ANOTHER VICTORY FOR MEDICAL MARIJUANA

A New Government Report Cautiously Endorses POT AS A PAINKILLER - And It
Not Only Embarrasses Drug Czar Barry McCaffrey But Also May Help To
Undermine The $17 Billion War On Drugs

PERHAPS THEY DIDN’T INHALE, BUT many Americans gasped when a
scientific study funded by the White House’s drug czar reported in
March that marijuana’s active ingredients seem to have medical value,
"particularly for pain relief, control of nausea and vomiting, and
appetite stimulation." As much as the contents of the report, its
irony -- as if the 1950s House Un-American Activities Committee had
paid for a report finding that communists were good guys after all --
attracted a barrage of media attention. Gen. Barry McCaffrey, director
of the Office of National Drug Control Policy, was forced to put on a
brave face.

McCaffrey, who since taking office in 1996 has called medical marijuana a
"cruel hoax" and "Cheech and Chong" medicine, commissioned the report,
which eventually cost $896,ooo, in January 1997, just months after
California and Arizona became the first two states to endorse the use of
marijuana for medicinal purposes. The study, "Marijuana and Medicine:
Assessing the Science Base," was conducted by the National Academy of
Sciences' Institute of Medicine, which in August 1997 assembled an
eleven-person panel to conduct an eighteen-month investigation of
marijuana's benefits and risks through a series of public hearings and
exhaustive study of current research.

What drew the most attention after the release of the report was its
finding that some of the sixty-six "cannabinoid" substances found in
smoked marijuana have "potential therapeutic value ... moderately
well-suited for certain conditions, such as chemotherapy-induced
nausea and vomiting and AIDS wasting." Less noticed, however, was the
report's point-by-point dismantling of many of the key anti-marijuana
arguments made by drug warriors. In understated, scientific language,
the institute questioned the widely cited "gateway" theory, which
holds that marijuana leads users on to harder drugs like heroin and
cocaine; cast doubt on marijuana's addictive properties; rejected the
notion that use of medical marijuana will stimulate wider recreational
use of the drug; and knocked down the idea that marijuana is dangerous
to its users.

Not surprisingly, marijuana advocates cheered the report's conclusion
and promised that behind these findings they would expand the campaign
to win statewide ballot initiatives in support of medical marijuana.
McCaffrey, on the other hand, was left with nothing to do but spin,
citing the report's conclusion that smoking marijuana is a risky and
uncertain method for delivering the drug's active ingredient, to the
body. "The study concludes that there is little future in smoked
marijuana as a medically approved medication," said McCaffrey in a
statement faxed from his office.

This point is essentially well taken. The report indeed notes that
research into the potential uses of marijuana ought to emphasize
pills, inhalers and other "non-smoked, rapid-onset cannabinoid
delivery systems." But it also says that for certain patients,
short-term use of smoked marijuana might be helpful. Until other
delivery systems are developed, the report says, “there is no clear
alternative for people suffering from chronic conditions that might be
relieved by smoking marijuana, such as pain or AIDS wasting."

It also points out that the very act of smoking marijuana raises
serious concerns about respiratory diseases and cancer, similar to or
even more intense than those associated with tobacco smoke. But if the
danger of marijuana rests chiefly in the fact that marijuana smoke can
cause lung and respiratory disease, that hardly justifies including
marijuana in the War on Drugs. "By that measure, it would be logical
to jail cigarette smokers,” says Bill Zimmerman, executive director of
Americans for Medical Rights, the organization leading the effort to
place medical-marijuana initiatives on statewide ballots.

THE INSTITUTE OF MEDICINE'S task force scoured the literature for
research on marijuana. Its researchers setup a Web site for public
comment and solicited input from 130 organizations, and they also
visited four cannabis-buyers' clubs in California and two HIV-AIDS
clinics.

In public hearings during the winter of 1997-98 in California,
Louisiana and Washington, D.C., the report's authors and its advisory
panel of scientists not only heard testimony from dozens of experts
but also listened to a wide range of patients who use marijuana to
treat AIDS, cancer, multiple sclerosis, glaucoma and other ailments.
While noting that exact data are not available, the report says that
based on its informal surveys, medical-marijuana users are
over-whelmingly male, usually in their forties and typically suffering
from AIDS. Cancer patients and victims of chronic pain, including back
pain, are the next most common users of medical marijuana.

Though patients' stories are often disparaged as anecdotal and
unscientific, one of the study's two principal investigators, Dr. John
A. Benson Jr., dean and professor emeritus at Oregon Health Sciences
University School of Medicine in Portland, says, “in medicine, you
start with anecdotes. The idea was to get a feel for, one, whether it
is harmless, and two, whether it helped them. So we're educating
ourselves and learning the scope of the illnesses." Many of the
patients who appeared before the panel were located and organized by
the Marijuana Policy Project, a marijuana-law-reform group based in
Washington, D.C. According to Chuck Thomas, a co-founder of the MPP,
the testimony from marijuana-using patients was crucial. "It humanized
the issue," he says. "It took it out of the realm of just scientific
data to show the human dimension."

A case study cited in the report is that of "G.S.," who used marijuana
to treat AIDS wasting syndrome. "After years of final-stage AIDS, I
had wasted to 130 pounds," G.S. testified. "The purple Kaposi's
sarcoma lesions were spreading. The dark circles under my eyes told of
sleepless nights and half-waking days." But smoking marijuana, said
G.S., "calmed my stomach against handfuls of pills [and] made me
hungry again so that I could eat without a tube." Pot, he said, also
eased his pain and "calmed my soul," leading him to accept the fact
that he was likely facing death: "I lived to gain fifty pounds, regain
my vigor and celebrate my thirty-fifth birthday."

Says Benson, clearly moved, "The patients were enormously, enormously
grateful to us. The National Institutes of Health didn't let them in
the door, and, well, we seemed official. They just wanted someone to
listen."

DRUG WARRIORS ARE WORRIED THAT the report grants new legitimacy to
medical marijuana, but they may have an even bigger problem on their
hands, because the report also undercuts one of their most precious
assumptions: the gateway theory. The warriors have argued for years
that there is scientific and medical proof that among many users, pot
acts as a steppingstone to more potent, more addictive and more
dangerous substances.

A leading advocate of that point of view is Dr. Herbert Kleber. Kleber
works for the National Center on Addiction and Substance Abuse (headed
by former Secretary of Health, Education and Welfare Joseph A.
Califano Jr.) at Columbia University. He was selected as one of
thirteen pre-publication reviewers of the report, but he says that his
criticisms of it were ignored. He had urged its authors to give more
weight to recent research showing that marijuana helps to release a
chemical in the brain, called dopamine, the same chemical whose
activation is triggered by harder drugs like heroin. By activating a
sort of "reward system' within the brain, Kleber's argument goes,
marijuana conditions the brain’s pleasure centers to certain kinds of
stimulation and sends the user on a quest to deliver ever-greater
kicks - from more powerful drugs - to those pleasure centers. "They
didn't pick it up," says Kleber of the report's authors. He adds that
the evidence of marijuana's effect on dopamine could be the “smoking
gun" that could help prove the gateway theory.

The Institute of Medicine report, however, explicitly dismisses this
idea, noting that "brain reward systems are not strictly 'drug
reinforcement centers.' Rather, their biological role is to respond to
a range of positive stimuli, including sweet foods and sexual
attraction." In other words, if marijuana is a gateway to cocaine, so
are chocolate and sex. If pot is a gate-way to use of narcotics, the
report continues, it may only be because of the drug's social and
legal stigma. That is, users have to break the law to obtain
marijuana, often interacting with dealers of other drugs. "There is no
evidence that marijuana serves as a steppingstone on the basis of its
particular drug effect," says the report. “Instead, it is the legal
status of marijuana that makes it a gateway drug."

Other points in the report:

Marijuana, if addictive, is only mildly so, and few users develop a
dependence on the drug. "They appear to be less likely to do so than
users of other drugs (including alcohol and nicotine)," it says, "and
marijuana dependence appears to be less severe than it is for other
drugs." It adds, "A distinctive marijuana withdrawal syndrome has been
identified, but it is mild and short-lived." It notes that in 1996
almost 69 million Americans over age twelve had tried marijuana, but
only five percent of the population were current users.

Contradicting those who say that approving marijuana for medical use
or decriminalizing it would increase its use for recreational
purposes, there port says, "At present the data on drug-use
progression neither support nor refute the suggestion that medical
availability would increase drug abuse." Also, it notes, "there is not
strong evidence that decrirminalization [of marijuana] causes a
significant increase in marijuana use."

While noting that "marijuana is not a completely benign substance,"
the report says, "Except for the harms associated with smoking, the
adverse effects of marijuana use are within the range [of effects]
tolerated for other medications." Yet, it warns, abuse of marijuana
can lead to "diminished psycho motor performance" (i.e., don't smoke
and drive) and possible short-term effects on the body's ability to
resist bacteria, viruses or tumors.

All of this doesn't help McCaffrey’s War on Drugs, which in 1997, the
most recent year for which FBI figures are available, resulted in the
arrest of 695,000 Americans on marijuana-related charges, eighty-seven
percent of them for possession. Mike Gray, author of Drug Crazy and
one of the most knowledgeable critics of U.S. drug policy, points out
that marijuana is the linchpin of the federal government's $17 billion
drug war (a total that, he says, expands to $50 billion when state and
local efforts and collateral programs are counted). Without
marijuana's 10 million regular users, the drug war involves just 3
million users of other drugs, hardly a significant enough problem to
sustain the all-out effort now under way, says Gray. "How would they
justify it? You can't, once you take marijuana out of the mix."

But taking marijuana out of the drug-war mix is not about to happen
any time soon.

Though the report suggests a wide range of research studies that might
lead to more-concrete conclusions about marijuana's usefulness as
medicine, it's unclear whether the powers that be -namely, McCaffrey's
ONDCP, the National Institute on Drug Abuse and Congress - will allow
such research to go forward. Both McCaffrey and Rep. Bill McCollum, a
Florida Republican who bitterly opposes efforts to approve medical
marijuana on state ballots, say that they will support further
research, as recommended by the Institute of Medicine's report. And
Benson, the Oregon scientist, says, "We hope that it will go on. It
was our intent to suggest specific research projects."

But others wonder who will be willing to put up the money - perhaps
tens or even hundreds of millions of dollars-to develop
cannabinoid-based medicines. (Only one such drug, called Marinol, a
synthetic version of THC, the active ingredient in marijuana, is
available in pill form now.) Private research into marijuana's
usefulness is hamstrung; scientists cannot obtain samples of the
illegal substance for research purposes except through NIDA, which is
reluctant to make it available.

"The Number One obstacle to this treatment is politics," says Daniel
Zingale, executive director of AIDS Action. In February, the group
joined up with dozens of other AIDS activists to urge McCaffrey to
change U.S. policy on medical marijuana, to no avail, and also battled
McCaffrey unsuccessfully over needle-exchange programs that could help
prevent AIDS transmission via shared syringes. "If it weren't for the
politically charged nature of this debate, the science would be
driving the policy," says Zingale. "But the politicians are lagging
behind the public."

Certainty, the public favors the idea of medical marijuana. Polls
consistently show strong support for marijuana for medical purposes,
usually in the range of sixty to eighty percent, says Chuck Thomas of
the MPP. But at the same time, the polls register a conflict: While
favoring medical marijuana, Americans also exhibit a strong and
fervent opposition to the legalization of marijuana for nonmedical
use. A poll taken for the. American Civil Liberties Union revealed
that two-thirds of Americans oppose legalization, most of them
adamantly, and fifty-seven percent agree that using marijuana to get
high is morally wrong.

Bill Zimmerman, who helped engineer the medical-marijuana ballot
initiative in California in 1996, as well as successful votes last
year in Alaska, Oregon, Washington and a first round in Nevada, says
that medical marijuana will appear on ballots in more and more states
- - unless the federal government radically revises its marijuana
policy. Maine will vote on a medical-marijuana initiative this year;
in 2000, votes will be taken in Colorado and Nevada.

Popular or not, the idea of using marijuana for medical purposes is a
non-starter in Congress. Last September, Bill McCollum, perhaps
Congress' leading militant in the War on Drugs, organized passage of a
House of Representatives resolution condemning efforts to approve
marijuana for medical use. Hard-core conservatives like Georgia
Republican Rep. Bob Barr - who called the Institute of Medicine report
"a waste of taxpayer money and another step toward drug legalization"
- - can be counted on to raise a furor over, say, research money to
study medical marijuana use. Says Zingale, "I think that we have a
long, long way to go before Congress understands this issue."