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STEVE INSKEEP, host:

On a Monday morning, it's MORNING EDITION, from NPR News. I'm Steve Inskeep.

DEBORAH AMOS, host:

And I'm Deborah Amos. Today in Your Health, we continue NPR's series on medical marijuana. Many patients say conventional medicines don't offer anything that works as well as marijuana to relieve their symptoms.

INSKEEP: That's why some states circumvent federal law, passing their own laws that allow the medical use of marijuana. Patients are using it for a long list of ailments, from glaucoma to Lou Gehrig's disease, from Alzheimer's to chronic pain.

AMOS: But some critics say it's not a good idea for states to decide which drugs are OK for patients to use. NPR's Richard Knox has our report.

RICHARD KNOX: This is the story of a medical experiment that doesn't follow any of the rules of science, and it's one that people have very strong feelings about, from the patients who swear they benefit...

Ms. ELLEN LENOX SMITH: I think I probably would've passed away if I didn't have this drug.

KNOX: ...to the doctors who recommend it...

Unidentified Man #1: Only for those patients who have reached an end point. There's nothing else left to give them.

KNOX: ...to the scientists who don't really know how it works...

Unidentified Man #2: We're kind of stuck betwixt and between, quite honestly.

KNOX: ...to the people who think it's a really bad idea.

Mr. JOSEPH CALIFANO (Director, National Center on Addiction and Substance Abuse at Columbia University): Approving medical use of marijuana by political referendum is a slippery slope.

KNOX: We'll hear more from all these people. But first, it's important to keep in mind that the federal government has an elaborate process for approving medicines, and it's highly unusual for states to bypass these rules. It's only happened once in recent memory. In the late 1970s, some states legalized the use of laetrile, a chemical made from apricot pits, as a cancer treatment. At least 50,000 cancer patients took it before it was exposed as totally useless.

Now, 14 states and the District of Columbia have authorized a new experiment: the medicinal use of marijuana. If you want to understand why, meet Ellen Lenox Smith.

Ms. SMITH: Hey. Come on up. I'm Ellen. Come on in.

KNOX: Pleasure to meet you.

Ms. SMITH: Nice to meet you.

KNOX: Smith is a lively, petite, 60-year-old grandmother, a former schoolteacher and athlete. When you first meet her, you don't suspect anything's seriously wrong with her health. The only signs are a brace on her leg and her helper Maggie, a black Lab.

Ms. SMITH: That's my service dog, Maggie. Maggie, say hello.

(Soundbite of bark)

Ms. SMITH: Oh, good girl.

KNOX: Among other things, Maggie's trained to open the refrigerator with a rope and pull food and medicine out. And once when Smith stopped breathing, Maggie sensed something was wrong, jumped up on the bed and licked her awake.

Ms. SMITH: Maggie saved my life Thanksgiving morning. She's my lifeline who sleeps next to me now.

(Soundbite of laughter)

KNOX: Smith has two incurable diseases: One is ravaging her lungs. The other makes her tendons and ligaments loose and fragile.

Ms. SMITH: My knee tore, and two weeks later the other knee tore. And the same thing with my shoulder. It was one shoulder, and then the other shoulder. So I was tearing like tissue paper, and no one knew why.

KNOX: After years of misdiagnosis and surgical repairs, she found out she has a rare connective tissue disorder.

Ms. SMITH: My condition causes pain throughout the entire body. And you get to the point that it keeps creeping in a little bit more and a little bit more. And you nudge up your medication to try to counteract it.

Dr. PRADEEP CHOPRA (Pain Specialist): She had tried everything.

KNOX: Smith's doctor, Pradeep Chopra.

Dr. CHOPRA: Either the medicines weren't working, or she was having a reaction to them.

Ms. SMITH: Many people that have this condition live on morphine and OxyContin. I can't tolerate them.

Dr. CHOPRA: She had absolutely no other option. So very, very hesitantly, I offered her - I said, listen, why don't you try medicinal marijuana?

Ms. SMITH: And I can remember laughing and thinking I wish my parents were alive to hear this conversation. You spend your life being told to stay away from certain things, and here I have a doctor suggesting it to help me.

Dr. CHOPRA: She was a little worried. She was a little nervous. I reassured her. I said, look, you really don't have anything. So the choice is either you live in this chronic, disabling pain, or we try this and see what happens.

KNOX: Smith's home state, Rhode Island, had just become the 11th to legalize medical marijuana. At the time, Chopra had never recommended marijuana and never imagined he would.

Dr. CHOPRA: With medicinal marijuana, every patient is an experiment. You don't know if it's going to work or not. You don't know whether it's going to have any issues with them, problems with them. It's that little risk that we all take as physicians.

KNOX: Smith got one of her adult sons to buy some pot from a friend. Because of her lung condition, she couldn't smoke it. So she soaked it in oil and stirred the oil into applesauce.

Ms. SMITH: I tried it that night, scared to death. I mean, I had no idea what to expect. The only time I'd ever tried marijuana was once in college, and it was horrible. So I was really nervous about it, but it was so amazing. I took this oil, went to bed, and the next thing I know, it was morning. I had literally slept through the entire night for the first time in months.

KNOX: She still has lots of pain every day, but she says marijuana has saved her life.

Ms. SMITH: I'm deteriorating pretty rapidly. I honestly - and my husband says it, too. I don't think I'd be here. I think I probably would've passed away if I didn't have this drug. I was rock bottom. There was nothing left to help me.

KNOX: Ellen Smith is exactly the kind of patient legislators have in mind when they allow marijuana to be used as a medicine. But some think this is dangerous.

Mr. CALIFANO: Approving medical use of marijuana by political referendum is a slippery slope. What the next substance we'll approve by political referendum?

KNOX: Joseph Califano heads a think tank on drug abuse. He was U.S. Secretary of Health, Education and Welfare during the laetrile period.

Mr. CALIFANO: We have the best system in the world for clearing drugs in the Food and Drug Administration, and that's the system we should follow.

KNOX: Interestingly, I didn't find very many people in the medical world who feel like Califano.

The FDA doesn't support the use of medical marijuana, but a spokeswoman said the agency is open to proposals to study it. Others who I thought might be against it, like the National Institute on Drug Abuse, didn't want to talk about it. In fact, it seems possible that many authorities who once were dead set against medical marijuana are now not so sure.

Take, for example, Glen Hanson. He's a former director of the National Institute on Drug Abuse and still advises them. He does drug research at the University of Utah, and he heads the Utah Addiction Center.

Hanson knows a lot about the scientific evidence on marijuana. I asked him to run through a list of things that some people claim it's good for.

Pain.

Dr. GLEN HANSON (Director, Utah Addiction Center): Yes. There's some significant evidence that it's useful in some types of pain.

KNOX: Weight gain.

Dr. HANSON: Yes.

KNOX: Multiple sclerosis?

Dr. HANSON: That's more controversial. There are clearly some individuals that have multiple sclerosis who say that it helps them.

KNOX: Glaucoma.

Dr. HANSON: There is some, but again, controversial.

KNOX: What about seizures?

Dr. HANSON: Again, some evidence that it may be useful in dealing with some seizures.

KNOX: There are a lot more conditions that people say marijuana works for. But the point is there's evidence for some of those claims and not for others.

The thing scientists are really excited about, Hanson says, is the discovery that cells in the human body and brain have special receptors for the chemicals in cannabis. For the last 10 years, they've been doing lots of research to figure out how these receptors work. They think it's really promising.

Dr. HANSON: If you're asking is this a system that can be targeted for therapeutic benefit, I think everybody that knows the scientific pieces would acknowledge that potential.

KNOX: But much of the research is in test tubes and animals, not in real patients with real diseases. Human marijuana research is spotty. Studies are small and short. They have conflicting results. So there's a big gap between the testimonials like Ellen Smith's and the science.

Dr. HANSON: The hardcore, rigorous science is taking place, but it hasn't caught up, and we've got a vacuum.

KNOX: Hanson has no doubt that cannabis research will lead to important new designer drugs, but he has no idea when.

Dr. HANSON: We don't know, is it going to be five years, 10 years, 20 years? That doesn't satisfy and meet the needs of those people who are suffering today.

KNOX: He says in the meantime, he has no problem with patients like Ellen Smith using marijuana.

Ms. SMITH: I don't have any side effects. It's not deteriorating any internal organs. I mean, this is safer than anything else that's out there for pain relief.

KNOX: Her doctor, Pradeep Chopra, said he'd like to have more solid evidence on marijuana, but it's the patients who are driving this movement.

Dr. CHOPRA: The people have spoken. It's basically the people who have come up and said, it does help us, and look at us. We're doing well, and they're telling the establishment, you're wrong. And the establishment has listened to them.

KNOX: At least important parts of the establishment. President Obama has said his administration has no interest in prosecuting doctors and patients who use marijuana, as long as their state allows it.

Richard Knox, NPR News.

(Soundbite of music)

AMOS: You can hear all of our stories in our series the New Marijuana at npr.org.

(Soundbite of music)

AMOS: This is MORNING EDITION, from NPR News.

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