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LETTERS TO THE EDITOR

Cannabis Is Not Equivalent to Cannabinoids

The International Drug Strategy Institute Topeka, KS 66606

Sharpe and Smith (1) do a nice job discussing the potential benefits and drawbacks of the use of cannabinoids for pain and other therapeutic indications. Their downfall is that they jump from the appropriate point that cannabinoids have some probable utility, to the conclusion that cannabis has utility. That would necessitate the study of smoking as a delivery system for cannabinoids.

Schwartz and I (2) raised serious questions about the smoking of marijuana as a delivery system for cannabinoids. These same concerns have been voiced by the American Medical Association (3), National Institutes of Health (4), and the Institute of Medicine (5).

Clearly, there may be some benefits from the therapeutic use of cannabinoids, but let us stick to delivery of specific cannabinoids via oral routes, transdermal patches, metered inhalers, or suppositories. Smoking marijuana is not an appropriate delivery system for cannabinoids.

References

1. Sharpe P, Smith G. Cannabis: time for scientific evaluation of this ancient remedy? Anesth Analg 2000;90:237–40.[Free Full Text]
2. Voth EA, Schwartz RH. Medicinal applications of delta 9 tetrahydrocannabinol and marijuana: a perspective. Ann Intern Med 1997;126:791–8.[Abstract/Free Full Text]
3. American Medical Association Council on Scientific Affairs Report 10. Medical marijuana. Adopted by the AMA House of Delegates, December 1997.
4. Workshop on the Medical Utility of Marijuana. Report to the Director, National Institutes of Health. http://www.nih.gov/news/medmarijuana/MedicalMarijuana.htm. Accessed April 17, 2000.
5. Marijuana and medicine: assessing the science base division of neuroscience and behavioral health, Institute of Medicine. Joy JE, Watson SJ, Benson JA Jr, eds. Washington DC: National Academy Press, 1999.

Response

University Department of Anaesthesia and Pain Management University of Leicester Leicester, UK

Thank you for the opportunity to reply to the letter from Dr. Voth following our recently published editorial in the Journal (1). We are concerned that Voth has misrepresented our editorial. We certainly did not advocate the use of cannabis by smoking, and indeed, we described the dangers of this practice in detail in our editorial (1–3). We did compare the bioavailability of cannabinoids administered via the oral and the inhaled routes and commented on the higher bioavailability via the latter route; as mentioned by Voth, therefore, metered dose inhalers (or nebulizers) would provide a high bioavailability without the associated presence of carcinogenic contaminants produced by smoking.

We hope that Dr. Voth now can interpret our editorial more properly.

References

1. Sharpe P, Smith G. Cannabis: time for scientific evaluation of this ancient remedy? Anesth Analg 2000;90:237–40.
2. Hall W, Solowij N. Adverse effects of cannabis. Lancet 1998;352:1611–6.[Web of Science][Medline]
3. Van Hoozen BE, Cross CE. Marijuana: respiratory tract effects. Clin Rev Allergy Immunol 1997;15:243–69.[Web of Science][Medline]

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