On the Cutting Edge: A look at the medical advances
A new study is set to answer the question of whether marijuana revives flagging appetites in AIDS patients.
By Charlene Laino
July 12 - This week, the first government-sanctioned trial of marijuana as medicine reached another milestone, with two-thirds of the patients now enrolled, says study head Dr. Donald Abrams. Results could be available as soon as next spring.
IT’S ONE of the most hotly contested issues in the health arena: marijuana as medicine. While anecdotal testimonials suggest pot should take its rightful, though perhaps limited, place in the American pharmacopoeia, the government has traditionally opposed its use. But that all changed two years ago when the University of California, San Francisco’s Abrams was granted approval to conduct the first federally sponsored study of the medical effects of marijuana in AIDS patients. Given that one in three adults has smoked pot at some point and thousands already use it to relieve a variety of ills, you would think receiving approval for an official study of the drug would have been easy.
But it was anything but simple, Abrams notes - a testimonial perhaps to the power of a drug czar in a country terrified that its youths will become a generation of addicts. One has to wonder about the government’s true agenda. After all, cocaine is a medication with few medical uses and plenty of room for abuse, but it’s legal to prescribe that. So why all the uproar about marijuana? Access and affordability probably play a role, says Abrams, who has been trying to unravel marijuana’s mysteries since the 1992 arrest of 70-something Mary Rathbun, fondly called “Brownie Mary.” A volunteer at San Francisco General Hospital, Rathbun would smuggle in marijuana-laced brownies, which she served to AIDS patients suffering from nausea, fatigue and wasting.
Abrams proposed a pilot trial to determine if marijuana helps to increase appetite in HIV-positive patients - give them the “munchies,” as it were - thereby warding off the debilitating weight loss associated with the AIDS wasting syndrome. “But our proposal was turned down time and again,” he says. So scorching were the repeated rejections that he was taken by surprise when in October, 1997, he was finally granted approval for the first federally sponsored study of the medical effects of marijuana in AIDS patients. Proponents of pot say it helps AIDS patients keep eating; relieves nausea and vomiting in patients undergoing chemotherapy; alleviates the chronic pain of conditions including headaches, arthritis and degenerative nerve disease; reduces spasticity in multiple sclerosis patients; and lowers the increased intraocular pressure associated with glaucoma.
Were the anecdotal reports about the benefits of cannabis finally too numerous to ignore? Not exactly, says Abrams. “It was a rather unique coming together of science and politics” that got his study approved, he says. California voters just said yes. And a prestigious panel convened by the feral National Institutes of Health recommended more clinical studies. The panel agreed that there was very strong evidence that THC - the active ingredient in marijuana - has some medicinal use: It is more effective than a placebo in stimulating appetite, for example. But is THC taken by mouth as effective as smoking a joint? No, the panel concluded. “The route of inhalation is more effective and works more quickly,” says Dr. Avram Goldstein, professor emeritus of pharmacology at Stanford University in Palo Alto.
“And the effects are more controllable because the patients can adjust the dose more easily.” Patients complain they become “zonked” when they take Marinol pills, says Abrams, referring to the FDA-sanctioned synthetic THC pills made by Roxane Pharmaceuticals. Because the pills must be absorbed through the digestive system, they are slower to take effect and slower to wear off than the smokable product. In Abrams’ study, 63 HIV- positive volunteers are being divided into three groups for a 25-day study period: one group smokes joints rolled from National Institute of Drug Abuse-supplied pot with 4 percent THC three times a day; one group takes Marinol three times a day; and one group is being given placebo pills. While patients have to stay in the hospital for the 25 days, they get $1,000 cash for their efforts. Some have come from as far away as New York to participate. At this stage, the study is designed only to determine whether marijuana is safe when taken in combination with the protease inhibitors indinavir and nelfinavir that have become a standard part of the drug cocktails given to many HIV-positive patients. “Both marijuana and protease inhibitors are degraded by the liver, so there’s the risk of drug-drug interactions,” Abrams says.
“Marijuana could allow protease levels to get too high, or too low.
Either way, there are dangers.” While the study will also look at weight
gain and appetite, a longer, larger clinical trial to measure marijuana’s
effectiveness will not begin until its safety is proven, he adds. “If there
is a product in nature that provides medical benefit, that might be a better
way [than to manipulate the product] into a little gelatin capsule,” the
San Francisco doctor says. “Maybe that’s why it’s there. In Western medicine,
we don’t appreciate that much.” Additional HIV-infected volunteers are
still being sought. In particular, Abrams says more women and people taking
indinavir, sold under the brand name Crixivan, are needed. Call 415-502-5705.