medically useful. For example, the antianxiety properties of cannabinoids may help relieve conditions worsened by anxiety, such as movement disorders or nausea. It is also possible that the euphoric good feelings of the marijuana high could enhance the benefits of marijuana-based medicines for pain relief or appetite stimulation. On the other hand, cannabinoid-induced euphoria or sedation may simply mask symptoms, leading some users to the false belief that marijuana improves their medical conditions. That is a problem if it causes patients to choose marijuana over more effective conventional medicines that have fewer undesirable side effects. Thus, the IOM researchers recommended that any future clinical trials of cannabinoid drugs include an evaluation of their psychological impact.

MEDICAL MARIJUANA: A DANGER TO SOCIETY?

Almost everyone who spoke or wrote to the IOM study team about medical marijuana's potential harms felt that acknowledgment of marijuana 's possible medical value would undermine its reputation as a dangerous drug, particularly among young people. Yet if marijuana-based drugs were to be developed, they would join a wide variety of effective medications known to be dangerous if misused. While it is important to explore the various ways that medical use of marijuana might encourage drug abuse, it must also be recognized that marijuana is hardly unique among medicines in carrying a burden of risk.

The question is not so much whether marijuana can be both harmful and helpful but whether public perception of its benefits will lead to increased abuse. There is also the concern that experience with marijuana may prompt people to use harder drugs, triggering a general rise in the abuse of illegal substances.

Those who depict marijuana as a so-called gateway drug recognize that other illicit drugs, such as cocaine or heroin, are even more dangerous to both individual health and society as a whole. The gateway concept also reflects strikingly consistent patterns of drug use from adolescence to adulthood. Because it is the most widely used illegal drug, marijuana is predictably the first one that most people encounter, including users who later turn to other illicit substances. Before experimenting with marijuana,



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