LITTLE SCIENTIFIC RESEARCH ON MEDICAL MARIJUANA'S BENEFITS

Gina Akeo doesn't need a bunch of randomized clinical trials to
convince her that marijuana can ease pain and alleviate nausea.

For several years after a 2004 pancreatic surgery gone bad, the
41-year-old Pueblo resident was taking 14 prescription drugs to combat
the lingering symptoms of an ordeal that put her in the hospital for
three months. She managed to survive septic shock and the removal of
part of her intestines, but the pain, nausea and harsh side effects
from the medications were too debilitating for her to live with a
capital "l."

"I couldn't do anything," Akeo says. "I could barely get out of my
bed. I had no life."

Medical marijuana has been her saving grace, she says, restoring her
ability to hold a job, to be involved with her family, to feel good
again.

"It gives me back a quality of life that, honestly, their pills can't
give me," says Akeo, who works at a Colorado Springs dispensary,
smokes medical marijuana in the morning and ingests edibles infused
with it at night.

But in the highly regulated world of science, medical research and
government, the kind of anecdotal evidence that Akeo and many other
medical marijuana patients provide isn't enough to prove its salubrity
and put it in the same category as Vicodin, Zofran and other federally
approved medications.

Only a battery of clinical studies, conducted according to stringent
scientific procedures to prove marijuana's medicinal benefits, can
persuade lawmakers, much of the medical establishment and government
agencies that it belongs in the same toolkit as pharmaceuticals
approved by the U.S. Food and Drug Administration.

The problem is, studies are expensive, funding for marijuana studies
is scarce and there are obstacles that make it difficult for
researchers to get their hands on the federal stash of marijuana
specifically grown for research.

For well over a decade, numerous agencies and medical organizations,
including the American Medical Association, have called for more
clinical studies to build on previous, smaller studies that attempted
to gauge how effective marijuana is in combating pain, nausea,
spasticity from multiple sclerosis, appetite loss from cancer and
HIV/AIDS, and a host of other medical problems.

But long-term, large-scale studies have been scarce, and perhaps the
largest research program in the U.S. - operated through the Center for
Medicinal Cannabis Research at the University of California at San
Diego - recently lost its funding.

"Nobody wants to do studies with marijuana because it's a thankless
job," says Dr. Donald Abrams, chief of oncology at San Francisco
General Hospital who conducted several studies through the cannabis
research center. "People say it's 'Cheech and Chong' medicine, and no
drug companies are supporting it because it's not patentable, so
what's the point?"

PROMISING RESULTS FOR A HANDFUL OF CONDITIONS

This doesn't mean marijuana and its active ingredients haven't been
studied. The International Association for Cannabinoid Medicines'
database has compiled more than 300 studies going back to 1970. Some
have attempted to calculate which methods of delivery - smoking vs.
vaporization, for example - are safer and more effective. Some have
looked into the negative side effects of medical marijuana use.

But the bulk have been designed to determine whether the drug or
synthetic versions can treat any variety of ailments, from incessant
hiccups to cancer.

Many of the studies have found promising results in the use of
marijuana for a handful of medical conditions, but the conclusions
haven't been unanimous. The website ProCon.org, run by a nonprofit
that attempts to provide unbiased educational resources on a variety
of issues, tracked down 73 peer-reviewed studies conducted between
2000 and 2011. Of those, 45.2 percent concluded that marijuana has
potential medical benefits; 31.51 percent were not clearly pro or con;
and 23.29 percent found no benefits and/or detrimental effects, such
as cognitive impairment.

Researchers at Leiden University in the Netherlands reviewed 37
controlled clinical studies conducted from 2005 to 2009 in the U.S.
and Europe and concluded that "based on the clinical results,
cannabinoids present an interesting therapeutic potential mainly as
analgesics in chronic neuropathic pain, appetite stimulants in
debilitating diseases (cancer and AIDS), as well as in the treatment
of multiple sclerosis."

Several of the studies conducted through the 11-year-old Center for
Medicinal Cannabis Research in California showed marijuana's promise
as an analgesic - something that might back up the anecdotal
experiences of Akeo and other patients seeking relief from pain.

"I think the research says that there seems to be an analgesic effect
for certain kinds of pain, and there's enough of an effect in a small
sample that encourages further research," says Dr. J.H. Atkinson, a
physician in the department of psychiatry at UCSD and co-director of
the cannabis research center.

One problem is that funding for more research in the U.S., especially
for those larger studies, is scarce. The California center's clinical
trials were considered Phase 2 trials under FDA protocols, which
usually involves a sample size of a few dozen to about 300
participants. Phase 3 trials, the next step in winning FDA approval,
can involve up to 3,000 people and are meant, in part, to determine if
findings from smaller studies hold up.

As much as center officials would have liked to conduct Phase 3
studies, they ran out of money, and California lawmakers did not
re-fund it. That's a pity, its administrators say, because the Phase 2
trials showed great promise for the use of marijuana as medicine.

"The center will continue to exist, but unless new research projects
are funded - unlikely in the current economy and political atmosphere
- - little progress can be expected," the center's director, Dr. Igor
Grant, wrote in a San Diego newspaper last fall. "If that happens,
opportunities to advance pain science and treatment may be snuffed
out."

Atkinson noted that only one of the 16 states with authorized
medicinal cannabis use has put up any money for research into its
effectiveness.

"It would be up to the states or private monies to fund research,"
Atkinson says. "I don't see the NIH funding studies."

SCHEDULE I STATUS A HINDRANCE TO RESEARCH

Even if scads of funding were available, research into marijuana's
therapeutic value is hampered by its status as a Schedule I drug -
those considered to have no proven medicinal benefit and a high
potential for abuse. Also on the list: heroin, LSD and Quaaludes.

Because marijuana is a Schedule I drug, researchers have to jump
through a lot of governmental hoops to get their hands on the only
legal cannabis available for scientific study. The American Medical
Association and many researchers, including Atkinson, believe
marijuana should at least be considered for Schedule II status, with
the likes of cocaine, Oxycodone and morphine, to loosen the reins on
its availability for research.

"Our studies would seem to point to the possibility that the drug
should be listed as a Schedule II agent, which, by definition, is a
drug that may have some benefit and, therefore, would be open to more
research," Atkinson says.

In 2006, the FDA came out against the use of smoked marijuana for
medical purposes, and issued a statement criticizing states that
approved it. The FDA cited marijuana's Schedule I status while, at the
same time, indicating the drug needs more testing to determine its
safety.

"A past evaluation by several Department of Health and Human Services
(HHS) agencies, including the Food and Drug Administration (FDA),
Substance Abuse and Mental Health Services Administration (SAMHSA) and
National Institute for Drug Abuse (NIDA), concluded that no sound
scientific studies supported medical use of marijuana for treatment in
the United States, and no animal or human data supported the safety or
efficacy of marijuana for general medical use," the FDA said in the
statement, its latest on the subject. "

Even if studies confirm and reconfirm marijuana's health benefits to
the satisfaction of federal lawmakers and agencies, there may still be
questions that need to be answered before it's accepted by mainstream
medicine. Among them: What is the most beneficial and safest way to
use it? Do synthetics perform as well as the plant? Can the quality,
purity and potency be standardized?

In spite of the many unanswered questions about medical marijuana and
the call for more studies, 16 states and Washington, D.C., have made
it legal, and Coloradans who find relief from it, like Akeo, are just
happy they can still buy it.

"I know what works for me, and how much, and I know it's not going to
destroy me," Akeo says. "People who really need it don't have to pump
themselves full of drugs that we now know have major side effects."

MEDICAL MARIJUANA in COLORADO

Statistics are as of March 31, the latest data available

Statistics of the registry include:

* Total number of patients with valid cards: 123,890

* Number of patients from El Paso County: 13,474, or about 11 percent
of the state total

* Number of patients from Teller County: 1,014, or less than 1
percent of the state total

* Percentage of cardholders who are male: 69

* Average age of patients: 40

* Number of people under age 18 with cards: 40

* About 94 percent of patients say they use medical marijuana for
severe pain; muscle spasms account for the second-most reported
condition at 21 percent. Other conditions include cancer, glaucoma,
HIV/AIDS, seizures and severe nausea. Patients can report more than
one condition.

* More than 1,100 physicians have signed for patients in Colorado.
Eighteen doctors account for 49.3 of the recommendations. One
physician authorized 2,381 patients, the most of any doctor. There is
no breakdown of the hometowns of the doctors who make
recommendations.

Source: Colorado Department of Public Health and Environment.

WHAT MARIJUANA CAN HELP, ACCORDING TO RESEARCH

Research conducted since 1970 has found that marijuana or its
derivatives show some promise in helping the following conditions. But
most researchers say more and bigger follow-up studies are needed to
validate the findings:

Chronic and neuropathic pain (including pain caused by rheumatoid
arthritis, fibromyalgia, cancer and HIV/AIDS)

Obsessive/compulsive disorder

Multiple sclerosis/spasticity

Appetite loss stemming from cancer, HIV/AIDS

Nausea

Anxiety

Headaches/migraines

Dystonia

Agitation caused by Alzheimer's disease

Intestinal dysfunction

Incontinence/overactive bladders

Tics/Tourette's

Glaucoma/interocular pressure

*Sources: ProCon.org; International Association for Cannabinoid Medicines