Workshop addresses benefits in medical uses of marijuana Better than other drugs? Scientists are skeptical


WASHINGTON -- The nation's top drug scientists appeared to be clearly skeptical yesterday about using marijuana to cure nausea or relieve pain when they say other medicines are more effective and don't send patients into dreamlike trances.

Patients are clamoring for marijuana, and voters, at least in California and Arizona, want to give it to them. Government officials are afraid it's a back-door way to legalize the drug completely.

But does marijuana pass scientific muster? A report from a workshop at the National Institutes of Health, held in Bethesda this week, won't be out for another month, but it was clear which way the scientists are leaning.

"Smoked marijuana will need to show some real advantage over alternatives, not just be effective but be advantageous," said Robert Temple, associate director for medical policy at the Food and Drug Administration. "The scientific task is extremely difficult. Showing superiority over existing therapy is very hard."

A critic in the audience pointed out that the FDA didn't hold other drugs to that standard.

"As far as FDA rules are concerned, it just has to work," Temple agreed. "But I don't think for a second that FDA is going to be the sole determinator of whether smoked marijuana makes it into the market."

The U.S. Drug Enforcement Administration, he said, "isn't going to be happy about smoked marijuana being out on the market unless there's an unassailable reason."

On the first of two days of hearings, scientists described mixed results from marijuana trials or insufficient data. Marijuana seems good at controlling nausea in cancer patients, weight loss in AIDS patients and pressure in the eyes of glaucoma patients.

About nausea caused by cancer chemotherapy: "There are many drugs that have efficacy," said Richard Gralla, director of the Ochsner Cancer Institute in New Orleans. Marijuana-like products "clearly have efficacy, including inhaled marijuana. But the degree of efficacy seems less than that of other agents."

On the AIDS-related wasting syndrome, which causes patients to lose appetites and weight: "Smoking marijuana increases appetite and food intake," said Richard Mattes, a nutrition and food scientist at Purdue University. "But it may not be an effect that persists. It may be a short-term effect."

Marijuana has also been touted for pain relief: "When it comes to symptom relief for pain, it is far from clear how effective marijuana can be," said Robert Payne, a neurologist at the M. D. Anderson Cancer Center at the University of Texas. "There are suggestions it can be, but if it is used as an analgesic, you have to ask 'compared to what?' and 'would it be better to use the drugs we have now?' "

As for glaucoma patients, Paul Kaufman, a glaucoma researcher at the University of Wisconsin Medical School, said: "I think there's no doubt that marijuana relieves intraocular pressure. The problem is it's very short-term control. You have to relieve the pressure around the clock."

The scientists also discussed some unusual difficulties in studying marijuana under strict scientific conditions: Patients in trials are often high. Besides, the drug affects the lungs, can exacerbate heart conditions and mental disorders, and impairs people's reflexes, awareness and safety.

Pro-marijuana activists at the conference accused the NIH of packing the science panel with those who opposed marijuana.

Pub Date: 2/20/97

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