CANADA'S MARIJUANA DECISION DEBATED HERE

The "Great White North Drugstore" just started carrying a new,
controversial product.

Currently a source of low-cost prescription medications for older people
without drug benefits, Canada is gearing up to supply its ill patients with
another drug: medical marijuana. And while Springfield doctors believe that
our northern neighbor's decision will have little impact here, national
marijuana advocates predict more Americans will try to get in on the action.

"Certainly, you will see patients making the trek to get medical
marijuana," said Keith Stroup, director of the National Organization for
the Reform of Marijuana Laws in Washington, D.C. "I would imagine that
fairly quickly there will be methods and means for Americans to obtain
medical marijuana through a 'gray market.'"

A new initiative from the Canadian health ministry, sanctioned by a
Canadian Supreme Court decision, gives patients the right to apply for
access to "research-grade" marijuana cultivated hydroponically in a
Manitoba mine. But Springfield doctors said that a northern rush for
marijuana is unlikely.

New serotonin antagonists such as Zofran and Kytril do a much better job of
relieving nausea, the condition against which marijuana is considered most
effective, said Springfield area medical oncologist Dr. Philip T. Glynn.

"It's been studied to treat nausea, vomiting, anorexia and pain," Glynn
said, "and in general it's only been moderately effective."

Canada's health minister, Allan Rock, set new regulations that permit
marijuana use for patients with certain illnesses for whom conventional
therapies have failed and for terminal patients with a life expectancy of
less than one year. Rock also earmarked $840,000 to study marijuana's
effectiveness in AIDS patients.

Researchers still debate marijuana's medical usefulness. The American
Medical Association, the National Institutes of Health, the Institute of
Medicine, and the World Health Organization have all recommended further
research on marijuana's potential to treat various conditions. In 1997,
former New England Journal of Medicine editor Dr. Jerome Kassirer called
federal drug authorities to "rescind their prohibition of the medical use
of marijuana for seriously ill patients and allow physicians to decide
which patients to treat."

But doctors need more evidence from careful research studies to prove that
marijuana treats nausea or anorexia better than existing agents, said Dr.
Wilson C. Mertens, medical director of cancer services at Baystate Medical
Center in Springfield.

"If it were a really effective agent that was demonstrated in clinical
trials to offer benefit, then I would be happier," Mertens said. "But this
is a political decision in a way that has nothing to do with effectiveness."

The U.S. Food and Drug Administration has approved marijuana derivatives
called Marinol and Nabalone for nausea, but they are considered far less
effective than other conventional treatments or inhaled marijuana, which
acts quickly and lasts long.

Stroup points out that although the U.S. Supreme Court ruled in May that
"cannabis clubs" cannot distribute marijuana to seriously ill patients,
nine states have legalized marijuana for medical purposes, and 11 have
decriminalized marijuana possession. The Canadian ruling only adds to "peer
pressure" on the United States to consider legalizing medical marijuana, he
said.

"There's no question but that the change under way in Canada will have an
enormous impact in this country," Stroup said.