patients and physicians testified and thousands of pages of documentation
were introduced.  In 1988 the DEA's Administrative Law Judge, Francis L.
Young, declared that marihuana fulfilled the requirement for transfer to
Schedule II.  In his opinion he described it as "one of the safest
therapeutically active substances known to man."  His order was overruled by
the DEA.
        Nevertheless, a few patients have been able to obtain medical
marihuana legally in the last twenty years.  Beginning in the 1970s,
thirty-five states passed legislation that would have permitted medical use
of cannabis but for the federal law.  Several of those states actually
established special research programs, with the permission of the federal
government, under which patients who were receiving cancer chemotherapy
would be allowed to use cannabis.  These projects demonstrated the value of
both smoked marihuana and oral THC.  The FDA then approved oral THC as a
prescription medicine, but ignored the data that suggested that smoked
marihuana was more useful than oral THC for some patients.  With the
approval of Marinol, this research came to an end.  In 1976, the federal
government introduced the Individual Treatment Investigational New Drug
program (commonly referred to as the Compassionate IND), which provided
marihuana to a few patients whose doctors were willing to undergo the
paperwork-burdened and time-consuming application process.  About three
dozen patients eventually received marihuana before the program was
discontinued in 1992, and eight survivors are still receiving it -- the only
persons in the country for whom it is not a forbidden medicine.  It is safe
to say that a significant number of the more than ten million American
citizens arrested on marihuana charges in the last thirty years were using
the drug therapeutically.  The Schedule I classification persists, although
in my view and the view of millions of other Americans, it is medically
absurd, legally questionable, and morally wrong.
        Opponents of medical marihuana often object that the evidence of its
usefulness, although strong, comes only from case reports and clinical
experience.  It is true that there are no double-blind controlled studies
meeting the standards of the Food and Drug Administration, chiefly because
legal, bureaucratic, and financial obstacles have been constantly put in the
way.  The situation is ironical, since so much research has been done on
marihuana, often in unsuccessful efforts to show health hazards and
addictive potential, that we know more about it than about most prescription
drugs.  In any case, individual therapeutic responses are often obscured in
group experiments, and case reports and clinical experience are the source
of much of our knowledge of drugs.  As Dr. Louis Lasagna has pointed out,
controlled experiments were not needed to recognize the therapeutic
potential of chloral hydrate, barbiturates, aspirin, insulin, or
penicillin.13   Nor was that the way we learned about the use of propranolol
for hypertension, diazepam for status epilepticus, and imipramine for
enuresis. All these drugs had originally been approved for other purposes.
        In the experimental method known as the single patient randomized
trial, active and placebo treatments are administered randomly in
alternation or succession.  The method is often used when large-scale
controlled studies are inappropriate because the disorder is rare, the
patient is atypical, or the response to treatment is idiosyncratic.14
Several patients have told me that they assured themselves of marihuana's
effectiveness by carrying out such experiments on themselves, alternating
periods of cannabis use with periods of abstention.  I am convinced that the
medical reputation of cannabis is derived partly from similar experiments
conducted by many other patients.
        Some physicians may regard it as irresponsible to advocate use of a
medicine on the basis of case reports, which are sometimes disparaged as
merely "anecdotal" evidence which counts apparent successes and ignore
apparent failures.  That would be a serious problem only if cannabis were a
dangerous drug.  The years of effort devoted to showing that marihuana is
exceedingly dangerous have proved the opposite.  It is safer, with fewer
serious side effects, than most prescription medicines, and far less
addictive or subject to abuse than many drugs now used as muscle relaxants,
hypnotics, and analgesics.
        Thus cannabis should be made available even if only a few patients
could get relief from it, because the risks would be so small.   For
example, as I mentioned, many patients with multiple sclerosis find that
cannabis reduces their muscle spasms and pain.  A physician may not be sure
that such a patient will get more relief from marihuana than from the
standard drugs baclofen, dantrolene, and diazepam -- all of which are
potentially dangerous or addictive -- but it is almost certain that a
serious toxic reaction to marihuana will not occur.   Therefore the
potential benefit is much greater than any potential risk.
        During the past few years, the medical uses of marihuana have become
increasingly clear to many physicians and patients, and the number of people
with direct experience of these uses has been growing.  Therefore the
discussion is now turning from whether cannabis is an effective medicine to
how it should be made available.  It is essential to relax legal
restrictions that prevent physicians and patients from achieving a workable
accommodation that takes into account the needs of suffering people.  H.R.
1782 (the Medical Use of Marihuana Act) is a worthwhile move in that
direction because it gets the federal government out of the way and allows
the states to experiment with their own solutions to the problem.  I
strongly urge that you pass this law.
REFERENCES
1.  Hayes, G.W., et al., The golden anniversary of the silver bullet.
Journal of the American Medical Association 1993;270:13:1610-1611.
2.  Grinspoon L, Bakalar JB. Marihuana, the Forbidden Medicine, Revised and
Expanded Edition.  New Haven: Yale University Press, 1997.
3.  Vinciguerra, V., et al.  Inhalation marihuana as an antiemetic for
cancer chemotherapy.  New York State Journal of Medicine 1988;88:525-527.
4.  Sallan, S.E., et al.  Antiemetic effect of delta-9-tetrahydrocannabinol
in patients receiving cancer chemotherapy.  New England Journal of Medicine
1975;293:795-797.
5. Chang, A.E., et al.  Delta-9-tetrahydrocannabinol as an antiemetic in
cancer patients receiving high-dose methotrexate: a prospective, randomized
evaluation.  Annals of Internal Medicine 1979;91:819-824.
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oncologists' attitudes and experiences.  Journal of Clinical Oncology
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7.  Hepler, R.S., et al.  Ocular effects of marihuana smoking.  In M.C.
Braude, S. Szara (eds.).  Pharmacology of Marihuana. New York: Raven Press,
1976.
8.  Consroe, Paul F., et al.  Anticonvulsant nature of marihuana smoking.
Journal of the American Medical Association 1975;234:306-307.
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volunteers and epileptic patients.  Pharmacology 1980;21:175-185.
10.  Petro, D.J.  Marihuana as a therapeutic agent for muscle spasm or
spasticity.  Psychosomatics 1980;21:81-85.
11.  Singh, G., Ramey, D.R. Morfeld, D. Shi, H. Hatoum, H.T., Fries, J.F.
Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug
treatment in rheumatoid arthritis.  Archives of Internal Medicine
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