SCIENCE'S VERDICT ON MEDICAL MARIJUANA STILL OUT

Patients' Reported Success Is Driving Bill

Texas is considering allowing people to smoke pot under doctor's orders,
but the science behind medical marijuana remains full of weeds.

Advocates say it might ease the relentless nausea of chemotherapy, the
wasting syndromes of the chronically ill or excruciating pain. Or it might
have little use beyond illegal recreation.

"There's really not enough data to support any claim," said Dr. Stanley
Watson, a neuroscientist at the University of Michigan in Ann Arbor.

Nor is there enough data to refute one. While some individual reports of
medicinal benefits are intriguing, he said, "we need good studies."

Even without the kind of research doctors would like, voters in eight
states -- Alaska, Arizona, California, Colorado, Maine, Nevada, Oregon and
Washington -- have approved the use of the drug by certain patients. And in
Hawaii last year, the state Legislature passed a bill allowing medicinal
use of marijuana.

Other states' lawmakers may not be far behind. This year, besides in Texas,
legislators have introduced bills in Maryland, Massachusetts, New Mexico
and Vermont. Texas will vote on its bill, authored by Rep. Terry Keel,
R-Austin, in the next few weeks, and Mr. Keel said he feels good about its
chances in the House. No sponsor has stepped forward to shepherd the
measure through the Senate.

Lacking solid clinical studies, the movement toward medical marijuana is
largely driven by the anecdotal reports of patients themselves. Research in
animals has also hinted at medical benefits from marijuana's active
ingredients. But no one can say scientifically whether marijuana alleviates
symptoms in people, which patients it will help most, how to take the drug,
or what dose works best.

The fact that marijuana is illegal is just one obstacle to medical research
in people. Another is its common method of delivery: smoking crushed
leaves. The amount of drug varies from plant to plant and from person to
person, depending on how deeply one inhales. For sound experiments,
researchers need to give each person the same dose.

Some doctors also are hesitant to recommend a smoked drug, which may
introduce a whole new set of health problems, Dr. Watson said. Studies
suggest that marijuana smoke is bad for the lungs, just as tobacco smoke is.

"We don't think studies should be done on the smoked material," Dr. Watson
said, but on other possible routes such as pills or inhalers.

He and others had hoped to generate more scientific interest in marijuana
research. In 1999, Dr. Watson and Dr. John Benson, from Oregon Health
Sciences University, were the principal authors of a government report on
medicinal marijuana. After reviewing data, along with meeting scientists,
marijuana smokers, and even opponents of marijuana use, the report's
authors concluded that marijuana has potential as a medicine. However, Dr.
Benson said at the time of the report's release, "there is far less
convincing data about actual medical benefits."

Existing drugs

Drugs already exist for conditions that marijuana might help. For most
patients, Dr. Benson said, "there are better medications in every case than
marijuana." Because major drug companies don't see a large potential
market, they aren't rushing to develop marijuana-based drugs, he said.

Many patients nevertheless believe strongly that marijuana is the only
means to relieve their nausea or pain, or to maintain appetite when weight
melts off their bodies from AIDS or chemotherapy.

"If you ask a bunch of AIDS patients, they'll say, 'We don't need any
research, we know that it works.' It's the anecdotal [evidence] that's very
prevalent," Dr. Benson said.

And in many cases, patients may be right, Dr. Benson acknowledges. As with
any medication, not all drugs work as well, or the same, in every patient.

"Standard therapy, which is approved and generally better, doesn't always
work," he said. That's the reason he believes that marijuana research
should continue.

But Dr. Benson's report, commissioned by the White House Office of National
Drug Control Policy, didn't light up much interest among scientists.

What's needed, he and others say, is a federal law that will make it easier
for researchers to do their jobs.

"There are many, many obstacles that dissuade them from this area of
study," said Dr. Andrew Mattison of the University of California, San
Diego, who is co-director of the Center for Medicinal Cannabis Research.
For example, he said, a scientist could be easily overwhelmed by the
paperwork involved in obtaining marijuana for a laboratory.The California
center, established by the state government last year, won't focus on
ailments like glaucoma that already have good treatment alternatives, Dr.
Mattison said. Although marijuana has been found to relieve the eye
pressure caused by glaucoma, conventional medicines already exist.

Safer methods

Dr. Mattison and his colleagues are also looking for safer ways to deliver
marijuana's active ingredients.

"There are clearly scientific data indicating the deleterious effects of
smoking," he said. "We are taking that charge seriously."

One drug now on the market does offer marijuana in pill form for people
with AIDS or undergoing chemotherapy. But many patients don't like it, Dr.
Mattison said. The medicine dumps the drug into the body all at once, while
patients might prefer to gradually take only as much as they need. An
inhaler, patch or under-the-tongue spray might be a better method.

Until there is a federal standard for marijuana's medicinal use, however,
states will pursue laws on their own. Each law might make it possible for
people to take the drug, Dr. Benson said, but beyond establishing specific
centers like the one in California, "I don't think the state bills have any
direct effect on research."

The federal government ultimately controls drug enforcement, Dr. Benson
said. At the same time, it also is the largest single sponsor of medical
research.

"The states can write in stuff that has to do with encouraging research,"
Dr. Benson said, "but it may not matter very much if the grants that come
and the substance they're going to test has to come through federal agencies