MEDICINAL MARIJUANA USE FINALLY BEING PUT TO TEST

SAN DIEGO -(AP)- 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 misplaced phobia about drug addiction.

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 the 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. (Even marijuana's usual reason to be -- the high -- is
dismissed as a mere side effect, and probably an unwanted one at that.)

One way to buff up a pharmaceutical's raffish image -- especially one that's
a drug in more than one sense of the word -- 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, they 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
passed a statewide proposition intended to make it legal. Alaska, Arizona,
Hawaii, Maine, Oregon, and Washington adopted similar laws, 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 with the disease. Animal studies suggest marijuana
may be a mild to moderate painkiller, and many with AIDS are already using
it, since there is no other good treatment.

One of the first questions to answer is whether objectively testing
marijuana as a medicine is even practical. At the San Mateo County Health
Center, Dr. Dennis Israelski will tackle this by enrolling 60 AIDS patients
who already use marijuana for painful neuropathy.

They will be randomly assigned to smoke marijuana -- or forgo it -- for six
weeks. Will people go along with this if it means giving up something they
already believe helps them? If not, larger, more elaborate studies of
marijuana may be hard to accomplish.

Other 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, although some 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.

A cigarette 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 of the new studies, 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 others show marijuana is a uniquely useful medicine,
many 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," says Grant. "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."