HARD DATA TRICKLES IN AS SCIENTISTS STUDY MARIJUANA

Paul Mocko really doesn't like to smoke.

But for 25 days, beginning in October, Mocko voluntarily puffed and coughed
his way through three marijuana cigarettes every 24 hours as researchers
watched for interactions between the cannabis and all the medications the
54-year-old takes to fight AIDS.

The data they are gleaning from that ongoing study is valuable, researchers
say. Legions of AIDS patients in the Bay Area have been using cannabis for
years to whet their appetites, not knowing how it mixes with the 30-odd
pills they take every day.

But many activists, physicians and research participants say another reason
the study is so significant is because it has the blessing and even
financial support of a wary U.S. government.

"I'm selective about what studies I participate in, but I try to
participate in the ones that seem promising," Mocko said, sipping a bowl of
soup in his San Francisco home. "This is a study that is sponsored and
funded by the federal government.... It's a historic study."

A number of new efforts are in the works to assess whether and how
marijuana affects ailments and chronic conditions, ranging from glaucoma
and AIDS to cancer and multiple sclerosis. Studies range from large-scale
surveys by the federal government to a $500,000 project San Mateo County
hopes to launch next month.

But three studies in particular - the University of California study Mocko
joined, a completed National Institutes of Health workshop, and a review by
the Institute of Medicine expected to be released next month - are
anxiously awaited by both sides of the smoldering debate over marijuana's
medicinal value. It's a debate long marked by complaints there isn't enough
data to prove either side's assertions.

The three studies could lead to a new "gold standard" for physicians and
policy makers to follow.

Marijuana has been used by humans for centuries, and by Western physicians
since at least the mid- 19th century as a physical and psychiatric
medication. But in 1937, the Marihuana Tax Act drove the first nail into
the coffin of medicinal cannabis. The drugs removal from the U.S.
Pharmacopoeia in 1942 was the second.

Attributing marijuana's murky status to "ignorance based hysteria,"
Berkeley psychiatrist Dr. Tod Mikuriya has prescribed the drug to treat
more than 120 ailments - from alcoholism and AIDS to thyroiditis and motion
sickness - between 1994 and 1998. He claims the drug helps his patients.

"I keep finding new ones all the time," said Mikuriya, who has served as
medical coordinator for cannabis clubs in Oakland and San Francisco. and on
medicinal marijuana panels for Oakland and the California Medical
Association. "Giving (patients) safe haven with medical status is very like
being a conductor at the end of the underground railroad."

Marijuana users and some researchers and doctors contend medicinal
marijuana is a wonder drug: an antidepressant, anticonvulsant, analgesic
and an appetite stimulant that can be smoked, vaporized, eaten or mixed
into poultices.

While the plant's main psychoactive ingredient,
delta-9-tetrahydrocannabinol, is available legally by prescription in pill
form, growers insist the complete plant contains many more ingredients that
might be equally important.

But even proponents acknowledge marijuana has its problems, most of them
linked to the inhalation of smoke from a burning plant into the lungs. The
National Institute of Drug Abuse warns that heavy cannabis use can diminish
learning ability, driving skills and workplace performance. And natural
forms of the drug can contain aspergillus, a mold dangerous to people with
damaged immune systems, such as those suffering from AIDS.

Nevertheless, Mikuriya wants to see marijuana placed on the 11 required
drug lists of all health maintenance organizations, to be tried before
medications with more serious side effects. He doesn't expect that to
happen soon - not unless significant changes occur at the federal level.

"We have a break-down of the health care delivery system," he said.
"Instead of the surgeon general controlling policy, we have the attorney
general controlling policy."

Dr. Donald Abrams, professor of clinical medicine at University of
California, San Francisco, understands that frustration. Beginning in 1993,
Abrams submitted a handful of proposals for studies to measure the
effectiveness of the cannabis his AIDS patients were using to improve their
appetites time after time, his proposals were rejected.

"They were perhaps not great proposals," Abrams said, "but I think there
were a lot of politics involved."

Finally, Abrams proposed a study that would focus on interactions between
cannabis and the protease inhibitors many AIDS patients also take. To his
surprise, the National Institute of Drug Abuse approved that proposal,
doling out $1 million and 1,400 marijuana cigarettes.

The next logical step, Abrams said, is more studies measuring the
effectiveness of cannabis as a medicine for a range of conditions - the
kinds of studies the government rejected before. Similar work has been done
from time to time since marijuana was rescheduled in 1942, but those
studies just aren't sufficient, Abrams said.

Although many users say marijuana helps them cope with everything from
multiple sclerosis to migraines, personal endorsements don't constitute
pure science. "Anecdote is fine, but it's not data at this point," Abrams
said. "If we show that marijuana is not dangerous and may have some
positive effects, I think we should pursue additional study."

Abrams isn't the only physician coming to that conclusion - nor the most
prominent. In August 1997. the National Institutes of Health reviewed the
studies of marijuana made to date and concluded more research is needed.

That recommendation led the non-governmental Institute of Medicine to spend
18 months reviewing past studies of marijuana. The report won't be released
until next month, but doctors and activists already are abuzz about the
institute's possible findings. Predictions range from another call for more
research to a complete federal reclassification of marijuana.

Those possibilities haven't escaped the attention of the California Medical
Association, which does not endorse widespread distribution of medicinal
marijuana but would favor its availability for medical use if controlled
studies prove it is effective.

New research and political sea changes led the association's legal adviser
to issue an internal memo last month suggesting the organization could
participate actively in a new marijuana distribution structure to ensure
patient health and safety.

"We believe that the distribution of marijuana, medicinal marijuana, should
not be dissimilar to that of other pharmaceuticals," said Sandra Bressler,
the association's director of professional and scientific policy. "In
general, I think we were concerned about quality, consistency and
controlled distribution."