ue, a 35-year-old former counselor for retarded adults, smoked marijuana every day for a year.  It was the only thing that relieved the debilitating nausea she suffered after a blood vessel ruptured in her brain.  When the medications her doctor had prescribed proved only minimally effective, she tried dronabinol, a prescription synthetic form of THC, the primary active ingredient in marijuana.
    But Sue still couldn't keep anything down, including the dronabinol.   "I was nauseated or vomiting every moment of every day and literally wasting away, she recalls.  Then she learned that for conditions like hers, smoking marijuana has several advantages over dronabinol: It's cheaper, doesn't have to be swallowed and digested, it acts faster with fewer side effects, and because it can be smoked one puff at a time, its easier to control the dose.  So she tried it.  "Taking just a few puffs relieved my nausea enough that I could eat," she says.  She no longer smokes marijuana but credits it with saving her life and sanity.  Yet she's angry that she had to break the law.  "People treat this thing that helped me so much like such an evil," she says.  "They'd put me in jail for it."

Pot Politics
Since 1978, 36 states have passed legislation recognizing marijuana's therapeutic value in a variety of ailments.  But for 60 years, the federal government has prohibited its use in any form, even though not a single death has been linked to marijuana's medical use.
    Politics distinguish marijuana from other potential pharmaceuticals, preventing it from undergoing the scientific testing that any new drug must undergo.   Scientists can legally get marijuana only from one federally regulated farm, and research requests often have been denied.  Meanwhile, thousands of sick people must get or grow the plant illegally, risking prosecution and exposure to product impurities.
    Because research has been so stymied, the spectrum of expert opinions on marijuana's future in medicine ranges widely.  "We have 5,000 years of recorded experience to show us it's not toxic," says Lester Grinspoon, M.D., associate professor of psychiatry at Harvard Medical School and co-author of Marihuana, the Forbidden Medicine (Yale University Press, 1997).  "In fact, the U.S. government has spent millions of do1lars trying to prove toxicity but has come up with nothing."
    Qthers are more cautious.  "A lot of positive anecdotal data doesn't mean it's safe," says toxicologist and pharmacist James O'Brien, M.D., Ph.D., associate professor at the University of Connecticut Health Center in Farmington.   "As for any drug, we need clinical trials to determine its value as well as the best dosages, purity standards and methods of using it."
    Momentum to do so is growing.  Among many organizations that have voiced support for research are the National Institutes of Health, the American Public Health Association, the National Academy of Sciences, and dozens of state nursing and medical groups.  Editorials supporting its use hase appeared in the Journal of the American Medical Association and The New England Journal of Medicine.

Is Reefer Madness?
Cannabis (marijuana's Latin name) was widely prescribed in the United States for pain relief until it was made illegal in 1937.  In 1970, despite copious anecdotal evidence of its effectiveness and safety, the Drug Enforcement Administration designated it a "Schedule I" drug, meaning that like heroin, it's considered unsafe, with no recognized therapeutic value and a high potential for abuse.   (Reclassifying it as a Schedule 2 drug would let doctors prescribe it.)  In 1976, the U.S, Food and Drug Administration began a compassionate Investigational New Drug program allowing government-sanctioned marijuana use in certain medical cases.  In the late '70s and early '80s, more than 35 states passed legislation establishing marijuana research programs.  Most were rendered defunct by Federal regulations.
    The IND program was suspended in 1991 because the flood of applicants resulting from AIDS was seen as an obstacle to the Bush administration's war on drugs.   Today, only eight people use marijuana legally in this country because of a grandfather clause.  But years of anecdotal evidence and at least 65 human studies established medicinal marijuana use as legitimate for these conditions:

• Cancer  The best-substantiated use is to relieve chemotherapy-induced nausea, vomiting and appetite loss.  A 1991 Harvard Medical School survey of 1,035 oncologists found that 54 percent favored making marijuana a prescription drug; 44 percent said they'd broken the law by suggesting that patients get it illegally.
• AIDS  Marijuana's ability to combat "wasting syndrome" by increasing appetite has been well-documented.
• Glaucoma  By reducing pressure in the eye caused by fluid buildup, inhaled marijuana can slow or halt this sight-robbing disease.  Many ophthalmologists counter that marijuana can accelerate vision loss by reducing blood flow to the optic nerve, and that new glaucoma drugs make it unnecessary.
• Multiple sclerosis, spinal cord injury  Marijuana may relieve muscle pain and spasms, tremors and urinary incontinence.
• Epilepsy, related disorders  Might help prevent seizures in up to 30 percent of patients not helped by standard drugs.
• Pain  Marijuana may be helpful for migraine headaches; inflammatory and autoimmune diseases such as arthritis, scleroderma and lupus; colitis; Crohn's disease; and menstrual cramps and premenstrual syndrome.  This use is well worth investigating: In 1996, more than 7,000 Americans died of gastric bleeding from taking aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen.

    The debate will only be resolved when large numbers of people are allowed to use marijuana under medical supervision.  As Harvard's Grinspoon says: "Doctors, not the federal government and the DEA, need to be in charge of this.  And we need to get over our misconceptions about it.  Many patients who use marijuana don't even really like it.  It's just the only thing that works for them.

the pot smoked and the damage done
"To withhold marijuana for medical use because some people abuse it would be like withholding Valium or morphine for the same reason, says Mary Lynn Mathre, M.S.N., R.N., C.A.R.N., addictions consultant at the University of Virginia Health System in Charlotesville and editor of Cannabis in Medical Practice; A Legal, Historical and Pharmacological Overview of the Therapeutic Use of Marijuana (McFarland & Co., 1997).  Marijuana has drawbacks, especially when used as a recreational drug, but they generally don't apply to medical use.  To sum up the evidence:

• Lung damage  Heavy marijuana smoking can be hazardous to the lungs, but medicinal users generally don't smoke enough for it to be a serious risk.  Marijuana also can be ingested in foods or teas, but the results take longer to be felt and last longer and the dose may be harder to control.
• Mental impairment  Because it can cause short-term impairment of judgment, concentration, recall and coordination, people are advised not to use marijuana before driving or performing other complex tasks.
• Dependence  "Problems with psychological dependence, accidents and lack of motivation may occur among heavy recreational users, but most medical users taper off or stop when the symptoms are relieved," Mathre says.  No valid evidence shows that using marijuana recreationally or medically leads to the use of "harder" drugs.   As for the argument that legalizing marijuana for medical use will open the door to full-scale legalization, that hasn't proved true of morphine and other opiates.
• Antisocial behavior  No human studies have shown that marijuana use leads to increased aggression.

-- S.C.