WASHINGTON, March 17 (UPI) -- A government-funded report says smoked
marijuana is potentially effective for a short list of symptoms, recommends
rigorous clinical trials and development of a delivery system so patients do
not have to inhale.

The 18-month, $1 million Institute of Medicine report released today in
Washington makes six recommendations, including clinical trials allowing
patients with chronic conditions or end-stage diseases, who have no other
alternative, to use smoked marijuana on an experimental basis for six
months. The IOM report, "Marijuana and Medicine: Assessing the Science Base,
" was ordered by drug czar Barry McCaffrey in 1997 after California and
Arizona passed state laws making medical marijuana legal as long as it is
prescribed by a physician. Voters in Alaska, Washington State and Oregon in
1998 passed similar laws and other states are readying ballot measures. In
1982, the IOM made its first report on medical marijuana, in which it said
cannabis and its derivatives had "shown promise" in treating a variety of
disorders, including glaucoma, asthma and nausea from chemotherapy
treatment. The IOM's latest report says smoked marijuana, as compared to the
synthetic pill Marinol, which is legal, is potentially effective in treating
chronic pain, nausea from cancer chemotherapy, lack of appetite and wasting
in AIDS patients. The report follows several public hearings and months of
examining the existing scientific database. "Marijuana's medical effects are
generally modest and for most symptoms there are more effective medications
already available on the market," co-author John Benson Jr. said in a
statement.

The report rebukes long-held beliefs by many physicians that smoked
marijuana is effective for treating glaucoma, adding relief of pressure on
the eye is only temporary, and it does not endorse using the drug to treat
Parkinson's or Huntington's diseases, seizures, migraines and a host of
other ailments doctors believe are helped by it.

"Although marijuana smoke delivers THC (its active agent) and other
cannabinoids to the body, it also delivers harmful substances, including
most of those found in tobacco smoke," the report says. Beyond the smoking
issue, however, the IOM said the range of problems associated with medical
marijuana is within the acceptable range of problems associated with the use
of other drugs.

In calling for development of a new delivery system so patients do not have
to smoke marijuana cigarettes, the IOM says research also should continue
into the effects, both positive and negative, of synthetic and plant-derived
cannabinoids. It warns the marijuana plant contains a "variable mixture" of
biological compounds that "cannot be expected to provide a precisely defined
drug effect" so the future of medical marijuana is not in smoked delivery
but in the development of "chemically defined drugs" that are predictable
and safe.

The report notes that while cannabinoids have a natural role in pain
control, the brain can develop tolerances to the drug, and it's impact on
the immune system is unclear. And while there is evidence smoking marijuana
often precedes use of harder drugs, the report says there is no conclusive
evidence that it acts as a "gateway" that actually causes people to take
that next step.

Sandra Bennett, director of the Northwest Center for Health & Safety and
president of Drug Watch International, says scientific studies have failed
to show marijuana is safe or effective for medical use. "But there are
studies that show it is harmful," Bennett says. "On top of that is the fact
that it is harmful as a psychoactive and addictive substance that should not
be mainstreamed."

The National Organization for the Reform of Marijuana Laws, or NORML, calls
the report a political document, not a scientific one. It says the IOM
ignored testimony from hundreds of patients who have found relief smoking
marijuana that other medications did not provide and is holding marijuana to
a higher standard than other drugs.

"The Food, Drug and Cosmetic Act does not require a drug to demonstrate
superiority over all existing medicines before receiving federal approval
and no such hurdle exists for any other drug," says Allen St. Pierre, NORML
Foundation executive director.

The IOM is a private, non-profit organization that operates under a
congressional charter grant to the National Academy of Sciences.