Can Marijuana Be Medicine?

Marijuana may not cure glaucoma, but it has other claims to respectability. People have used it for centuries to stimulate appetite, and an unknown number now use it to combat the wasting associated with AIDS. No one knows how much good it's doing--the drug-control agencies have recently thwarted studies intended to answer that question--but some experts suspect the benefits are modest. The wasting syndrome doesn't stem solely from a lack of appetite, says Dr. Donald Kotler, an immunologist at New York's St. Luke's-Roosevelt Hospital. The patient may have an intestinal infection that blocks the absorption of nutrients, or a neck tumor that interferes with swallowing.

Skeptics also note that the FDA has already approved several effective remedies for wasting. To stimulate appetite, patients can take Marinol, a synthetic version of THC that comes in pill form, or Megace, a derivative of the hormone progesterone. In premarketing studies, AIDS patients who took Megace for 12 weeks gained an average of 11 pounds, while those getting a placebo lost 21. Since AIDS takes a particular toll on muscle tissue, the FDA has also approved several muscle-building steroids (testosterone and its kin) as AIDS treatments. Patients with good insurance can also get synthetic human-growth hormone, a bone-and-muscle builder that costs $1,000 a month.

Yet as many patients have discovered, plain old pot may still have a valuable role. Keith Vines, a 46-year-old San Francisco prosecutor, considers himself a stalwart in the war on drugs. As an assistant district attorney, he has spent years putting street dealers in jail. As an AIDS patient, he has seen his body threaten to disintegrate. ""Three years ago my ribs were protruding,'' he says. ""I was terrified to get on the scale.'' He wanted to enroll in a study of human-growth hormone, but participants had to eat three meals a day, and he could hardly force down one. He tried several drugs--including Marinol, which often left him too blasted to function--but nothing worked until he joined a local buyers' club and started smoking pot. Once he took that leap, he qualified for the human-growth-hormone study, put on 45 pounds and managed to salvage his job. ""With- out marijuana,'' he says earnestly, ""I would be dead.''

Like AIDS-related wasting, the nausea from cancer chemotherapy is readily treated by prescription drugs. But those drugs are expensive, they don't always work and they're not always harmless. Their warning labels are littered with phrases like ""hives,'' ""impotence,'' ""difficulty breathing,'' ""tremors and rigidity'' and ""leukopenia'' (a drop in white blood cells). Marijuana isn't risk-free--its smoke contains a number of carcinogens--but it's less toxic than many prescription drugs. There is no recorded instance of a death from overdose. And because people consume it one puff at a time, feeling the effects as they go, they can easily tailor their intake to their needs.

That's a big advantage for people with chronic pain or with spastic disorders such as multiple sclerosis. Whereas prescription drugs may zonk them out for the whole day, marijuana lets them respond directly to their symptoms. No one has conducted trials to gauge marijuana's genuine therapeutic effect on pain and spasms. But that doesn't much concern 39-year-old Andrew Hasenfeld, who was diagnosed with multiple sclerosis in 1980. He tried the prescription drug bactofen, but it never relieved the spasms, the stiffness, the sensation of ""being all locked up.'' He resorted to marijuana six months ago, at the urging of fellow sufferers in Amherst, Mass., and the result was dramatic. ""There's no comparison with any drug I could buy in a pharmacy,'' he says.

Few people would argue that Andrew Hasenfeld, Keith Vines or Susan Nelson belongs behind bars. (""I'm already in a wheelchair,'' says Hasenfeld. ""Isn't that enough?'') And though recreational pot smokers can get involved with harder drugs, it's hard to see how easing one's nausea, wasting or muscle spasms could cause what the drug office describes as ""a downward spiral of self-destruction.'' Still, federal regulatory policy can't rest entirely on individual testimonials. As McCaffrey argues in a forthcoming ""myths and truth'' position paper, ""drug policy must be based on science, not ideology.'' Approving marijuana as a prescription drug would require organizing clinical trials, identifying appropriate uses and finding ways to regulate its cultivation and sale. Those aren't insurmountable obstacles; morphine has been used medically for years. But federal policy has long discouraged clinical research with marijuana. The drug-control office is now pledging that ""any serious marijuana research request will be considered.'' Perhaps that will begin to clear the smoke.