MEDICAL ROLE FOR POT IS SEEN

Report Urges Clinical Trials Of Marijuana

The latest federal report on marijuana's medical uses calls for
further study so that patients suffering from pain and nausea can
benefit from pot's active ingredients without inhaling its smoke.

The Institute of Medicine report, which likely will reignite the
debate over marijuana, says there is no conclusive evidence that
smoking pot leads to using harder drugs.

The report, released yesterday, says that because the chemicals in
marijuana ease anxiety and pain, stimulate the appetite and reduce
nausea and vomiting, they can help people undergoing chemotherapy or
those with AIDS.

"This report says that under certain circumstances, in chronic
patients, that medical marijuana has a role, and we should conduct
clinical trials to determine its efficacy," said Dr. Billy Martin of
Virginia Commonwealth University, who served as an adviser for the
report. "Just like we've done with anything else."

The report stresses that it is marijuana's active ingredients, the
cannabinoids, not the plant itself, that have medicinal value.

"Marijuana has potential as medicine, but it is undermined by the fact
that patients must inhale harmful smoke," said one of the report's
editors, Stanley Watson of the University of Michigan.

Smoking pot should be recommended only for terminally ill patients or
for those who do not respond to other treatments, the report says.

The report was commissioned in 1997 by the White House Office of
National Drug Control Policy as a review of research on marijuana's
medicinal uses. It does not address legalization. It comes 17 years
after the first federal scientific report on marijuana and 18 months
after the National Institutes of Health concluded that there are too
few scientific studies to determine marijuana's therapeutic utility,
but that research into its medical uses was justified.

The drug control office said it would examine the recommendations.

"We note in the report's conclusion that the future of cannabinoid
drugs lies not in smoked marijuana, but in chemically defined drugs"
delivered by other means, the office headed by retired Gen. Barry
McCaffrey said in a statement.

The report urges clinical trials to determine the usefulness of
marijuana in treating muscle spasms. It also urges development of
standardized forms of marijuana's cannabinoids that patients can
easily use, such as inhalers.

Marinol, a drug based on marijuana's psychoactive ingredient, THC,
already is on the market. It is federally approved to treat nausea and
vomiting associated with chemotherapy, as well as the anorexia and
wasting AIDS patients often suffer. However, marijuana advocates say
it doesn't work as well as the real thing.

While smoked marijuana also has been promoted as a treatment for
glaucoma, the report says it only temporarily reduces some of the eye
pressure associated with the disease. Glaucoma often has been cited by
marijuana advocates as benefiting from smoked pot.

Despite claims by opponents of marijuana's medical uses that pot is a
"gateway" drug leading to more dangerous drugs such as heroin and
cocaine, the report concludes that there is no such evidence.

In fact, the report says, most drug users did not begin with marijuana
but started by using tobacco and alcohol while they were underage.

The New England Journal of Medicine has editorialized in favor of
medical marijuana, and the American Medical Association has urged the
federal National Institutes of Health to support more research on the
subject.

VCU's Martin, who has spent the past two decades studying marijuana,
its effects on the brain and how and to what extent users become
dependent, said he expects the report and its recommendations to be
controversial because of the stigma attached to research on illegal
drugs.

"It could be that [the report] will give the NIH some cover for
supporting some clinical trials," he said. Such studies "are not a
politically positive thing to do," given that passions run high among
marijuana's advocates and critics.

Congress, for example, has taken a hard line on the issue, with the
House last fall adopting by 310-93 a resolution that said marijuana
was a dangerous and addictive drug and should not be legalized for
medical use.

There is some political support for the legal medical use of
marijuana. Voters in Alaska, Arizona, California, Colorado, Nevada,
Oregon and Washington recently approved measures in pot's support. In
Virginia, a 1979 law allows the use of marijuana for medical purposes,
although federal law still bans its use.

The Drug Free American Foundation, based in St. Petersburg, Fla.,
opposes voter referendums on marijuana, saying that pot's medical use
and research should be determined by its proven scientific value.

"This is not a voter issue," said Katherine Ford, a spokeswoman for
the group. "Let's see the science on this."

One patient, a former Virginian whose doctor prescribed pot to relieve
his pain, called the findings long overdue.

"It's taken a long time, but I feel like now, people will stand up and
listen," said Irvin Rosenfeld, a stockbroker in Boca Raton, Fla., and
one of just eight people in the country receiving marijuana from the
government because of unusual diseases.

"When you have a devastating disease, all you care about is getting
the right medicine . . . and not having to worry about being made a
criminal," Rosenfeld said.

He suffers from tumors that press into the muscles at the end of long
bones. The marijuana relaxes those muscles, keeping them from being
torn by the tumors and allowing him to move with less pain.
Rosenfeld's illness was diagnosed in 1979, when he lived in Portsmouth.

The Institute of Medicine, an affiliate of the National Academy of
Sciences, provides the federal government with independent scientific
advice.