San Francisco Examiner - Wednesday, March 17, 1999
Ulysses Torassa, Examiner Medical Writer

At the same time, research on marijuana should get under way to isolate compounds that could eventually be given to patients via inhalers or other fast-acting delivery systems, the National Academy of Sciences said in a report released Wednesday.

The long-awaited review was done by the academy's Institute of Medicine at the request of White House drug czar Barry McCaffrey, who has been under pressure to reverse the federal government's opposition to medical use of marijuana. Advocates have pinned their hopes on the report, expecting it would show that the drug has enough promise to persuade McCaffrey and others to loosen regulations.

Among the report's findings:

*It makes sense to let patients with severe symptoms, such as intractable pain or vomiting, smoke marijuana for short periods - less than six months. But it should be a last resort after other medications fail, patients should be informed of the risks, and data should be collected from their experiences to gain more insights into marijuana's effects.

*Marijuana should not be used to treat glaucoma, its most frequently cited medical application. Although it can reduce some of the eye pressure, it works for only a short time, and the limited benefits don't outweigh the hazards. There also is not enough evidence to support its use for migraine headaches or for movement disorders such as Parkinson's disease.

*Studies show marijuana smoke is an important risk factor for the development of respiratory disease.

*Cannabinoids, the class of compounds that includes marijuana's active ingredient, most likely have a role in pain modulation, control of movement and memory.

*The brain develops a tolerance for cannabinoids, and there is a potential for dependence. However, it is less powerful than nicotine, cocaine, opiates or the class of sedatives that includes drugs such as Valium. Withdrawal also is less intense than with opiates and Valium-like drugs.

*There is no conclusive evidence that marijuana is a "gateway" to harder drugs. The concern that allowing marijuana for medical treatment will induce more people in the general population to use it also appears unfounded.

Synthetic future

The report's principal investigators wrote that while cannabinoids showed promise, their future as a medicine was in a synthesized form, not in smoked marijuana.

"For patients, such as those with AIDS or undergoing chemotherapy, who suffer simultaneously from severe pain, nausea and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication," they wrote.

However, smoking marijuana exposes users to more tar than tobacco, as well as to cancer-causing compounds similar to ones found in cigarettes. Furthermore, deeply inhaling and holding in the smoke tends to concentrate harmful substances in the lungs, John A. Benson, one of the report's principal investigators, said Wednesday.

"While we see a future in the development of chemically defined cannabinoid drugs, we see little future in smoked marijuana," he said.

Not surprisingly, both sides in the medical marijuana debate are claiming victory.

"The report gives clear support to the claim that marijuana is medically useful," said David Zimmerman, director of Americans for Medical Rights, which sponsored successful ballot initiatives in California and several other states to allow medical use of the drug.

But Terry Hensley of the Drug Free America Foundation said the report supported his group's position that "crude, smoked marijuana" wasn't a real treatment.

"What they endorse is research, which is what we've been endorsing," Hensley said.

Meanwhile, McCaffrey isn't ready to budge just yet. He issued a statement saying he awaited further responses from public health officials.

Howard L. Fields, a UC-San Francisco researcher and director of the Wheeler Center for the Neurobiology of Addiction, was one of the 11 scientists who produced the report.

While on the one hand their conclusions probably won't satisfy those who think the drug should be available as the equivalent of an "herbal remedy for pain," they did find enough evidence to justify using it in some circumstances, he said.

"At least people can't say, "This is all baloney, there is no medical uses for marijuana, and it shouldn't be available at all,' " Fields said.

Treats nausea

Fields, who has studied cannabinoids in animals, said it showed real promise for treating pain. For one thing, it tends to alleviate nausea, a common side effect of other painkillers such as morphine.

McCaffrey and other federal officials have been under increasing pressure to ease up on the medical use of marijuana since 1996 when California passed Proposition 215, the nation's first initiative to make it possible for sick people with a doctor's recommendation to use it.

In November, well-funded advocates managed to win all six similar initiatives on ballots in Oregon, Nevada, Arizona, Alaska, Washington and the District of Columbia. And last month, 20 AIDS groups wrote to McCaffrey, calling on him to allow HIV-positive patients access to the drug.

State marijuana advocates have been cheered by the election of Attorney General Bill Lockyer, who is reversing his predecessor's adamant opposition to Prop. 215. Lockyer has convened a task force to help figure out how to construct a system so patients can get access to the drug.

Meanwhile, a few marijuana clubs are operating openly in such places as Santa Cruz and Los Angeles. Clubs in Northern California were shut down by federal prosecutors.

However, well-known marijuana activist Dennis Peron has been operating a marijuana farm in Lake County, where he grows plants for 200 members of a cooperative who have doctors' recommendations and pay $20 per month. They either come to the farm to collect their plants, or Peron delivers them to their Bay Area homes.

Farm raided

Twice last year, federal agents raided the farm and made off with the plants, but no one was arrested, Peron said.

He expects the report's findings to persuade the government to reclassify marijuana from Schedule 1, which means it has no medical use, to Schedule 2, which would allow it to be dispensed with a prescription.

Getting access to marijuana, even for legitimate scientific research, has been an arduous process. The only government-funded clinical trial under way in the United States using smoked marijuana is at UCSF, where the effects on HIV-positive patients are being investigated.

It took principal investigator Donald Abrams six years to get approval from the federal government for his study, which began last year and is still seeking volunteers.

Abrams' study compares the effects of smoked marijuana with that of Marinol, an FDA-approved drug that contains THC, marijuana's active ingredient.

Many people continue to resort to smoked marijuana because they say Marinol takes too long to become active and has unwanted side effects, including an excessively intense "high."

Abrams said it had long been known that marijuana contains enough potentially useful ingredients to warrant further study. He said he hoped the climate for conducting medical research on it would improve from having yet another prestigious scientific body call for investigation.

"I know of a few investigators who have submitted proposals to the government. I don't know how they've fared," he said. "I hope the Institute of Medicine report would stimulate more people to investigate."
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