Let them smoke pot A new report rejects American government policy on therapeutic cannabis Marijuana can treat nausea, pain, the wasting caused by AIDS and other symptoms, a controversial report paid for by the US government concludes. In November, six states legalised marijuana for medical use following referendums, but doctors generally do not recommend the drug because the White House Office of National Drug Control Policy has said that users will be arrested. In 1997, however, the drug control office commissioned a scientific review of the therapeutic uses of marijuana from the Institute of Medicine (IOM), the medical branch of the National Academy of Sciences in Washington DC. Its report, released last week, rejects several of the drug control office's long-held positions. The IOM found no compelling evidence that marijuana acts as a "gateway" drug that makes people more likely to take drugs such as heroin. And it does not believe that letting sick people smoke marijuana would increase use among the general public. The report recommends that if nothing else can help them, patients with debilitating symptoms should be allowed to smoke marijuana in clinical trials. However, the IOM warns that smoking is not the ideal drug-delivery system, because of the respiratory problems it can cause. "We see little future in smoked marijuana as medicine," says John Benson of the Oregon Health Sciences University School of Medicine in Portland, who co-chaired the panel that wrote the report. The Office of National Drug Control Policy and the National Institutes of Health have seized on this aspect of the report, noting that clinical trials of marijuana smoking would only be done as a first step towards the development of more sophisticated cannabinoid delivery systems. Several companies are working on delivery systems similar to asthma inhalers. Patient groups have welcomed the report's positive assessment of marijuana as medicine. "All of the major myths that the government has been espousing for the past few decades to justify putting patients in jail have been shot down by this report," says Chuck Thomas of the Marijuana Policy Project in Washington DC. But some groups claim it doesn't go far enough. "In many ways it was a political compromise," says Paul Armentano of the National Organization for the Reform of Marijuana Laws in Washington DC. "It gave enough cover to the administration that they could essentially take this report and do nothing." He contrasts it with a report in Britain from the House of Lords, published in November, which called for the law to be changed to allow doctors to prescribe cannabis (This Week, 14 November 1998, p 24). The British government has rejected this proposal. Armentano also argues that the IOM is naive in thinking that patients will be able to obtain marijuana through clinical trials. It took five years for Donald Abrams of the San Francisco General Hospital to get approval for one trial of marijuana in AIDS patients, he notes. Abrams says he had to play down his goal of studying the drug's medical benefits to obtain the green light. "We had to decoy our study as a safety study," he says. Nell Boyce, Washington DC