Source: The Wall Street Journal Contact: Mail: Wall Street Journal, 200 Liberty St., New York, NY 10281 Email: Thu, 30 Oct 1997 Medical Marijuana: Research, Don't Legalize By SALLY SATEL Never shy to embrace a trendy cause, especially during the November sweeps, next Wednesday CBS'S Murphy Brown, recovering from breast cancer surgery, will smoke marijuana to relieve chemotherapy induced nausea. The day before the show airs, voters in Washington state will cast ballots on the nation's third initiative to decriminalize the use of "medicinal" marijuana. Advocates of similar initiatives in Alaska, Arkansas, Oregon and Washington, D.C., are collecting signatures for elections next year. Last year's ballot victories in California and Arizona showed how deftly proponents of decriminalizing pot have exploited compassion for the desperately ill. And make no mistake: These initiatives, with their notoriously loose provisions, are stalking horses for outright legalization. The Washington, D.C., measure, for example, wouldn't even require a prescription: A physician's "oral recommendation" would authorize up to four "best friends" to cultivate pot for an ill pal. Yet there is a case to be made for research on the medical use of marijuana a case that is usually ignored in the highly politicized debate between legalizers and antidrug activists. The oncologists, neurologists and AIDS doctors familiar with the clinical realities can offer considerable anecdotal evidence of marijuana's usefulness. But only a handful of objective studies have been conducted, mostly in the 1970s and 1980s. They found that smoked marijuana was better than a placebo and comparable tosometimes better thanconventional therapies available at that time for nausea and vomiting and for glaucoma. (There have been no studies of AIDS patients smoking marijuana.) In 1985 the main psychoactive component in marijuanaknown as delta 9 tetrahydrocannabinol, or THC was made available as a pill sold under the brand name Marinol. THC was found to be useful in relieving glaucoma and pain, nausea and vomiting in cancer patients, and in inducing appetite and weight gain in AIDS and cancer patients. Marinol, however, has its drawbacks It makes some people too "stoned" or sedated, it is impossible to keep down if one is retching, and it can take too long to work. Moreover, it lacks the two main advantages of smoking: quick onset of effect and the ability to regulate the dose so that the user gets relief but avoids the nod. Unimed, the company that markets Marinol, plans to market a THC inhaler, but there will remain patients for whom THC alone is wholly or the report partly ineffective. Many of these patients insist that raw marijuana, even when eaten, is better than pure THC. And they may be on to something. "There are at least 200 compounds in marijuana, and it's quite plausible that some may have useful effects or interact in some beneficial way with THC," explains psychiatrist Herbert D. Kieber, former deputy to Bush drug czar William Bennett. Though a firm opponent of legalization, Dr. Kleber favors limited clinical trials of smoked marijuana "to help first determine whether the patients helped are the same or different from those helped by conventional treatments. From there we can go on to the process of identifying and purifying the active components in a standard pharmaceutical manner." Support for this view comes from a recently released report from the National Institutes of Health. Written by a group of solid researchers, the report recommends studying smoked marijuana and inhaled THC as treatments for epilepsy and for muscle spasticity associated with neurological conditions like multiple sclerosis. Since nausea and vomiting can be well controlled with other new medications, the report says, researchers should study smoked marijuana and THC only in patients for whom other medications have failed. The report also calls for an examination of longterm marijuana use to determine if there are adverse consequences for pulmonary and immune function critical for MDS patients, whose compromised immune systems render them vulnerable to pneumonia, tuberculosis and many other serious diseases. The National Institute on Drug Abuse, a division of the NIH, has recently given some $1 million to Donald Abrams, a medical researcher at the University of California, San Francisco, to study whether smoked marijuana is safe (and ultimately effective) in underweight AIDS patients taking a protease inhibitor. "Doing the clinical research has to be the right course of action," says Mark Kleiman, professor of public policy at UCLA. "Even negative results would have value: Sick people could stop wasting money and hope on a drug that doesn't work for them. What about the objection Rep. Bob Barr (R., Ga.) raised at a recent congressional hearing "I can't understand how we can want the government to fund research when we say it's a dangerous drug"? Such a policy sends a mixed message," Mr. Barr argued. In fact, there's no contradiction at all. Just as addictive morphine has medical uses, so might marijuana or newly identified components of it. What's crucial is that the research be conducted in a carefully controlled, scientific setting. An oncologist at a university hospital might conduct a study on the use of marijuana to combat chemotherapyinduced nausea and vomiting. To find subjects for this work, he would notify colleagues and patient advocacy groups and place newspaper ads calling for subjects undergoing chemotherapy. After screening, patients in the study would receive research marijuana as part of a protocol. Meanwhile, other studies on marijuana in people with cancer, AIDS, multiple sclerosis and other conditions would be going on around the country, involving thousands of patients. Once the work got off the ground, patients would not have to wait a decade or morethe time it would take to get FDA approvalbefore they can use raw marijuana or its pharmaceutically refined products. The research itself would be the opportunity for patients to receive marijuana but only under strict medical supervision. Such an approach would be scientifically sound. And, by preempting the legalizers' phony claims of compassion, it would bring to a halt the effort to make marijuana available to everybody, sick or not. Dr. Satel is a Washington, D.C. based psychiatrist specializing in addiction.