Pubdate: Thu, 23 Nov 2000
Source: Salt Lake Tribune (UT)
Copyright: 2000 The Salt Lake Tribune
Contact:  143 S Main, Salt Lake City UT 84111
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Author: Daniel Q. Haney, The Associated Press

SMOKE MAY FINALLY BE CLEARING IN MEDICAL MARIJUANA DEBATE

SAN DIEGO -- Maybe the smoke is about to clear in the debate over medical 
marijuana.

Few ideas, it seems, are so firmly held by the public and so doubted by the 
medical profession as the healing powers of pot. But at last, researchers 
are tiptoeing into this field, hoping to prove once and for all whether 
marijuana really is good medicine.

To believers, marijuana's benefits are already beyond discussion: Pot eases 
pain, settles the stomach, builds weight and steadies spastic muscles. And 
that's hardly the beginning. They speak of relief from PMS, glaucoma, 
itching, insomnia, arthritis, depression, childbirth, attention deficit 
disorder and ringing in the ears.

Marijuana is a powerful and needed medicine, they say, tragically withheld 
by misplaced phobia about drug addiction.

However, the drive to legalize medical marijuana is based almost entirely 
on the testimonials of sick people who swear it makes them feel better. 
Those stories are not the kind of dispassionate experimentation that drives 
medical thinking.

"We lack evidence that there is something unique about marijuana, other 
than an impressive number of anecdotal reports," says Billy Martin, chief 
of pharmacology at the Medical College of Virginia.

In the medical establishment's view, the buzz about marijuana is little 
more than that.

Pot has many effects on the body, including some that are probably 
worthwhile. But does it substantially relieve human suffering, they ask? 
And if so, is it any better than medicines already in drugstores?

For the first time in at least two decades, marijuana the medicine is being 
put to the test. Scientists say they will try to hold marijuana to the same 
standards as any other drug, to settle whether its benefits match its mystique.

Given marijuana's recreational uses and abuses, people in this new field 
are understandably eager to come across as serious scientists experimenting 
with a serious medicine. (Even marijuana's usual reason to be -- the high 
- -- is dismissed as a mere side effect, and probably an unwanted one at that.)

One way to buff up a pharmaceutical's raffish image -- especially one 
that's a drug in more than one sense of the word -- is to call it something 
else. When the University of California at San Diego started the country's 
first institute to study the medical uses of marijuana this year, they 
named it the Center for Medicinal Cannabis Research. Cannabis is the 
botanical term for pot.

"We talked about it a lot," says Igor Grant, the psychiatrist who heads the 
new center. "Marijuana is such a polarizing name. We don't want this 
institute to be caught in the cross fire between proponents and 
antagonists. Ultimately, if cannabis drugs become medicine, they will 
almost certainly be known by that name, not marijuana."

The center will give out $9 million over the next three years to California 
researchers -- enough to underwrite six or seven marijuana studies a year 
each involving between 20 and 50 patients.

At least four other studies of the medical effects of marijuana are 
planned. Three are sponsored by the National Institutes of Health, the 
other by California's San Mateo County.

The medical marijuana movement began in earnest in 1996, when California 
passed a statewide referendum intended to make it legal. Alaska, Arizona, 
Hawaii, Maine, Oregon and Washington adopted similar laws, and Colorado and 
Nevada joined them in the November election.

"I was just so surprised at these policy decisions being made with so 
little scientific information," says Margaret Haney of Columbia University. 
"I'm not against the use of medical marijuana. There's just no data about 
its efficacy."

Most of the new research will probably focus on four main uses of marijuana 
that seem to hold the greatest promise:

- -- Relieving severe nausea and vomiting caused by cancer chemotherapy. This 
is probably marijuana's best-known medical use. While the drug almost 
certainly helps ease nausea, there is no research showing how it stacks up 
against highly effective anti-nausea drugs developed over the past 15 years.

- -- Stopping weight loss. Marijuana clearly improves appetite. However, the 
drug has not been adequately tested in people who are unintentionally 
losing weight, such as those with AIDS or cancer.

- -- Treating muscle spasticity conditions, including multiple sclerosis. 
Many victims say it helps, and some animal research backs up the idea. But 
is it better than standard medicines?

- -- Easing pain. Researchers especially want to test it on AIDS patients 
with peripheral neuropathy, numbness and pain in the feet that afflicts 
between 20 percent and 30 percent with the disease. Animal studies suggest 
marijuana may be a mild to moderate painkiller, and many people with AIDS 
are already using it, since there is no other good treatment.

One of the first questions to answer is whether objectively testing 
marijuana as a medicine is even practical. At the San Mateo County Health 
Center, Dennis Israelski will tackle this by enrolling 60 AIDS patients who 
already use marijuana for painful neuropathy.

They will be randomly assigned to smoke marijuana -- or forgo it -- for six 
weeks. Will people go along with this if it means giving up something they 
already believe helps them? If not, larger studies of marijuana may be hard 
to accomplish.
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