MEDICAL MARIJUANA: POT OF GOLD OR PIPE DREAM

CHICAGO -- In about a dozen states, you can smoke a joint if you have
cancer or HIV and meet certain conditions, like having a doctor's note.

In California, you can light up if you have just about anything --
headaches, anxiety, epilepsy -- and a physician's okay.

Illinois could join these states as legislators consider a bill that
would allow patients to use marijuana as medicine so long as they have
one of 14 conditions and illnesses, from cancer to Crohn's Disease.

But interviews with scientists and physicians and a review of medical
literature reveal scant evidence that marijuana is a safe and
effective treatment for most of those 14.

A handful of uses in the bill -- like pain suffered by people with HIV
and cancer -- are supported by some solid scientific evidence. But none
meet the standards, such as multiple, large, well-designed clinical
trials, required by the U.S. Food and Drug Administration in approving
new drugs.

"What defines a medicine? And how do we bring medicines to market?"
said Dr. Eric A. Voth, chairman of the Institute on Global Drug
Policy. "And we do not bring them through the legislative vote process
and say: Here we deem this as medicine."

And yet the momentum across the U.S. leans toward legalizing medical
marijuana, with bills being weighed from Pennsylvania to Ohio. On
Tuesday, the District of Columbia Council passed a measure that
legalizes medical cannabis. Advocates are also championing a change in
federal law.

In the world of medicine, there's nothing quite like pot. It's a
medicine sold with names like Haze ($160 an ounce at one California
dispensary) and Grand Daddy Purple ($300 an ounce) and descriptions
like "get lifted and be happy," a stigmatized plant with therapeutic
promise that few want to study because it remains illegal on the
federal level and a drug that raises concerns because you have to smoke it.

"We need more science and we need to treat it like a medicine," said
Allan Young, a professor of psychiatry at the University of British
Columbia who is conducting a trial examining the effect of chemicals
in marijuana on bipolar disorder.

Advocates say they are only trying to decriminalize use of the plant
by sick people who have failed to gain relief from pharmaceutical
drugs. Under the Illinois bill, patients with permission from the
state and a physician would be able to possess two ounces of dried
marijuana or grow a small number of plants.

"These sick people are looking for compassion," said Dan Linn,
executive director of the Illinois Cannabis Patients Association. "And
if treatment includes cannabis, in Illinois, should we consider these
people criminals?"

Illinois rep. Lou Lang, a sponsor of the Illinois bill, said: "We have
to think of this as a product, not a drug. Not as a menace. Nobody has
ever died from an overdose of marijuana."

But there is reason to worry that marijuana could actually prove
harmful for patients with some of the conditions it is supposed to
treat.

Take glaucoma, a disease listed in the Illinois bill and often cited
by advocates because marijuana can lower the pressure inside the eye.
Increased eye pressure is a common feature of glaucoma, and can lead
to damage of the optic nerve and blindness.

"They think that even if this unconventional therapy doesn't work that
it can't possibly hurt their disease," said ophthalmologist Dr. James
Tsai, chairman of the Department of Ophthalmology and Visual Science
at Yale University School of Medicine and chairman of the medical
advisory board at The Glaucoma Foundation. "However, studies suggest
that it might be in fact damaging to do so."

Marijuana only lowers pressure for several hours, requiring patients
to continuously medicate day and night, glaucoma experts said. Failing
to do so can lead to a rebound spike in eye pressure, which can be
damaging. Marijuana also can lower blood pressure, which can damage
the optic nerve.

In February, the Journal of Glaucoma ran an editorial warning against
using pot to treat glaucoma.

Epilepsy is another disease commonly cited by advocates as treatable
because marijuana is suspected to have anti-seizure properties. But
ask epilepsy experts and they will tell another story.

"Statistically, there is no evidence that it is effective when used as
a therapeutic agent and, besides, it has more side effects than other
anti-seizure medications available," said neurologist Dr. Stephan
Schuele, medical director of the Northwestern University Comprehensive
Epilepsy Center.

There are serious concerns, said neurologist Dr. Alan Ettinger,
Epilepsy Director of Neurological Surgery P.C. in Rockville Center,
N.Y., and a member of the executive board of The National Epilepsy
Foundation. First, he said, withdrawal among chronic users with
epilepsy can cause severe exacerbations of the seizures.

And, he said, some individuals with epilepsy are struggling with
depression, sleepiness and cognitive difficulties to begin with.
Marijuana can compound these problems, he said.

Like glaucoma and epilepsy, research is mixed when it comes to another
commonly cited medical use of marijuana -- spasticity in people with
multiple sclerosis, according to experts in the field.

One trial in Europe found that objective measures showed cannabis did
not affect spasticity, even though patients thought it did, said
neurologist Dr. Carlo Pozzilli, director of the Multiple Sclerosis
Center in Rome, Italy, who has conducted research on cannabis and
multiple sclerosis. It did, however, affect pain.

"This is the gap between what the patients say and what the doctor
sees in terms of objectivity," Pozzilli said. "This is the big problem
of cannabis as a therapeutic."

Advocates say marijuana can be a safe and effective alternative to
FDA-approved pharmaceuticals, which can come with their own addiction
problems and side effects. Mike Graham, a 47-year-old former
restaurant manager from Manteno, Ill., said his degenerative disk
disease left him bedridden with horrible nerve pain. "It is like
getting hit by a baseball bat every time my heart beats," he said.
"Boom. Boom. Boom. It doesn't stop."

The painkillers he was taking, including a morphine pump, failed to
manage the pain but caused nausea and vomiting, he said. A hospice
nurse suggested he try pot. He says it worked. Now he takes several
puffs every three hours. "There is no euphoric feeling, but I can have
a semblance of a life," said Graham, co-director of Illinois Safe Access.

His story echoes that of Rev. Wayne Dagit, a Michigan minister also
pushing for the Illinois bill who runs a cannabis smokers club in
Williamston, Mich.

Dagit said he awakens some mornings in so much pain he can barely
move. He has been prescribed oxycodone, a strong painkiller that can
become addictive and takes 30 minutes to take effect. "But," he said,
"if I can scoot up to the edge of the bed and do one hit (of
marijuana), I wait four minutes and it is a euphoric effect and that
is all I need."

People long have sought out pot's positive effects, intriguing
researchers. Could cannabinoids, which affect areas of the brain that
control movement, help people with multiple sclerosis control
spasticity? Could the chemicals, which affect areas of the brain
associated with stress, help veterans suffering from post-traumatic
stress disorder?

In 1999, the Institute of Medicine released a report citing the
promise of cannabinoids, recommending short-term use of marijuana for
debilitating conditions like intractable pain or vomiting if, among
other conditions, all other treatments have failed.The report mostly
calls for more research on uses of cannabis. But
since that report, relatively little work has been done. Marijuana's
status as an illegal drug, not just in the United States but across
much of the world, has stymied researchers.

Marijuana, especially smoked marijuana, as a target of research faces
serious obstacles, said internist Dr. Eric Larson, a co-author of the
1999 Institute of Medicine report. "It is an orphan drug, there is no
U.S. company that is going to promote it and then there's the stigma,"
he said.

Larson said the social advocacy groups -- pro and con -- also make
marijuana an unpopular choice for researchers: "Many traditional
scientists will say, I don't want to have to deal with this sort of
wild advocacy group where my science runs the risk of being
expropriated for an agenda that isn't about discovery but rather about
advocating a point of view."