MEDICAL MARIJUANA IS ENDORSED BY RESEARCHERS IN A FEDERAL REPORT

WASHINGTON - Entering the fractious debate over medical marijuana,
the 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 the potential to ease some of
medicine's most intractable problems, the Institute of Medicine report
said. The institute is an independent research organization chartered
by the National Academy of Sciences and conducts studies of issues
related to health and science.

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

To avoid the smoke, the authors called for new delivery systems, such
as 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
Stanley Watson, a neuroscientist and substance-abuse expert from the
University of Michigan who cowrote 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 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, calling the report "tepid" and "political." They
said it ignored the fact that many patients had 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 for people who used marijuana for medicinal purposes.
Since then, Arizona, Alaska, Oregon, Nevada and Washington state 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
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. 'Nothing's happened'

"There are so many strictures on doctors, so much uncertainty on the
part of licensing boards . . . that nothing's happened," said Dr. John
A. Benson Jr., a former dean of the Oregon Health Sciences University
School of Medicine and the report's other coauthor.

In Philadelphia, Lawrence Elliott Hirsch, a lawyer who has filed a
class-action suit against the federal government over its
medical-marijuana policy, called the new recommendations "too little,
too late." He said doctors should immediately be able to prescribe
marijuana to alleviate the pain and suffering of patients.

The suit, filed in U.S. District Court in Philadelphia last summer,
names 165 plaintiffs around the country who say that marijuana has
provided the only relief they have found from a wide array of
ailments, ranging from the nausea associated with the new AIDS drugs
to the muscle spasms that often accompany multiple sclerosis.

The plaintiffs charge that the government has violated their right to
equal protection under the law by refusing to let them take part in a
federal program set up in 1978 to provide marijuana to some critically
ill patients on a "compassionate use" basis. The government shut the
program to new patients in 1992. A June trial expected

Last week, U.S. District Judge Marvin Katz refused to dismiss the
suit, saying that it raised an important constitutional issue. The
case is expected to go to trial June 21.

Only eight patients in the United States have federal government
permission to smoke marijuana for their conditions under the
"compassionate use" program. Yesterday, Dr. Randy Wykoff, associate
commissioner of the Food and Drug Administration, said individual
patients were not likely to receive marijuana until it was proven
"safe and effective."

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

Patients such as Jim Harden, 48, a Vietnam veteran from Virginia who
uses a wheelchair and who smokes marijuana illegally to ease the pain
of cancer, liver disease and a back injury, said he lived 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 news
conference organized by the Marijuana Policy Project, which praised
the report.

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

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 attacks 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.

In a statement, McCaffrey said he would study the report's
conclusions. He emphasized that there was some evidence that marijuana
was addictive and could lead to further drug use. He left it to the
nation's health agencies to judge whether more patients should be
provided with marijuana cigarettes.

Other antidrug groups seemed to signal a softening in their strong
public stance against medical marijuana. "We support all the
recommendations," said Steve Dnistrian, an executive vice president of
the Partnership for a Drug Free America, the nonprofit organization
that creates antidrug public-service announcements. "Who are we to
contradict what the doctors and scientists say?"

The report concluded that marijuana compounds held the most potential
against pain and nausea caused by AIDS, chemotherapy and nerve damage,
and would likely benefit only those who did not respond to standard
drugs, which work in a majority of patients. The report said side
effects such as euphoria could enhance patient well-being. The report
found little proof that marijuana would help with migraines, epilepsy,
glaucoma or Parkinson's and Huntington's disease.

Inquirer staff writer Huntly Collins contributed to this
article.