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.