The intersection between cannabis and cancer in the United States

Critical Reviews in Oncology/Hematology

Volumn 83, Issue 1, 2012, Pages 1-10

  Bowles, Daniel W ^a,b   O'Bryant, Cindy L ^a,c   Camidge, D Ross ^a   Jimeno, Antonio ^a  

^a UNIVERSITY OF COLORADO CANCER CENTER   (United States)

^b Colorado Department of Public Health and Environment ^*  (United States)

^c UNIVERSITY OF COLORADO   (United States)

Author keywords

Cancer; Cannabinoids; Cannabis; Medical marijuana; Tetrahydrocannabinol

Indexed keywords

ANTIEMETIC AGENT; CANNABIDIOL; CANNABINOID; CANNABIS; CODEINE; DIHYDROCODEINE; DRONABINOL; LEVONANTRADOL; MEGESTROL; METOCLOPRAMIDE; NABILONE; NABIXIMOLS; NARCOTIC ANALGESIC AGENT; ONDANSETRON; PLACEBO; PROCHLORPERAZINE; PROMETHAZINE; SEROTONIN 3 ANTAGONIST;

ANALGESIA; ANOREXIA; ANTINEOPLASTIC ACTIVITY; BREAST CANCER; CANCER CHEMOTHERAPY; CANCER GROWTH; CANCER PAIN; CANCER PALLIATIVE THERAPY; CANCER RESEARCH; CANNABIS SMOKING; CHEMOTHERAPY INDUCED NAUSEA AND VOMITING; CHRONIC PAIN; CLINICAL EFFECTIVENESS; COLON CANCER; DISEASE CONTROL; DOSE RESPONSE; DRUG APPROVAL; DRUG BIOAVAILABILITY; DRUG DISTRIBUTION; DRUG EFFECT; DRUG EFFICACY; DRUG ELIMINATION; DRUG HALF LIFE; DRUG MECHANISM; DRUG MEGADOSE; DRUG METABOLISM; DRUG SAFETY; DRUG TOLERABILITY; DRUG URINE LEVEL; GLIOBLASTOMA; HUMAN; LEGAL PROCEDURE; LEUKEMIA; LOW DRUG DOSE; LUNG ADENOCARCINOMA; LYMPHOMA; NEOPLASM; NEUROPATHIC PAIN; NONHUMAN; PANCREAS CANCER; PROSTATE CANCER; REVIEW; SINGLE DRUG DOSE; SKIN CANCER; SYMPTOMATOLOGY; THYROID CANCER; TIME TO MAXIMUM PLASMA CONCENTRATION; TREATMENT DURATION; TREATMENT PLANNING; UNITED STATES; UNSPECIFIED SIDE EFFECT;

ANIMALS; BIOLOGICAL AVAILABILITY; CANNABINOIDS; CANNABIS; HUMANS; MARIJUANA SMOKING; MICE; NEOPLASMS; PAIN; PALLIATIVE CARE; PHYTOTHERAPY; UNITED STATES;

EID: 84862127777     PISSN: 10408428     EISSN: 18790461     Source Type: Journal    
DOI: 10.1016/j.critrevonc.2011.09.008     Document Type: Review

References (106)

1. Abrams DI. Cannabis and cannabinoids. (August 1, 2011, date last accessed). http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional.
2. Hall W., Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet 2009, 374:1383-1391.
3. Turcotte D., Le Dorze J.A., Esfahani F., Frost E., Gomori A., Namaka M. Examining the roles of cannabinoids in pain and other therapeutic indications: a review. Expert Opin Pharmacother 2010, 11:17-31.
4. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet 2003, 42:327-360.
5. Rahn E.J., Hohmann A.G. Cannabinoids as pharmacotherapies for neuropathic pain: from the bench to the bedside. Neurotherapeutics 2009, 6:713-737.
6. Turu G., Hunyady L. Signal transduction of the CB1 cannabinoid receptor. J Mol Endocrinol 2010, 44:75-85.
7. Atwood B.K., Mackie K. CB2: a cannabinoid receptor with an identity crisis. Br J Pharmacol 2010, 160:467-479.
8. Hegde V.L., Nagarkatti P.S., Nagarkatti M. Role of myeloid-derived suppressor cells in amelioration of experimental autoimmune hepatitis following activation of TRPV1 receptors by cannabidiol. PLoS One 2011, 6:e18281.
9. Ruhaak L.R., Felth J., Karlsson P.C., Rafter J.J., Verpoorte R., Bohlin L. Evaluation of the cyclooxygenase inhibiting effects of six major cannabinoids isolated from Cannabis sativa. Biol Pharm Bull 2011, 34:774-778.
10. McLaren J., Swift W., Dillon P., Allsop S. Cannabis potency and contamination: a review of the literature. Addiction 2008, 103:1100-1109.
11. Pijlman F.T., Rigter S.M., Hoek J., Goldschmidt H.M., Niesink R.J. Strong increase in total delta-THC in cannabis preparations sold in Dutch coffee shops. Addict Biol 2005, 10:171-180.
12. Abrams D.I., Vizoso H.P., Shade S.B., Jay C., Kelly M.E., Benowitz N.L. Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 2007, 82:572-578.
13. Lemberger L., Martz R., Rodda B., Forney R., Rowe H. Comparative pharmacology of Delta9-tetrahydrocannabinol and its metabolite, 11-OH-Delta9-tetrahydrocannabinol. J Clin Invest 1973, 52:2411-2417.
14. Chan P.C., Sills R.C., Braun A.G., Haseman J.K., Bucher J.R. Toxicity and carcinogenicity of delta 9-tetrahydrocannabinol in Fischer rats and B6C3F1 mice. Fundam Appl Toxicol 1996, 30:109-117.
15. Hall W., MacPhee D. Cannabis use and cancer. Addiction 2002, 97:243-247.
16. MacPhee D. Effects of marijuana on cell nuclei. A review of the literature relating to the genotoxicity of cannabis. The health effects of cannabis 1999, 425-458. Centre for Addiction and Mental Health, Toronto. H. Kalant, W. Corrigal, W.D. Hall, R. Smart (Eds.).
17. Marselos M., Karamanakos P. Mutagenicity, developmental toxicity and carcinogenicity of cannabis. Addict Biol 1999, 4:5-12.
18. Novotny M., Lee M.L., Bartle K.D. A possible chemical basis for the higher mutagenicity of marijuana smoke as compared to tobacco smoke. Experientia 1976, 32:280-282.
19. Moir D., Rickert W.S., Levasseur G., et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol 2008, 21:494-502.
20. Singh R., Sandhu J., Kaur B., et al. Evaluation of the DNA damaging potential of cannabis cigarette smoke by the determination of acetaldehyde derived N2-ethyl-2'-deoxyguanosine adducts. Chem Res Toxicol 2009, 22:1181-1188.
21. Wu T.C., Tashkin D.P., Djahed B., Rose J.E. Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med 1988, 318:347-351.
22. Fligiel S.E., Roth M.D., Kleerup E.C., Barsky S.H., Simmons M.S., Tashkin D.P. Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco. Chest 1997, 112:319-326.
23. Barsky S.H., Roth M.D., Kleerup E.C., Simmons M., Tashkin D.P. Histopathologic and molecular alterations in bronchial epithelium in habitual smokers of marijuana, cocaine, and/or tobacco. J Natl Cancer Inst 1998, 90:1198-1205.
24. Zhang Z.F., Morgenstern H., Spitz M.R., et al. Marijuana use and increased risk of squamous cell carcinoma of the head and neck. Cancer Epidemiol Biomarkers Prev 1999, 8:1071-1078.
25. Feng B.J., Khyatti M., Ben-Ayoub W., et al. Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa. Br J Cancer 2009, 101:1207-1212.
26. Gillison M.L., D'Souza G., Westra W., et al. Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. JNCI J Natl Cancer Inst 2008, 100:407-420.
27. Llewellyn C.D., Johnson N.W., Warnakulasuriya K.A. Risk factors for oral cancer in newly diagnosed patients aged 45years and younger: a case-control study in Southern England. J Oral Pathol Med 2004, 33:525-532.
28. Llewellyn C.D., Linklater K., Bell J., Johnson N.W., Warnakulasuriya S. An analysis of risk factors for oral cancer in young people: a case-control study. Oral Oncol 2004, 40:304-313.
29. Aldington S., Harwood M., Cox B., et al. Cannabis use and cancer of the head and neck: case-control study. Otolaryngol Head Neck Surg 2008, 138:374-380.
30. Rosenblatt K.A., Daling J.R., Chen C., Sherman K.J., Schwartz S.M. Marijuana use and risk of oral squamous cell carcinoma. Cancer Res 2004, 64:4049-4054.
31. Hashibe M., Morgenstern H., Cui Y., et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2006, 15:1829-1834.
32. Berthiller J., Lee Y.C., Boffetta P., et al. Marijuana smoking and the risk of head and neck cancer: pooled analysis in the INHANCE Consortium. Cancer Epidemiol Biomarkers Prev 2009, 18:1544-1551.
33. Liang C., McClean M.D., Marsit C., et al. A population-based case-control study of marijuana use and head and neck squamous cell carcinoma. Cancer Prev Res 2009, 2:759-768.
34. Mehra R., Moore B.A., Crothers K., Tetrault J., Fiellin D.A. The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med 2006, 166:1359-1367.
35. Berthiller J., Straif K., Boniol M., et al. Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb. J Thorac Oncol 2008, 3:1398-1403.
36. Aldington S., Harwood M., Cox B., et al. Cannabis use and risk of lung cancer: a case-control study. Eur Respir J 2008, 31:280-286.
37. Sidney S., Beck J.E., Tekawa I.S., Quesenberry C.P., Friedman G.D. Marijuana use and mortality. Am J Public Health 1997, 87:585-590.
38. Efird J.T., Friedman G.D., Sidney S., et al. The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: cigarette smoking and other lifestyle behaviors. J Neurooncol 2004, 68:57-69.
39. Chacko J.A., Heiner J.G., Siu W., Macy M., Terris M.K. Association between marijuana use and transitional cell carcinoma. Urology 2006, 67:100-104.
40. Trabert B., Sigurdson A.J., Sweeney A.M., Strom S.S., McGlynn K.A. Marijuana use and testicular germ cell tumors. Cancer 2011, 117:848-853.
41. Munson A.E., Harris L.S., Friedman M.A., Dewey W.L., Carchman R.A. Antineoplastic activity of cannabinoids. J Natl Cancer Inst 1975, 55:597-602.
42. Pisanti S., Malfitano A.M., Grimaldi C., et al. Use of cannabinoid receptor agonists in cancer therapy as palliative and curative agents. Best Pract Res Clin Endocrinol Metab 2009, 23:117-131.
43. Salazar M., Carracedo A., Salanueva I.J., et al. Cannabinoid action induces autophagy-mediated cell death through stimulation of ER stress in human glioma cells. J Clin Invest 2009, 119:1359-1372.
44. Flygare J., Sander B. The endocannabinoid system in cancer-potential therapeutic target?. Semin Cancer Biol 2008, 18:176-189.
45. Sarfaraz S., Adhami V.M., Syed D.N., Afaq F., Mukhtar H. Cannabinoids for cancer treatment: progress and promise. Cancer Res 2008, 68:339-342.
46. Cianchi F., Papucci L., Schiavone N., et al. Cannabinoid receptor activation induces apoptosis through tumor necrosis factor alpha-mediated ceramide de novo synthesis in colon cancer cells. Clin Cancer Res 2008, 14:7691-7700.
47. Blazquez C., Casanova M.L., Planas A., et al. Inhibition of tumor angiogenesis by cannabinoids. FASEB J 2003, 17:529-531.
48. Mimeault M., Pommery N., Wattez N., Bailly C., Henichart J.P. Anti-proliferative and apoptotic effects of anandamide in human prostatic cancer cell lines: implication of epidermal growth factor receptor down-regulation and ceramide production. Prostate 2003, 56:1-12.
49. Olea-Herrero N., Vara D., Malagarie-Cazenave S., Diaz-Laviada I. Inhibition of human tumour prostate PC-3 cell growth by cannabinoids R(+)-Methanandamide and JWH-015: involvement of CB2. Br J Cancer 2009, 101:940-950.
50. Sanchez C., de Ceballos M.L., Gomez del Pulgar T., et al. Inhibition of glioma growth in vivo by selective activation of the CB(2) cannabinoid receptor. Cancer Res 2001, 61:5784-5789.
51. Caffarel M.M., Andradas C., Mira E., et al. Cannabinoids reduce ErbB2-driven breast cancer progression through Akt inhibition. Mol Cancer 2010, 9:196.
52. Qamri Z., Preet A., Nasser M.W., et al. Synthetic cannabinoid receptor agonists inhibit tumor growth and metastasis of breast cancer. Mol Cancer Ther 2009, 8:3117-3129.
53. McKallip R.J., Nagarkatti M., Nagarkatti P.S. Delta-9-tetrahydrocannabinol enhances breast cancer growth and metastasis by suppression of the antitumor immune response. J Immunol 2005, 174:3281-3289.
54. Yamada T., Ueda T., Shibata Y., et al. TRPV2 activation induces apoptotic cell death in human T24 bladder cancer cells: a potential therapeutic target for bladder cancer. Urology 2010, 76. 509 e1-7.
55. Shrivastava A., Kuzontkoski P.M., Groopman J.E., Prasad A. Cannabidiol induces programmed cell death in breast cancer cells by coordinating the cross-talk between apoptosis and autophagy. Mol Cancer Ther 2011, 10:1161-1172.
56. Gustafsson K., Wang X., Severa D., et al. Expression of cannabinoid receptors type 1 and type 2 in non-Hodgkin lymphoma: growth inhibition by receptor activation. Int J Cancer 2008, 123:1025-1033.
57. Marcu J.P., Christian R.T., Lau D., et al. Cannabidiol enhances the inhibitory effects of delta9-tetrahydrocannabinol on human glioblastoma cell proliferation and survival. Mol Cancer Ther 2010, 9:180-189.
58. Xu X., Liu Y., Huang S., et al. Overexpression of cannabinoid receptors CB1 and CB2 correlates with improved prognosis of patients with hepatocellular carcinoma. Cancer Genet Cytogenet 2006, 171:31-38.
59. Ellert-Miklaszewska A., Grajkowska W., Gabrusiewicz K., Kaminska B., Konarska L. Distinctive pattern of cannabinoid receptor type II (CB2) expression in adult and pediatric brain tumors. Brain Res 2007, 1137:161-169.
60. Guzman M., Duarte M.J., Blazquez C., et al. A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br J Cancer 2006, 95:197-203.
61. Sallan S.E., Zinberg N.E., Frei E. Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. N Engl J Med 1975, 293:795-797.
62. Kraft B., Frickey N.A., Kaufmann R.M., et al. Lack of analgesia by oral standardized cannabis extract on acute inflammatory pain and hyperalgesia in volunteers. Anesthesiology 2008, 109:101-110.
63. Wallace M., Schulteis G., Atkinson J.H., et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology 2007, 107:785-796.
64. Notcutt W., Price M., Miller R., et al. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 'N of 1' studies. Anaesthesia 2004, 59:440-452.
65. Ellis R.J., Toperoff W., Vaida F., et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 2009, 34:672-680.
66. Wilsey B., Marcotte T., Tsodikov A., et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain 2008, 9:506-521.
67. Abrams D.I., Jay C.A., Shade S.B., et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 2007, 68:515-521.
68. Ware M.A., Wang T., Shapiro S., et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 2010, 182:E694-E701.
69. Karst M., Salim K., Burstein S., Conrad I., Hoy L., Schneider U. Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. JAMA 2003, 290:1757-1762.
70. Rog D.J., Nurmikko T.J., Friede T., Young C.A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005, 65:812-819.
71. Campbell F.A., Tramer M.R., Carroll D., Reynolds D.J., Moore R.A., McQuay H.J. Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 2001, 323:13-16.
72. Frank B., Serpell M.G., Hughes J., Matthews J.N.S., Kapur D. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ 2008, 336:199-201.
73. Johnson J.R., Burnell-Nugent M., Lossignol D., Ganae-Motan E.D., Potts R., Fallon M.T. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage 2010, 39:167-179.
74. Brisbois T.D., de Kock I.H., Watanabe S.M., et al. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol 2011.
75. Jatoi A., Windschitl H.E., Loprinzi C.L., et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol 2002, 20:567-573.
76. Strasser F. Comparison of orally administered cannabis extract and Delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol 2006, 24:3394-3400.
77. Vinciguerra V., Moore T., Brennan E. Inhalation marijuana as an antiemetic for cancer chemotherapy. N Y State J Med 1988, 88:525-527.
78. Tramer M.R., Carroll D., Campbell F.A., Reynolds D.J., Moore R.A., McQuay H.J. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001, 323:16-21.
79. Meiri E., Jhangiani H., Vredenburgh J.J., et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin 2007, 23:533-543.
80. Kris M.G., Hesketh P.J., Somerfield M.R., et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 2006, 24:2932-2947.
81. Roila F., Herrstedt J., Aapro M., et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010, 21(Suppl. 5):v232-v243.
82. Mack A., Joy J.E. Marijuana as medicine? The science beyond the controversy 2001, National Academy Press, Washington, DC.
83. American College of Physicians Supporting research into the therapeutic role of marijuana 2008, American College of Physicians, Philadelphia.
84. American Medical Association Report 3 of the Council on Science and Public Health (I-09). Use of cannabis for medicinal purposes (resolutions 910, I-08; 921, I-08; and 229, A-09). AMA interim meeting 2009.
85. Engels F.K., de Jong F.A., Mathijssen R.H., Erkens J.A., Herings R.M., Verweij J. Medicinal cannabis in oncology. Eur J Cancer 2007, 43:2638-2644.
86. Doblin R.E., Kleiman M.A. Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes. J Clin Oncol 1991, 9:1314-1319.
87. Charuvastra A., Friedmann P.D., Stein M.D. Physician attitudes regarding the prescription of medical marijuana. J Addict Dis 2005, 24:87-93.
88. O'Connell T.J., Bou-Matar C.B. Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduct J 2007, 4:16.
89. Montana Department of Health and Human Services. Montana Medical Marijuana Program. (June 19, 2011, date last accessed). http://www.dphhs.mt.gov/medicalmarijuana/.
90. Degenhardt L., Hall W.D. The adverse effects of cannabinoids: implications for use of medical marijuana. CMAJ 2008, 178:1685-1686.
91. Alaska Bureau of Vital Statistics. Marijuana Registry. (April 19, 2011, date last accessed). http://www.hss.state.ak.us/dph/bvs/marijuana.htm.
92. Arizona Department of Health Services. Medical Marijuana Program. (April 19, 2011, date last accessed). http://www.azdhs.gov/prop203/.
93. California Department of Public Health. Medical Marijuana Program. (April 19, 2011, date last accessed). http://www.cdph.ca.gov/programs/mmp/Pages/Medical%2520Marijuana%2520Program.aspx.
94. Colorado Department of Public Health and Environment. The Colorado Medical Marijuana Registry. (April 19, 2011, date last accessed). http://www.cdphe.state.co.us/hs/medicalmarijuana/.
95. State of Hawaii Department of Public Safety. Narcotics Enforcement Division. (April 19, 2011, date last accessed). http://hawaii.gov/psd/law-enforcement/narcotics-enforcement.
96. Maine Department of Health and Human Services. Maine Medical use of Marijuana. (April 19, 2011, date last accessed). http://www.maine.gov/dhhs/dlrs/mmm/index.shtml.
97. Michigan Department of Community Health. Michigan Medical Marihuana Program. (April 19, 2011, date last accessed). http://www.michigan.gov/mdch/0,1607,7-132-27417_51869---,00.html.
98. Nevada Department of Health and Human Services. Medical Marijuana. (April 19, 2011, date last accessed). http://health.nv.gov/MedicalMarijuana.htm.
99. State of New Jersey Department of Health and Senior Services. Medicinal Marijuana Program. (April 19, 2011, date last accessed). http://www.state.nj.us/health/med_marijuana.shtml.
100. New Mexico Department of Health. Medical Cannabis Program. (April 19, 2011, date last accessed). http://www.health.state.nm.us/idb/medical_cannabis.shtml.
101. Oregon Department of Human Services. Oregon Medical Marijuana Program. (April 19, 2011, date last accessed). http://public.health.oregon.gov/PHD/OCHHP/OMMP/Pages/index.aspx.
102. Rhode Island Department of Health. Medical Marijuana. (April 19, 2011, date last accessed). http://www.health.ri.gov/healthcare/medicalmarijuana/index.php.
103. Vermont Criminal Information Center. Vermont Marijuana Registry. (April 19, 2011, date last accessed). http://www.dps.state.vt.us/cjs/marijuana.htm.
104. Washington State Department of Health. Medical Marijuana. (April 19, 2011, date last accessed). http://www.doh.wa.gov/hsqa/medical-marijuana/default.htm.
105. Sun LH. DC council approves medical marijuana, posing challenges for doctors. (April 19, 2011, date last accessed). http://www.washingtonpost.com/wp-dyn/content/article/2010/05/04/AR2010050405305.html.
106. Nevada Department of Health and Human Services. Medical Marijuana Program. (April 19, 2011, date last accessed). http://health.nv.gov/BudgetDocuments/2012-2013/MMPWHITEPAPR_FY11.pdf.