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Marijuana Report Draws Mixed Reactions
Pubdate: Wed, 17 Mar 1999
Source: United Press International
Copyright: 1999 United Press International
Feedback: http://www.sciencenews.org/sn_forms/sn_ctact.htm
Author: ELLEN BECK
MARIJUANA REPORT DRAWS MIXED REACTIONS
WASHINGTON, March 17 (UPI) - The Institute of Medicine's report recommending
more clinical trials on the effects of marijuana as a medicine is drawing
mixed reactions from the scientific and medical communities.
``They can't say there is not a shred of evidence, as the government would
like,'' said Dr. Lester Grinspoon of Harvard, who wrote 20 pages of
criticism as a peer reviewer for the $1 million government-funded report
issued today.
``But they certainly have shied away from an honest assessment of its use as
a medicine,'' Grinspoon said.
The IOM spent 18 months interviewing patients, holding public hearings and
examining the scientific database on medical marijuana. Its report
recommends rigorous clinical trials on the efficacy and safety of the drug
in conjunction with the development of a smokeless delivery system and new
synthetic formulations of cannibinoids, the active agents found in the
marijuana plant.
White House drug czar Barry McCaffrey, who ordered the report, said while
the report says there's ``little future'' for medically smoked marijuana,
``The door should remain always open for evidence-based research on this or
other compounds.''
He said the administration was not rethinking the federal government's
opposition to state initiatives seeking to legalize marijuana.
While acknowledging the potential use in the treatment of nausea from cancer
chemotherapy, in increasing appetite in AIDS patients and in alleviating
chronic pain, the report downplayed marijuana's use in many other ailments
and diseases. It warned that the positive value is offset by side effects of
smoking.
It did, however, support controlled, short-term use in clinical trials by
chronically ill or dying patients for whom other medications did not work.
President Clinton's press secretary Joe Lockhart said today said the
government respects the handful of states that have passed laws legalizing
the medical use of marijuana but added, ``These are complex, scientific
issues that ought to be debated on a scientific basis.''
Grinspoon criticized the report for ignoring anecdotal evidence from
patients who have found relief with marijuana for a variety of symptoms, and
for emphasizing the hazards of smoking.
``So there is a way to do this now,'' he said, adding that even if patients
do smoke marijuana he is not convinced they ``are going to do great damage
to their lungs.''
He said patients using medical marijuana actually smoke only a puff or two
to get the relief and one marijuana cigarette may last a long time. He
compared that to smokers who inhale two packs of cigarettes a day for 20
years, placing them at high risk for lung cancer.
Grinspoon said machines have been developed overseas that allow for the
vapors of the marijuana plant to be delivered to patients without smoking
the plant.
Study co-author, Dr. Stanley Watson said he respected Grinspoon's comments
but argued investigators spent nine days interviewing patients who used
medical marijuana, who he called ``brave and very informative.''
``These are guideposts, in our view,'' Watson said. ``We did not ignore them
and to a degree we did embrace them.
One such patient is Jim Harden, who uses smoked marijuana to alleviate the
pain and nausea caused by multi-system failure brought on by Hepatitis C. He
and other patients brought to the IOM news conference by the activist group,
the Marijuana Policy Project of Washington, argued federal laws making the
use of the drug a crime need to be repealed.
``Why arrest someone who is sick,'' said Harden, who is suffering from
end-stage liver disease.
Critics have said the report would not lead to changing marijuana from a
prohibited Schedule I drug to a controlled Schedule II medication, and say
the government is giving only lip service to the issue in hopes it will go
away.
Dr. Jane Marmor, of the California Medical Association, was happy with the
report, however, and said it took the issue of medical marijuana to the
right place.
``They actually recommended an action,'' she said. ``They were saying there
should be clinical trials conducted under limited circumstances because
there is the long-term effect of smoking.''
The CMA has had a long-standing position in support of the study of medical
marijuana and Marmor is on the state task force set up to devise ways to
implement Proposition 215, the state law allowing the use of medical
marijuana. She agreed with the IOM's statement that marijuana is not a
gateway drug that causes people to move into harder drug use.
``I thought it (the report) was quite thorough,'' Marmor said. ``I thought
it was quite reasonable.''
Dr. Kathleen Boyle, a psychologist at the UCLA Drug Abuse Research program,
said she was ``pleasantly surprised'' by the report, but finds some
shortcomings.
``I think it may make a difference,'' Boyle said. ``I thought it would be
much more cautious and much more bland. I feel that they've done a fairly
good job of going over the science base, but I think they too narrowly
focused on AIDS and cancer-type diseases.''
She strongly disagreed with the authors' conclusion that the effects of
medical marijuana were modest, saying her studies showed the ``effects on
symptoms are very robust.''
She also took issue with the report's conclusion that the marijuana plant
provides a variable effect and that taking the synthetic pill provides
better relief. Boyle said Marinol, the prescription pill based on an active
ingredient of marijuana, actually produces highly variable effects. She
added nausea or chronic pain sufferers do not want to wait for a pill to get
into their system.
``It's much easier to make the plant product more predictable,'' she
said.``The smoked marijuana is so effective and it's as instantaneous as you
can get.''
One IOM recommendation drew questions and raised eyebrows. It said clinical
trials in which patients use smoked marijuana should involve ``an oversight
strategy comparable to an institutional review board process that could
provide guidance within 24 hours of a submission by a physician to provide
marijuana to a patient for a specified use.''
It wasn't clear whether the IOM was recommending establishment of a new
governing entity or referring to existing criteria for conducting clinical
trials.
Marmor said the wording ``seemed inappropriate'' in the sense of clinical
trial guidelines and Boyle wondered who would meet the qualifications of the
review board.
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