Delay in Lifting Pot Ban to Aid Seriously Ill Is Assailed : Health: White House drug office condemns inaction, says marijuana should immediately be given to 30 previously approved patients.

The White House Office of Drug Control Policy on Thursday accused the Health and Human Services Department of an “unconscionable” delay in deciding whether to lift a ban on marijuana for seriously ill patients who want the drug for pain relief.

In a letter to James O. Mason, chief of the Public Health Service, the drug policy office urged that the drug be given immediately to 30 patients, previously approved to receive government-provided marijuana but put on hold seven months ago while HHS reviewed the program.

A copy of the unusually caustic letter from Ingrid A. C. Kolb, acting deputy director for demand reduction at the drug control office, was obtained by The Times.

“For HHS to treat this matter as just another bureaucratic decision is unconscionable and, to me, shows an intolerable lack of compassion,” Kolb wrote.

In addition to the 30 previously approved patients, Kolb said that dozens of patients who would have been eligible for the drug “are suffering from great pain--many are dying.”

The medical use of marijuana has long been controversial. Advocates contend that, in addition to relieving the side effects of cancer therapy, marijuana alleviates pain and stimulates the appetite, counteracting the wasting phenomenon seen in some diseases.

But opponents argue that its value is unproven, that it is potentially harmful because it contains possible carcinogens and that other drugs are available to fight some of the same symptoms.

When HHS announced last year that it was discontinuing the program of providing free marijuana to the seriously ill, Mason said that he had become concerned about a surge in applications, especially from AIDS patients, and about the message that would be sent if HHS approved them.

Mason did not respond to calls about Kolb’s letter Thursday and his spokesman said that he did not want to be drawn into a public dispute with “an employee” of Bob Martinez, head of the drug control office.

The spokesman said that the program for providing marijuana for nausea and vomiting as a result of cancer therapies had been set up “years ago,” and that the number of patients receiving the drug had dwindled to 12. They include one or two with cancer, while the rest have other conditions, including glaucoma and multiple sclerosis.

“They don’t have true proof (of marijuana’s usefulness), but they had a doctor’s opinion” and convinced judges that they should be given marijuana under the government program, the spokesman said.

Since then, other drugs, including synthetic forms of delta-9THC, the psychoactive ingredient in marijuana, have become available under the government program, the spokesman noted.

“The concern of the Public Health Service and its components is that there is no proved value for marijuana for the various conditions for which it is promoted and, beyond that, that there is potential harm that may result from smoked marijuana for immune-suppressed people,” the spokesman said.

In what the spokesman called “a bureaucratic gem,” the Public Health Service was confronted with the choice of allowing the 30 previously approved patients to have the marijuana while refusing to do so for additional applicants on grounds that it would be “harmful.”

“That’s why the doctors of these (30) patients are being contacted to show them there are alternatives,” the spokesman said.

Last April, the U.S. Circuit Court of Appeals here ordered the Drug Enforcement Administration to reconsider its criteria for determining that marijuana had “no currently accepted medical use in treatment in the United States.”

Relying on that determination, the DEA has continued to classify marijuana as a Schedule I drug--the category of controlled substances carrying the most severe restrictions.

A DEA spokesman said Thursday that Robert C. Bonner, the agency’s administrator, is reviewing the nine-month-old court decision.

Despite the drug’s illegality, a survey last year found that 40% of U.S. cancer specialists have recommended that patients smoke marijuana to relieve chemotherapy-induced nausea and 48% of those questioned said that they would prescribe it in some cases if the drug were legal.

The survey was conducted by Mark Kleiman, a lecturer in public policy at Harvard’s John F. Kennedy School of Government, and Rick Doblin a graduate student at the school.

In her letter to Mason, Kolb also called for the National Institutes of Health to begin research immediately on an alternative to marijuana smoking for pain relief.

“When we last met, you assured me and Director Martinez that this research would be a high priority for NIH and that it would be quickly initiated,” Kolb said. “I must question HHS’ commitment to conducting this research and call on HHS to take action now.

“Director Martinez and I believe that at this point it would be grossly unfair for the federal government to reverse its approval of the 30 applications,” Kolb said in her letter. She said that their applications had been “submitted in good faith before there was any indication that the program was under review.”