THE POT ISSUE: SEPARATING SMOKE FROM SCIENCE

* Marijuana Indeed Shows Medical Potential, But The Delivery System
Shouldn't Involve Smoking

When a study on the medical use of marijuana was issued recently, advocates
for legalizing the drug cheered the report's conclusions that marijuana's
compounds do have some potential as medicine. Their opponents, however,
cited the report's caveat that the harmful effects of smoking far outweigh
marijuana's potential benefits for most patients.

Both sides are right. And this is not scientific hair-splitting.

To date, it has been nearly impossible to separate scientific evidence about
marijuana's potential from larger societal concerns about its use. But doing
so may be the key to advancing the rancorous debate over this issue since
medical marijuana began to appear on state ballot initiatives in the mid-1990s.

Some may be surprised to learn that in the scientific realm, we found
remarkable consensus that marijuana's components have potential to relieve
symptoms such as pain, nausea and vomiting, as well as the poor appetite
associated with wasting in cancer or AIDS. For most symptoms, there are more
effective drugs already on the market, but physicians encounter patients who
do not respond well to standard medications, or who need additional
therapies. These patients could benefit from new drugs based on
cannabinoids, the active components in marijuana.

Marijuana's future as medicine rests in developing new ways of delivering
these cannabinoids -- including the most common one, THC.

Marinol, a THC capsule, is approved by the Food and Drug Administration for
treatment of nausea and vomiting associated with chemotherapy, as well as
poor appetite and weight loss associated with AIDS. However, some who have
used Marinol complain that it takes effect slowly, and its results are
variable. Sufferers, obviously,
need fast-acting medication. For that reason, we recommend that clinical
trials move forward, with the goal of developing a rapid-onset, non-smoked
delivery system, such as an inhaler. This would deliver precise doses
without the health problems associated with smoking.

But an inhaler could take years to produce. What do we do now?

In deciding whether marijuana should be smoked as medicine, society must
weigh the reality of this crude drug-delivery system against the benefits it
might bestow. Chronic smoking of marijuana increases a person's chances of
developing cancer, lung damage and problems with pregnancies, including low
birth weight. It simply is not an acceptable long-term option. Smoking
should be allowed only for short-term use by patients with debilitating
symptoms, or who are terminally ill and do not respond well to approved
medications.

Even in these cases, marijuana use should be carefully controlled. Patients
who are prescribed marijuana should be enrolled in short-term clinical
trials involving only those most likely to benefit.

These clinical trials of smoked marijuana should not be designed to develop
it as a licensed drug, but to make way for developing new, safe delivery
systems of cannabinoids. There is no evidence that using marijuana in
controlled settings -- or cannabinoids in the form of drugs such as Marinol
- -- will lead to increased illicit drug use in society.

Our review of the science behind marijuana and cannabinoids convinces us
that the debate so far has been miscast. Rather than focusing on
drug-control policy, the debate should really be about the promise of future
drug development. Mining the pharmaceutical potential of cannabinoids
requires the same kind of development that brought us any number of
pain-killing drugs prescribed by physicians today.

With public investments in research, or enough incentives to convince
private companies to develop these drugs, the perceived need to smoke
marijuana to alleviate symptoms could vanish.