DEBATE HEATS UP STUDY: MARIJUANA HAS MEDICAL USES

The most comprehensive medical study of marijuana yet makes a case for the
drug's limited use in treating patient.

The active ingredients in marijuana can be useful for treating pain, nausea
and the severe weight loss associated with cancer and AIDS, according to a
new study commissioned by the government. The study's results are
intensifying the contentious debate over whether doctors should be
permitted to prescribe the drug.

The report, the most comprehensive analysis to date of the medical
literature about marijuana, said there was no evidence that giving the drug
to sick people would increase illicit use in the general population. Nor is
marijuana a "gateway drug" that prompts patients to use harder drugs like
cocaine and heroin, the study said.

The authors of the study, a panel of 11 independent experts at the
Institute of Medicine, a branch of the National Academy of Sciences,
cautioned that the benefits of smoking marijuana were limited because the
smoke itself was so toxic. But they recommended that the drug be given, on
a short-term basis under close supervision, to patients who did not respond
to other therapies.

The authors recommended that researchers study alternative delivery methods
- - such as pills, patches or inhalers - for the drug.

The release of the delicately worded report, at a morning news conference
in Washington, prompted a flurry of political maneuvering.

Proponents of state initiatives to legalize marijuana for medical purposes
seized upon the findings as long-awaited evidence that it had therapeutic
value. They called on the Clinton administration, and in particular the
Office of National Drug Control Policy, which requested the study, to ease
its steadfast opposition to the initiatives.

But the study is unlikely to change the administration's position. The
Department of Health and Human Services, which is already financing some
research involving medical marijuana, issued a written statement noting
simply that it would continue to fund the work.

While the study's authors said they had been surprised to discover "an
explosion of new scientific knowledge about how the active components of
marijuana affect the body," they added that the future of marijuana as a
medicine does not lie in smoking it. Marijuana smoke, they said, is even
more toxic than tobacco smoke, and can cause cancer, lung damage and
complications during pregnancy.

The true benefits of marijuana, the experts said, would only be realized
when alternative methods, such as capsules, patches and bronchial inhalers,
were developed to deliver its active components, called cannabinoids, to
the body without the harmful effects of smoke.

So far, there is only one cannabinoid-based drug on the market, Marinol,
manufactured by Unimed of Somerville, N.J. It comes in pill form and was
approved in May 1985 by the Food and Drug Administration for nausea and
vomiting associated with chemotherapy, as well as for anorexia and weight
loss associated with AIDS.

Some patients have complained that marinol is more expensive than marijuana
and that they do not feel its effects as quickly.

The researchers recommended that the government pay for research that would
speed up the development of more cannabinoid drugs, and were particularly
keen on the promise of inhalers.

But recognizing that such methods might take years to perfect, they also
recommended that people who did not respond to other therapy be permitted
to smoke marijuana in the interim.

"Marijuana should only be smoked in circumstances where the long-term risks
are not of great concern, such as for terminally ill patients or those with
debilitating symptoms that do not respond to approved medications," said
Dr. John A. Benson Jr., former dean of Oregon Health Sciences University
School of Medicine and one of the study's two lead authors. "Even in these
cases, smoking should be limited to carefully controlled situations."

Benson and his co-author, Dr. Stanley J. Watson Jr. of the Mental Health
Research Institute of the University of Michigan, unveiled their findings
Wednesday at the Institute of Medicine. As the two scientists spoke, a
handful of people sat quietly in the audience, wearing fire-engine red
T-shirts with white block lettering that blared: "Medical Marijuana Patient."

Among them was Jim Hardin, a 48-year-old Virginia man who testified before
the panel and whose story was among several personal anecdotes included in
the report. Hardin suffers from Hepatitis C, a disease that is destroying
his liver, and he uses a wheelchair. He said smoking marijuana helps him
cope with the intense nausea and rapid weight loss the disease has caused.

"I lost 95 pounds," Hardin said. "I tried everything: 35 different pills.
Finally doctors told me to go to Europe and try marijuana." He did that, in
November 1997, visiting the Netherlands, where a doctor prescribed one to 2
grams of marijuana per day.

A Virginia law passed in 1979 allows doctors to prescribe marijuana for
glaucoma and cancer patients. But physicians would still break federal law
if they prescribed it.

The report contained some surprising findings. It concluded that, despite
popular belief, marijuana was not useful in treating glaucoma. While the
drug can reduce some of the eye pressure associated with glaucoma, the
effects were short-lived.

In addition, the study found that there was little evidence for marijuana's
potential in treating movement disorders like Parkinson's disease or
Huntington's disease, but that it was effective in combating the muscle
spasms associated with multiple sclerosis.

In addition to the Virginia law, voters in seven states - California,
Alaska, Arizona, Colorado, Nevada, Oregon and Washington - have approved
initiatives intended to make marijuana legal for medical purposes.

But the federal government has threatened to prosecute doctors, and
patients often have difficulty obtaining the drug.