NATIONAL INSTITUTE URGES MEDICAL MARIJUANA USE

WASHINGTON -- Entering the fractious debate over medical marijuana,
the nation's Institute of Medicine recommended Wednes-day 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.

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, dir-ector of the
Lindesmith Center, a New York-based drug policy think tank.

Other advocates, including the National Organization for the Re-form
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 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 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 overwhel-mingly 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.

"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 co-author.

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.