MEDICINAL MARIJUANA GETS SUPPORT

WASHINGTON -- Entering the debate over medical marijuana, the nation's
Institute of Medicine recommended Wednesday 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 anti-drug groups was subdued.

Recent scientific work and patient anecdotes show 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-birthweight 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, authors 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-wrote 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, 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 medical use of marijuana.

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

"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. Each patient receives about 300 cigarettes a month.

Those cigarettes are rolled by Research Triangle Institute in North
Carolina under a federal contract. The institute uses marijuana grown
on a government farm at the University of Mississippi campus in
Oxford. In 1996, RTI estimated that it spent on average between
$50,000 and $100,000 each year making marijuana cigarettes.

On Wednesday, Dr. Randy Wykoff, associate commissioner of the Food and
Drug Administration, said individual patients were not likely to
receive marijuana until it is proved "safe and effective."

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

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 that 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.

In a statement, McCaffrey said he would study the report's
conclusions. He emphasized that there is some evidence that marijuana
is addictive and can 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 anti-drug 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 anti-drug public service announcements. "Who are we to
contradict what the doctors and scientists say?"

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. The report
found little proof that marijuana will help with migraine headaches,
epilepsy, glaucoma or Parkinson's and Huntington's disease.

The report's authors said they were excited by findings in recent
years that the human brain has its own marijuana-like compounds, or
cannabinoids, and that they regulate pain, movement and memory.

The report favors alternative delivery systems, such as inhalers that
can rapidly deliver compounds to the body for quick relief. There is
now only one marijuana-based drug available: Marinol, a pill with a
single active ingredient called THC. Many patients say it is not
effective and works too slowly.