INSTITUTE ADVOCATES MEDICAL USE OF POT

U.S. Health Organization Say Marijuana Cigarettes Should Be Made Available
To Cancer, Aids Patients

WASHINGTON: Entering the fractious debate over medical marijuana, the
nation's Institute of Medicine recommended yesterday that marijuana
cigarettes be made available for short periods to help cancer and AIDS
patients who can find no other relief for their severe pain and nausea.

Officials with the Department of Health and Human Services almost
immediately responded by saying they would not dispense marijuana to
individual patients until more clinical research showed it was safe.

Still, the report was seen as a victory by many who advocate the use of
marijuana as medicine. The response from drug-fighting groups was subdued.

An explosion of recent scientific work, as well as patient anecdotes, shows
that compounds in marijuana have potential to ease some of medicine's most
intractable problems, the Institute of Medicine report said.

The Institute of Medicine is a private, nonprofit organization that
provides health policy advice under a congressional charter.

But its authors warned that smoking marijuana carries its own health
hazards -- including lung damage and low-birth-weight babies -- and should
be used only as a last resort after standard therapies have failed.
Addiction was seen as a relatively minor problem likely to affect only a
few users.

To avoid the smoke, they called for new delivery systems, like inhalers,
and for the development of pharmaceutical drugs made from or modeled after
the active ingredients in marijuana, chemicals known as cannabinoids.

``Marijuana's future as a medicine does not involve smoking,'' said Dr.
Stanley Watson, a neuroscientist and substance abuse expert from the
University of Michigan who co-authored the report. ``It involves exploiting
the potential in cannabinoids.''

The endorsement pleased groups that have been working to make marijuana
available to patients. Many were expecting a blander call for further
research. ``It's a discreet but clear call to make marijuana available,''
said Ethan A. Nadelman, who directs the Lindesmith Center, a New York-based
drug policy think tank.

Other advocates, including the National Organization for the Reform of
Marijuana Laws and Harvard Medical School professor Lester Grinspoon, were
more critical of the report. They said it ignored the fact that many
patients have successfully used marijuana as medicine for years with few
harmful effects.

Battles over medical marijuana have raged across the nation since 1996,
when California passed a ballot initiative that removed any state penalties
from people who used marijuana for medicinal purposes. Since then, Arizona,
Alaska, Oregon, Nevada and Washington have passed laws permitting the use
of medical marijuana.

Many mainstream medical organizations, and the relatively conservative New
England Journal of Medicine, have endorsed the use of medical marijuana.

But last fall Congress overwhelmingly passed a resolution condemning the
medical use of marijuana and because federal law still outlaws marijuana
use, many physicians are reluctant to prescribe it, even in states that
have passed initiatives.

Only eight patients in the United States have federal government permission
to smoke marijuana for their conditions. They receive government-grown
cigarettes under a ``compassionate use'' program no longer in existence.
Yesterday, Dr. Randy Wykoff, associate commissioner of the Food and Drug
Administration, said individual patients were not likely to receive
marijuana until it is proven ``safe and effective.''

Marijuana advocates predicted change is more likely to come with
state-by-state ballot initiatives.

Patients like Jim Harden, 48, a Vietnam veteran from Virginia who uses a
wheelchair and who smokes pot illegally to ease the pain of cancer, liver
disease and a back injury, says he lives in fear of a jail sentence.
``Every day, I live in fear of the police coming, arresting me and taking
my kids away,'' he said, speaking at a press conference organized by the
Marijuana Policy Project, which praised the report.

The federal government's most visible opponent of medical marijuana has
been White House drug czar Gen. Barry McCaffrey. In campaigning against
state marijuana initiatives, he said there was no proof marijuana had
medical benefits, that marijuana was a gateway drug that led to abuse of
drugs like heroin and that allowing marijuana to be used as medicine would
increase illicit recreational marijuana use.

McCaffrey, who heads the Office of National Drug Control Policy,
commissioned the institute's $900,000 report in response to calls that
federal drug policy on medical marijuana be changed.

The study disarms some of McCaffrey's arguments. Its authors found no
evidence that marijuana use caused people to progress to harder drugs or
that medical use brought increases in recreational use.

The report concluded that marijuana compounds hold the most potential for
easing pain and nausea caused by AIDS, chemotherapy and nerve damage and
would likely benefit only those who do not respond to standard drugs, which
work in a majority of patients. It also said side effects like euphoria can
enhance patient well-being.