MEDICINAL MARIJUANA USES SEEN

Scientific study commissioned by President Clinton's antidrug policy
adviser has found that marijuana can be useful in treating people with
AIDS, cancer, and other diseases, adding fire to the already
politically charged issue of whether to legalize the drug for
medicinal purposes.

The Institute of Medicine report, released yesterday, also found no
evidence to support the theory that marijuana is a ''gateway'' to
harder drugs of abuse, and urged further study of marijuana's active
ingredients in treating pain, nausea, and other ailments.

The $896,000 study was commissioned in 1997 by retired Army General
Barry R. McCaffrey after he and other US officials criticized state
ballot measures legalizing medical marijuana, calling them `hoax
initiatives,'' and dismissed reports on the drug's benefits as a
''Cheech & Chong show,'' referring to a pair of actor-comedians who
have glamorized drug use.

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

Its report concludes that the future of the drug's medicinal use lies
not in lighting up joints, since smoking can lead to lung damage and
low-birthweight babies, but in the development of pharmaceuticals or
other drug delivery systems, like a vaporizer, that would be based on
marijuana's active ingredients.

In the meantime, the report did support interim solutions for some
sick and dying patients who do not benefit from approved painkillers
and anti-nausea drugs.

''There are limited circumstances in which we see recommending smoked
marijuana for medical uses,'' said Dr. John A. Benson Jr., former dean
of Oregon Health Sciences Unversity and one of the two principal
investigators for the report. But he said this would be only in the
context of a carefully controlled study in which patients are told of
the potential harmful effects.

Thousands of patients with nausea and vomiting from chemotherapy, for
example, could be among those who could benefit from smoked marijuana
in carefully controlled trials, Benson said during a news conference.

McCaffrey told the Washington Post he endorsed the report
''thoroughly,'' and called it a ''significant contribution to
discussing the issue from a scientific and medical viewpoint.'' He
said he wouldn't oppose 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 report did not find evidence to support the use of marijuana to
reduce some of the eye pressure that comes with glaucoma, however,
even though people have reported it to be helpful.

One scientist asked by the institute to review the report, Dr. Lester
Grinspoon of Harvard Medical School and author of ''Marihuana: The
Forbidden Medicine,'' said he found fault with the glaucoma finding and
other conclusions, but overall backed the report because ''it does say
unequivocally that marijuana has medicinal capacities.''

Yesterday, other supporters of the legal use of marijuana for medical
purposes also welcomed the report. And AIDS groups used the report to
demand that federal officials immediately allow experimental access to
medical marijuana.

''I think this report is General McCaffrey's worst nightmare,'' said
Bill Zimmerman, executive director of the California-based Americans
for Medical Rights, which has sponsored successful medical marijuana
initiatives in seven states, mostly out West, and has put one on
Maine's ballot for November.

''Most of what the government has been telling us is false ... It's
not a gateway to heroin and cocaine. It has proven medical value,''
said Zimmerman. ''I think from both a scientific and moral standpoint,
government has no choice but to make it available for patients who
need it,'' he said.

Antidrug activists generally called the report an objective
evaluation, but continued to oppose the state initiatives as political
ploys by people seeking to have all marijuana use legalized.

''General McCaffrey has been wonderfully responsible and responsive to
fund this report and to get the medical community injected into this
issue,'' said Steve Dnistrian, executive vice president for the
Partnership for a Drug-Free America, a private nonprofit organization
known for its national antidrug advertising campaigns. ''The best
thing is to have this issue pulled out of the political arena, and put
into the scientific arena.''

But Dnistrian said the report's findings could send the wrong message
about marijuana to children. Imagine a situation in which a parent
discusses marijuana with a son and discovers that the teenager ''has
just been offered a joint at school, and a friend tells him, `It can't
be so bad, sick people use it.'''

`It's going to be inherently more difficult for that parent to talk to
that kid persuasively about marijuana,'' Dnistrian said. ''It's not
impossible to deal with, it just makes it all the more
complicated.''

He also disputed the conclusion that marijuana does not play a role in
teenagers progressing to harder drugs.

While the Institute of Medicine report supports limited use of smoked
marijuana for some patients, federal agencies, including the White
House Office of National Drug Control Policy that McCaffrey heads up,
remained silent on whether they would expand experimental access to
the drug outside of some small federally approved programs.

''We will carefully study the recommendations and conclusions
contained in this report,'' said McCaffrey, who then deferred to the
US Department of Health and Human Services.

Health and Human Services, in its own statement, said the National
Institutes of Health, which it oversees, ''will continue to consider
any grant applications it receives on the medical utility of marijuana
and its constituents, and is prepared to fund those applications that
meet the accepted standards of scientific design and are found, on the
basis of peer review, to be competitive with other applications that
qualify for funding.''

Globe correspondent Louise D. Palmer contributed to this report, which
also includes material from the Associated Press.