Medical Marijuana: Research, Don't Legalize
By SALLY SATEL

Never shy to embrace a trendy cause, especially during the November sweeps,
next Wednesday CBS'S Murphy Brown, recovering from breast cancer surgery,
will smoke marijuana to relieve chemotherapy induced nausea. The day before
the show airs, voters in Washington state will cast ballots on the nation's
third initiative to decriminalize the use of "medicinal" marijuana.
Advocates of similar initiatives in Alaska, Arkansas, Oregon and
Washington, D.C., are collecting signatures for elections next year.

Last year's ballot victories in California and Arizona showed how deftly
proponents of decriminalizing pot have exploited compassion for the
desperately ill. And make no mistake: These initiatives, with their
notoriously loose provisions, are stalking horses for outright
legalization. The Washington, D.C., measure, for example, wouldn't even
require a prescription: A physician's "oral recommendation" would authorize
up to four "best friends" to cultivate pot for an ill pal.

Yet there is a case to be made for research on the medical use of marijuana
a case that is usually ignored in the highly politicized debate between
legalizers and antidrug activists. The oncologists, neurologists and AIDS
doctors familiar with the clinical realities can offer considerable
anecdotal evidence of marijuana's usefulness. But only a handful of
objective studies have been conducted, mostly in the 1970s and 1980s. They
found that smoked marijuana was better than a placebo and comparable
tosometimes better thanconventional therapies available at that time
for nausea and vomiting and for glaucoma. (There have been no studies of
AIDS patients smoking marijuana.)

In 1985 the main psychoactive component in marijuanaknown as delta 9
tetrahydrocannabinol, or THC was made available as a pill sold under the
brand name Marinol. THC was found to be useful in relieving glaucoma and
pain, nausea and vomiting in cancer patients, and in inducing appetite and
weight gain in AIDS and cancer patients. Marinol, however, has its
drawbacks It makes some people too "stoned" or sedated, it is impossible to
keep down if one is retching, and it can take too long to work. Moreover,
it lacks the two main advantages of smoking: quick onset of effect and the
ability to regulate the dose so that the user gets relief but avoids the
nod. Unimed, the company that markets Marinol, plans to market a THC
inhaler, but there will remain patients for whom THC alone is wholly or the
report partly ineffective.

Many of these patients insist that raw marijuana, even when eaten, is
better than pure THC. And they may be on to something. "There are at least
200 compounds in marijuana, and it's quite plausible that some may have
useful effects or interact in some beneficial way with THC," explains
psychiatrist Herbert D. Kieber, former deputy to Bush drug czar William
Bennett. Though a firm opponent of legalization, Dr. Kleber favors limited
clinical trials of smoked marijuana "to help first determine whether the
patients helped are the same or different from those helped by conventional
treatments. From there we can go on to the process of identifying and
purifying the active components in a standard pharmaceutical manner."

Support for this view comes from a recently released report from the
National Institutes of Health. Written by a group of solid researchers, the
report recommends studying smoked marijuana and inhaled THC as treatments
for epilepsy and for muscle spasticity associated with neurological
conditions like multiple sclerosis. Since nausea and vomiting can be well
controlled with other new medications, the report says, researchers should
study smoked marijuana and THC only in patients for whom other medications
have failed. The report also calls for an examination of longterm
marijuana use to determine if there are adverse consequences for pulmonary
and immune function critical for MDS patients, whose compromised immune
systems render them vulnerable to pneumonia, tuberculosis and many other
serious diseases. The National Institute on Drug Abuse, a division of the
NIH, has recently given some $1 million to Donald Abrams, a medical
researcher at the University of California, San Francisco, to study whether
smoked marijuana is safe (and ultimately effective) in underweight AIDS
patients taking a protease inhibitor. "Doing the clinical research has to
be the right course of action," says Mark Kleiman, professor of public
policy at UCLA. "Even negative results would have value: Sick people could
stop wasting money and hope on a drug that doesn't work for them.

What about the objection Rep. Bob Barr (R., Ga.) raised at a recent
congressional hearing "I can't understand how we can want the government
to fund research when we say it's a dangerous drug"? Such a policy sends a
mixed message," Mr. Barr argued. In fact, there's no contradiction at all.
Just as addictive morphine has medical uses, so might marijuana or newly
identified components of it.

What's crucial is that the research be conducted in a carefully controlled,
scientific setting. An oncologist at a university hospital might conduct a
study on the use of marijuana to combat chemotherapyinduced nausea and
vomiting. To find subjects for this work, he would notify colleagues and
patient advocacy groups and place newspaper ads calling for subjects
undergoing chemotherapy.

After screening, patients in the study would receive research marijuana as
part of a protocol. Meanwhile, other studies on marijuana in people with
cancer, AIDS, multiple sclerosis and other conditions would be going on
around the country, involving thousands of patients. Once the work got off
the ground, patients would not have to wait a decade or morethe time it
would take to get FDA approvalbefore they can use raw marijuana or its
pharmaceutically refined products. The research itself would be the
opportunity for patients to receive marijuana but only under strict medical
supervision.

Such an approach would be scientifically sound. And, by preempting the
legalizers' phony claims of compassion, it would bring to a halt the effort
to make marijuana available to everybody, sick or not.

Dr. Satel is a Washington, D.C. based psychiatrist specializing in
addiction.