RESEARCHERS INTEND TO FIND OUT WHETHER POT IS GOOD MEDICINE

California Researchers Will Receive $9 Million During The Next Three Years
To Conduct Marijuana Studies

SAN DIEGO -- 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 beyond discussion: Pot eases pain,
settles the stomach, builds weight and steadies spastic muscles. It
relieves 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.

Pot has many effects on the body, including some that are probably
worthwhile. But does it substantially relieve human suffering? 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 field are
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 is to call it something
else. When the University of California-San Diego started the first
institute to study the medical uses of marijuana this year, they named it
the Center for Medicinal Cannabis Research, using 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,
with each involving between 20 and 50 patients.

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

The movement began in earnest in 1996, when California passed a referendum
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."

Four Primary Promising Uses

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 it helps ease nausea,
there is no research showing how it stacks up against anti-nausea drugs
developed 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, including multiple sclerosis. Many patients say
it helps, and some animal research backs up the idea.

Easing pain. Researchers want to test it on AIDS patients with peripheral
neuropathy, numbness and pain in the feet that afflicts 20-30 percent of
AIDS patients. Animal studies suggest marijuana may be a mild to moderate
painkiller, and many with AIDS already use it.

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 studies of marijuana may be hard
to accomplish.

Other studies will compare marijuana to THC --
delta-9-tetrahydro-cannabinol -- 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
easier to control.

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

When smoked, marijuana's chemicals reach the bloodstream in seconds and hit
the brain soon thereafter. Users can regulate the effect.

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

But even if Haney and others show marijuana to be uniquely useful, many
doubt that packs of marijuana cigarettes will ever become standard items at
the pharmacy.

Probably Not By Prescription

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."

That may mean 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, refashioned
to avoid pot's unwanted effects and delivered without smoke.

"Marijuana does too many things to be a really good drug by itself," says
John Huffman of Clemson University, a chemist who works with cannabinoids
full time.

Some of the things it does are obvious to the 70 million or so Americans
who admit trying marijuana: the sense of well-being, a ravenous appetite,
messed-up perception of time and distance, talkativeness and the rest.
Marijuana also appears to disrupt short-term memory and suppress immune
defenses.

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, intended to offer the quick, easily
controllable wallop of marijuana smoking.

Unimed President Robert E. Dudley says that in testing, the spray seems to
work pretty much like smoked pot, 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 is one thing some designers would like to get rid of.

Atlantic Technology Ventures of New York is testing a synthetic form of THC
as a painkiller. CEO Joseph Rudnick says, "We kept most of the benefits of
THC but got rid of the psychogenic effects."

All the research done on genuine marijuana will use pot supplied by the
nation's only legal supplier, the federal government's National Institute
on Drug Abuse. Every year or two, it pays the University of Mississippi to
plant an acre and a half of marijuana for experiments.