DUDE, WHERE'S MY PAIN?

San Diego-- Turning marijuana into a prescription medicine is a challenge
- -- and not just because pot is illegal.

Patients with cancer and AIDS insist that the nation's most popular
recreational drug relieves their pain and nausea, but as they get stoned
their motivation often vanishes too. Not to mention that inhaling smoke
five times a day can increase sick people's risk of lung cancer and emphysema.

In a flurry of new research, scientists are trying to smoke out a solution.
They're developing ways to take the high out of marijuana and transfer its
legendary powers to an inhaler or a tablet patients put under their tongue.

But a British expert told an international convention of pain experts this
week that pot pills won't show up on pharmacy shelves anytime soon.

"We've got a long way to go," said Dr. Andrew Rice, a senior lecturer in
pain research at Imperial College in London, at the 10th World Congress on
Pain in San Diego. While people have used marijuana to relieve pain for
thousands of years, there's little scientific evidence that it actually
works in humans, he said.

New research projects may change all that.

In 1996, California became the first of eight states to allow sick people
to smoke marijuana to ease their symptoms. Three years later, state
legislators authorized funding for medical marijuana research projects at
the University of California at San Diego and its sister campus in San
Francisco.

While the federal government cracks down on the illegal cultivation and
trafficking of marijuana, the National Institute on Drug Abuse actually
provides the drug to researchers.

At UC San Diego, researchers sting the arms of test subjects with
capsaicin, the active ingredient in red chili peppers, and check to see if
they react differently to the pain after smoking pot.

Researchers working with animals use similar approaches on rats. They apply
stinging chemicals to the rats and measure whether they appear to suffer
less pain after getting doses of marijuana.

UCSD researchers will also test the effects that smoking marijuana has on
cancer patients who suffer severe pain, on multiple sclerosis patients who
hope to reduce their muscle spasms and on AIDS patients coping with nerve pain.

Some pain patients learn how to adjust their use of marijuana so they avoid
getting high, Rice said. But researchers want to eliminate the side effects
entirely.

"If someone is looking to carry on normal functioning in terms of the
workplace, driving and dealing with daily life, you really don't want to go
around stoned all the time," said Sumner Burstein, a professor of
biochemistry at the University of Massachusetts Medical School in Worcester.

This week, Burstein is presenting the results of his work with
marijuana-derived drugs at a national conference of the American Chemical
Society in Boston. He has developed a synthetic compound that is 50 to 100
times more potent than THC -- an active ingredient in marijuana -- but
that, unlike THC, doesn't make people high.

Researchers at a pharmaceutical company are in the second phase of testing
the compound in people, Burstein said. He declined to identify the company,
which he said doesn't want publicity.

Rice, the British expert, said he isn't so sure that marijuana-derived
drugs are ready for prime time. Even so, he said, scientists have learned
much in the past two years about how the chemicals in marijuana infiltrate
the body and bind with the receptors that produce its effects.

Researchers have known about the active ingredient THC since 1964, and
doctors can prescribe Marinol, a drug made from a synthetic form of it. But
while some AIDS and cancer patients take Marinol to control nausea and
improve appetite, experts say it's not as effective as marijuana itself
because it doesn't absorb easily through the mouth.

Also, Marinol costs more than a joint. Drugstore.com offers Marinol in the
highest dose available for $14 a pill.

Marijuana researchers face other obstacles. "These compounds are very
difficult to work with," Rice said.

What's more, smoking isn't healthy -- although in some cases, long-term
risks don't matter.

"If you have terminal cancer patients, they'll die before they run into the
lung problem," said Dr. Mark Wallace, chief of a pain clinic at UCSD. But
in general, doctors want to avoid "trading one problem for another."

Unfortunately, there aren't many alternatives to smoking. The body doesn't
absorb marijuana well through the digestive system. That's why people tend
to smoke pot instead of baking it in brownies.

Rice said scientists are looking at "delivering" marijuana in a fine mist
with the help of an inhaler or through a sublingual pill that's absorbed
under the tongue like some heart drugs.

But there are other options too. Some researchers think the solution may
lie in the other end of the alimentary canal -- in a suppository.

Many patients will no doubt prefer to take marijuana the old-fashioned way.