STUDY BACKS MEDICAL POT USE

A national report says that although of limited value, marijuana is
effective and not a "gateway drug" but more research is needed

Marijuana's active ingredients are effective in treating pain, nausea
and poor appetite, but more-rigorous studies on patients should be
done to determine the medical benefits, according to a long-awaited
report released Wednesday.

The Institute of Medicine's report on the medical effects of marijuana
also found no conclusive data that it is a "gateway drug" leading to
the use of harder, illicit drugs -- one of the issues in the national
controversy over legalizing marijuana for medical use.

Furthermore, the report found no evidence that approving marijuana for
medical use would increase its use among the general population,
particularly if it were regulated as closely as other medications with
the potential for abuse, such as morphine.

But the report emphasized that the drug's usefulness is limited
because the plant, when smoked, has harmful effects and can increase
risks of cancer, lung damage and low-birth-weight babies. Therefore,
the report said, smoking marijuana should be recommended only for
terminally ill patients or those with debilitating symptoms that do
not respond to approved medications.

"We aren't keen about smoking tobacco or anything else," said Dr. John
A. Benson Jr. of Portland, who is the study's co-principal
investigator and a former dean of Oregon Health Sciences University's
School of Medicine.

Sharply divided opinion on the value of medical marijuana and a flurry
of state medical marijuana initiatives prompted the White House Office
of National Drug Control Policy to ask the Institute of Medicine to
review scientific evidence and assess the potential health benefits
and risks.

The institute is a private, nonprofit organization that provides
health policy advice to the federal government.

The review began in August 1997 and culminated in the current
report.

Oregon is one of six states that allow use of medical
marijuana.

Advocates of the medical use of marijuana say the drug should be
available for treatment of a variety disorders, including easing
severe nausea and vomiting associated with chemotherapy; decreasing
inner-eye pressure in glaucoma patients; reducing muscle spasms in
patients with multiple sclerosis; and stimulating the appetites of
patients with HIV or AIDS. The counter-argument is that marijuana is a
gateway drug and that the fight to approve it for medical purposes is
just a ploy in a strategy to get it legalized.

Marijuana is a powerful drug that produces a variety of biological
effects from compounds called cannabinoids, including THC, its primary
psychoactive ingredient. In recent years, scientists have found that
some compounds act on cannabinoid receptors in the brain and play a
role in pain, memory and control of movement. More study of these
effects could lead to the development of better medicines and a better
understanding of the brain, Benson said.

There is evidence that patients who would smoke marijuana to ease
long-term chronic medical conditions, such as multiple sclerosis and
spinal cord injury, could put themselves at increased risk of
developing lung cancer. However, additional studies may lead to safer
ways of delivering marijuana and cannabinoids through inhalers --
squirts in the mouth or the nose that would be absorbed as quickly as
marijuana smoke.

But even if a safer drug delivery system could be found, medical
marijuana can only relieve a narrow range of symptoms and is not as
good as drugs already on the market, Benson said. But he noted that a
small number of patients do not respond to conventional medicines and
that they might benefit from further marijuana research.

Although marijuana is effective in treating nausea and vomiting in
chemotherapy patients, new conventional drugs are about 90 percent
more effective. And although marijuana increased the appetite of AIDS
patients and made them gain weight, it is not good weight, Benson said.

"What happens is, you lay down fat," he said, "and what AIDS patients
need is muscle, and that is lean body mass that they lose."

Medical marijuana also has little promise for treatment of migraine
headaches or epilepsy, Benson said. And in glaucoma, a potentially
blinding condition signaled by increased pressure in the eye,
marijuana lowered the pressure but did not slow progression of the
disease, he said.

Allen St. Pierre, executive director of the NORML Foundation -- the
National Organization for the Reform of Marijuana Laws -- found the
report to be "tepid in its recommendations."

He said the new report "will not stop a lot of the legal and medical
confusion in states such as Oregon over the medical access to the plant."

Critics also contend marijuana has the potential for physical and
medical harm.

Rep. Bill McCollum, R-Fla., who led the fight to get the House of
Representatives to condemn medical marijuana last fall, said he was
"deeply concerned" the report might encourage people to smoke
marijuana. It's known that some of the chemicals in marijuana can be
useful, he acknowledged, but he said their place was in inhalers or
pill form. "We should not sanction smoked marijuana, because there is
no way to control that," McCollum said.

White House drug adviser Barry McCaffrey said the findings were
unlikely to send pharmaceutical companies scrambling to do research on
marijuana.

Gail Willock, a Northeast Portland resident who said she suffers from
degenerative arthritis, calls the report "a fantastic thing."

She has used marijuana medicinally for 12 years, she said, either
growing her own or buying it from dealers. She realizes that buying
and selling marijuana is illegal, but she said she preferred that to
using prescription painkillers.

"It's just verifying what people like me who have debilitating
conditions have known (about marijuana) for many, many years," she
said of the report. "It does indeed reduce pain, it does indeed reduce
swelling, it does indeed give you more mobility. "

[SIDEBAR;]

MEDICAL MARIJUANA

The study: The federal drug czar asked the private, nonprofit
Institute of Medicine to assess all that is known and not known about
the medical applications of marijuana. It was the first comprehensive
review of the scientific literature on the drug and included new data
and interviews with health care and scientific experts.

What the study found:

The active ingredients in marijuana can help fight pain, ease nausea
and stimulate the appetite, especially in people with cancer or AIDS.

Marijuana's medical effects are generally modest, and for most
symptoms more-effective medicines are already available.

Smoking marijuana can lead to cellular changes associated with lung
cancer. Safer delivery systems, such as inhalers, should be developed.

There is no conclusive evidence that marijuana use leads to abuse of
harder drugs, such as cocaine or heroin.

Data do not support the contention that marijuana should be used to
treat glaucoma.

With the exception of muscle spasms in multiple sclerosis, there is
little evidence marijuana can help with disorders such as Parkinson's
disease or Huntington's disease.

People with chronic conditions and no alternative could be permitted
to smoke marijuana, after being informed that they are experimental
subjects and are using a harmful drug-delivery system.

Studies to define the individual health risks of smoking marijuana
should be conducted, particularly among populations in which marijuana
use is prevalent.

The medical marijuana law, approved in November, permits its use for
cancer, glaucoma, HIV infection, severe weight loss, pain, nausea,
seizures and muscle spasms. Sick Oregonians were able to begin using
marijuana in December, though the state's regulations won't be in
place until May 1.