More than two years after it was commissioned by the Office of National Drug Control Policy, a long-awaited report from the National Academy of Science's Institute of Medicine (IOM) has confirmed much of what thousands of doctors and seriously ill patients have contended for years: marijuana provides effective relief for a variety of symptoms and ailments. Further, the report concluded that there is no scientific basis for the oft repeated claims that marijuana use acts as a "gateway" to harder drugs, nor that the medicinal use of marijuana is likely to encourage its abuse either among patients or the public at large.
The reaction among patients who gathered at the National Academy of Sciences in Washington for the report's release was jubilant. "I feel vindicated, absolutely vindicated," said Greg Scott, who suffers from AIDS and smokes marijuana to combat nausea and loss of appetite caused both by the disease and by the medications used to treat it. "After years of risking arrest, property forfeiture, fines, and imprisonment, the findings of this report demonstrate that clearly enough evidence already exists to permit people who need this as medicine to smoke it legally." Scott's and the other patients' presence represented the culmination of a two-year advocacy effort coordinated by the Marijuana Policy Project (MPP -- http://www.mpp.org), and their testimony before the IOM investigators is included in the report.
The sense of victory among the patients and their supporters was sweetened by the circumstances under which the report was commissioned. Furious with voters in the wake of the passage of medical marijuana initiatives in California and Arizona in 1996, ONDCP chief Barry McCaffrey had ordered the report to settle the question of what he mockingly called "Cheech and Chong medicine" for which "not a shred of evidence exists" to prove its efficacy. In comments to the press this week, McCaffrey ignored the report's finding that smoked marijuana has legitimate therapeutic value, and focused instead on the recommendation that alternative delivery devices such as inhalers be developed to eliminate the need for smoking the drug. The IOM report notes that such a device will likely take years, and hundreds of millions of dollars to develop.
Scott said that's fine for the future, but what about right now? "I have to deal with taking my medications twice a day, today, tomorrow, and all next week. And the inhaler is not going to help me for years to come. So I would ask (McCaffrey), what should be done with people like me? Does he advocate that he continues to arrest us? I have long been amazed by McCaffrey's ability to spin things in his own direction. But he has never satisfactorily answered how he would handle all the patients who need this medicine. He refuses to say what alternative there is to arresting us."
The IOM report does recommend alternatives to arrest, though as co-principal investigator Stanley J. Watson noted in response to a reporter's question on the matter, the scientists impaneled on the report were "specifically not asked" to consider questions related to marijuana's illicit status. Instead, the panel suggests the development of a program similar to the now-defunct government compassionate use program, in which patients for whom already approved treatments failed would obtain permission to use marijuana under strict medical supervision.
But Harvard professor of psychiatric medicine Dr. Lester Grinspoon, who was one of the report's reviewers, told DRCNet he is concerned that the onerous bureaucratic requirements involved in such a program hamper its effectiveness. "The old IND (compassionate use) program started in 1976, and by the time it was closed down in 1992 only about three dozen people had passed the hurdles to receive legal access to marijuana. Why? Because physicians just couldn't take the time to do all the paperwork that was involved. And physicians are a lot busier now with managed care, with paperwork. I just don't see how that's going to provide a solution."
Given McCaffrey's indication that he has not been swayed by the scientific evidence, however, such concerns may be moot. MPP co-director Chuck Thomas said he doubts the ONDCP will follow the report's recommendations, noting McCaffrey's comment to the press that he didn't expect to see patients in the Intensive Care Unit "with blunts stuck in their faces." Thomas said that as long as official government policy puts patients at risk of arrest, MPP's advocacy will continue unabated. "The IOM recommended one way for patients to have legal access," he said. "We support that, and we support all of the other ways for people to have legal access as well."
The full text of the IOM report is available online at http://www.nas.edu.