U.S. EXPERTS ADVOCATE MARIJUANA FOR PATIENTS

WASHINGTON -- Entering the fractious debate over medical marijuana,
the nation's Institute of Medicine recommended Wednesday that
marijuana cigarettes be made available for short periods to help
cancer and AIDS patients who can find no other relief for their severe
pain and nausea.

Officials with the Department of Health and Human Services almost
immediately responded by saying they would not dispense marijuana to
individual patients until more clinical research showed it is safe.

Still, the report was seen as a victory by many who advocate the use
of marijuana as medicine. The response from drug-fighting groups was
subdued.

An explosion of recent scientific work, as well as patient anecdotes,
shows that compounds in marijuana have potential to ease some of
medicine's most intractable problems, said the report from the
Institute of Medicine, an arm of the National Academy of Sciences.

But its authors warned that smoking marijuana carries its own health
hazards -- including lung damage and low-birth-weight babies -- and
should be adopted only as a last resort after standard therapies have
failed. Addiction was seen as a relatively minor problem likely to
affect few users.

To avoid the smoke, they called for new delivery systems, like
inhalers, and for the development of pharmaceutical drugs made from or
modeled after the active ingredients in marijuana, chemicals known as
cannabinoids.

``Marijuana's future as a medicine does not involve smoking,'' said
Dr. Stanley Watson, a neuroscientist and substance-abuse expert from
the University of Michigan who co-authored the report. ``It involves
exploiting the potential in cannabinoids.''

The endorsement pleased groups that have been working to make
marijuana available to patients. Many were expecting a blander call
for further research. ``It's a discreet but clear call to make
marijuana available,'' said Ethan A. Nadelman, who directs the
Lindesmith Center, a New York-based drug policy think tank.

Report Is Called Tepid

Other advocates, including the National Organization for the Reform of
Marijuana Laws and Harvard Medical School Professor Lester Grinspoon,
were more critical, calling the report ``tepid'' and ``political.''
They said it ignored the fact that many patients have successfully
used marijuana as medicine for years with few harmful effects.

Battles over medical marijuana have been fought across the nation
since 1996, when California passed a ballot initiative that removed
any state penalties from people who used marijuana for medicinal
purposes. Since then, Arizona, Alaska, Oregon, Nevada and Washington
state have passed laws permitting the use of medical marijuana.

Some mainstream medical organizations, and the relatively conservative
New England Journal of Medicine, have endorsed the use of medical marijuana.

But last fall Congress overwhelmingly passed a resolution condemning
the medical use of marijuana, and because federal law still outlaws
marijuana use, many physicians are reluctant to prescribe it, even in
states that have passed initiatives.

`Nothing's Happened'

``There are so many strictures on doctors, so much uncertainty on the
part of licensing boards . . . that nothing's happened,'' said Dr.
John A. Benson Jr., a former dean of the Oregon Health Sciences
University School of Medicine and the report's other co-author.

Only eight patients in the United States have federal government
permission to smoke marijuana for their conditions. They receive
government-grown cigarettes under a ``compassionate use'' program no
longer open to patients.

A Florida glaucoma patient, Elvy Musikka of Hollywood, started using
marijuana in 1976. She started getting it legally prescribed after a
1988 court battle. Her drugs are provided each month through her
doctor at the Bascom Palmer Eye Institute. The drugs come from the
National Institute of Drug Abuse on the campus of the University of
Mississippi.

Some glaucoma patients use marijuana to reduce pressure behind the
eyes.

``I'd be blind'' without regular use of the drug, said Musikka, who is
in her 50s. ``My life would have turned into a total disaster if I
didn't do this. I would have become a tax burden. Instead, I have
limited vision and I can get around on my own.''

Drug Director's Views

The federal government's most visible opponent of medical marijuana
has been White House drug-control director Barry McCaffrey. In
campaigning against state marijuana initiatives, he said there was no
proof that marijuana has medical benefits, that marijuana is a gateway
drug that leads to abuse of drugs like heroin and that allowing
marijuana to be used as medicine would increase illicit recreational
marijuana use.

McCaffrey, who heads the Office of National Drug Control Policy,
commissioned the institute's $900,000 report in response to calls that
federal drug policy on medical marijuana be changed.

The study disarms some of McCaffrey's arguments. Its authors found no
evidence that marijuana use caused people to progress to harder drugs
or that medical use brought increases in recreational use.

In a statement, McCaffrey said he would study the report's
conclusions. He emphasized that there is some evidence that marijuana
is addictive and can lead to further drug use. He left it to the
nation's health agencies to judge whether more patients should be
provided with marijuana cigarettes.