MEDICAL POT GETS CAUTIOUS KUDOS

Elite Panel Finds Marijuana Helpful But Smoking It Harmful

In what amounts to a consensus of scientific opinion, a prestigious
panel has found that marijuana probably helps a number of ailments,
but because smoking it is also hazardous, it should be used sparingly.

At the same time, research on marijuana should get under way to
isolate compounds that could eventually be given to patients via
inhalers or other fast-acting delivery systems, the National Academy
of Sciences said in a report released Wednesday.

The long-awaited review was done by the academy's Institute of
Medicine at the request of White House drug czar Barry McCaffrey, who
has been under pressure to reverse the federal government's opposition
to medical use of marijuana. Advocates have pinned their hopes on the
report, expecting it would show that the drug has enough promise to
persuade McCaffrey and others to loosen regulations.

Among the report's findings:

*It makes sense to let patients with severe symptoms, such as
intractable pain or vomiting, smoke marijuana for short periods - less
than six months. But it should be a last resort after other
medications fail, patients should be informed of the risks, and data
should be collected from their experiences to gain more insights into
marijuana's effects.

*Marijuana should not be used to treat glaucoma, its most frequently
cited medical application. Although it can reduce some of the eye
pressure, it works for only a short time, and the limited benefits
don't outweigh the hazards. There also is not enough evidence to
support its use for migraine headaches or for movement disorders such
as Parkinson's disease.

*Studies show marijuana smoke is an important risk factor for the
development of respiratory disease.

*Cannabinoids, the class of compounds that includes marijuana's active
ingredient, most likely have a role in pain modulation, control of
movement and memory.

*The brain develops a tolerance for cannabinoids, and there is a
potential for dependence. However, it is less powerful than nicotine,
cocaine, opiates or the class of sedatives that includes drugs such as
Valium. Withdrawal also is less intense than with opiates and
Valium-like drugs.

*There is no conclusive evidence that marijuana is a "gateway" to
harder drugs. The concern that allowing marijuana for medical
treatment will induce more people in the general population to use it
also appears unfounded.

Synthetic future

The report's principal investigators wrote that while cannabinoids
showed promise, their future as a medicine was in a synthesized form,
not in smoked marijuana.

"For patients, such as those with AIDS or undergoing chemotherapy, who
suffer simultaneously from severe pain, nausea and appetite loss,
cannabinoid drugs might offer broad-spectrum relief not found in any
other single medication," they wrote.

However, smoking marijuana exposes users to more tar than tobacco, as
well as to cancer-causing compounds similar to ones found in
cigarettes. Furthermore, deeply inhaling and holding in the smoke
tends to concentrate harmful substances in the lungs, John A. Benson,
one of the report's principal investigators, said Wednesday.

"While we see a future in the development of chemically defined
cannabinoid drugs, we see little future in smoked marijuana," he said.

Not surprisingly, both sides in the medical marijuana debate are
claiming victory.

"The report gives clear support to the claim that marijuana is
medically useful," said David Zimmerman, director of Americans for
Medical Rights, which sponsored successful ballot initiatives in
California and several other states to allow medical use of the drug.

But Terry Hensley of the Drug Free America Foundation said the report
supported his group's position that "crude, smoked marijuana" wasn't a
real treatment.

"What they endorse is research, which is what we've been endorsing,"
Hensley said.

Meanwhile, McCaffrey isn't ready to budge just yet. He issued a
statement saying he awaited further responses from public health officials.

Howard L. Fields, a UC-San Francisco researcher and director of the
Wheeler Center for the Neurobiology of Addiction, was one of the 11
scientists who produced the report.

While on the one hand their conclusions probably won't satisfy those
who think the drug should be available as the equivalent of an "herbal
remedy for pain," they did find enough evidence to justify using it in
some circumstances, he said.

"At least people can't say, "This is all baloney, there is no medical
uses for marijuana, and it shouldn't be available at all,' " Fields
said.

Treats nausea

Fields, who has studied cannabinoids in animals, said it showed real
promise for treating pain. For one thing, it tends to alleviate
nausea, a common side effect of other painkillers such as morphine.

McCaffrey and other federal officials have been under increasing
pressure to ease up on the medical use of marijuana since 1996 when
California passed Proposition 215, the nation's first initiative to
make it possible for sick people with a doctor's recommendation to use
it.

In November, well-funded advocates managed to win all six similar
initiatives on ballots in Oregon, Nevada, Arizona, Alaska, Washington
and the District of Columbia. And last month, 20 AIDS groups wrote to
McCaffrey, calling on him to allow HIV-positive patients access to the
drug.

State marijuana advocates have been cheered by the election of
Attorney General Bill Lockyer, who is reversing his predecessor's
adamant opposition to Prop. 215. Lockyer has convened a task force to
help figure out how to construct a system so patients can get access
to the drug.

Meanwhile, a few marijuana clubs are operating openly in such places
as Santa Cruz and Los Angeles. Clubs in Northern California were shut
down by federal prosecutors.

However, well-known marijuana activist Dennis Peron has been operating
a marijuana farm in Lake County, where he grows plants for 200 members
of a cooperative who have doctors' recommendations and pay $20 per
month. They either come to the farm to collect their plants, or Peron
delivers them to their Bay Area homes.

Farm raided

Twice last year, federal agents raided the farm and made off with the
plants, but no one was arrested, Peron said.

He expects the report's findings to persuade the government to
reclassify marijuana from Schedule 1, which means it has no medical
use, to Schedule 2, which would allow it to be dispensed with a
prescription.

Getting access to marijuana, even for legitimate scientific research,
has been an arduous process. The only government-funded clinical trial
under way in the United States using smoked marijuana is at UCSF,
where the effects on HIV-positive patients are being
investigated.

It took principal investigator Donald Abrams six years to get approval
from the federal government for his study, which began last year and
is still seeking volunteers.

Abrams' study compares the effects of smoked marijuana with that of
Marinol, an FDA-approved drug that contains THC, marijuana's active
ingredient.

Many people continue to resort to smoked marijuana because they say
Marinol takes too long to become active and has unwanted side effects,
including an excessively intense "high."

Abrams said it had long been known that marijuana contains enough
potentially useful ingredients to warrant further study. He said he
hoped the climate for conducting medical research on it would improve
from having yet another prestigious scientific body call for
investigation.

"I know of a few investigators who have submitted proposals to the
government. I don't know how they've fared," he said. "I hope the
Institute of Medicine report would stimulate more people to
investigate."