Science once again slammed politics in the public debate over the use of marijuana as medicine. The latest compendium of facts, as opposed to rhetoric, is "Marijuana and Medicine: Assessing the Science Base" a report by the prestigious nonprofit Institute of Medicine ( IOM ) .
The report was commissioned by Drug Czar Barry McCaffrey for $896,000, and released by the IOM at a packed Washington, D.C. news conference March 17.
"There is remarkable consensus about the science that suggests the potential of cannabinoid [ components of marijuana ] drugs for medical use," said John A. Benson Jr., one of the principal investigators on the study. He is dean and professor of medicine emeritus at the Oregon Health Sciences University School of Medicine, Portland.
"There is far less convincing data about actual medical benefits" from marijuana, he said. That is largely because "the appropriate studies have not been done." He urged that those clinical trials be undertaken.
The report has a strong bias against smoking marijuana, which reflects the hysteria gripping American public debate on all types of smoking. But Benson conceded, "there are some limited circumstances," such as terminal illness or short- term use to deal with the effects of chemotherapy, "in which we recommend smoking marijuana for medical uses."
"Beyond the harmful effects from smoking," the report concluded, "the range of problems associated with marijuana is not out of line with those of substances used in other medicines."
Stanley J. Watson Jr. was the other principal investigator for the study. He is co- director and research scientist at the Mental Health Research Institute of the University of Michigan at Ann Arbor.
"MarijuanaÂ's future as medicine does not involve smoking," he said. "It involves exploiting the potential in cannabinoids such as THC, the key psychoactive ingredient in marijuana."
Natural marijuana contains about 400 compounds, about 30 of which so are have been identified as active ingredients that may have some type of effect on the human body.
The report shot down two core myths perpetuated by anti- drug warriors. One is that marijuana is highly addictive, the other is that it is a "gateway drug" to other substance abuse.
It said, "few marijuana users develop dependence, some do." It characterized withdrawal symptoms as "mild and short- lived."
"Most drug users begin with alcohol and nicotine before marijuana-usually before they are of legal age," they wrote. Watson said they "found no conclusive evidence that something in marijuana causes a progression" to harder drugs.
He believes the public can make the distinction between legitimate medical use and abuse of marijuana.
The report pushed for identification of cannabinoids that are "active ingredients" in marijuana, and development of synthetic compounds of these as drugs. It also wants to see a mechanical inhaler developed that delivers the drugs in the same rapid manner as smoking does, while eliminating the noxious components from burning the plant.
Benson said that the euphoric effect of marijuana may be lost in other formulations. He thought the euphoria might be "a beneficial side effect," both because it may enhance a sense of well being and because it "titrates the dose" so that the patient takes enough but not too much of the marijuana to have the desired effect.
Watson pushed for access to marijuana through a compassionate use program similar to those for other experimental drugs. He said, "It would offer the opportunity for a broader spectrum of physicians to offer some relief from the conflict between medicine and law."
The federal government still runs a marijuana compassionate use program for eight individuals. One patient has been on it for more than two decades. But the government closed off new entries to the program in 1992.
Reactions
The IOM is "in effect saying that most of what the government has told us about marijuana is false. ... ItÂ's not addictive, itÂ's not a gateway to heroin and cocaine, it has a legitimate medical use, and itÂ's not as dangerous as common drugs like Prozac and Viagra," said Bill Zimmerman, director of Americans for Medical Rights. The group has pushed state ballot initiatives opening up medical use of marijuana.
"Patients already using marijuana would be given the benefit of he doubt and should not be arrested," said Chuck Thomas, director of the Marijuana Policy Project based in Washington, D.C.
AIDS activist Kiyoshi Kuromiya, the lead plaintiff in a class action medical marijuana lawsuit now in federal court in Philadelphia, said that the report "will help people get their marijuana without risking arrest for a while."
"The report seems to recommend something [ a federally run compassionate use program ] that is very close to Judge KatzÂ's settlement offer that the feds turned down."
Kuromiya said the report "also destroys the main argument for keeping marijuana a Schedule I drug" under the Controlled Substances Act. "It doesnÂ't fit that definition."
Don Abrams, MD, is conducting the only clinical trial of smoked marijuana in the United States [ see related story ] at the University of California in San Francisco. He explained, "A Schedule I drug has no medical benefits, a Schedule II drug does."
Reclassification would have a tremendous impact on conducting research on marijuana as a medicine, making it much easier to do. As a Schedule I drug, "there is only one legal source, NIDA [ the National Institute for Drug Abuse at NIH ] ," Abrams said. "And that means every attempt to study marijuana needs to go through rigorous peer review" prior to initiation.
Abrams panned the reportÂ's criticism of natural marijuana and its preference for seeking the active ingredients. "To me that is just our typically western pharmaceutical industry inspired paradigm."
"If it works, why do we have to alter it? ItÂ's our reductionist western approach as well as the capitalist way. LetÂ's see if we can isolate and synthesize something that somebody is going to make money off of."
Drug Czar Barry McCaffrey, who commissioned the study, acknowledged the scientific content. But he chose to emphasize the fact that smoking was not the route to go. He implied that emphasis should be placed on finding alternative delivery mechanisms rather than evaluating clinical effects of marijuana delivered through smoke. That means further delay.
White House spokesman Joe Lockhart acknowledged the positive aspects of the report but his key message was that "further research" is required.
Medical marijuana
trial seeks volunteers
by Bob Roehr
Don Abrams, MD, is at the halfway point of the only clinical trial on smoked marijuana in the United States, at the University of California in San Francisco. More precisely, he is looking at the impact of cannabinoids delivered by smoke, pill, and placebo in people with HIV. HeÂ's still looking for volunteers.
The study began in May 1998. The count is at 31 of the 64 patients needed, and with any luck it will wrap up next January. He says "the limiting factor is that we can only have four beds at any one time, so we have to stagger enrollment."
Years of hassling with federal regulators finally allowed the research to move forward as a safety trial. ItÂ's built around the question of possible interactions with protease inhibitors as both marijuana and PIs are metabolized through the P- 450 system in the liver.
But itÂ's packed with data collection in a number of other areas that should give greater insight into metabolism, the immune system, and hormones in the context of HIV therapy and cannabinoids.
"WeÂ're looking for patients with stable HIV infection who are taking either indinavir [ Crixivan ] or nelfinavir [ Viracept ] , people who have in the past smoked marijuana, but not within the last 30 days," Abrams explains. Volunteers cannot be cigarette smokers, substance abusers, or on methadone.
The 25- day trial requires that volunteers be hospitalized the entire time, with no visitors, though Internet access is provided. Some will see that as a form of house arrest, while others call it a respite from the world, a chance to slow down, relax, maybe catch up on reading.
Abrams says that many of the volunteers really like the fact that "you donÂ't have to do your own cooking or housework for 25 days, you donÂ't have to worry about those activities of daily living. And you get a paid vacation."
The pay is not much, just $40 dollars a day. But that adds up to a nice round $1,000 over the course of the trial.
He says that volunteers have come from New York, Los Angeles, and Seattle. The trial does not cover travel expenses, but the payment should cover airfare and more than a few nights on the town once your part in the trial is completed.
Other factors can screen you out from participating. "We have to talk with about a dozen people for every one we enroll," says Abrams. For more information and to be considered as a volunteer in this trial, contact Abrams at ( 415 ) 502- 5705. There is a recorded message and someone will get back to you.
Right now there is no waiting list, so Abrams is eager to hear from potential volunteers. "ItÂ's an historic study," he says, "I would hate to have the opponents say, look, they canÂ't even do a clinical trial when they get funded and the marijuana to do it."
* Lambda Publications is now Windy City Media Group
