MEDICINAL USE — There is considerable public and political pressure on the Drug Enforcement Agency to reschedule marijuana leaf as a medicinal drug. As of August 2005, California and 10 other states have passed laws allowing the medicinal use of marijuana cigarettes. On May 14, 2001 the Supreme Court ruled that marijuana is an illegal substance and cannot be distributed for medicinal use. In 2005, the US Supreme Court, in Gonzalez versus Raich, held that patients prescribed marijuana in accordance with state law could be criminally prosecuted under the federal statutes.

A number of potential medical uses for marijuana and cannabinoids have been identified:

 
• Antiemetic  
• Treatment of intractable hiccups  
• Treatment of cachexia associated with AIDS or cancer  
• Lowering intraocular pressure in patients with glaucoma  
• Tremor reduction and improvement of symptoms of multiple sclerosis

A systematic review of randomized, controlled trials that evaluated the use of cannabinoids for treatment of chronic pain (including cancer pain, chronic non-malignant pain, and acute postoperative pain) found that cannabinoids were no more effective than codeine in controlling pain, and they have depressant effects that limit their use .

The primary active ingredient in marijuana, THC, is available in purified form without other cannabinoids or carcinogens as an oral tablet under the name dronabinol. Other delivery forms currently in development are a transdermal patch, a nasal spray, and a metered dose inhaler. The debate over medicinal use of smoked marijuana will continue.

SUMMARY AND RECOMMENDATIONS

 
• Marijuana is the most frequently used illicit drug in the US and its use is on the rise. Marijuana use predicts later use of opiates and other drugs, but its role in causality of other substance abuse is controversial (see “Epidemiology” above).  
• When smoked, marijuana has physiologic and psychologic effects for three to four hours. Motor performance may be impaired for up to 24 hours. There is a high prevalence of recent marijuana use in studies of drivers involved in motor vehicle accidents (see “Signs and symptoms” above).  
• Acute marijuana intoxication rarely requires treatment. Chronic use leads to physical dependence with withdrawal symptoms that can last five to seven days (see “Treatment” above).  
• Marijuana smoke contains carcinogens, but data do not show a definitive increase in lung or head and neck squamous cell cancers in marijuana users. Marijuana causes decreased libido and may cause male infertility. Smoking marijuana has been shown to impair pulmonary function tests and can cause cough; its association with chronic lung disease is suspected (see “Chronic health problems” above).  
• Chronic cannabis syndrome has been described in which chronic heavy users have a reduced ability to establish or attain life goals. Data are conflicting on chronic marijuana use as a cause of long-term cognitive impairment (see “Cognitive dysfunction” above).  
• Marijuana use is associated with increased prevalence of schizophrenia and depression; it is not clear that this is causal (see “Psychiatric illness” above).  
• Marijuana has multiple potential medicinal uses: treatment of nausea, intractable hiccups, cancer- or HIV-associated cachexia, glaucoma, tremor control in multiple sclerosis, sleep disorder, pain management and rheumatoid arthritis. Several states in the US have passed laws permitting its medicinal use, though it remains illegal under federal statutes

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