THE MEDICAL DOPE/INDEPENDENT PANEL SAYS MARIJUANA CAN HELP PATIENTS

Marijuana can help treat a variety of medical conditions, including the
pain, nausea and anxiety linked to AIDS and cancer, an independent panel of
experts told the federal government yesterday.

The report by the Washington-based Institute of Medicine, an arm of the
National Academy of Sciences, said there is strong scientific evidence that
the chemicals in marijuana can help people cope with the side effects of
chemotherapy for cancer, and the wasting caused by AIDS. It also stressed
that the panel found no clear evidence that use of marijuana leads to other
drug use.

However, the panel said smoking marijuana can cause respiratory problems and
called for development of standardized forms of the drugs, called
cannabinoids, that can be taken by inhaler or other methods. And it
suggested that institutional review boards be formed to oversee the drug's
use until more study is completed.

Dr. John Benson, a co-principal investigator of the study and a professor of
medicine at the Oregon Health Sciences University School of Medicine, said
the panel did not "recommend it for long-term use. But for patients who do
not respond well to other medications, short-term marijuana use appears to
be suitable in treating" certain conditions.

The report was requested by the White House Office of National Drug Control
Policy. It is expected to prompt new debate on an issue which has drawn
increasing interest over the past few years.

Robert Randall, a glaucoma patient who is one of eight people being supplied
federally grown marijuana for his condition, said the institute's
conclusions were long-awaited.

"Reefer madness in America died today," said Randall, who lives in Florida
and has been arrested for growing marijuana to be used to ward off his
illness. "The IOM has confronted the fact that marijuana can make a profound
difference in the outcome of patient's care.

"I have watched others go blind, or cancer and AIDS patients starve to death
because they had no access to marijuana. You don't need a guy in a white
coat to tell you that it works. Ask any cancer patient who gets immediate
relief from nausea when nothing else seems to work."

But while ballot measures have approved its use as medicine in eight states
since 1996, U.S. Justice Department officials have said it remains illegal
under federal law.

The White House office, headed by retired Gen. Barry McCaffrey, said in a
statement that it would carefully study the report's recommendations. But it
stressed, "We note in the report's conclusion that the future of cannabinoid
drugs lies not in smoked marijuana, but in chemically defined drugs"
delivered by other means.

A Justice Department spokesman said it, too, would review the report
extensively. But Brian Steel said his department "remains committed to
upholding and enforcing the laws that have been passed by the United States
Congress. The U.S. Congress in the Controlled Substances Act has made the
distribution, manufacture or possession of marijuana illegal."

The House voted 310 to 93 last year to condemn marijuana as a "dangerous and
addictive drug" that should not be legalized for medicinal use.

Yesterday, Benson said "doctors are afraid to put their name on a piece of
paper recommending" use of marijauana for fear of losing their license to
prescribe medicine.

In addition to its effects as an anti-nausea drug, the panel also found
evidence that it helped in controlling some of the movement problems in
multiple sclerosis, and called for further study in this area.

No one knows how many patients have smoked marijuana to relieve symptoms.
The National Institute on Drug Abuse has been growing marijuana for decades
and makes it available on a limited basis to scientists, and to eight
patients - including Randall - who receive it through a restricted federal
program that was dismantled in 1991. Patients in the program prior to that
date can continue to get the drug.

Dr. Herbert Kleber, a former director of the National Institute on Drug
Abuse who now runs the division on substance abuse at Columbia University
College of Physicians and Surgeons in Manhattan, stressed that the medical
use of marijuana "is an issue that should be decided by science and not by
opinion polls. It should be evaluated by the Food and Drug Administration
just like any other drug."

However, Rep. Bill McCollum (R-Fla.), who led the fight to get the House to
condemn medical marijuana last fall, said he is "deeply concerned" the
report might encourage people to smoke marijuana who do not need it for a
medical condition.

It's known that some of the chemicals in marijuana can be useful, he
acknowledged, but their place is in inhalers or pill form. "We should not
sanction smoked marijuana because there is no way to control that," McCollum
said.

Currently, there is one federally approved cannabinoid, Marinol, developed
by Roxane Laboratories in Columbus, Ohio. This oral substance, available
only by prescription since 1985, doesn't provide the fast relief that the
smoked form does. It is classified, like morphine, as a controlled
substance.

Kleber, who was a reviewer for the report, said that much of the scientific
evidence presented to the panel was anecdotal, but "suggestive enough that
more research is warranted." He believes that patients should try existing
medicines before they turn to alternative substances like marijuana.

Marijuana's treatment uses have only come to light in the last decade as
researchers found receptors in the brain and chemicals that act on the
receptors that resemble the main ingredients of marijuana. In the last few
years, two cannabinoid genes have been cloned, one found primarily in the
brain and the other expressed in the immune system.

Drug companies are working on medicines that manipulate the marijuana
receptor sites in the brain, said Dr. Miles Herkenham, a neuroscientist at
the National Institute of Mental Health who mapped the entire cannabinoid
receptor system. The receptors are also present throughout the body's pain
pathway, he said, which could explain why it is such a powerful analgesic.