Biology professor Robert Melamede is almost manic as he preaches the virtues of medical marijuana. He spews scientific jargon as he discusses the "thousands" of studies that prove it's one of the greatest drugs in modern medicine.
"In my mind, it's the first thing you should use, not the last," he says. "We've had it backwards."
On the other side is the U.S. Food and Drug Administration, which declared in 2006 that "no sound scientific studies supported medical use of marijuana treatment in the United States."
In those two extremes lies the problem. At a time when more than a dozen states have legalized marijuana for medicinal use and at least two others are considering it, just how useful marijuana is as medicine remains largely a mystery. Major clinical research into the drug has been stymied by politics and controversy. And the known facts about marijuana are often laced with spin and emotion from the two sides that Melamede and the FDA represent.
Physicians and scientists familiar with marijuana's medicinal uses generally agree that the drug has at least some benefits for some patients. In 1999, the Institute of Medicine, home to some of the world's top scientists, acknowledged the drug's potential and called for more research into it. The American Medical Association has taken a similar position.
But measured responses to marijuana are often lost amid the emotions of advocacy or condemnation.
Melamede, who teaches at the University of Colorado at Colorado Springs, can quote studies on marijuana like a preacher quotes the Bible. He is both a scholar and a patient on the state's registry, and he says the drug has the potential to benefit almost everyone: stroke patients, cancer patients, the mentally ill and possibly even soldiers exposed to chemical warfare.
"For people with strokes, the first thing they should be doing is toking up a joint," says Melamede, who uses marijuana to treat chronic back pain. And he notes one claim in which marijuana reversed some of the effects of Sarin, a deadly nerve gas, in mice. His latest hypothesis: Eating cannabis could help fight avian and swine flu.
He and other supporters point to patients who have benefited from medical marijuana - including Frank Blakely, who at 60 suffers from cerebral palsy. He also has a degenerative nervous disorder, one working kidney and a pacemaker to correct a slow heartbeat, and he lost his right leg below the knee to antibiotic-resistant bacteria.
"The doctors have given me absolutely no hope of things doing anything but getting worse," says Blakely, a retired software developer. Marijuana, he says, has helped him reduce his reliance on morphine and oxycodone.
"It doesn't completely replace the oxycodone or the morphine, but for me it replaces about 75 percent ... The part of me that is in pain, it helps divorce me from those parts, whereas the narcotics overwhelm the pain but they overwhelm me in the process. With the number of medicines I take, everything is contraindicated, and it's good to have a medicine without side effects."
Searching for science
But animal studies, anecdotes and the bulk of existing research don't measure up to the standards of clinical trials, which drive drug approvals and treatments. For pharmaceuticals, mice may be the beginning, but the end is usually a set of extensive human trials with rigorous controls and procedures to ensure other factors don't taint results. In many instances, what proves true for lab rats doesn't pan out for humans.
"There's research. But it's crappy research," says Dr. Randall J. Bjork, a Colorado Springs neurologist who is one of more than 600 Colorado doctors who will certify patients to use medical marijuana. "It would be nice to see something definitive printed up in the New England Journal of Medicine or Annals of Neurology."
He said his marijuana-using patients do seem more able to manage their conditions than do many other patients. He sees them just once a year, when it's time to re-certify them for the registry. And he's intrigued by reports from other doctors, such as a Prague physician who claimed two-thirds of his Parkinson's disease patients have improved on marijuana.
Yet Bjork remains skeptical of the effectiveness of a drug that has yet to be tested in large-scale, well-organized studies. For now, he considers marijuana a low-tier treatment and has never suggested marijuana to a patient who wasn't already inquiring about it.
Pot and pain
Dr. Igor Grant would disagree that all research into medicinal marijuana is shoddy. He runs the University of California at San Diego's Center for Medicinal Cannabis Research, established after California became the first state to legalize marijuana for medicinal use in 1996.
Four controlled human studies at Grant's center, led by different researchers at different campuses, found marijuana was effective in treating certain types of pain. Three of them explored the use of marijuana to relieve neuropathy, a type of pain associated with a number of conditions, in AIDS patients. The fourth evaluated pain relief for healthy volunteers who agreed to have pain induced under the skin.
"I would say that, in general, the size of the statistical effect was about what we see with the other treatments," he says. He sees the potential for marijuana to be developed into a whole class of medications.
Even so, he acknowledges that clinical research is in its infancy.
The kind of gold-standard research that Bjork and Grant seek isn't likely to come soon.
Researchers face regulatory hurdles in obtaining or growing pot, not to mention a lack of funding.
When asked why more people are not doing research like his, Grant jokes: "I'd like you to do a study on a completely useless and dangerous drug."
Bjork suspects some scholars might be afraid to wade into the controversy.
Melamede is convinced clinical trials would only confirm what early studies have shown, and he's started a company to raise money to support such research.
"The real tragedy is that nobody does the real science on it," he says.
WHO'S USING IN COLORADO?
• 5,920 patients have valid ID cards.
• 71 percent of approved applicants are male.
• The average patient age is 32. Three are minors.
• 95 percent of Colorado counties - 62 - have registered applicants. Nearly half reside in the Denver and Boulder areas.
• Severe pain accounts for 88 percent of all reported conditions; muscle spasms account for the second-most reported condition. at 23 percent.
• 53 percent of patients have designated a primary caregiver.
Source: The Colorado Department of Public Health and Environment