WHY I SUPPORT MEDICAL MARIJUANA

In late May, the U.S. Department of Health and Human Services (HHS) --
after decades of obstruction -- finally loosened its restrictions on
medical marijuana research. Now, changes in HHS guidelines will make it
easier for researchers to obtain legal (i.e., federally grown) marijuana
for clinical trials. This change came in response to a report issued in
March by the Institute of Medicine (IOM), a branch of the National Academy
of Sciences. The report found convincing evidence that marijuana may help
people with AIDS wasting syndrome, chemotherapy-induced nausea, or multiple
sclerosis. The IOM panel of experts recommended further research on the use
of marijuana for these conditions as well as others for which there is
strong anecdotal evidence.

The IOM panel's call for changes in federal policy on medical marijuana
echoed those in recent years of an expert panel of the National Institutes
of Health (NIH), the editors of the New England Journal of Medicine, the
American Medical Association, and voters in seven states. Despite long
years of use as a folk medicine and anecdotal evidence of its usefulness in
medical conditions from epilepsy to migraine to chronic pain, until now the
federal government has balked at approving, funding, or providing legal
marijuana for clinical research on conditions that might benefit from the
herb. I'm pleased to see some sign that more studies may finally be done on
the therapeutic effects of marijuana, but I'm disappointed that the federal
prohibition on the actual use of marijuana for medical purposes by patients
is still in effect.

It's unbelievable to me that it is still illegal to use marijuana medically
in this country. When I published a study in Science on the physiological
and psychological effects on humans in 1968 while I was still a student at
Harvard Medical School, I thought that medical use of the plant would be
legalized within five years. I never expected the federal government to
take such a harsh stance on what is, after all, an herb for which no fatal
dose has ever been established. But federal policymakers have continued to
demonize marijuana, labeling it a "gateway" drug that leads to the use of
harder drugs. (I was pleased to see that the IOM panel refuted that claim
in their report.)

Like the IOM panel, I don't believe the future of medical marijuana lies in
smoking it. Marijuana smoke contains carcinogenic toxins, and long-term use
of smoked marijuana (medical or otherwise) can raise the risk of lung
disease, including lung cancer. For this reason I support research into
safer delivery systems, such as inhalers (like those used by asthmatics)
and low-temperature vaporizers. But for patients with certain conditions,
the benefits of using medicinal marijuana to relieve symptoms may well
outweigh the risks.

Over the years, many patients have told me that marijuana eased the
discomforts of multiple sclerosis, cancer chemotherapy, migraine headaches,
severe menstrual cramps, and fibromyalgia. These were not "potheads"
avoiding conventional medicines; in most cases, they either used marijuana
to moderate the side effects of conventional treatment (such as
chemotherapy) or had conditions for which conventional medicines provided
no relief. Because of their testimony, I'm now more likely to suggest the
herb myself, especially to patients suffering from chemotherapy side
effects, muscle spasticity (as seen in MS or spinal-cord injuries), or AIDS
wasting syndrome. I'm frustrated that as a physician I cannot write them
prescriptions or refer them to a reliable source.

A legal form of marijuana has long been available by prescription under the
name Marinol, a synthetic form of THC, the main psychoactive constituent of
marijuana. But patients consistently tell me this pill is inferior to
smoking the natural herb -- that it causes much greater intoxication, for
one thing. Both the NIH and IOM panels agreed that the smoked whole plant
is faster-acting than Marinol and the dosage more easily adjusted.

The Clinton Administration has taken one small step toward putting the
issue of medical marijuana in the hands of health experts rather than the
criminal-justice system. But it needs to go much further. The HHS
guidelines may indeed increase access to legal marijuana for research
purposes -- although the process will never be swift, given the need for
approval by at least three federal agencies. Unfortunately, the HHS has
rejected what I consider the most important recommendation made by the IOM
panel -- that physicians be able to prescribe marijuana to individual
patients with debilitating or terminal conditions who have no other
alternative for relief of pain and suffering. I believe such compassionate
use is justified. But until the federal government backs this policy, as a
physician my hands are tied.