Marihuana: The Forbidden Medicine

N Engl J Med 1994; 331:749-750September 15, 1994

Article

Marihuana: The Forbidden Medicine
By Lester Grinspoon and James B. Bakalar. 184 pp. New Haven, Conn., Yale University Press, 1993. $28.50. ISBN: 0-300-05435-1

On December 7, 1993, the Surgeon General of the United States, Joycelyn Elders, fired a shot heard around the world when she publicly stated that the legalization of drugs should be explored. Although Dr. Elders's statement gained considerable media exposure, legalization of certain drugs has many other distinguished advocates within the health care profession. One of these is Dr. Lester Grinspoon, associate professor of psychiatry at Harvard Medical School. Dr. Grinspoon has long felt that certain psychopharmacologic agents labeled illicit by American society should be legalized because of their therapeutic value.

In this easy-to-read book, coauthored by James B. Bakalar, Grinspoon presents cogent and convincing arguments for the legalization of marijuana and its pharmacologically active components. The book focuses on the medical, rather than the sociological, benefits of decriminalization but does present a detailed history of the regulation and proscription of marijuana. The arguments are mostly supported by referenced scientific literature and a logic of common sense. They are highlighted by vignettes of desperate people who benefited from the medicinal properties of marijuana but who came into conflict with the law because of their use of the substance.

There is no doubt that the psychoactive components of marijuana have therapeutic properties. The authors present a concise summary of the therapeutic uses of marijuana and its components. The main active components, Δ⁹-tetrahydrocannabinol (THC) and other cannabinols, have antiemetic, analgesic, and muscle-relaxant properties, reduce intraocular pressure, and stimulate appetite. As yet unidentified components of the plant also have medicinal effects. Marijuana has reported therapeutic value in treating glaucoma, side effects of cancer chemotherapy, muscle spasticity associated with neurologic disorders, and various psychiatric disorders. Although some of the reports of therapeutic efficacy are anecdotal, the authors emphasize that there have been few controlled studies. The recent identification of the THC receptor -- a neuronal THC-binding site coupled to a G protein -- has increased our understanding of the mechanism of action of the cannabinoids and will stimulate new research with these compounds.

The authors present a compelling argument for unrestricted access to these therapeutic agents derived from marijuana. The federal, state, and local laws regarding marijuana or its active components and the criminal penalties for its use are inconsistent among jurisdictions and inconsistently enforced. The Food and Drug Administration, which regulates the medicinal use of THC and other marijuana components, sometimes permits medicinal use, sometimes does not. The authors argue that THC does not produce drug dependence or lead to addiction, whereas comparable legal pharmacologic agents such as opiates and benzodiazepines produce substantial drug dependence and withdrawal symptoms.

This book is written to enlist the reader in the cause of the legalization of marijuana, and the authors tend to underemphasize reports of its negative medical effects. Nevertheless, whether or not one personally supports the decriminalization or legalization of marijuana, this book provides an excellent overview of the subject from a medical perspective.

Robert M. Swift, M.D., Ph.D.
Brown University Medical School, Providence, RI 02908

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