would be to determine whether existing cannabinoids could be modified to retain their analgesic properties while reducing or removing unwanted side effects such as amnesia and sedation. But some of those side effects may make marijuana an especially useful pain reliever. Cannabinoids appear to reduce nausea, vomiting, and appetite loss as well as pain. And the euphoric lift that attracts recreational users to marijuana could benefit people with anxiety-producing disorders such as AIDS or cancer. In fact, for that reason the IOM team recommended that researchers undertake clinical studies of cannabinoid medications among cancer patients on chemotherapy and AIDS patients suffering from wasting or significant pain. The IOM also recommended that the following groups of patients be included in such studies:

  • Surgical patients. In this case, cannabinoids should be administered along with opiates to determine whether cannabinoids reduce the nausea and vomiting associated with opiate painkillers.

  • Patients with spinal cord injury or other pain caused by nerve damage.

  • Patients with chronic pain who also suffer from insomnia.

All of the above patients are currently treated with opiate drugs, which produce tolerance and dependence as well as undesirable side effects. Could lower doses of opiates give these patients the same degree of relief when supplemented with cannabinoids? The answer lies in carefully conducted clinical experiments. Clinical trials could also determine whether THC is the sole—and, if not, the best —pain-relieving compound in marijuana. If additional cannabinoids relieve pain, researchers must then consider which cannabinoids or combinations thereof work best.

Although there has been very little clinical pain research on marijuana, the findings support positive results from animal and other basic experiments. Further clinical research appears to be well worth pursuing if it leads to a new class of drugs to complement existing painkillers or medications that could simultaneously relieve pain and nausea or appetite loss. The latter would be especially useful to people with AIDS and cancer, as described in the next two chapters.

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