Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2012 Feb;87(2):172-86. doi: 10.1016/j.mayocp.2011.10.003.
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, δ-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.
五千年来，大麻一直被全世界用于医疗、娱乐和精神领域。从 19 世纪中叶到 20 世纪 30 年代，美国医生开出了大量大麻用于治疗各种疾病的处方，直到联邦政府开始对其使用施加限制，最终导致 1970 年美国国会将其归类为附表 I 物质，即非法且无医疗价值的物质。与此同时，大麻成为美国使用最广泛的非法娱乐性药物，这种药物通常被认为是令人愉悦和放松的，而没有阿片类药物或兴奋剂的成瘾危险。与此同时，大麻在替代医学领域从未失去其吸引力，1995 年加利福尼亚州成为 16 个迄今将其医疗用途合法化的州之一，尽管存在联邦禁令。大麻的事情并不简单。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，人们才意识到人体内内源性大麻素系统的深远调节作用。这一系统的阐明提出了许多有前途的药物应用的可能性，尽管阻碍研究的严厉联邦限制没有显示出软化的迹象。尽管越来越多的证据表明大麻具有成瘾潜力，特别是在年轻人中，而且它容易诱发和加重易感人群的精神病，但娱乐性使用仍在继续。尽管缺乏通常需要证明新药引入的科学数据，但公众的认可推动了医用大麻合法化的努力。本文探讨了每一个争议，旨在让医生自己决定大麻是万灵药、祸害，还是两者兼而有之。使用以下关键词在 PubMed 上进行了搜索：医用大麻、医用大麻、内源性大麻素系统、CB1 受体、CB2 受体、THC、大麻二酚、纳比隆、屈大麻酚、大麻二酚/THC 复方制剂、利莫那班、大麻立法、大麻滥用、大麻依赖和精神分裂症。此外，还对参考文献进行了手工搜索，以获取更多关于澄清医用和娱乐性大麻使用和滥用之间关系的信息。
