Pubdate: Thu, 18 Mar 1999
Source: New York Times (NY)
Copyright: 1999 The New York Times Company
Author: Sheryl Gay Stolberg


WASHINGTON -- The active ingredients in marijuana appear to be useful for
treating pain, nausea and the severe weight loss associated with AIDS,
according to a new study commissioned by the Government that is inflaming
the contentious debate over whether doctors should be permitted to
prescribe the drug.

The report, the most comprehensive analysis to date of the medical
literature about marijuana, said there was no evidence that giving the drug
to sick people would increase illicit use in the general population. Nor is
marijuana a "gateway drug" that prompts patients to use harder drugs like
cocaine and heroin, the study said.

The authors of the study, a panel of 11 independent experts at the
Institute of Medicine, a branch of the National Academy of Sciences,
cautioned that the benefits of smoking marijuana were limited because the
smoke itself was so toxic. Yet they recommended that the drug be given, on
a short-term basis under close supervision, to patients who did not respond
to other therapies.

The release of the delicately worded report, at a morning news conference
here, prompted a flurry of political maneuvering. Proponents of state
initiatives to legalize marijuana for medical purposes seized upon the
findings as long-awaited evidence that it had therapeutic value. They
called on the Clinton Administration, and in particular Gen. Barry R.
McCaffrey, director of the Office of National Drug Control Policy, which
requested the study, to ease its steadfast opposition to the initiatives.

"This report has proved McCaffrey wrong," said Chuck Thomas, a spokesman
for the Marijuana Policy Project, a nonprofit organization in Washington
that lobbies for the legalization of medical marijuana. "We never said
marijuana was a panacea and a be-all or end-all. What we have said is there
are some patients who don't respond to existing medications, and this
report confirms that."

But the study is unlikely to change the Administration's position. The
Department of Health and Human Services, which is already financing some
research involving medical marijuana, issued a written statement noting
simply that it would continue to finance the work. And General McCaffrey,
speaking in a telephone interview from Los Angeles, said, "This study seems
to suggest that there is little future in smoked marijuana." General
McCaffrey politely praised the analysis as a "superb piece of work" and
said he would take the recommendations under advisement. But he said there
was "enormous confusion in law enforcement" about how to handle the issue,
and added, "We've got people with mischievous agendas at work."

While the study's authors said they had been surprised to discover "an
explosion of new scientific knowledge about how the active components of
marijuana affect the body," they added pointedly that the future of
marijuana as a medicine did not lie in smoking it.

Marijuana smoke, they said, is even more toxic than tobacco smoke, and can
cause cancer, lung damage and complications during pregnancy.

The true benefits of marijuana, the experts said, would only be realized
when alternative methods, like capsules, patches and bronchial inhalers,
were developed to deliver its active components, called cannabinoids, to
the body without the harmful effects of smoke.

So far there is only one cannabinoid-based drug on the market, Marinol,
manufactured by Unimed of Somerville, N.J.

It comes in pill form and was approved in May 1985 by the Food and Drug
Administration for nausea and vomiting associated with chemotherapy, as
well as for anorexia and weight loss associated with AIDS. Some patients
have complained that Marinol is more expensive than marijuana and that they
do not feel its effects as quickly.

The researchers recommended that the Government pay for research that would
speed the development of more cannabinoid drugs, and were particularly keen
on the promise of inhalers. But, recognizing that such methods might take
years to perfect, they also recommended that people who did not respond to
other therapy be permitted to smoke marijuana in the interim.

"Marijuana should only be smoked in circumstances where the long-term risks
are not of great concern, such as for terminally ill patients or those with
debilitating symptoms that do not respond to approved medications," said
Dr. John A. Benson Jr., former dean of the Oregon Health Sciences
University School of Medicine and one of the study's two lead authors.
"Even in these cases, smoking should be limited to carefully controlled

Dr. Benson and his co-author, Dr. Stanley J. Watson Jr. of the Mental
Health Research Institute of the University of Michigan, announced their
findings in a stately wood-paneled lecture hall at the Institute of
Medicine here. As the scientists spoke, a handful of people sat in the
audience, wearing fire-engine red T-shirts with white block lettering that
blared: "Medical Marijuana Patient."

Among them was Jim Hardin, a 48-year-old Virginia man who testified before
the panel and whose story was among several personal anecdotes included in
the report. Hardin suffers from Hepatitis C, a disease that is destroying
his liver, and uses a wheelchair. He said smoking marijuana helped him cope
with the intense nausea and rapid weight loss the disease has caused.

"I lost 95 pounds," Hardin said. "I tried everything: 35 different pills.
Finally, doctors told me to go to Europe and try marijuana." He did just
that, in November 1997, visiting the Netherlands, where a doctor prescribed
one to two grams of marijuana per day. Now, Hardin said, he obtains the
drug "from a network of care providers that are willing to grow a safe and
clean cannabis."

Also in the audience was Joyce Nalepka of America Cares, a parents'
anti-drug group based in Maryland that has criticized efforts to legalize
marijuana for medical use.

"I'm concerned about the message we are sending," Ms. Nalepka said. "Kids
interpret things differently than adults. What they're going to hear is,
'Marijuana is good for something.' "

The report contained some surprising findings. It concluded that, despite
popular belief, marijuana was not useful in treating glaucoma. While the
drug can reduce some of the eye pressure associated with glaucoma, the
effects were short-lived, the report found, and did not outweigh the
long-term hazards of using the drug.

In addition, the study found that there was little evidence for marijuana's
potential in treating movement disorders like Parkinson's disease or
Huntington's disease, but that it was effective in combating the muscle
spasms associated with multiple sclerosis.

So far, voters in seven states -- California, Alaska, Arizona, Colorado,
Nevada, Oregon and Washington -- have approved initiatives intended to make
marijuana legal for medical purposes. But doctors are often afraid to write
prescriptions because the Federal Government has threatened to prosecute
them, and patients often have difficulty obtaining the drug, in part
because the Government has moved to shut the marijuana buyers' clubs that
had been distributing it. In the District of Columbia the November ballot
contained a proposal to legalize medical marijuana, but Congress prevented
the vote from being counted. 

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