From The Washington Post
http://www.washingtonpost.com

By David Brown
Washington Post Staff Writer
Thursday, March 18, 1999; Page A01

The active substances in marijuana may be "moderately" useful for treating such problems as pain, nausea and appetite loss, but smoked marijuana has little future as a medicine, a panel of experts advising the federal government said yesterday.

The long-awaited review comes after several states have legalized marijuana for medical use, and was immediately seized upon by marijuana’s advocates as an endorsement of their position.

"We are very pleased with this report, which clearly shows there is scientific evidence that marijuana has bona fide therapeutic effects for some patients," said Chuck Thomas, the director of the Washington-based Marijuana Policy Project. "Patients already using marijuana should be given the benefit of the doubt, and should not be arrested."

The report, prepared by 11 scientists convened by the National Academy of Sciences’ Institute of Medicine, specifically warned against smoked marijuana because of risks of lung damage. Therapeutic marijuana smoking should be permitted only in a few short clinical trials designed to assess claims for marijuana’s usefulness as a pharmaceutical.

(Marijuananews note: That may not be correct. The report did not limit the number of trials to "a few" – and made it clear that there are patients for whom nothing else worked.)

White House drug control policy director Barry R. McCaffrey, who requested the report, said he endorsed it "thoroughly" and called it a "significant contribution to discussing the issue from a scientific and medical viewpoint." He said he would not oppose limited studies of smoked marijuana until a less harmful way of inhaling the substance’s active ingredients is found.

"I would note, however, that the report says ‘smoked marijuana has little future as an approved medication,’ " McCaffrey said. "You should not expect to go into an ICU [intensive care unit] in 15 years and find someone with prostate cancer with a ‘blunt’ stuck in his face as a pain management tool."

(Marijuananews note: That is such an insultingly stupid thing to say that it is interesting the Post would choose that quote. It would appear that this reflects their attitude.)

The 250-page report was prepared over the last year at a cost of $896,000. The panel reviewed published medical studies on marijuana’s physiological effects and possible clinical benefits, and took testimony from researchers and patients.

The claims for marijuana are very broad. People have used it as treatment for nausea caused by chemotherapy, appetite loss arising from AIDS, the painful spasms of multiple sclerosis, the pain of migraine headache, the sight-threatening condition known as glaucoma and the memory loss of Alzheimer’s disease.

Reliable data on the drug’s benefits, however, have been hard to get. The Drug Enforcement Administration places marijuana—along with heroin and several other addictive drugs—in the category reserved for substances with "a high abuse potential." This has made research on patients unusually difficult. Many of the claims for marijuana are based on small, poorly designed studies, or on "clinical anecdotes," the recounted experiences of individuals.

The body produces a marijuana-like substance naturally—its evolutionary purpose is uncertain—which stimulates specific receptors on nerve cells distributed widely in the brain. Marijuana contains about 30 active ingredients, collectively known as "cannabinoids," that also activate these receptors. One cannabinoid drug, dronabinol, is licensed in the United States for use in appetite stimulation in AIDS patients, and to prevent nausea and vomiting caused by chemotherapy.

"There is remarkable consensus about the science—the science suggests the potential of cannabinoid drugs for medical use," said John A. Benson Jr., the former dean of the Oregon Health Sciences University School of Medicine, who was one of the two heads of the panel. "There is far less convincing data about actual medical benefits."

Most studies suggest there are existing drugs that do what marijuana is reputed to do, but better. This was especially true in the case of glaucoma treatment and nausea prevention, the panel found. Nevertheless, a few patients who do not respond to those pharmaceuticals are helped by marijuana.

(Marijuananews note: Again the use of the word "few." The only time the word appears in the Executive Summary is in the following sentence: "Although few marijuana users develop dependence, some do." This was not even reported by The Post.)

The panel advocated research aimed at isolating marijuana’s ingredients and testing them in randomized controlled trials. An inhalation device is a high priority because it will allow patients to take in the drug as quickly as when it’s smoked, without delivering tar and other unwanted substances. In the meantime, studies of smoked marijuana are warranted, the panel said. They should last six months or less, and enroll patients, such as those with terminal cancer, for whom the long-term risks of smoking are relatively unimportant.

The panel found no evidence that closely controlled medical marijuana use would be a "gateway" to illicit drug use, either in ill patients or in society at large.

(Marijuananews note: That considerably downplays the report’s dismissal of the "gateway theory.")

In the last three years, seven states have passed referenda allowing the medical use of marijuana. Several, however, have run into legal problems, and the statutes have not taken effect.

In the District, a marijuana legalization measure appeared on the ballot in November. Ballots were counted, but the results were not released because Congress prohibited the spending of public money on the legalization effort. The matter is now in federal court.

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 situations."

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."

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.