143-145 dystonia, 117 glaucoma, 127, 128 Huntington's disease, 118 immune system, 34, 44 multiple sclerosis/muscle spasticity, 108, 109, 111-113 nabilone, 98, 100, 109, 111, 112-113, 142-143, 180 nausea and vomiting control, 33-34, 82, 88, 98-101, 102 pain, 79-83, 91, 181 regulatory controls, 139-140, 142, 151 Marinol, 134-135, 137, 140-141, 142-148, 149, 150, 152, 159 reproductive system, 45-46 side effects, general, 59, 60, 81-82, 92, 101, 143

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MARIJUANA AS MEDICINE?: The Science Beyond the Controversy tolerance, 48, 50-51 withdrawal, 51-52 see also Drug delivery; Marinol Tobacco, 38-39, 40-41, 42, 45, 47, 58, 183 Tolerance, 11, 48, 49, 50, 52-53, 78 Tourette's syndrome, 116, 118-119 U Unimet Pharmaceuticals, 122, 137, 142-147 ,(passim) 150, 159 United Kingdom, 10, 143, 150, 151, 178-179, 180, 183-184 United Nations Single Convention on Narcotic Drugs, 169-170 United States Pharmacopoeia, V Vomiting, 8, 27, 96-101, 103, 174, 182, 185 clinical studies, 33-34, 87-88, 97-101, 104, 176, 178-179 history of marijuana, 14, 15-16 Marinol, 27, 88, 89-90, 144, 145, 147 neurological processes, 31, 32, 33-34, 96, 97 patients' views, 20, 21, 87, 96 smoking, antiemetic effects, 98, 100-101, 103 THC, 33-34, 82, 88, 98-101, 102 see also Nausea W Washington, D.C., see District of Columbia Washington State, 4, 164, 165 Wasting syndrome cancer patients, 101-102, 171 clinical trials, 24, 178-179 see also AIDS wasting; Appetite Withdrawal, 11, 48, 49, 51-54 tobacco smokers, 41, 48 Women, see Gender factors; Pregnancy; Reproductive system effects World Health Organization, 178-179 World Wide Web, see Internet