Has your head started to spin yet?

The federal medical marijuana program -- referred to as a Compassionate Investigational New Drug (IND) program -- resulted from a lawsuit filed by glaucoma patient Robert Randall, who successfully showed that his use of marijuana was a medical necessity. After a couple years of legal wrangling and one attempt by the administration of President Jimmy Carter to cut off his marijuana supply, the program was formally established on May 10, 1978. Randall received his first official marijuana prescription six days later.

The program slowly grew, with 34 patients approved to participate by1991. But a flood of new applications from patients battling AIDS -- who found that marijuana boosted their appetite and relieved the nausea often caused by anti-HIV drugs -- threw the administration of George H.W. Bush into a panic. The administration closed the program to new applicants in March 1992.

The reaction was scathing. The Chicago Tribune, for example, called the decision "arbitrary, mean-spirited, and inhumane." But officials stuck to their guns.

Still, they continued the program for those who were already enrolled. Four of these patients remain alive today, and each still receives a monthly canister of government marijuana.

Since then, succeeding administrations have dug in their heels as states began passing medical marijuana laws. President Clinton's drug czar, Gen. Barry McCaffrey, scoffed at medical marijuana as "a Cheech and Chong show." His successor, John P. Walters, has called it a "farce" cooked up by a sinister cabal of "drug legalizers."

Meanwhile, science keeps finding that marijuana really does work for some medical conditions. Recent studies have confirmed, for example, that marijuana (the very same government-grown marijuana supplied to the four IND patients) is safe and effective at relieving neuropathic pain -- a particularly difficult to treat type of pain that afflicts millions of Americans with multiple sclerosis, diabetes, HIV/AIDS and other illnesses. Earlier this year, the American College of Physicians -- 124,000 internal medicine specialists, including neurologists, oncologists, and infectious disease doctors -- called on the government to reclassify marijuana to allow physician prescriptions, "given marijuana's proven efficacy at treating certain symptoms and its relatively low toxicity."

Scores of other groups, including the American Public Health Association, American Nurses Association, and American Academy of HIV Medicine, have taken similar -- or even stronger -- positions supporting medical use of marijuana.

It gets stranger: The IND is officially a research program, designed to find out if marijuana works as a medicine. The consent form patients were required to sign when they enrolled calls it a "study." Yet the federal government has never studied its own patients.

The only study that has ever been published of these patients was privately financed and conducted. It found that while the government-supplied marijuana was of poor quality, it "provides effective symptomatic relief of pain, muscle spasms, and intraocular pressure elevations," with relatively mild side effects. This enables the patients to have "improved quality of life" -- in part by allowing them to reduce or eliminate their use of prescription medications, avoiding their side effects.

If our government approached the issue with any shred of integrity, officials would have read that 2002 study, admitted it was time to rethink our approach to medical marijuana, and started making changes. Instead, four lucky patients get the U.S. government's protection and support for their use of medical marijuana, while hundreds of thousands of others who are just as deserving risk arrest and jail every day for simply trying to stay alive in the face of illness.

Aaron Houston

www.mpp.org