Medical Marijuana in HIV/AIDS - Part 2: Science Is Mostly Positive On Medical Marijuana For People With HIV

June 30, 2010

Shruti Kalra and Stephen Gardner, The AIDS Beacon

This article is the second in a two-part series and will discuss the results of scientific studies examining medical marijuana use in people with HIV. Part 1 explored the current legal environment for medical marijuana.

Research has mostly shown that using medical marijuana helps ease common symptoms and side effects in people with HIV. However, there are also potentially serious risks, some of which are specific to people who are HIV positive.

Studies have estimated that about a quarter to a third of people with HIV use medical marijuana to ease their symptoms.

The active ingredient in marijuana, called tetrahydrocannabinol (THC), is actually available in two forms: the cannabis plant itself, which is usually smoked, and two different pills, which are available by prescription.

The cannabis plant, known simply as marijuana, is not approved by the United States Food and Drug Administration (FDA) and its use, possession, and cultivation are illegal according to federal law. However, the government has said it does not plan to pursue medical marijuana users or their caregivers (see Part 1 of this series).

The two prescription drugs are Marinol (dronabinol), which contains THC, and Cesamet (nabilone), which contains a synthetic version of THC.

Marinol and Cesamet are approved by the FDA and are legal when prescribed by a doctor. They also are swallowed, not smoked, which may be preferred by some users.

Some patients have argued that the dosages in the pills last longer and are harder to control. Studies have shown that smoked marijuana takes effect more quickly (about 20 minutes, versus two hours for pills) and does not stay in the body as long.

Benefits Of Medical Marijuana

Kris Hermes, Media Specialist for Americans for Safe Access (ASA), an organization that promotes legalization of medical marijuana, told The AIDS Beacon in an interview that there are a variety of reasons people with HIV use medical marijuana.

“One main reason is relief of side effects from antiretroviral therapy,” said Hermes, “which can make patients better at taking their medications.”

“Many users also say it helps reduce symptoms from other illnesses, such as hepatitis C, that are common in people with HIV,” he added.

Reduced Nausea And Increased Appetite. The ability of marijuana to reduce nausea and vomiting and stimulate the appetite has been well established. Most studies and clinical trials have been done with cancer patients undergoing chemotherapy, but results appear to extend to people with HIV as well.

A study published in the Journal of Pain and Symptom Management (pdf) in 2005 asked HIV-positive medical marijuana users in a survey whether the drug helped decrease nausea and other symptoms. Of those who responded, 93 percent said the drug helped: 56 percent said their nausea was “much better,” while 37 percent said it was a “little better.”

A small, placebo-controlled 2007 study in JAIDS found that either smoking marijuana or taking Marinol successfully stimulated the appetites of people with HIV. The study authors reported that the drug resulted in a weight gain of about 2.5 pounds over four days of treatment.

Reduced Depression And Anxiety. Relief of anxiety and depression are among the most common reasons people with HIV take marijuana. According to the study published in the Journal of Pain and Symptom Management, 93 percent of marijuana users reported that it helped decrease anxiety, and 86 percent said it helped with depression.

The study published in JAIDS also found that marijuana slightly increased the amount of time users were able to sleep and how well they slept.

Reduced Muscle And/Or Nerve Pain. People with HIV can have damage to nerves or muscles that causes tingling, numbness, or pain.

The study published in the Journal of Pain and Symptom Management found that 90 percent of marijuana users reported a reduction in nerve pain, and 94 percent said they had less muscle pain.

A 2007 placebo-controlled study published in Neurology (abstract) confirmed that marijuana reduced pain twice as much as a placebo. Furthermore, 52 percent of marijuana users reported at least a 30 percent reduction in their pain, compared to 24 percent of patients taking the placebo.

Drawbacks And Side Effects Of Medical Marijuana Use

Using medical marijuana is not risk-free, particularly for people with HIV. Marijuana may have some harmful effects on the immune system, which can lead to more illnesses and faster disease progression. There are also some additional unwanted side effects of the drug.

Immune System Effects. The effect of marijuana on the immune system is still unclear. Animal studies have shown that marijuana can affect the immune system, and a 2003 study in the Journal of the American Medical Association found that people who smoked marijuana had lower numbers of certain types of immune cells.

Some older studies from the 1980s and 1990s have also linked marijuana smoking to faster disease progression and increased risk of illnesses, such as pneumonia and Kaposi’s sarcoma.

On the other hand, several short-term studies have found no effects of marijuana on the immune system. Some scientists have also argued that if marijuana use helps people with HIV take their antiretroviral medications, which help the immune system heal, the effects of marijuana could be positive overall.

Cancer Risks. The risks of cancer in HIV-positive marijuana smokers are also uncertain.

Marijuana smoke is similar to tobacco smoke, which can cause severe breathing problems, respiratory infections, and lung cancer.

However, a study published in 2006 in Cancer Epidemiology, Biomarkers & Prevention found that a history of heavy marijuana usage was not associated with a risk of lung or upper respiratory cancer.

Scientists will need to do more studies to make sure this holds true for people with HIV as well. HIV-positive individuals are already at higher risk for cancers, including lung cancer.

Additional Side Effects. Finally, like any drug, medical marijuana has side effects. These include a “high” that can affect the ability to drive, concentrate, or think clearly. In addition, 47 percent of medical marijuana users in the 2005 Journal of Pain and Symptom Management study reported memory deterioration.

Marinol, which is taken in pill form, has also been reported to cause mental cloudiness and confusion.

As with any drug, patients are advised to talk with their doctor before starting or stopping medical marijuana.

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