FEDERAL PANEL URGES TESTS OF MEDICAL POT

Drug czar won't ease stance despite findings from study

A science panel commissioned by the Clinton administration called yesterday
for clinical trials of medical marijuana, declaring that cannabis could be a
useful drug but that smoking is a hazardous way to take it.

Begun at the request of President Clinton's drug czar, Barry McCaffrey, the
National Academy of Sciences' Institute of Medicine study carefully charts a
middle path through the minefield of American pot politics.

``Smoked marijuana should generally not be recommended for long-term medical
use,'' researchers said. ``Nonetheless, for certain patients such as the
terminally ill or those with debilitating symptoms, the long-term risks are
not of great concern.''

Like other studies that have preceded it, the new report neither encourages
nor condemns the medical use of marijuana. Instead, it calls for more
studies, under rigid controls.

But proponents of laws permitting medical use of marijuana seized on the
report as a thinly veiled endorsement of pot for patients. They call it a
repudiation of McCaffrey, who considers medicinal use of the drug a hoax,
perpetrated by those who want the weed legalized.

``The equivocation is there for political reasons, but the underlying
science is there, too: They clearly support the use of medicinal
marijuana,'' said Bill Zimmerman, executive director of Americans for
Medical Rights, a Santa Monica advocacy group.

McCaffrey's Office of National Drug Control Policy stressed the problems
with medical marijuana spotlighted in the report. In a written response
yesterday, the office declared, ``The study concludes there is little future
in smoked marijuana as a medically approved medication.''

At a Los Angeles news conference, McCaffrey said there would be no
relaxation of federal policy on medical pot. ``Smokable marijuana is not the
answer,'' McCaffrey said.

He praised the Institute of Medicine study, declaring that it took the issue
out of the political arena and placed it ``firmly in the context of science,
where it belongs.''

Dr. Donald Abrams, a physician at the University of California at San
Francisco who is conducting the only approved study of medical marijuana,
said the latest report has a familiar ring to it. ``I don't know why they
needed to do this again. They did the same thing in 1982 and came up with
similar findings. The National Institutes of Health panel said the same
thing in 1997. . . . I think a million dollars could have been better spent
doing the studies they are proposing.''

However, the panel's tacit recognition that smoking marijuana can help some
patients may embolden more states to pass laws making it legal for patients
to do so. California led the way in 1996, when 56 percent of voters passed
Proposition 215. Last November, similar measures passed in five other
states.

If the Institute of Medicine study provides ammunition for medical marijuana
advocates, however, it doesn't provide much. The beneficial effects of
cannabinoids -- the active ingredients in pot -- were modest, limited and
come at a cost. ``In most cases, there are more effective medications,'' the
researchers wrote.

The scientists cautioned that ``marijuana is not a completely benign
substance,'' calling it a ``powerful drug'' that can cause dependence in
some users and can cause a distinct but mild withdrawal syndrome when use is
stopped. The psychological effects of cannabinoids can be ``disturbing,''
particularly to older patients who have never smoked pot.

Most of the blue-ribbon panel's criticism of medical pot focused on the
unhealthful effects of marijuana smoke, which contains many of the same
cancer-causing agents that are in tobacco.

Consequently, the panel called for development of a device that would
deliver the beneficial effects of marijuana chemicals to patients quickly,
without the smoke. The implicit suggestion is for an inhaler, like those
used to deliver a mist of drugs to asthma sufferers.

``I think the main take-home message from this report is that we prefer to
move away from the plant,'' said report co-author Dr. Stanley Watson at a
Washington, D.C., press conference. ``From the point of view of safety, we
are quite concerned about it.''

But the panel's report also concludes there is no convincing evidence that
marijuana is a ``gateway'' drug that leads to abuse of other, more dangerous
substances; nor was there any proof that sanctioning medical use of
marijuana would increase its nonmedical use among the general population.

Medical pot advocates said those findings are extremely significant.
Marijuana is currently listed in drug enforcement guidelines as a Schedule I
drug, comparable to heroin. Schedule I drugs are both ``dangerous'' and ``of
no medical use.''

The study findings undercut the view that pot is either dangerous or
medically useless -- evidence medical marijuana advocates say supports
reclassifying pot to Schedule II, comparable to drugs such as morphine,
which can be legally prescribed.

Instead, the scientists concluded that evidence from prior studies indicates
``a potential therapeutic value for cannabinoid drugs, particularly for
symptoms such as pain relief, control of nausea and vomiting and appetite
stimulation.''

The report notes that AIDS patients suffering from wasting syndrome, in
which they lose much of their body mass because of an inability to keep down
foods, ``would likely benefit from a medication that simultaneously reduces
anxiety, pain and nausea while stimulating appetite.''

Currently, the only way for patients to take cannabinoids is to smoke
marijuana, eat it in brownies or cookies, or take a prescription pill,
Marinol, which contains the cannabinoid THC, the primary active ingredient
in marijuana.

Approved by the FDA for cancer patients in 1985, Marinol has racked up
modest sales of $20 million. It can cost patients $200 a month -- a problem
for those without insurance.

But AIDS patients have long insisted that Marinol alone does not provide the
same beneficial effects they get from smoking marijuana. Patients who cannot
hold down food have the same problem with absorbing a swallowed pill or
brownie.

Daniel Zingale, executive director of AIDS Action, the nation's largest AIDS
lobby, said he is pleased with the new study. ``It validates the value of
medicinal marijuana,'' he said. ``I hope it will shed some light on the
politics of this misunderstood therapy.''

MARIJUANA STUDY

The National Academy of Science's Institute of Medicine made six
recommendations in its study of medical marijuana:

- -- Continue research on the differences between natural and synthetic
cannabinoids, the active ingredients in marijuana.

- -- Clinical trials should be conducted on safer ways to deliver
cannabinoids, such as use of nasal sprays or inhalers.

- -- Studies should examine the psychological effects of medicinal pot, aside
from drug's anti-nausea and appetite-stimulating effects.

- -- Long-term health risks of marijuana smoking, such as lung cancer, should
be assessed.

- -- Clinical trials of marijuana should be limited to six months and be
limited to patients for which there is ``reasonable expectation of
efficacy.''

- -- Rules for trials: Documented failure of other drugs; close medical
supervision of marijuana treatment; 24-hour turnaround on acceptance by
review board of patient admission to study.