The initial wire stories have a largely anti-prohibitionist spin, in part because the report was authorized by the Drug Czar himself, so it must be true. Perhaps that irony generates the appearance of conflict and controversy, second only to sex in its news appeal.

Whether it will lead to more serious journalism in the longer run remains to be seen. It will be fun to follow the prohibitionist media over the next few days.

It is notable that marijuana prohibition in general, not just the suppression of medical marijuana is taking major hits from the report.

The problem for the prohibitionists is that they tied the two subjects together, both by using the same arguments against medical marijuana as they use for marijuana prohibition, and by saying that medical marijuana would undermine marijuana prohibition and its stated objectives.

For example, the opponents of medical marijuana have been saying that it should not be used medically because it is "addictive." This argument is really irrelevant, because many highly addictive drugs are used in medicine. It should have been laughed off the stage. Instead it became part of the rationale given for the House Resolution against even considering medical marijuana.
See
The Congressional Record On The House Medical Marijuana Debate
Requires Powerful Anti-Emetics

So "addictiveness" was part of the medical marijuana issue, and the IOM found that marijuana has no significant addictive potential. The report notes that "few marijuana users develop dependence" and if there are withdrawal symptoms, they are "mild and short-lived."

Perhaps the silliest argument against medical marijuana is the statistical artifact known as the "gateway theory" based on the observation that most DEAland hard drug addicts used marijuana before they used hard drugs. The argument is simply irrelevant in the medical context. But it is a part of the arguments offered against medical marijuana and the IOM concluded that it also happens to be untrue. Marijuana is not a "gateway drug."

As almost everyone knows, alcohol and cigarettes, not marijuana, are the first drugs – other than caffeine, which the IOM did not mention, -- used by people who later use hard drugs. There is no biochemical basis for concluding that using marijuana "primes" individuals for the use of other drugs, a view which was further undermined by the recent discovery that dopamine may not be the key to happiness, after all.

On a related irrelevancy, the prohibitionists had claimed that allowing sick people to use marijuana would "send the wrong message" about non-medical use. However, the IOM concluded that there is no evidence that medical marijuana would increase non-medical use, or even that decriminalization had much impact on use! Well, the prohibitionist are the ones who brought it up!

Also, although the AIDS community and AIDS specialists are among the strongest backers of medical marijuana, the prohibitionists like to claim that marijuana is somehow immunosuppressive. But the IOM also says that despite considerable research, marijuana has not been shown to cause immunological damage in humans. Of course, many useful drugs are somewhat immunosuppressive, so even if marijuana had such effects, they "are not likely great enough to preclude a legitimate medical use."
See
Press Release And Full Text Of Letter From AIDS Groups
Calling For Immediate Access To Medical Marijuana.

Despite their obsession with the hazards of smoking, they had to admit that marijuana still has not been proven to cause lung cancer, or any other type of malignancy. The line "marijuana isn’t harmless" has become a basic strawman argument for prohibitionists, but the IOM had to admit that short-term or occasional marijuana use has little risk.

Consequently, on its way to getting around to the subject of medical marijuana, the IOM had to discover the same things that every other major study of marijuana had found in the last hundred years. Marijuana is simply not a dangerous drug.

Somehow I don’t think that "1898 Indian Hemp Commission Report was right, after all" would have made much of a headline, but that is just about where the best of official medicine almost reached today. Nonetheless, once again a government commission has made a devastating case against marijuana prohibition – by accident.

And, oh yes, marijuana is a useful medicine, which relieves pain, reduces nausea, and increases appetite for people with AIDS and cancer. "For patients, such as those with AIDS or undergoing chemotherapy, who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad spectrum relief not found in any other single medication."

Perhaps their biggest "breakthrough" –at least for official medicine – is that they recognize that being happy is not necessarily bad medicine. Marijuana’s euphoric side-effects "might be desirable for certain patients." However, they remain prisoners of the single molecule paradigm, even as they recognize that they do not understand the synergistic effect of the various cannabinoids.

Unfortunately, they have an obsession with the risks of smoking marijuana that is not supported by their own statements about the risks in marijuana use. What makes this even worse is that they completely ignore the practice of vaporization in which marijuana is heated to just below the point of combustion. This allows the inhalation of the cannabinoids without any smoke. Moreover, marijuana can also be eaten or drunk in teas.

I know for a fact that Dr. Grinspoon told them about vaporization, but it is hardly a secret. Why they chose to ignore it is puzzling, but this omission seriously undermines their only major objection to medical marijuana.

This emphasis on the risks of smoking have been the basis of the prohibitionist spin on the report.
See
Drug Free America Foundation Issues The First Prohibitionist Press Release
Using The IOM Report To Justify Arresting the Sick and Dying:
"Smoking Marijuana is Not Medicine."

In fact, the IOM authors got themselves into an impossible muddle. They admit "it will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, will be available for patients. In the meantime, there are patients with debilitating symptoms for whom smoked marijuana might provide relief."

In short, there is presently no substitute for whole smoked cannabis for some patients, and it will be years before there is something better than smoking -- ignoring vaporization, as they do. Still they know that something must be done.

They also oppose "licensing" whole marijuana. This reflects their commitment to the single molecule paradigm.

Their solution is "Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions: failure of all approved medications to provide relief has been documented; the symptoms can reasonably be expected to be relieved by rapid-onset cannabinoid drugs; such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness; and involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use."

But they do not explain what happens to the patients after the six months.

They also propose that patients could be enrolled in one-person clinical trials, while ignoring the existing eight people in such trials.

They also set burdens for access to marijuana that do not apply to any other drugs, even while they admit that "except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications." They know that marijuana is far less dangerous by any measure than most other drugs, simply because there is no lethal dose.

In short, they ignore existing technology and programs, and set standards for access to medical marijuana not justified by their own data.

While the report will be useful in the Class Action lawsuit, and it will help the states’ medical marijuana movements, the IOM has actually made a stronger case against marijuana prohibition than for medical marijuana.

That is really not surprising. The medical establishment has consistently failed the public in dealing with the marijuana issue in general, with the ironic exception of the 1937 hearings that created marijuana prohibition in the first place.