FOR A VERY FEW PATIENTS, U.S. PROVIDES FREE MARIJUANA

WASHINGTON - Every weekday morning around 11 o'clock, a middle-aged
stockbroker named Irvin Rosenfeld gets up from his desk and walks to a
breezeway outside his office in Boca Raton, Fla. There, alongside the
potted palms and smokers taking their breaks, he lights up a cigarette of
his own -- not tobacco, but marijuana, sent to him by the Federal Government.

The arrangement is 16 years old and perfectly legal. Rosenfeld, who suffers
from a rare bone disorder and smokes to relieve his pain, is part of an
exclusive club of Americans who receive a free can of marijuana cigarettes
each month under a "compassionate use" program sanctioned by the Food and
Drug Administration and the National Institute on Drug Abuse.

There are only eight participants in the program. "I'm one of the fortunate
people," Rosenfeld said.

Or at least, blessed with good timing. Since 1992 the door has been shut on
the little-known program, which began in 1978 and at its height had no more
than about 20 patients. Now, however, the question of whether the
Government should be providing an illegal drug to a chosen few has been
thrust into the spotlight by a new study showing that marijuana is
beneficial for certain conditions, including pain, nausea and the severe
weight loss associated with AIDS.

The study, the most comprehensive review of the literature about medical
marijuana to date, was commissioned by the White House and conducted by a
committee of 11 scientists appointed by the Institute of Medicine, a branch
of the National Academy of Sciences. A report on the study concluded that
the benefits of smoking marijuana were limited by the toxic effects of the
smoke, but nonetheless recommended that the drug be given under close
supervision to patients who do not respond to other therapies.

Yet, it does not appear likely that the list of Government-approved
marijuana smokers will grow any time soon. Indeed, that the program
continues to exist at all is testimony to the Government's schizophrenic
approach to one of the thorniest questions in law and medicine: whether
doctors should be able to write prescriptions for marijuana.

On the one hand, the Institute on Drug Abuse pays the University of
Mississippi to grow what a spokeswoman called a "consistent, reliable
source of research-grade cannabis" for Rosenfeld and the others.

A North Carolina manufacturer receives $62,000 a year from the Government
to roll the cigarettes and ship them Federal Express, in sealed tins of 300
each, to the patients' doctors and pharmacists.

Rosenfeld, who is 46, carries a folded letter in his wallet, dated March
17, 1983, from the Food and Drug Administration, authorizing him to use a
substance that might otherwise bring a Federal prison term of up to five
years. Most days, he smokes in his car while driving to work; "I get no
euphoric effect," he said.

The F.D.A. letter, he added, has been helpful on those rare occasions that
the police have pulled him over.

On the other hand, Congress has prevented the District of Columbia from
releasing the results of a recent ballot question that asked voters to
decide if marijuana should be made legal for medical purposes. And the
Clinton Administration has moved to shut down marijuana buyers' clubs in
California and has threatened to prosecute doctors who write prescriptions
for the drug.

"Why allow eight patients to have legal access to marijuana but criminalize
thousands of other patients in very similar circumstances who have the same
conditions, virtually identical medical histories?" asked Chuck Thomas,
spokesman for the Marijuana Policy Project, a nonprofit group in Washington
that lobbies to make the drug legal for medical use. "Why deny them legal
access?"

That question is now before a Federal judge in Philadelphia, where 165
patients have filed a lawsuit seeking to force the F.D.A. to grant wider
access to the drug. The the case is scheduled for trial in June.

"The compassionate access program is an acknowledgment by the Government of
the United States that marijuana has medicinal value," said Lawrence
Hirsch, the lawyer for the patients. "It is fundamentally unfair for the
Government to supply marijuana for medical necessity to eight people in the
United States, when the rest of the potential candidates for therapeutic
cannabis are excluded."

In response, a spokesman for the Department of Justice argues that Congress
has made the possession and distribution of marijuana illegal and that the
F.D.A. has no obligation to make further exceptions.

The Government hopes the program will eventually become extinct through
attrition; some of the patients who were enrolled have died.

Those who remain owe their precious exceptions to a 51-year-old glaucoma
patient, Robert Randall of Sarasota, Fla. While the Institute of Medicine
has found marijuana is not particularly useful for glaucoma, Randall begs
to differ. In 1973, when he was a college student in Washington, Randall
said, he found that smoking marijuana helped ease the pressure on his eyes.

"So I grew four little marijuana plants on my sun deck on Capitol Hill, to
make up for those times that I couldn't afford to buy it," he said. "Then I
got arrested."

As his case worked its way through the legal system, Randall sued the
Federal Government, contending that his smoking was a "medical necessity."
In 1976 a judge agreed, he said, and he began receiving marijuana under the
supervision of a doctor at Howard University.

But that arrangement unraveled in 1978, and he sued again. The Government
settled the case through the compassionate use program, under which the
F.D.A. gives patients access to unapproved drugs if no other therapies will
help them.

"The marijuana is mediocre," said Randall, who was the first enrollee.
"It's what you would expect from a Government-controlled monopoly. But it
works."

Randall later helped others apply, among them Rosenfeld and two Iowa
patients, Barbara Douglass and Ladd Huffman.

Both have multiple sclerosis, a condition for which the Institute of
Medicine found marijuana beneficial. They met in 1990 after a local
newspaper published an article about Huffman, who had been arrested for
growing the drug in a shed behind his home. In 1991 they applied for
Federal marijuana together.

Both received F.D.A. approval. Ms. Douglass began receiving the drug
shortly therafter.

"It relaxes the muscle spasms," she said.

But the program was shut down before the final paperwork was finished for
Huffman.

A spokesman for the Department of Health and Human Services said today that
the department determined that the marijuana was no longer necessary
because of the advent of the drug Marinol, a capsule containing marijuana's
active ingredient that was approved by the F.D.A. in 1985.

Huffman says Marinol does not work. "With these capsules, you take them and
about an hour later you get so stoned you can hardly function," he said.
But, having been sentenced to two years' probation for his marijuana
offense, he is afraid to smoke the drug again.

As for Rosenfeld, he has pangs of conscience, knowing that people like
Huffman have been prosecuted for buying a drug he gets courtesy of the
taxpayers. And he worries that his supply could be cut off at any time,
particularly if the Government loses the lawsuit in Philadelphia.

"I'm not against the Government," he said. "I appreciate what they do for
me."