Institute of Medicine report, 1999
In January 1997, shortly after passage of the California and Arizona medical marijuana initiatives,
the Director of the Office of National Drug Control Policy (the federal drug czar) commissioned
the Institute of Medicine (IOM) of the National Academy of Sciences to review the scientific
evidence on the potential health benefits and risks of marijuana and its constituent cannabinoids.
Begun in August 1997, IOM’s 257-page report, Marijuana and Medicine: Assessing the Science
Base, was released in March 1999.39 A review of all existing studies of the therapeutic value of
cannabis, the IOM Report was also based on public hearings and consultations held around the
country with biomedical and social scientists and concerned citizens.
For the most part, the IOM Report straddled the fence and provided sound bites for both sides of
the medical marijuana debate. For example, “Until a nonsmoked rapid-onset cannabinoid drug
delivery system becomes available, we acknowledge that there is no clear alternative for people
suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or
AIDS-wasting” (p. 179) and “Smoked marijuana is unlikely to be a safe medication for any
chronic medical condition” (p. 126). For another example, “There is no conclusive evidence that
marijuana causes cancer in humans, including cancers usually related to tobacco use” (p. 119) and
“Numerous studies suggest that marijuana smoke is an important risk factor in the development
of respiratory disease” (p. 127).
The IOM Report did find more potential promise in synthetic cannabinoid drugs than in smoked
marijuana (p. 177):
The accumulated data suggest a variety of indications, particularly for pain relief, antiemesis,
and appetite stimulation. For patients such as those with AIDS or who are undergoing
chemotherapy, and who suffer simultaneously from severe pain, nausea, and appetite loss,
cannabinoid drugs might offer broad-spectrum relief not found in any other single
In general, the report emphasized the need for well-formulated, scientific research into the
therapeutic effects of marijuana and its cannabinoid components on patients with specific disease
conditions. To this end, the report recommended that clinical trials be conducted with the goal of
developing safe delivery systems.