IS POT ANY MORE MEDICINAL THAN A SPOON FULL OF SUGAR?

Science: Tests Will Prove Or Disprove Belief In Marijuana As Remedy

Maybe the smoke is about to clear in the debate over medical marijuana.

Few ideas, it seems, are so firmly held by the public and so doubted by the
medical profession as the healing powers of pot. But at last, researchers
are tiptoeing into this field, hoping to prove once and for all whether
marijuana really is good medicine.

To believers, marijuana's benefits are already beyond discussion: Pot eases
pain, settles the stomach, builds weight and steadies spastic muscles. And
that's hardly the beginning. They speak of relief from PMS, glaucoma,
itching, insomnia, arthritis, depression, childbirth, attention deficit
disorder and ringing in the ears.

Marijuana is a powerful and needed medicine, they say, tragically withheld
by phobia about drug addiction.

Nine states, including Alaska, have adopted measures to legalize marijuana
for medical purposes. However, the drive to legalize medical marijuana is
based almost entirely on the testimonials of sick people who swear it makes
them feel better. Those stories are not the kind of dispassionate
experimentation that drives medical thinking.

"We lack evidence that there is something unique about marijuana, other
than an impressive number of anecdotal reports," says Dr. Billy Martin,
chief of pharmacology at the Medical College of Virginia.

In the medical establishment's view, the buzz about marijuana is little
more than that.

Pot has many effects on the body, including some that are probably
worthwhile. But does it substantially relieve human suffering, they ask.
And if so, is it any better than medicines already in drugstores?

For the first time in at least two decades, marijuana as medicine is being
put to the test. Scientists say they will try to hold marijuana to the same
standards as any other drug, to settle whether its benefits match its mystique.

Given marijuana's recreational uses and abuses, people in this new field
are understandably eager to come across as serious scientists experimenting
with a serious medicine.

One way to buff up a pharmaceutical's raffish image is to call it something
else. When the University of California at San Diego started the country's
first institute to study the medical uses of marijuana this year, it named
it the Center for Medicinal Cannabis Research. Cannabis is the botanical
term for pot.

"We talked about it a lot," says Dr. Igor Grant, the psychiatrist who heads
the new center. "Marijuana is such a polarizing name. We don't want this
institute to be caught in the cross fire between proponents and
antagonists. Ultimately, if cannabis drugs become medicine, they will
almost certainly be known by that name, not marijuana."

The center will give out $9 million over the next three years to California
researchers -- enough to underwrite six or seven marijuana studies a year,
each involving between 20 and 50 patients.

At least four other studies of the medical effects of marijuana are
planned. Three are sponsored by the National Institutes of Health, the
other by California's San Mateo County.

The medical marijuana movement began in earnest in 1996, when California
adopted a statewide referendum intended to make it legal. Alaska, Arizona,
Hawaii, Maine, Oregon and Washington adopted similar measures, and Colorado
and Nevada joined them in the November election.

"I was just so surprised at these policy decisions being made with so
little scientific information," says Margaret Haney of Columbia University.
"I'm not against the use of medical marijuana. There's just no data about
its efficacy."

Most of the new research will probably focus on four main uses of marijuana
that seem to hold the greatest promise:

Relieving severe nausea and vomiting caused by cancer chemotherapy. This is
probably marijuana's best-known medical use. While the drug almost
certainly helps ease nausea, there is no research showing how it stacks up
against highly effective anti-nausea drugs developed over the past 15 years.

Stopping weight loss. Marijuana clearly improves appetite. However, the
drug has not been adequately tested in people who are unintentionally
losing weight, such as those with AIDS or cancer.

Treating muscle spasticity conditions, including multiple sclerosis. Many
victims say it helps, and some animal research backs up the idea. But is it
better than standard medicines?

Easing pain. Researchers especially want to test it on AIDS patients with
peripheral neuropathy, numbness and pain in the feet that afflicts between
20 percent and 30 percent of people with the disease. Animal studies
suggest marijuana may be a mild to moderate painkiller, and many people
with AIDS are already using it, as there is no other good treatment.

Studies will compare marijuana to THC -- delta-9-tetrahydrocannabinol --
the most active ingredient in pot. THC has been available since the 1980s
in a synthetic pill form called Marinol.

Theoretically, THC and smoked marijuana should do pretty much the same
things, though some people argue that the other chemicals in pot are
essential for its effects. But many prefer smoking marijuana because the
dose is much easier to control.

Marinol takes a couple of hours to kick in. By then it's impossible to
fine-tune the level in the bloodstream, which sometimes is too high,
producing an unpleasantly intense and uncontrollable high.

The joint is an efficient drug delivery system. When smoked, marijuana's
chemicals reach the bloodstream in seconds and hit the brain soon
thereafter. Users can regulate the effect puff by puff.

In one new study, Haney will compare marijuana with Marinol in AIDS
patients experiencing unwanted weight loss. Volunteers won't be told
whether they are getting genuine marijuana or dummy joints, Marinol or
sugar pills. Then she'll see who eats the most.

But even if Haney and other researchers show marijuana is a uniquely useful
medicine, many people doubt that packs of marijuana cigarettes will ever
become standard items at the pharmacy.

The job of making marijuana an official prescription medicine would be
daunting. Because the stuff cannot be patented, no drug company will pay
hundreds of millions for the encyclopedic testing necessary to convince
regulators.

And then there is that drug delivery system. Nonsmokers often have trouble
inhaling marijuana smoke, which they find harsh. And it is, after all, a
form of smoking, one of the ultimate health taboos.

"It's not going to be easy to sell marijuana cigarettes as a medicine, even
if it could be shown there are particular benefits," Grant says. "It seems
that if these things are indeed useful, we would have to find a way to
deliver them in a manner that is prescribable."

To many people, that means marijuana's real future is its ingredients, THC
and the other 60 or so unique compounds called cannabinoids. These are
chemicals that pharmaceutical firms can isolate, improve and call their
own. These products could offer the health benefits of marijuana, only
better, refashioned to avoid pot's unwanted effects and delivered without
smoke.

Among the companies searching for better ways to harness marijuana are
Unimed Pharmaceutics of Deerfield, Ill., which makes Marinol. The company
is working on a THC aerosol spray.

Unimed president Robert Dudley says that in testing so far, the spray seems
to work pretty much like a joint, reaching peak blood levels of THC within
minutes. "It mirrors what you would expect to see with inhaled marijuana
smoke," he says, including the high.

The high, in fact, is one thing that some pharmaceutical designers would
like to get rid of.

Atlantic Technology Ventures of New York City is testing a synthetic form
of THC intended to be a painkiller. By tweaking the molecule, says CEO
Joseph Rudnick, "we kept most of the benefits of THC but got rid of the
psychogenic effects." In safety testing in France, no one got high.

On the Net:

Center for Medicinal Cannabis Research: http://www.cmcr.ucsd.edu/home.htm

Institute of Medicine report: http://books.nap.edu/html/marimed/

National Institutes of Health report:
http://www.nih.gov/news/medmarijuana/MedicalMarijuana.htm