U.S. RESISTS MARIJUANA FOR THE SICK

Patients With AIDS, Cancer Press For Exceptions To Ban; States
Reforming Their Laws

Paul Boone says he never intended to start smoking marijuana. But
last summer, when the cancer that was attacking his liver made him so
nauseated that he lost 40 pounds, he became desperate.

So the 35-year-old computer consultant searched the Internet for a
local head shop. He drove to Fells Point, bought two pipes and called
a friend who had offered to find marijuana for him. In September,
when he lighted up for the first time, the relief was almost instant,
he says.

"I couldn't believe how fast it stopped my nausea," says the Harford
County resident, who has since regained 20 pounds despite six rounds
of chemotherapy. "I still can't believe it works. I didn't believe it
at the time."

Boone is one of many patients in Maryland and across the country who
say they have come to depend on marijuana as part of their treatment.
Cancer patients smoke it to cope with the effects of chemotherapy,
AIDS patients to stimulate hunger and gain weight, and people
suffering from neuromuscular disorders to ease pain and muscle spasms.

The growing demand of such patients for marijuana has led to a
striking reform of state criminal laws. In the past five years, eight
states have approved measures allowing patients with certain medical
conditions to smoke marijuana under a doctor's supervision.
Legislatures in five other states, including Maryland, have begun to
consider the matter.

But the federal government continues to classify marijuana as a
Schedule I narcotic, meaning that its use is a crime under any
circumstances. And in a case pending before the Supreme Court, the
government is trying to undercut the state measures and put an end to
the medical use of pot.

The case involves six "cannabis clubs" that sprang up in California
after the approval of Proposition 215, the first of the state
initiatives to legalize medical marijuana. Started by local
activists, the clubs began growing marijuana and selling it to
patients whose doctors had cleared them to use the drug.

Local officials gave their blessing to that arrangement, and county
prosecutors agreed not to interfere. But the Justice Department sued
three years ago to shut the clubs, saying their activities violated
federal laws against possessing or distributing marijuana.

A U.S. district judge initially granted the government's request. But
after being reversed by an appeals court, he ruled that the clubs
could continue to serve patients who faced imminent harm and had no
other choice. The government appealed to the Supreme Court, which
will probably issue a decision by early summer.

The stakes are high. If the court sides with the government, it will
significantly disrupt the medical marijuana movement. Though the case
involves only the right of clubs to distribute marijuana - not the
right of patients to smoke it - closing the clubs would leave
patients with no legitimate source.

If the court rules for the clubs, it could put a stamp of legitimacy
on medical marijuana. It could also rejuvenate efforts to legalize
its use for patients nationwide.

"It would be tremendous," says Alan St. Pierre, executive director of
the National Organization for the Reform of Marijuana Laws. "It would
galvanize and institutionalize the concept that marijuana is
medicine."

When the case was argued before the Supreme Court last month, the
justices sent conflicting signals. A few appeared sympathetic to the
claim that marijuana is sometimes medically necessary, but others
seemed skeptical. And some justices, while allowing that the drug
might have benefits, questioned whether it was possible to
distinguish between those patients who need it and those who simply
enjoy it.

The dispute among the justices reflects a larger societal rift. Since
rising to national attention in the late 1980s and early 1990s, the
medical use of marijuana has been vigorously debated.

Supporters say marijuana is an ancient remedy that has been
classified unwisely as a dangerous drug. They say it stops nausea,
stimulates hunger, relieves pain and soothes nerves, all of which can
help the seriously ill cope with their diseases and the often brutal
treatments for them.

They also argue that marijuana is valuable in treating glaucoma,
epilepsy and multiple sclerosis.

Most opponents don't deny that marijuana provides benefits. A study
commissioned by the federal government concluded that the drug has
"potential therapeutic value." But they argue that any benefits are
outweighed by other considerations.

For one thing, critics say, smoking marijuana - like smoking tobacco
- - can lead to lung cancer and other respiratory diseases.

They also argue that marijuana has undesirable side effects, such as
paranoia and dizziness.

Their biggest fear is that the medical use of marijuana would
increase drug use in general. They express particular concern that if
children saw adults smoking pot to treat illnesses, they would be
encouraged to smoke it themselves.

"When we have mixed messages on the street, that has an impact on
kids," says Robert L. Maginnis, a vice president at the Family
Research Council, which supports the government's case. "It's a
public policy trade-off.

"If officials excuse the use of marijuana for a limited number of
people, they risk the negative impact on a particular segment of the
population."

Maginnis argues that the government should not run that risk until it
has exhausted other options. He notes that researchers are studying
ways to replicate the benefits of marijuana without the hazards.
Until they succeed, he says, other medicines can help patients cope
with their suffering.

Hormone pills, for instance, help build muscle mass and increase
weight, and prescription drugs such as Zofran ease nausea. Marinol, a
drug that contains one of the active ingredients of marijuana, helps
stimulate hunger.

Doctors say such drugs have drawbacks. Testosterone causes mood
swings and often leads to prostate enlargement, which, some doctors
fear, raises the risk of prostate cancer. Zofran costs about $30 a
pill.

Many patients say Marinol makes them sleepy. In addition, it takes up
to two hours to start working. Marijuana provides almost instant
relief.

"I have yet to meet a patient who has used both marijuana and Marinol
who will say that Marinol is better or as good," says Lester
Grinspoon, a Harvard psychiatrist who interviewed dozens of patients
for his book, "Marijuana: The Forbidden Medicine."

Dale Cunningham, an acquired immune deficiency syndrome patient in
Virginia, agrees.

"I have been prescribed Marinol," says Cunningham, who is often
nauseated from the 27 pills he must take daily. "I've tried
Compazene. I don't know, the list goes on. But the only thing I've
found that helps is natural marijuana."

The debate over medical marijuana has been conventional in many ways,
with conservatives on one side and liberals on the other. But there
have been surprises. Some who support medical marijuana are
self-described conservatives who reversed field once they became sick
or met someone who was.

Del. Donald E. Murphy, a Baltimore County Republican in the Maryland
House of Delegates, says he never considered legalizing pot for
medical use before being introduced to Darrel Putman, a former Green
Beret who developed non-Hodgkin's lymphoma. But when Putman described
how smoking marijuana had allowed him to gain the weight he needed
for a vital operation, Murphy was persuaded.

He promised Putman he would introduce a bill to legalize medical
marijuana if Putman would testify before the General Assembly. The
former soldier died before he could do so, but Murphy went ahead with
the proposal anyway. Now, he finds himself defending the proposal
against fellow conservatives who think he's gone soft.

"This is very much a conservative position," Murphy says. "You trust
a person with a deadly weapon, but not with pot for cancer. It's
certainly not as deadly as a firearm."

Murphy's bill stalled in the legislature this year, in part because
of uncertainty about how the Supreme Court would rule on the
California cannabis clubs. He plans to reintroduce it next session
and says a favorable Supreme Court ruling could give it a boost.

In the meantime, he has recruited another patient to take Putman's
place as a witness. He heard the story of Boone, the Harford County
man, on a radio call-in show last year and was so moved that he asked
him to appear before the General Assembly.

Boone says he's an unlikely spokesman for the medical marijuana
movement. Though he tried marijuana once in high school, he has
always opposed drugs and used to think that medical marijuana was
just an excuse for "hippies" to get high.

When he became ill and got no relief from other medicine, Boone says,
he changed his mind. Now, he's frustrated that a drug that helps him
so much is still illegal. "I'm not a kingpin or anything," he says.
"I'm just a guy with cancer."