UNORTHODOX USES FOR MEDICINAL MARIJUANA

The drug is being recommended by some doctors for conditions such as
depression and ADD.

Buoyed by a recent federal court decision, a small but growing number
of California doctors are treating patients with marijuana for a host
of medical conditions, including some controversial ones, such as
adult depression and attention deficit disorder in children.

Experts say most of these doctors are recommending medicinal marijuana
only for the treatment of conditions for which there is some
scientific research supporting its benefit: pain management, glaucoma
and as an appetite enhancer for cancer and AIDS patients. But others
already are raising concerns about doctors who recommend marijuana for
purposes for which there is little or no science demonstrating its
effectiveness.

It is common for doctors to use medications to treat "off-label"
conditions for which the drug is not approved. However, some experts
are concerned that patients using marijuana for unorthodox treatments
may not be receiving medications proven to be effective.

Doctors are split about the overall safety of using marijuana. Some
consider it extremely safe, noting that an estimated one-third of U.S.
adults have tried it, with few reported medical complications. Others,
however, contend that smoking marijuana may be as harmful as tobacco,
doing more harm than good.

"Marijuana shows encouraging results in some areas like pain
management and nausea. But there is little evidence to suggest it has
any benefit beyond a few defined areas," says Igor Grant, director of
the University of California's Center for Medicinal Cannabis Research
in San Diego.

Physicians who recommend cannabis insist its health benefits are
plentiful, and they advise patients to use it only after other
medications and treatment have failed.

Dr. Claudia Jensen, a Ventura family doctor, says she is treating
dozens of patients with marijuana for a range of medical conditions,
including children with ADD.

Jensen acknowledges that the science is lacking to justify some of her
unorthodox uses, but says she has seen many patients for whom
marijuana is the only treatment that seems to work. For patients
younger than 18, Jensen says she first recommends Marinol, an
FDA-approved synthetic oral form of the drug available by
prescription. If that doesn't work - and the children's parents agree
- - she recommends growing marijuana at home and incorporating the drug
into prepared foods, such as brownies.

Only as a last resort does Jensen recommend young patients smoke the
drug. She says the amount she recommends varies.

A spokeswoman for the Medical Board of California says that few
doctors recommend marijuana as a treatment for children and that doing
so isn't necessarily improper. The board's position, however, is that
it should be done in only extreme cases, such as with cancer patients
and only with careful doctor supervision.

The science surrounding medical marijuana is as controversial as its
politics. A widely cited study in 1999 by the influential Institute of
Medicine found that cannabis may benefit several conditions,
especially pain and loss of appetite. The report found little evidence
to support its use beyond those areas.

Separate research shows that marijuana may have counterproductive
effects on young users. Dr. Martin Stein, a San Diego pediatrician who
specializes in ADD, says that recommending marijuana to minors is
"extremely controversial" and that "there are better and safer
medications and behavioral treatments we have available to us." The
Bush administration's position is that cannabis has no medical value,
and it has strongly opposed its use by doctors.

But last October, after challenges by the federal government, the 9th
U.S. Circuit Court of Appeals ruled that doctors have a constitutional
right to discuss marijuana with patients. The federal ruling covers
California and four other states with their own medical marijuana laws.

Partially because of the ruling, some doctors say they are more
comfortable with prescribing marijuana. Earlier this month, two Lake
Forest doctors opened a storefront clinic for patients seeking medical
marijuana. And San Francisco is studying how to set up growing
cooperatives to provide marijuana to chronically and terminally ill
patients in the city.

Many patients say they aren't concerned with all the legal and
scientific confusion surrounding marijuana. They just know it works
for them. Matt Farrell, a 27-year-old Los Angeles cameraman, says he
began smoking marijuana several times a day three years ago after his
doctor recommended it to treat his recurrent depression and insomnia.
Farrell says he tried a half dozen other medications first, including
the antidepressants Paxil and Zoloft, but they either didn't work or
had too many side effects. "I have some medication before bed, or in
the afternoon when I am feeling stressed. It just makes me feel
better," he says.

Frank Lucido, a Berkeley family physician who treats patients with
marijuana for conditions including depression and post traumatic
stress disorder, says he plans to continue recommending cannabis.
"How are we ever going to know how much this drug can do unless we
try?" he asks.