MARIJUANA IS BOOSTED AS BENEFIT TO PATIENTS

Report Backs Some Use In Cancer, AIDS Cases

WASHINGTON -- Entering the debate about the medical benefits of
marijuana, a new study commissioned by the government 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.

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. 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.

Officials with the Department of Health and Human Services immediately
responded by saying they would not dispense marijuana to patients
until more clinical research showed it was 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 the potential to ease some of
medicine's most intractable problems, the Institute of Medicine report
said.

But its authors warned that smoking marijuana carries its own health
hazards -- including lung damage.

To avoid the smoke, researchers called for new delivery systems, like
inhalers, and for the development of pharmaceutical drugs made from or
modeled after the active ingredients in marijuana --
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 coauthored the report. "It involves
exploiting the potential in cannabinoids."

The endorsement pleased groups that have been working to make
marijuana available to patients. "It's a discreet but clear call to
make marijuana available," said Ethan Nadelman, who directs the
Lindesmith Center, a New York-based drug-policy think tank.

Other advocates, including the National Organization for the Reform of
Marijuana Laws and Harvard Medical School professor Lester Grinspoon,
said it ignored the fact that many patients have successfully used
marijuana as medicine for years with few harmful effects.

Battles about the medical benefits of marijuana have raged 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 marijuana for
medical purposes.

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

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

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

Only eight patients in the United States have federal government
permission to smoke marijuana for their conditions. They once received
government-grown marijuana in cigarettes under a "compassionate use"
program, which no longer exists.

On Wednesday, Dr. Randy Wykoff, associate commissioner of the Food and
Drug Administration, said individual patients were not likely to
receive marijuana until it is proven "safe and effective."

Marijuana advocates predicted change is more likely to come with
state-by-state ballot initiatives.

Patients like Jim Harden, 48, a Vietnam veteran from Virginia who uses
a wheelchair and who smokes pot illegally to ease the pain of cancer,
liver disease and a back injury, says he lives in fear of a jail
sentence. "Every day, I live in fear of the police coming, arresting
me and taking my kids away," he said at a press conference in Washington.

The federal government's most visible opponent of medical marijuana
has been White House drug czar Gen. Barry McCaffrey.

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.

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.

The study disarms some of McCaffrey's arguments. Its authors found no
evidence that medical use brought increases in recreational use.

Other anti-drug groups seemed to signal a softening in their strong
public stance against medical marijuana.

"We support all the recommendations," said Steve Dnistrian, an
executive vice president of the Partnership for a Drug Free America, a
nonprofit organization that creates anti-drug public service
announcements. "Who are we to contradict what the doctors and
scientists say?"

WHAT CONDITIONS CAN BE HELPED

Research indicates that the active ingredients of marijuana can be
helpful in treating a wide array of medical conditions. Here is a
summary of findings from recent studies of the medical use of marijuana:

Pain relief: Three studies on cancer pain have shown that THC, an
active component of pot, is as effective as codeine in reducing pain.
The studies also showed that THC curbed nausea and enhanced feelings
of well-being.

Nausea and vomiting in cancer patients: Marijuana components can
reduce the nausea and vomiting associated with chemotherapy, but
clinical trials show they are not as effective as newly introduced
anti-nausea drugs. For patients who do not respond to standard
therapy, marijuana may be a good alternative.

Rapid weight loss in AIDS patients: The standard treatment of appetite
stimulants has not proven successful in some AIDS patients who rapidly
lose weight. Marijuana is a promising treatment for wasting because it
helps control nausea, appetite loss, pain and anxiety.

Multiple sclerosis and movement disorders: There is some evidence that
marijuana compounds can reduce spasticity, but more proof is needed.
THC might help patients with multiple sclerosis, who can suffer from
intense and lengthy muscle spasms.

Alzheimer's disease: One study showed THC improved appetite and
reduced disturbed behavior in some Alzheimer's patients, suggesting
more studies should be done.

Glaucoma: Both marijuana and THC reduce the eyeball pressure that increases
risk of glaucoma and blindness, but the effect lasts only a few hours and
requires high doses. Other treatments, including topical drugs and surgery,
are more effective.