Pubdate: Thu, 18 Mar 1999 Source: Philadelphia Inquirer (PA) Copyright: 1999 Philadelphia Newspapers Inc. Contact: Website: Forum: Author: Usha Lee McFarling, Inquirer Washington Bureau


WASHINGTON - Entering the fractious debate over medical marijuana, the Institute of Medicine recommended yesterday that marijuana cigarettes be made available for short periods to help cancer and AIDS patients who can find no other relief for their severe pain and nausea.

Officials with the Department of Health and Human Services almost immediately responded by saying they would not dispense marijuana to individual patients until more clinical research showed it was safe.

Still, the report was seen as a victory by many who advocate the use of marijuana as medicine. The response from drug-fighting groups was subdued.

An explosion of recent scientific work, as well as patient anecdotes, shows that compounds in marijuana have the potential to ease some of medicine's most intractable problems, the Institute of Medicine report said. The institute is an independent research organization chartered by the National Academy of Sciences and conducts studies of issues related to health and science.

But the authors of the report warned that smoking marijuana carried its own health hazards -- including lung damage and low-birth-weight babies -- and should be used only as a last resort after standard therapies had failed. Addiction was seen as a relatively minor problem likely to affect only a few users.

To avoid the smoke, the authors called for new delivery systems, such as inhalers, and for the development of pharmaceutical drugs made from or modeled after the active ingredients in marijuana, chemicals known as cannabinoids.

"Marijuana's future as a medicine does not involve smoking," said Stanley Watson, a neuroscientist and substance-abuse expert from the University of Michigan who cowrote the report. "It involves exploiting the potential in cannabinoids."

The endorsement pleased groups that have been working to make marijuana available to patients. Many were expecting a call for further research. "It's a discreet but clear call to make marijuana available," said Ethan A. Nadelman, who directs the Lindesmith Center, a New York-based drug-policy think tank.

Other advocates, including the National Organization for the Reform of Marijuana Laws and Harvard Medical School professor Lester Grinspoon, were more critical, calling the report "tepid" and "political." They said it ignored the fact that many patients had successfully used marijuana as medicine for years with few harmful effects.

Battles over medical marijuana have raged across the nation since 1996, when California passed a ballot initiative that removed any state penalties for people who used marijuana for medicinal purposes. Since then, Arizona, Alaska, Oregon, Nevada and Washington state have passed laws permitting the use of medical marijuana.

Many mainstream medical organizations, and the relatively conservative New England Journal of Medicine, have endorsed the use of medical marijuana.

But last fall Congress overwhelmingly passed a resolution condemning medical use of marijuana, and because federal law still outlaws marijuana use, many physicians are reluctant to prescribe it, even in states that have passed initiatives. 'Nothing's happened'

"There are so many strictures on doctors, so much uncertainty on the part of licensing boards . . . that nothing's happened," said Dr. John A. Benson Jr., a former dean of the Oregon Health Sciences University School of Medicine and the report's other coauthor.

In Philadelphia, Lawrence Elliott Hirsch, a lawyer who has filed a class-action suit against the federal government over its medical-marijuana policy, called the new recommendations "too little, too late." He said doctors should immediately be able to prescribe marijuana to alleviate the pain and suffering of patients.

The suit, filed in U.S. District Court in Philadelphia last summer, names 165 plaintiffs around the country who say that marijuana has provided the only relief they have found from a wide array of ailments, ranging from the nausea associated with the new AIDS drugs to the muscle spasms that often accompany multiple sclerosis.

The plaintiffs charge that the government has violated their right to equal protection under the law by refusing to let them take part in a federal program set up in 1978 to provide marijuana to some critically ill patients on a "compassionate use" basis. The government shut the program to new patients in 1992. A June trial expected

Last week, U.S. District Judge Marvin Katz refused to dismiss the suit, saying that it raised an important constitutional issue. The case is expected to go to trial June 21.

Only eight patients in the United States have federal government permission to smoke marijuana for their conditions under the "compassionate use" program. Yesterday, Dr. Randy Wykoff, associate commissioner of the Food and Drug Administration, said individual patients were not likely to receive marijuana until it was proven "safe and effective."

Marijuana advocates predicted that change was more likely to come with state-by-state ballot initiatives.

Patients such as Jim Harden, 48, a Vietnam veteran from Virginia who uses a wheelchair and who smokes marijuana illegally to ease the pain of cancer, liver disease and a back injury, said he lived in fear of a jail sentence. "Every day, I live in fear of the police coming, arresting me, and taking my kids away," he said, speaking at a news conference organized by the Marijuana Policy Project, which praised the report.

The federal government's most visible opponent of medical marijuana has been the White House antidrug czar, Gen. Barry McCaffrey. In campaigning against state marijuana initiatives, he said that there was no proof marijuana had medical benefits, that marijuana was a gateway drug that led to abuse of drugs such as heroin, and that allowing marijuana to be used as medicine would increase illicit recreational use of marijuana.

McCaffrey, who heads the Office of National Drug Control Policy, commissioned the institute's $900,000 report in response to calls that federal drug policy on medical marijuana be changed.

The study attacks some of McCaffrey's arguments. Its authors found no evidence that marijuana use caused people to progress to harder drugs or that medical use brought increases in recreational use.

In a statement, McCaffrey said he would study the report's conclusions. He emphasized that there was some evidence that marijuana was addictive and could lead to further drug use. He left it to the nation's health agencies to judge whether more patients should be provided with marijuana cigarettes.

Other antidrug groups seemed to signal a softening in their strong public stance against medical marijuana. "We support all the recommendations," said Steve Dnistrian, an executive vice president of the Partnership for a Drug Free America, the nonprofit organization that creates antidrug public-service announcements. "Who are we to contradict what the doctors and scientists say?"

The report concluded that marijuana compounds held the most potential against pain and nausea caused by AIDS, chemotherapy and nerve damage, and would likely benefit only those who did not respond to standard drugs, which work in a majority of patients. The report said side effects such as euphoria could enhance patient well-being. The report found little proof that marijuana would help with migraines, epilepsy, glaucoma or Parkinson's and Huntington's disease.

Inquirer staff writer Huntly Collins contributed to this article.