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To access this report please log in to the Members Only site at www.amaassn.org/ csaphreports. To protect possible future publication, go/ please do not redistribute this report. REPORT 3 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (I-09) Use of Cannabis for M edicinal Purposes (Resolutions 91 I-08 92 , I-08 and 2 9, A-09) 0, ; 1 ; 2 (Reference Committee K) EXECUTIVE SUM M ARY Obj e. This report: ) prov ectiv (1 ides a brief historical perspectiv on the use of cannabis as e medicine; ) ex (2 amines the current federal and state-based legal env elope relev to the medical ant use of cannabis; prov (3) ides a brief ov iew of our current understanding of the pharmacology erv and physiology of the endocannabinoid system; ) rev (4 iews clinical trials on the relativ safety and e efficacy of smoked cannabis and botanical-based products; (5 places this information in and ) perspectiv with respect to the current drug regulatory framework. e Data Sources. English-language reports on studies using human subj were selected from a ects PubM ed search of the literature from 2 to August 2 using the M eSH terms marij 000 009 uana cannabis, and tetrahydrocannabinol, or cannabinoids, in combination with drug effects, therapeutic use, administration & dosage, smoking, metabolism, physiology, adv erse effects, and pharmacology. Additionally the terms abuse/ epidemiology, and receptors, cannabinoid in combination with agonists, or antagonists & inhibitors as well as endocannabinoids, in combination with pharmacology, physiology, or metabolism were used. Additional articles were identified by manual rev of the references cited in these iew publications. W eb sites of the Food and Drug Administration, Drug Enforcement Administration, National Institute on Drug Abuse, M arij uana Policy Proj ProCon.org, and the International ect, Association for Cannabis as M edicine also were searched for relev resources. ant Results. The cannabis sativ plant contains more than 6 uniq structurally related chemicals a 0 ue (phytocannabinoids). Thirteen states hav enacted laws to remov state-lev criminal penalties for e e el possessing marij uana for q ualifying patients, howev the federal gov er ernment refuses to recogniz e that the cannabis plant has an accepted medical benefit. Despite the public controv ersy, less than 2 small randomiz controlled trials of short duration inv ing ~ 0 ed olv 300 patients hav been e conducted ov the last 35years on smoked cannabis. M any others hav been conducted on FDAer e approv oral preparations of THC and synthetic analogues, and more recently on botanical ed ex tracts of cannabis. Federal court cases hav upheld the priv e ileges of doctor-patient discussions on the use of cannabis for medicinal purposes but also preserv the right of the federal ed gov ernment to prosecute patients using cannabis for medicinal purposes. Efforts to reschedule marij uana from Schedule I of the Controlled Substances Act hav been unsuccessful to date. e Disagreements persist about the long term conseq uences of marij uana use for medicinal purposes. Conclusions. Results of short term controlled trials indicate that smoked cannabis reduces neuropathic pain, improv appetite and caloric intake especially in patients with reduced muscle es mass, and may reliev spasticity and pain in patients with multiple sclerosis. Howev the e er, patchwork of state-based systems that hav been established for medical marij e uana is woefully inadeq uate in establishing ev rudimentary safeguards that normally would be applied to the en appropriate clinical use of psychoactiv substances. The future of cannabinoid-based medicine lies e in the rapidly ev ing field of botanical drug substance dev olv elopment, as well as the design of molecules that target v arious aspects of the endocannabinoid system. To the ex that tent rescheduling marij uana out of Schedule I will benefit this effort, such a mov can be supported. e