Acquired Immune Deficiency Syndrome

Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV). The virus is usually contracted through sexual contact, intravenous needle sharing, maternal transmission to newborns, or transfusion of contaminated blood products. AIDS is now considered the worst plague in human history. The United Nations estimates that more than 16,000 new victims are infected everyday.[1] The United States has one of the largest epidemics in the world. In 1996, the Centers for Disease Control and Prevention estimated that 235,470 citizens were living with AIDS.[2] In 2007, the UN Health Organization estimated more than 1.2 American are living with HIV. [3] Research in San Francisco recently discovered that nearly 40% of people infected with HIV develop AIDS in less than one year. Even more alarming, about one-quarter of infected Americans are unaware that they are carrying the deadly virus.[4]

In January of 1998, Newsday reported that Americans over the age of 50 were the highest AIDS risk group of the 1990s. The number of older Americans with AIDS rose at twice the rate of that of younger people from 1991 to 1996. The mortality rate of those cases was twice that of 13-to-49-year-olds.[5] Although HIV is transmitted through unportected sex between men in most cases, there has been a 30% rise in female infections in recent years. Studies show the greatest AIDS risk among African Americans. While African Americans comprise only 13% of the American population, they account for 48% of all new AIDS cases. (UN WHO Report, 2007) AIDS is considered the leading cause of death among African Americans aged 25 to 44. [6]

Although the worldwide death toll from AIDS continues to rise sharply, the AIDS mortality rate in the United States actually dropped by 23% in 1996 compared to 1995.[7] Some sources were quick to credit new multidrug “cocktails” containing protease inhibitors. Yet a study from the University of California indicates that those drugs are effective for only about half of the patients who use them. UCSF researchers are tracking 136 HIV patients at San Francisco General Hospital’s AIDS clinic showed a 50% failure rate of protease inhibitor therapy.[8] One study from 2006 found that antiretroviral therapy has led to a 44% reduction in hospital admissions and up an 80% reduction in AIDS related deaths. In another study, however, it is shown that about 3 out of 4 new cases are undetected even after repeated health care examinations. [9]

The mounting AIDS crisis, with San Francisco at the epicenter, was the most prominent driving force behind California’s Proposition 215, “The Compassionate Use Act of 1996.” The controversial ballot initiative provided an affirmative legal defense to charges of possession and cultivation of marijuana when recommended by a physician. In some northern California counties, the Compassionate Use Act of 1996 garnered over 70% of the vote. In San Francisco, for example, more votes were cast for legalization of medical marijuana than were cast for reelection of President Clinton. Two months after the law was approved the US Drug Czar, General Barry McCaffrey, threatened to prosecute doctors who discussed cannabis therapeutics with their patients. California’s physicians were then forced to defend their right to recommend medical marijuana, and that right was upheld in Federal Court.[10] Aparently, regardless of federal bully tactics, a large number of doctors believe that cannabis deserves some share of the credit for the decrease of AIDS-related deaths in the United States.

Thousands of people with AIDS have sworn by medical marijuana, both in press reports and in numerous government hearings. Malignant lymphoma is a common ailment in AIDS cases, as is Kaposi’s Sarcoma, a rare form of vascular cancer. Both of these cancers have been treated successfully with the adjunctive application of natural cannabis. [11], [12] Such cancerous complications are very common in people with AIDS.

More commonly, however, HIV and AIDS patients suffer from severe anorexia. They become unable to eat and frequently drop weight at an alarming pace. This pattern, called “the wasting syndrome,” is the major contributor to death through AIDS-related conditions. Cannabis has been known to stimulate the appetite and promote gastrointestinal reflexes since the beginning of recorded civilization. Shen-Nung, the Father of Chinese Medicine, prescribed Ma for constipation almost five thousand years ago. In 1814, Nicholas Culpepper wrote that cannabis was useful for “allaying humors of the bowels.” Traditional Hindu medicine also credits cannabis with promoting efficient digestion. Western physicians published many studies in the mid- and late 1800s verifying cannabis’ remarkable appetite stimulating properties. This universal effect of marijuana became known as the “the munchies” in popular vernacular of the 1960s. In modern America, Marinol, a pill containing synthetic THC, the most powerful of 61 naturally occurring cannabinoid compounds, is routinely prescribed for AIDS patients when other medications fail, yet the source of THC, the marijuana plant, is officially classified by the US government as having “no medical value.”

Marinol is effective for some but not all AIDS patients. One problem with synthetic THC is its high potency. Marinol is considered about five times more psychoactive than cannabis,[13] often causing intoxication to the point of incapacity or sedation: perplexing to patients attempting to maintain their lifestyles. Because the body’s ability to assimilate THC fluctuates throughout the day, a marijuana smoker is better able to accurately judge dose effectiveness and thereby avoid excessive and prolonged intoxication.[14] However, the difference in potency between Marinol and marijuana is not simply a matter of different dosages. Orally ingested THC is assimilated by the liver, producing cannabinoid metabolite by-products that are active intoxicants remaining in the bloodstream for up to 30 hours following ingestion. When marijuana is smoked rather than eaten, the medicinal compounds enter the bloodstream from the respiratory system, bypassing the liver. Smoked marijuana is also less overwhelming than the THC pill because of it’s natural complexity. Along with tetrahydrocannabinol, marijuana contains other medicinal cannabinoids that are known to offset the over-stimulation of THC. These complementary cannabinoids are not found in Marinol. The National Academy of Science’s Institute of Medicine is one of many medical bodies that have recommended further research on these other cannabinoids,[15] but the huge cost of such research is a major obstacle. Pharmaceutical companies prefer to patent synthetic cannabinoid analogues rather than naturally-occurring cannabinoid compounds that can be produced at home in a small garden.

Many HIV and AIDS patients report that natural cannabis is far more effective than Marinol, and that cannabis relieves not only the deadly “wasting syndrome,” but also the side-effects of protease inhibitor therapy, a daily regimen of 25 to 30 powerful chemotherapy drugs hat cause severe nausea. One AIDS physician has remarked, “Not only is marijuana the safest drug an AIDS patient takes, inhalation is the perfect delivery system because it is rapidly effective, easy to dose for the individual patient, and it bypasses complicating factors in the digestive tract.”[16]

In addition, the Merck guide to pharmaceutical medicines indicates that Marinol has been shown to increase appetite, but research does not indicate that using the Marinol pill actually increases a patient’s body mass. Marijuana’s effect on increasing body mass was a subject of comparative study at San Francisco General Hospital.[17]

While the United Nations World Health Organization reports that a 1989 study indicated that continued cannabis use by HIV-positive males did not increase the progression of AIDS,[18] important American studies confirming the medical utility of marijuana have been mired in federal bureaucracy for many years. A study by Donald Abrams, Director of HIV research at San Francisco General Hospital, was designed to compare the medical effectiveness of cannabis with that of Marinol. The first version of that study was submitted for federal approval in 1992. After seven years of rejection, Abrams’ research was finally approved only after being modified to test for marijuana’s safety rather than its medical effectiveness—a distinction ensuring that the study would be ineligible as a test of medical effectiveness required for FDA approval.[19] After two more years of federal hurdles, the National Institutes of Health allowed Dr. Abrams and the University of California to undertake the revised study, which began in December of 1997.[20] While this new version of Abrams’ study was designed to determine how cannabinoid use affects the use of protease inhibitors, and is specifically not a test of marijuana’s medical utility, Dr. Abrams is commited to collecting a wealth of data on the effectiveness of marijuana in use by AIDS patients.[21]

The results of Abrams study are as follows:

“Patients with HIV Infection taking protease inhibitors do not experience short-term adverse virologic effects from using cannabinoids. “The inpatient study lasted 21 days and measured changes in HIV RNA levels between baseline and day 21.” --Donald Abrams, "Marijuana does not appear to alter viral loads of HIV patients taking protease inhibitors.” University of California, July 13, 2000. Source: Cannabis MD Reports, ww.cannabismd.org/reports/abrams1.php

The National Institutes of Health has officially recognized the medical utility of marijuana in combating the AIDS epidemic,[22] and the Institute of Medicine (IOM) has reported that marijuana is effective in fighting the many symptoms of wasting syndrome. The Executive Summary of the groundbreaking IOM report includes this detailed endorsement in a list of therapeutic effects:

Third, for cases that are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. [23]

Drug Czars McCaffrey and Walters dismiss these recommendations, [24] and federal approval of FDA research that might lead to legalization of cannabis for medical uses seems unlikely.[25] Following the release of the IOM’s Marijuana and Medicine: Assessing the Science Base, the Clinton administration did announce a policy reversal, saying it would loosen restrictions on marijuana research as early as December 1999.[26] Nonetheless, informed observers remain unconvinced, reminding us that legitimate studies on cannabis designed by state legislatures, universities and private researchers have been repeatedly denied for more than 22 years. Clinical studies designed to measure the effectiveness of marijuana as medicine will probably not be allowed because those studies might be applicable as evidence for FDA approval of the natural medicinal resource. [27]

While the federal government continues to block the legalization of medical marijuana, experts in the field are increasingly convinced of its value. The American Medical Association is only one of the many medical authorities that has urged the National Institutes of Health to support further studies.[28] Other medical and political groups have called for immediate access to the herbal medication, regardless of FDA approval. Organizations and groups such as the seventeen most prominent AIDS coalitions, the AIDS Treatment News, the American Academy of Family Physicians, the American Medical Student Association, at least 44% of American oncologists,[29] the American Preventative Medical Association, the American Public Health Association, the American Society of Addictive Medicine, the British Medical Association,[30] the California Medical Association,[31] the California Society on Addiction Medicine, the Florida Medical Association, the Los Angeles County AIDS Commission, the Lymphoma Foundation of America, the Maine AIDS Alliance, the Marin Medical Society, the National Nurses Society on Addictions, The New England Journal of Medicine, the New Mexico State Board of Nursing, the Chairman of the New York State Assembly Committee on Health,[32] the North Carolina Nurses Association, the Oakland City Council,[33] the Royal College of Physicians,[34] the Royal Pharmaceutical Society (UK),[35] the San Francisco Mayor’s Office, the San Francisco Medical Society, the Virginia Nurses Association, 70% of all physicians in the United Kingdom,[36] 120,000 members of The American College of physicians,[37] and a majority of American citizens in statewide ballot initiatives and have all voiced support for the use of medical cannabis.[38]

In the opening remarks at the Institute of Medicine’s news conference on Marijuana and Medicine, Principal Investigator John Benson seemed to echo a similar sentiment: “[W]e concluded that there are some limited circumstances in which we recommend smoking marijuana for medical uses.”[39] Seven months later, in U.S. v. Oakland Cannabis Buyer’s Club, a three judge panel of the 9^th U.S. Circuit Court of Appeals unanimously ruled:

[T]here is a class of people with serious medical conditions for whom the use of cannabis is necessary in order to treat or alleviate those conditions or their symptoms; who will suffer serious harm if they are denied cannabis; and for whom there is no legal alternative to cannabis for the effective treatment of their medical conditions because they have tried other alternatives and have found that they are ineffective or that they result in intolerable side effects.[40]

While that landmark federal ruling clearly recognized the medical necessity of marijuana use for victims of the AIDS epidemic, it was soon challenged buy the Department of Justice. A humane resolution to this clash between law and medicine appears as elusive as the discovery of a cure for the deadly disease.

While legal issues continue to frustrate treatment of this terminal disease, science continues to furnish ample evidence to justify non-compliance with the irrational federal policy on medical marijuana. The following abstract from a human trial of smoked cannabis published in June 2008 is included in full:

"Despite management with opioids and other pain modifying therapies, neuropathic pain continues to reduce the quality of life and daily functioning in HIV-infected individuals. Cannabinoid receptors in the central and peripheral nervous systems have been shown to modulate pain perception. We conducted a clinical trial to assess the impact of smoked cannabis on neuropathic pain in HIV. This was a phase II, double-blind, placebo-controlled, crossover trial of analgesia with smoked cannabis in HIV-associated distal sensory predominant polyneuropathy (DSPN). Eligible subjects had neuropathic pain refractory to at least two previous analgesic classes; they continued on their prestudy analgesic regimens throughout the trial. Regulatory considerations dictated that subjects smoke under direct observation in a hospital setting. Treatments were placebo and active cannabis ranging in potency between 1 and 8% -9-tetrahydrocannabinol, four times daily for 5 consecutive days during each of 2 treatment weeks, separated by a 2-week washout. The primary outcome was change in pain intensity as measured by the Descriptor Differential Scale (DDS) from a pretreatment baseline to the end of each treatment week. Secondary measures included assessments of mood and daily functioning. Of 127 volunteers screened, 34 eligible subjects enrolled and 28 completed both cannabis and placebo treatments. Among the completers, pain relief was greater with cannabis than placebo (median difference in DDS pain intensity change, 3.3 points, effect size=0.60; p=0.016). The proportions of subjects achieving at least 30% pain relief with cannabis versus placebo were 0.46 (95%CI 0.28, 0.65) and 0.18 (0.03, 0.32). Mood and daily functioning improved to a similar extent during both treatment periods. Although most side effects were mild and self-limited, two subjects experienced treatment-limiting toxicities. Smoked cannabis was generally well tolerated and effective when added to concomitant analgesic therapy in patients with medically refractory pain due to HIV DSPN. Addiction/Tolerance." [41]

Related sections: Cancer, Digestive Disorders, Immune Responses, Marinol, Replacement of Medications, Smoking Methods, Stress Reduction.

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[1] “UN says HIV more widespread than thought.” Associated Press, November 26, 1997

[2] “Study shows first downturn in AIDS.” Associated Press, September 19, 1997

[3] "2007 AIDS Epidemic Update" UN World Health Organization, http://data.unaids.org

[4] ibid.

[5] “AIDS cases up dramatically among Americans 50 and up.” Newsday, January 23, 1998

[6] ABC Evening News, July 11, 1998

[7[ “Study shows first downturn in AIDS,” Associated Press, September 19, 1997

[8] “Palella et. Al., “Declining morbidity and mortality among patients with advanced human immunodeficiency virus.” New England Journal of Medicine, Vol. 338, No. 13, p. 853, March 26, 1998

[9] "2007 AIDS Epidemic Update" UN World Health Organization, http://data.unaids.org

[10] Conant vs. McCaffrey, 1999, online at: www.cannabismd.org/foundation/

[11]McWilliams, “Medical marijuana and me.” Source: Grinspoon, the Forbidden Medicine Website, www.rxmarijuana.com

[12] Podrebarac, op. cit.

[13] McWilliams, Testimony before the California Senate Medical Marijuana Distribution Summit, May 26, 1998

[14] Abrams, Lindesmith Center Lecture, San Francisco, May 17, 1999

[15] Institute of Medicine, Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academy Press, 1999

[16] Podrebarac, op. cit.

[17] Abrams, op. cit.

[18] Kaslow et al., World Health Organization Project on Health Implications of Cannabis Use

[19] California NORML Reports, Vol. 21, No. 3, October, 1997

[20] Latimer, “Highwitness news.” High Times, No. 270, p. 30, February, 1998

[21] Abrams, op. cit.

[22] “NIH panelists agree: marijuana is safe and effective medicine.” MPP News, Marijuana Policy Project, August 4, 1997, www.mpp.org

[23] Institute of Medicine, op. cit.

[24] “Federal report reignites medical marijuana debate.” CNN, March 17, 1999

[25] “Medicinal marijuana briefing paper 1997-98.” MPP News, Marijuana Policy Project, 1998, www.mpp.org

[26] “Feds OK Marijuana Research.” Los Angeles Times, May 21, 1999

[27] Abrams, op. cit.

[28] “Federal report reignites medical marijuana debate.” CNN, March 17, 1999

[29] Doblin and Kleiman, “Marijuana as anti-emitic medicine: A survey of oncologists experiences and attitudes.” Journal of Clinical Oncology, Vol. 9, pp. 1314-1319, 1991

[30] Robson, “Cannabis as medicine: time for the phoenix to rise?” British Medical Journal, Vol. 316, No. 7137, p. 1034(2), 1998

[31] “CMA backs removal of marijuana from Schedule I prohibitive status.” NORML News, May 28, 1998

[32] “NY State Legistlator and head of NY Hospital’s Department of Public Health supports medical marijuana.” Source: Cowen, www.marijuananews.com, January 1998

[33] Oakland City Council Resolutions on Medical Marijuana, June 1998

[34] Robson, op. cit.

[35] Robson, op. cit.

[36] Statement of the British Medical Association. February 1994

[37] Supporting Research into the Therapeutic Role of Marijuana, A Position Paper of the American College of Physicians, 2008 (See Abstracts and Studies section of this website)

[38] All organizations not individually noted) Medical Groups’ Endorsements. NORML News

[39] www.mpp.org/science.html#2

[40] McWilliams, “In the war on drugs, a Red Cross is just another target.” www.petertrial.com

[41] " Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial", Ronald J Ellis1, Will Toperoff1, Florin Vaida2, Geoffrey van den Brande3, James Gonzales4, Ben Gouaux5, Heather Bentley5 and J Hampton Atkinson5