MARIJUANA'S TRUTH AND CONSEQUENCES

Many Docs Oppose 'Cheech And Chong' Medicine But Clinical Trials Planned

Jim Wakeford smokes marijuana every day.

But he says it's rare -- unless he's lucky and having a good day -- for him
to feel the drug's high.

Marijuana is not a habit or a hobby for the Toronto man, 55, who has been
living with AIDS for more than a decade.

The marijuana joint Wakeford smokes before dinner every evening helps keep
him alive, he says.

Without it, Wakeford says, he has no appetite. The potent mix of AIDS drugs
and the rigors of the disease leave him nauseated, robbing food of its
taste and smell.

"Without it, I only just puke," Wakeford says. "This goes on every single
day. This is not the odd hit or toke. This is fighting for my life every
single day."

Last June, Wakeford was one of two Ontario men with AIDS given exemptions
under Section 56 of the Controlled Substances Act, allowing him to use and
cultivate marijuana.

In October, Health Minister Allan Rock says he was motivated by "the
humanitarian approach, a compassionate approach" to lift the legal barriers
for another 14 Canadians who are sick and dying.

At the same time, Rock released details of the first clinical trials to
determine the drug's effectiveness.

The Medical Research Council of Canada will receive $1.5 million a year
over five years for trials involving a variety of illnesses, such as
multiple sclerosis. And the Community Research Initiative of Toronto will
get up to $1 million in one-time funding for its study of marijuana as a
treatment for nausea in AIDS sufferers.

As early as the New Year, James Austin, a researcher with the Toronto
group, hopes to begin a double-blind, randomized study involving 250 men
and women who will be given either marijuana, a placebo or Marinol.

Marinol, a synthetic version of marijuana's active ingredient,
tetrahydrocannabinol or THC, is already legally available by prescription.
But Austin says many patients complain they can't control the dosage with a
pill like they could with smoking a joint.

"(Marinol) does abate the nausea in some cases but can also give you a
high, the psychological effects. They feel out of it," Austin says. "They
just want enough to curb their nausea."

There are still hurdles to clear, including where the supply of the drug
will come from, but Austin says the question of marijuana as medicine needs
answering.

"It's a question worthy of the best science we can do. A lot of people
believe it works," Austin says. "If you look at the evidence, if you look
at the literature, it is suggestive of a potential benefit. There is enough
evidence to rationalize a study."

Hazy Area

The issue of marijuana as medicine is black and white for Wakeford, but for
many it hangs in a hazy, grey area between anecdotal evidence and
scientific proof. One U.S. drug official even dubbed it, "Cheech and Chong
medicine."

There are groups who stand firmly on one side of the issue or the other,
arguing sick or dying patients should have access to marijuana; or that its
side effects, including anxiety and paranoia, far outweigh any benefit.

There are also those in the middle, who say the anecdotal evidence is
promising but clinical trials are needed to render a verdict on the drug's
powers to relieve suffering in those with AIDS and other illnesses,
including cancer, multiple sclerosis, epilepsy and glaucoma.

Health Canada hopes to clear away some of the haze with the clinical trials.

Medicinal marijuana is often associated with AIDS but there are a host of
other symptoms said to be alleviated by the drug. It is said to relieve
pain and nausea in cancer patients and control seizures in those with
epilepsy.

It is also said to ease intra-ocular pressure in patients with glaucoma as
well as lessen spasticity and loss of co-ordination in multiple sclerosis.

Physicians and advocacy groups for these diseases say they are watching
with interest the upcoming clinical trials.

But many are skeptical marijuana's benefits will prove to be anything more
than a puff of smoke.

"There is a view today we need a heroic new drug to relieve pain," says Dr.
Neil Hagen, former chairman of the Canadian Cancer Society's national
medical advisory council.

"There's very little evidence that marijuana relieves pain. I wouldn't say
there's no evidence because there is some."

Previous studies in rats have shown THC can interfere with the brain's pain
pathways, says Hagen, who heads a Calgary cancer pain clinic. "That's a
very long way from saying if you smoke dope, you'll relieve pain."

Hagen favours a chronic approach to managing cancer pain and nausea -- a
regimen of slow-release drugs taken "by the clock and around the clock" --
as opposed to a quick hit of marijuana.

Drugs that are fast-acting also fade quickly, giving users unsteady relief
of their symptoms and leaving them "hungry for more." This raises the ugly
spectre of addiction.

Dr. Raju Hajela, president of the Kingston-based Canadian Society of
Addiction Medicine, says marijuana is classified as a hallucinogen -- in
the same category as the psychedelic drugs LSD and magic mushrooms.

The perception-changing drug works by stimulating the brain's reward
centres, turning on receptors in the frontal lobe which deal with feelings
and emotions.

"It's reinforcing people to get high using that particular pathway. They're
using it to escape their everyday problems," Hajela says.

The drug's active ingredient, THC, is also very addictive. Anything that's
smoked hits the brain within seven seconds, Hajela says.

"I'm not of the camp that marijuana is a bad thing. It's well worth
investigating," he says. "I think we need to act on evidence; not rhetoric
or personal feeling."

In the debate over medicinal marijuana, Dr. Bill Corrigall, a scientist at
Toronto's Centre for Addiction and Mental Health, says the plant needs to
be separated from the components that could be beneficial to patients.

As a whole, Corrigall says, the plant -- which has some 400 compounds --
lacks the specificity to be taken seriously as a medical treatment.

"If you're smoking something like the leaves of the cannabis plant, you're
dosing yourself with literally hundreds of compounds," Corrigall says.

The drug also marries the worst of two other addictions -- the intoxicating
lure of alcohol and the health risks of cigarette smoking.

"The case is far from black and white," Corrigall says. "(But) I don't see
how we can have smoking a marijuana joint as medicine."

The use of marijuana as medicine dates back some 5,000 years to ancient
China, when it was used to treat a host of ailments from malaria and
constipation to rheumatic pains and absentmindedness.

An English doctor working in Calcutta found another use for marijuana in
1839 -- as an anti-convulsant, when mixed with alcohol.

Dr. Allan Sherwin, retired professor at the Montreal Neurological
Institute, says the drug became widely prescribed for epilepsy, as well as
a host of other illnesses, until the 1890s, when better anti-convulsant
drugs were developed.

This despite the fact that marijuana's effectiveness was never proven, he
says.

Sherwin says marijuana appears to work much like an anesthetic -- the
drug's active ingredient makes the brain's nerve cells less excitable.

Mixed Bag

But any benefit from marijuana is outweighed by its side effects, including
euphoria, anxiety and paranoia, Sherwin says.

There have been studies on marijuana and epilepsy, but the evidence is both
limited and conflicting.

"It's a mixed bag of helping and not helping," says Sherwin, whose research
has appeared in Epilepsy Canada's Lumina magazine. "It can cause seizures
and make it worse."

Sherwin says users would also need heavy doses of the drug -- about four
joints a day -- to achieve an anti-convulsant effect.

"They have to be under the influence all the time," he says.

But, in a Toronto courtroom earlier this month, lawyers for epileptic Terry
Parker argued marijuana is the best way to control his seizures.

The Crown was appealing a 1997 ruling that found Canada's drug laws
violated Parker's constitutional rights.

The ruling meant charges of cultivation and possession were stayed against
Parker, who has been fighting for 20 years for legal access to the drug.

"There is no question that Terry Parker receives therapeutic benefit from
marijuana," his lawyer told court.

Despite his objections, Sherwin does not dismiss marijuana entirely. He
sees a potential for a synthetic version of the drug -- one without the
toxic baggage.

Like epilepsy, evidence that marijuana lessens the symptoms of multiple
sclerosis, including spasticity and loss of co-ordination, is both sparse
and conflicting.

Clear The Air

The Multiple Sclerosis Society of Canada hopes the clinical trials will
clear the air and it is collecting a list of patients -- already some 50
names long -- who want to participate in the studies.

"I don't think anybody knows if it's actually beneficial for MS. We would
hope that clinical trials can take place," says spokesman Deanna Groetzinger.

To Dr. Graham Trope, chairman of the ophthalmology department at the
University of Toronto, there's little doubt marijuana helps relieve
intra-ocular pressure in patients with glaucoma. But the high potency of
the drug needed to ease the fluid build-up that ultimately destroys the
optic nerve -- a joint every two to four hours -- renders it "ridiculous"
as an effective treatment, he says.

"If somebody were to try to control their glaucoma through marijuana, they
would have to be totally stoned," says Trope, who also runs the glaucoma
service at the University Health Network. "Why would I intoxicate a patient
and make them non-functional? It's not a reasonable suggestion."

Smoking marijuana is also a "silly idea," given that effective treatments
for glaucoma are already available, including laser surgery and eyedrops.

"I'm not sure why anybody would give (marijuana) any consideration."

Wakeford says he turned to marijuana in 1996 in a desperate bid to
alleviate the powerful side effects of AIDS drugs that were wasting him away.

At the time, Wakeford was on a regimen of protease inhibitors which brought
some horrible side effects, including nausea, diarrhea and weight loss. At
one time, the weight on Wakeford's 5-foot-7 frame plunged to 116 pounds
from 142.

He had tried Marinol, but the pill brought waves of nausea that lasted for
eight hours.

"I was desperate. I would have tried anything," says Wakeford, a smoker
since age 15. "When you're sick as I am, you try what's available."

After a "polite" letter-writing campaign to the federal government and an
unsuccessful lawsuit to gain access to the "hysterically banned substance,"
Wakeford won his exemption.

To Wakeford, it is a hollow victory.

Too sick to grow his own marijuana, Wakeford says the exemption doesn't
give him legal access to other sources of the drug.

"They're busting the people who are trying to help me," Wakeford says,
adding three of his caregivers have been arrested for providing him with pot.

The exemption also doesn't deal with the high price of marijuana, which
costs Wakeford a "prohibitive" $300 a month.

"If it wasn't so critical to my survival, I wouldn't fight so hard,"
Wakeford says.

"I think they would speak differently if they suffered from the kind of
illness I do and experienced the kind of relief I do."