Hall Wayne, Degenhardt Louisa
Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia.
CNS Drugs. 2003;17(10):689-97. doi: 10.2165/00023210-200317100-00001.
The principal constituent of cannabis, Delta(9)-tetrahydrocannabinol (THC), is moderately effective in treating nausea and vomiting, appetite loss, and acute and chronic pain. Oral THC (dronabinol) and the synthetic cannabinoid, nabilone, have been registered for medical use in the US and UK, but they have not been widely used because patients find it difficult to titrate doses of these drugs. Advocates for the medical use of cannabis argue that patients should be allowed to smoke cannabis to relieve these above-mentioned symptoms. Some US state governments have legislated to allow the medical prescription of cannabis, but the US federal government has tried to prevent patients from obtaining cannabis and threatened physicians who prescribe it with criminal prosecution or loss of their licence to practise. In the UK and Australia, committees of inquiry have recommended medical prescription (UK) and exemption from criminal prosecution (New South Wales, Australia), but governments have not accepted these recommendations. The Canadian government allows an exemption from criminal prosecution to patients with specified medical conditions. It has recently legislated to provide cannabis on medical prescription to registered patients, but this scheme so far has not been implemented. Some advocates argue that legalising cannabis is the only way to ensure that patients can use it for medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions could be given exemptions from criminal prosecution to grow cannabis for their own use, at their own risk.
大麻的主要成分Δ⁹-四氢大麻酚（THC）在治疗恶心、呕吐、食欲不振以及急慢性疼痛方面有一定疗效。口服THC（屈大麻酚）和合成大麻素那必隆已在美国和英国注册用于医疗用途，但未得到广泛应用，因为患者发现难以调整这些药物的剂量。支持大麻用于医疗的人士认为，应允许患者吸食大麻以缓解上述症状。美国一些州政府已立法允许开具大麻医疗处方，但美国联邦政府试图阻止患者获取大麻，并威胁对开具此类处方的医生提起刑事诉讼或吊销其行医执照。在英国和澳大利亚，调查委员会建议进行医疗处方（英国）以及免于刑事起诉（澳大利亚新南威尔士州），但政府并未接受这些建议。加拿大政府允许特定医疗状况的患者免于刑事起诉。该国最近立法规定向注册患者提供大麻医疗处方，但该计划迄今尚未实施。一些支持者认为，将大麻合法化是确保患者能将其用于医疗目的的唯一途径。然而，这将违背国际药物管制条约，且在选举中不受欢迎。大麻素用于医疗的最佳前景在于找到不涉及吸食的THC给药方式，以及研发具有最小精神活性效应的合成大麻素。在等待这些进展的同时，可允许患有特定医疗状况的患者自行种植大麻以供自用，风险自负，但免于刑事起诉。
