MARIJUANA: MEDICINE OF LAST RESORT FOR VERY ILL

WASHINGTON - Angel McClary, a 35-year-old Oakland, Calif., paralegal, has a
brain tumor, anorexia and frequent nausea. When traditional medications
proved ineffective, McClary's doctor recommended marijuana.

"It's saved my life," says McClary, who has been using marijuana since
1998. She has gotten out of a wheelchair, gained some weight and been able
to get the nausea partially under control.

Still, McClary has a problem: The federal government does not think she
should have marijuana and has gone to the Supreme Court to enforce its
opinion. On Wednesday, the court will hear arguments that could determine
how easy - or difficult - it will be for McClary, as well as other
residents of California and at least eight other states, to obtain
marijuana legally for medical reasons.

The case, which has already rekindled the debate over medicinal uses of
marijuana, also could affect states like Connecticut that are considering
proposals to ease or lift restrictions on marijuana use for medical
conditions that may not respond to conventional treatment.

"The upcoming Supreme Court decision will be the most important court
ruling with regard to medical marijuana in U.S. history," said Chuck
Thomas, communications director of the Marijuana Policy Project, which
favors allowing people to cultivate small amounts of marijuana for their
personal use.

R. Keith Stroup, executive director of the National Organization to Reform
Marijuana Laws, said: "Surely federal law must recognize the right of
seriously ill patients to use marijuana, if recommended by a physician,
when other medications are ineffective."

On the other side, Robert L. Maginnis, vice president of the conservative
Family Research Council, contends the harmful effects of marijuana outweigh
any benefits. "Permitting `medicalization' of crude marijuana would result
in many negative consequences that the federal drug laws are designed to
prevent," he said.

Not-for-profit marijuana cooperatives sprang up in California, especially
around the San Francisco-Oakland area, after voters in 1996 approved
Proposition 215, legalizing marijuana when a doctor found it medically
necessary for a seriously ill patient. At their peak, the cooperatives are
believed to have had tens of thousands of members. Some have closed in
recent years, but many remain in operation pending the high court's
decision, which is expected by early July.

Purchasers say the cooperatives provide a safe and affordable place to buy
good-quality marijuana.

In 1998, however, the Justice Department filed a civil action in federal
district court to prevent the popular Oakland Cannabis Buyers' Cooperative
from continuing to operate. Government lawyers argued that Proposition 215
conflicted with the 1970 federal Controlled Substances Act, which forbids
anyone from distributing or dispensing marijuana.

Over the next two years, federal district and appeals courts in California
issued several confusing rulings that the Supreme Court will attempt to
sort out.

Initially, District Judge Charles R. Breyer of San Francisco granted the
government's request for an injunction to close the Oakland cooperative.
But the U.S. 9th Circuit Court of Appeals later said that Breyer should
have modified his injunction to consider medical necessity and the "strong
public interest" in the availability of marijuana for patients whose
doctors think they need it.

As a result, Breyer last summer issued a new order saying the cooperative
could continue supplying marijuana to those who have a "serious medical
condition" and could suffer imminent harm without it. The government moved
a second time, persuading the Supreme Court to stay Breyer's new ruling and
to consider the legality of Proposition 215. Breyer's brother, Supreme
Court Justice Stephen G. Breyer, has recused himself from the case.

The central legal question is Congress' intent in passing the Controlled
Substances Act. Government lawyers argue that Congress "specified certain
substances to be included" in a controlled category and that marijuana has
been in that category from the start.

Lawyers for the Oakland cooperative contend that Proposition 215 is based
on the principle of medical necessity, which they argue "is one of the
oldest and most well-entrenched common law defenses in Anglo-American
jurisprudence," going back to 13th century England.

While reluctant to predict how the court will rule, lawyers involved in the
case said three outcomes seem possible: The high court could uphold the
medical necessity argument and allow cooperatives in California and other
states to resume operations. The justices could invalidate Proposition 215,
forcing cooperatives in California and elsewhere to close permanently. Or
the justices could decide they prematurely agreed to take up the case and
send it back to California for additional argument.

Some lawyers doubt the current conservative Supreme Court will accept the
medical argument because it could be seen as undercutting the nation's war
on drugs. In any case, they said that many who need it will continue to get
marijuana, either from the street or from family or friends, but purchases
will be more difficult and more dangerous and buyers could be subject to
prosecution.

Many are waiting to see if the high court's opinion applies only to
California or to the other states that have permitted medical uses of
marijuana. Those states are Alaska, Arizona, Colorado, Hawaii, Oregon,
Maine, Nevada and Washington.

Lawmakers elsewhere will be paying attention, too. Since 1996, eight of the
nine states that have adopted policies similar to California's have been in
the West. This year, the focus has shifted to the East, where legislators
in five states - Connecticut, Rhode Island, Massachusetts, Vermont and
Maryland - have introduced proposals that could lead to legalizing
marijuana for medical use. New Mexico and Iowa also are considering similar
proposals.

In Connecticut, current law allows cancer and glaucoma patients to possess
marijuana obtained from a doctor's prescription. But there is no place to
fill such prescriptions, and physicians who prescribe marijuana may be
barred from participating in Medicaid, the federal-state health program for
the poor. A bill under consideration in the legislature would provide for
research into ways of legally distributing medical marijuana in the state.

In the background of the legal and legislative maneuvering is the question
of how much good marijuana really does for those who are ill. The Institute
of Medicine, an arm of the National Academy of Sciences, has tried to
straddle the issue, saying that marijuana use has potential as a medicine
but the good effects are undermined because patients must inhale harmful smoke.