SCIENTISTS BACK USE OF MARIJUANA FOR MEDICAL THERAPY

A panel of leading scientists says marijuana should be considered a medical
therapy, confirming a conclusion already reached by many patients, doctors
and voters in Washington and six other Western states.

Yesterday, the National Academy of Science's Institute of Medicine reported
that marijuana does have potential medical benefits and that further
clinical studies of the drug should be allowed.

"It's going to be interesting to see how the government responds to this,"
said Dr. Robert Killian, the Seattle physician who was the primary sponsor
of the medical marijuana initiative that Washington state voters passed last
fall.

Voters in Alaska, Arizona, California, Colorado, Nevada and Oregon also have
approved ballot measures supporting the medical use of marijuana.

Yesterday, the Washington Senate voted to authorize the state Department of
Health to adopt rules to clarify the medical marijuana law. Certain
provisions of the law are confusing, and prosecutors have asked for
clarification. For example, the law permits medical users to have a 60-day
supply of pot, but law enforcement officials aren't sure how much that is.

The bill passed the Senate 33-12, just barely the two-thirds majority
required to amend an initiative. It now goes to the House, which must also
approve it by a two-thirds majority.

The Institute of Medicine study was requested in January 1997 by Barry
McCaffrey, director of the White House Office of National Drug Control
Policy, who yesterday continued to argue that marijuana has no proven
medical benefit.

But the Institute of Medicine findings were hardly a wholesale endorsement
of marijuana as therapy. "We see little future in smoked marijuana as
medicine," Dr. John Benson Jr. said yesterday. He is dean emeritus of Oregon
Health Science University in Portland and one of the study's lead
scientists.

Emphasizing the hazards of smoking marijuana, the scientists called for
clinical evaluation of active chemicals found in marijuana that appear to
provide health benefits for treating pain, nausea, anorexia and perhaps
muscle disorders. "There is remarkable consensus about the science," Benson
said. Despite the panel's desire to eventually move away from smoking
marijuana, he said there are "some limited circumstances in which we
recommend smoking marijuana for medical uses."

The institute's report constitutes a turnabout from its 1982 review of
claims for medical marijuana, "Marijuana and Health," in which experts found
only weak evidence to support such claims.

"This report was really prompted by the first referenda in California and
Arizona," said Dr. Eric Larson, medical director at the University of
Washington Medical Center and one of the report authors.

The popularity of marijuana as a medical therapy has increased along with
its abuse as an illicit substance, Larson said, which has thrown social and
legal complications into the task of evaluating claims of medical benefit.

But in the mid-1980s, he said, new discoveries opened the way for better
scientific understanding of marijuana and its claimed medical benefits.

Scientists discovered naturally occurring molecules in the brain, known as
receptors, that responded to some of the active chemicals in marijuana,
known as cannibinoids. One cannibinoid is THC, the primary psychoactive
ingredient in marijuana.

These discoveries stimulated further research into the basic biochemistry of
how marijuana acts in the brain.

"We knew nothing about how it worked," said Dr. Ken Mackie, a UW professor
of anesthesiology who studies cannibinoid receptors. Now, Mackie said, it's
become clear the brain has a natural chemical affinity for cannibinoids,
just as it does for opiates.

Bob Weiner, spokesman for McCaffrey, said the White House doesn't support
easing any of the legal restrictions governing the use or distribution of
marijuana yet.

"That would be based on medical evidence, and it's not there yet," Weiner
said. He said the institute's report supported McCaffrey's stance that it is
an addictive substance and a "gateway" drug among youths that leads to more
serious drug abuse.

In the report's executive summary, however, the study's authors say tobacco
and alcohol use appear to be the more common gateways to illicit drug abuse
among youths.

"There is no conclusive evidence that the drug effects of marijuana are
causally linked to the subsequent use of other illicit drugs," they wrote.

The study's authors also conclude that "few marijuana users develop
dependence," but that chronic users of the drug do experience a distinct
withdrawal that appears "mild and short-lived."

Dr. Francis Podreberac of Seattle is a psychiatrist and a user of medical
marijuana. In 1995, Podreberac was diagnosed with intestinal cancer as a
complication of HIV infection. The cancer was inoperable, and he had a bowel
obstruction and couldn't eat or drink.

"I was starving to death," Podreberac said. "They tried Marinol (synthetic
THC), but it made me nauseated. . . . The only alternative was to try
smoking marijuana."

He said it reduced the pain and spasms he experienced and allowed him to eat
again. He regained enough strength to withstand chemotherapy, which
successfully beat back the cancer. New anti-HIV drugs have helped to rebuild
his immune system.

"My weight's back and I'm doing fairly good," Podreberac said.

Now that the Institute of Medicine has found enough evidence to support
further clinical evaluation of the therapeutic potential of marijuana, he
said he hopes those who want to fight drug abuse will look elsewhere for
battles.

"The federal government has been interfering with the practice of medicine,"
Podreberac said. "Now I hope they won't stand in the way of medical
progress."