Publications
APS Bulletin • Volume 9, Number 5, September/October 1999
Resource Reviews
John D. Loeser, MD, Department Editor
Marihuana and Medicine
Reviewed by Lawrence M. Halpern, PhD
G. Nahas, K. Sutin, D.J. Harvey, & S. Agurell (Eds.), Humana Press, Totowa, NJ, 1999, 848 pages, $125 (hardcover), ISBN 0-89603-593-X
This volume records the proceedings of a symposium held in New York, March 20-21, 1998, and includes other papers reprinted from various sources. Approximately 80 papers are contained in the book—roughly 15 are by Gabriel Nahas and his associates; the remaining group of papers include some that are new and some that date back to 1979. The book includes a reprint of an editorial by Kassirer from the New England Journal of Medicine, dated January 30, 1997, and a response by Dr. Nahas et al., “Marihuana is the Wrong Medicine,” which was published in The Wall Street Journal on March 11, 1997. It seems as if Dr. Nahas has used the present volume to express his viewpoints on this debate again.
The book contains a great deal of examination of the pharmacological and molecular basis of the putative therapeutic properties of marihuana and its active ingredient, THC. Much of the content comes from studies of animal preparations, not from well-designed clinical pharmacological studies. This examination comes at a time when careful clinical pharmacological studies are under way, with results expected to be reported soon.
There is a good section on the chemistry and pharmacokinetics of marihuana that contains reprinted papers by Mechoulam (1992), Harvey (1998), Huestis (1988), Stambaugh (1981), and Jones (1998). One section discusses biochemistry and molecular mechanisms and contains new information concerning cannabinoid receptors and their interaction with brain reward systems; there are also discussions of the effects of marihuana on gene expression. Dr. Domino’s paper on cannabinoids and the cholinergic system is a republication of his 1981 paper. Miller’s paper, which focuses on the acute effects on human memory, is a reprint of his 1984 paper.
The section on pharmacology and pathophysiology includes “Psychologic and Physiologic Effects of Active Cannabinoids,” “Physiological and Pharmacological Interactions of Marihuana (THC) with Drugs and Anesthetics,” and “Marihuana and the Lung.” Many of the studies reported in this section indicate that marihuana persistently impairs the brain and reproductive function and that its smoke is more toxic and damaging to the lungs than tobacco smoke. This presents a dilemma: Should you tell a nauseated hospice patient dying of smoking-induced lung cancer not to smoke— anything?
Hollister’s contribution, “What We Should but Don’t Know,” restores a modicum of balance to the proceedings. He writes: “The expanding social and now possible therapeutic use of marihuana and THC contrasts to the relative lack of information about drug interactions between cannabinoids and other drugs.” The recent literature, such as it is (and the present volume), focuses mainly on animal studies, few of which pertain to the way cannabinoids are used in the real world. This book certainly is food for thought, but it will not be the last word on this contentious topic.
Lawrence M. Halpern is associate professor of pharmacology at the University of Washington in Seattle.