U.S. PANEL SEES POTENTIAL FOR MEDICAL MARIJUANA

More Research Urged; Smoking Discouraged

The active substances in marijuana may be "moderately" useful for treating
such problems as pain, nausea and appetite loss, but smoked marijuana has
little future as a medicine, a panel of experts advising the federal
government said yesterday.

The long-awaited review comes after several states have legalized marijuana
for medical use, and was immediately seized upon by marijuana's advocates
as an endorsement of their position.

"We are very pleased with this report, which clearly shows there is
scientific evidence that marijuana has bona fide therapeutic effects for
some patients," said Chuck Thomas, the director of the Washington-based
Marijuana Policy Project. "Patients already using marijuana should be given
the benefit of the doubt, and should not be arrested."

The report, prepared by 11 scientists convened by the National Academy of
Sciences' Institute of Medicine, specifically warned against smoked
marijuana because of risks of lung damage. Therapeutic marijuana smoking
should be permitted only in a few short clinical trials designed to assess
claims for marijuana's usefulness as a pharmaceutical.

White House drug control policy director Barry R. McCaffrey, who requested
the report, said he endorsed it "thoroughly" and called it a "significant
contribution to discussing the issue from a scientific and medical
viewpoint." He said he would not oppose limited studies of smoked marijuana
until a less harmful way of inhaling the substance's active ingredients is
found.

"I would note, however, that the report says 'smoked marijuana has little
future as an approved medication,' " McCaffrey said. "You should not expect
to go into an ICU [intensive care unit] in 15 years and find someone with
prostate cancer with a 'blunt' stuck in his face as a pain management tool."

The 250-page report was prepared over the last year at a cost of $896,000.
The panel reviewed published medical studies on marijuana's physiological
effects and possible clinical benefits, and took testimony from researchers
and patients.

The claims for marijuana are very broad. People have used it as treatment
for nausea caused by chemotherapy, appetite loss arising from AIDS, the
painful spasms of multiple sclerosis, the pain of migraine headache, the
sight-threatening condition known as glaucoma and the memory loss of
Alzheimer's disease.

Reliable data on the drug's benefits, however, have been hard to get. The
Drug Enforcement Administration places marijuana -- along with heroin and
several other addictive drugs -- in the category reserved for substances
with "a high abuse potential." This has made research on patients unusually
difficult. Many of the claims for marijuana are based on small, poorly
designed studies, or on "clinical anecdotes," the recounted experiences of
individuals.

The body produces a marijuana-like substance naturally -- its evolutionary
purpose is uncertain -- which stimulates specific receptors on nerve cells
distributed widely in the brain. Marijuana contains about 30 active
ingredients, collectively known as "cannabinoids," that also activate these
receptors. One cannabinoid drug, dronabinol, is licensed in the United
States for use in appetite stimulation in AIDS patients, and to prevent
nausea and vomiting caused by chemotherapy.

"There is remarkable consensus about the science -- the science suggests
the potential of cannabinoid drugs for medical use," said John A. Benson
Jr., the former dean of the Oregon Health Sciences University School of
Medicine, who was one of the two heads of the panel. "There is far less
convincing data about actual medical benefits."

Most studies suggest there are existing drugs that do what marijuana is
reputed to do, but better. This was especially true in the case of glaucoma
treatment and nausea prevention, the panel found. Nevertheless, a few
patients who do not respond to those pharmaceuticals are helped by marijuana.

The panel advocated research aimed at isolating marijuana's ingredients and
testing them in randomized controlled trials. An inhalation device is a
high priority because it will allow patients to take in the drug as quickly
as when it's smoked, without delivering tar and other unwanted substances.
In the meantime, studies of smoked marijuana are warranted, the panel said.
They should last six months or less, and enroll patients, such as those
with terminal cancer, for whom the long-term risks of smoking are
relatively unimportant.

The panel found no evidence that closely controlled medical marijuana use
would be a "gateway" to illicit drug use, either in ill patients or in
society at large.

In the last three years, seven states have passed referenda allowing the
medical use of marijuana. Several, however, have run into legal problems,
and the statutes have not taken effect.

In the District, a marijuana legalization measure appeared on the ballot in
November. Ballots were counted, but the results were not released because
Congress prohibited the spending of public money on the legalization
effort. The matter is now in federal court.