MARIJUANA HAS TREATMENT VALUE, STUDY FINDS

The active ingredients in marijuana appear to be useful for treating
pain, nausea and the severe weight loss associated with AIDS,
according to a new study commissioned by the government that is
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. Yet at the same time, 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 release of the delicately worded report, at a morning press
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 Barry McCaffrey, director of the Office of National Drug
Control Policy, which requested the study, to ease its steadfast
opposition to the initiatives.

"This report has proved McCaffrey wrong," said Chuck Thomas, a
spokesman for the Marijuana Policy Project, a nonprofit organization
in Washington that lobbies for the legalization of medical marijuana.
"We never said marijuana was a panacea and a be-all or end-all. What
we have said is there are some patients who don't respond to existing
medications, and this report confirms that."

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. And McCaffrey,
speaking in a telephone interview from Los Angeles, said, "This study
seems to suggest that there is little future in smoked marijuana."

McCaffrey politely praised the analysis as a "superb piece of work"
and said he would take the recommendations under advisement. But he
said there was "enormous confusion in law enforcement" about how to
handle the issue, and added, "We've got people with mischievous
agendas at work."

Toxic smoke

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 pointedly 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, like 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, presented
their findings in a stately wood-paneled lecture hall at the Institute
of Medicine in Washington, D.C. 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."

Personal testimony

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 uses a wheelchair. He said smoking
marijuana helped 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 just that, in November 1997, visiting the Netherlands, where a
doctor prescribed one to two grams of marijuana per day. Here in the
United States, Hardin said, he obtains the drug "from a network of
care providers that are willing to grow a safe and clean cannabis."

Also in the audience was Joyce Nalepka of America Cares, a parents'
antidrug group based in Maryland that has been critical of efforts to
legalize marijuana for medical use.

"I'm concerned about the message we are sending," Nalepka said. "Kids
interpret things differently than adults. What they're going to hear
is, Marijuana is good for something."

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, the report found, and did not
outweigh the long-term hazards of using the drug.

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.

So far, voters in seven states - California, Alaska, Arizona,
Colorado, Nevada, Oregon and Washington - have approved initiatives
intended to make marijuana legal for medical purposes. But doctors are
often afraid to write prescriptions because the federal government has
threatened to prosecute them, and patients often have difficulty
obtaining the drug, in part because the government has moved to shut
the marijuana buyers clubs that had been distributing it. In the
District of Columbia, meanwhile, the November ballot contained a
proposal to legalize medical marijuana, but Congress intervened and
prevented the vote from being counted.