Politics, Science Clash on Marijuana as Medicine

At the heart of the roiling debate over the medical marijuana initiative on next week’s statewide ballot lies a simple question: Does pot truly help the ill?

Unraveling this decades-long mystery would seem an achievable goal, yet no studies have delivered the sort of ironclad proof needed to validate marijuana’s merits as medicine.

The reason, marijuana proponents say, has less to do with pot and more to do with politics. They contend that the federal government, girded for its war on the drug world, has in recent years stood in the way of significant clinical research into the potential therapeutic value of cannabis.

Their prime exhibit is the drawn-out battle between federal drug officials and Dr. Donald Abrams, a noted AIDs researcher at UC San Francisco.

In 1992, Abrams embarked on a simple pilot study to see if marijuana really does help HIV-positive patients fight the “wasting syndrome” that causes debilitating weight loss.

Abrams said his motivation was strictly scientific--given that thousands of AIDS patients were already smoking marijuana to fight wasting syndrome, the project was meant as much to determine if cannabis could cause more harm than good.

But the oncologist said that despite obtaining private funding for the research, he has been blocked at every turn in his effort to obtain the research-grade marijuana necessary for his study to qualify as good clinical science.

First, uneasy officials at the federal Drug Enforcement Agency wouldn’t allow the importation of marijuana from a licensed Dutch grower. Then, the National Institute on Drug Abuse, which has a monopoly on the only research-grade marijuana farm in the United States, refused to let loose some of its crop.

In a last-ditch effort for official acceptance, Abrams submitted an upgraded version of his study to the National Institutes of Health. It got scorching reviews and was rejected.

As federal officials saw it, Abrams’ study was simply bad science. What’s more, they said, the negative effects of smoking marijuana were well proven by a litany of drug abuse and toxicity studies, which number in the thousands.

The experience has left Abrams and his backers crestfallen and searching for alternatives, including trying to start a research-grade marijuana farm of their own.

“When we first embarked on this, all the medical marijuana advocates were weaving this government conspiracy business, and I just told them, ‘God, you are so paranoid!’ ” Abrams recalled. “But now, after butting my head on this for four years, I’m just as paranoid and just as convinced that there are politics being played.”

Marijuana has been a controversial topic in the United States for decades. A battlefield painkiller during the Civil War, it was added to many medicines until the turn of the century. Even after it was declared an illegal drug by many states beginning in the 1940s, advocates have continued to boast of its medicinal benefits for a host of maladies.

Proponents of Proposition 215, the initiative on Tuesday’s ballot that seeks to make marijuana legal for medical use in California, ballyhoo anecdotal evidence that in addition to reversing AIDS wasting, marijuana can ease nausea in cancer chemotherapy patients, reduce muscle spasms in paralyzed people, and provide benefits for glaucoma, arthritis and other ailments.

But many researchers and federal health officials say the risks of smoking marijuana far outweigh the benefits.

Curtis Wright, a federal drug evaluation scientist at the FDA in Washington, said he has seen no evidence of a government-wide conspiracy to block worthy research and suggested that there is “precious little evidence that marijuana helps people do anything other than get high.”

He and others cite evidence that marijuana can be harmful.

Research presented in 1993 at the Ninth International AIDS Conference in Berlin showed that smoking marijuana is significantly associated with bacterial pneumonia among HIV patients.

The drug contains carcinogens that are of particular concern to people with compromised immune systems, federal health officials say. Some street-purchased marijuana is contaminated with salmonella and fungal spores.

National Cancer Institute scientists, meanwhile, believe that the active ingredient in marijuana--delta 9 tetrahydrocannabinol, or THC--is not as effective in treating post-chemotherapy patients as several new anti-nausea drugs. They also say the carcinogens and contaminants in marijuana could pose harm after chemotherapy, which affects the immune system’s ability to fight infection.

Federal officials also note that a pill form of marijuana, a synthetic of THC called Marinol, is available with a doctor’s prescription.

Backers of medical marijuana counter that many patients prefer the smoked form because it acts more quickly, they can more easily control the dosage, and it is cheaper than the pill. They note that cancer patients smoke marijuana only for a short time during their chemotherapy cycle, not nearly long enough to cause long-term harm.

Pro-pot forces cite studies that they feel bolster the belief that marijuana could prove to be a therapeutic drug in more rigorous trials. A 1988 study published in the New York State Journal of Medicine found that 78% of the cancer patients who had not responded to other anti-nausea drugs experienced benefits from smoking marijuana.

“Medicine is a combination of risk and benefits,” said Rick Doblin, president of the North Carolina-based Multidisciplinary Assn. for Psychedelic Studies, which is backing Abrams’ research. “We have a clear idea of the risks from marijuana. Now let’s get an idea of the potential benefits and weigh one against another.”

Much of the renewed interest in medical marijuana was generated by AIDS activists during the late 1980s. They flooded the federal government with requests to participate in the “compassionate use” program that allowed patients access to marijuana grown for the federal government at the University of Mississippi.

The sudden surge in interest prompted Bush administration officials to close the program to new applicants in 1992.

The proliferation of marijuana as a self-administered medicine caught the attention of Abrams, who is director of the Community Consortium, a San Francisco AIDS research group. Abrams has an eminent international reputation in AIDS research and has written dozens of scientific proposals accepted by federal regulators.

But he has run aground trying to get marijuana for his study.

As now crafted, the initial stage of the study would require about a pound of marijuana. The federal government has more than a ton in stock at the University of Mississippi.

Officials at the National Institute on Drug Abuse said the study just didn’t hit the mark. In an April 1995 letter, institute Director Alan I. Leshner said Abrams’ request for marijuana was being rejected because of the study’s “design, scientific merit and rationale.”

After pro-marijuana forces complained to Leshner, he suggested that the study be submitted to a peer review panel at the National Institutes of Health for another measure of its merits. The three-member panel rejected the study, raising numerous questions about its design.

Leshner declined to comment, but a spokeswoman said the government has been fair.

“Nothing is being blocked here,” said Mona Brown, a spokeswoman for the National Institute on Drug Abuse. “The system is available for anyone to submit research projects.”