Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana
Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana
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DOI：
10.1016/j.mayocp.2011.10.003
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发表时间：
2012-02-01
影响因子：
8.9
通讯作者：
Bostwick, J. Michael
中科院分区：
文献类型：
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作者：
Bostwick, J. Michael
5000年来，大麻在世界各地被用于医学，娱乐和精神上。从世纪中期到20世纪30年代，美国医生将其用于过多的适应症，直到联邦政府开始限制其使用，最终在1970年美国国会将其列为附表I物质，非法，没有医疗价值。与此同时，大麻成为美国最广泛使用的非法娱乐毒品，这种物质通常被认为是令人愉快和放松的，没有阿片类药物或兴奋剂的成瘾危险。与此同时，大麻在替代医学界从未失去其声望，1995年，尽管联邦禁止，但加州成为迄今为止16个州中第一个将其医疗用途合法化的州，大麻成为主流。关于大麻的事情很少是简单的。其主要活性成分δ-9-四氢大麻酚直到1964年才被分离出来，直到20世纪90年代才认识到人体内内源性大麻素系统的深远调节活性。这一系统的阐明提高了许多有前途的药物应用的可能性，即使严格的联邦限制腿筋研究没有软化的迹象。尽管越来越多的证据表明大麻有成瘾的潜力，特别是在年轻人中，而且它有诱发和加剧易感人群精神病的倾向，但长期使用大麻的情况仍有增无减。公众的批准推动了医用大麻合法化的努力，而没有通常需要的科学数据来证明一种新药的引入。本文探讨了这些争议中的每一个，目的是教育医生自己决定大麻是否是灵丹妙药，祸害，或两者兼而有之。使用以下关键词进行PubMed检索：医用大麻、医用大麻、内源性大麻素系统、CB 1受体、CB 2受体、THC、大麻二酚、大麻隆、屈大麻酚、那比昔莫、利莫那班、大麻立法、大麻滥用、大麻依赖、大麻和精神分裂症。手动检索参考书目，以获得与澄清医用和娱乐性大麻使用和滥用之间关系相关的其他参考文献。(C)2012年马约医学教育和研究基金会广场马约临床学报201287（2）172-186
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, delta-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse. (C) 2012 Mayo Foundation for Medical Education and Research square Mayo Clin Proc. 201287(2)172-186