Medical Marijuana Key Issue for HIV/AIDS Patients

By Justin Barton-Caplin and Euan Bear

     Last month the so-called “Medical Marijuana” bill passed the Republican-controlled Vermont House of Representatives by a vote of 82-59. According to Rep. Bill Lippert (D-Hinesburg), support came from across the political spectrum, as members rose to share personal stories of relatives with serious diseases who could have been or were helped or made more comfortable by the (currently illicit) use of marijuana. Diseases whose sufferers may benefit from marijuana use include various forms of cancer, multiple sclerosis, glaucoma, AIDS, anorexia, chronic pains, spasticity, epilepsy, arthritis, and migraine, among others.
      Democratic members of the Senate expected the bill to pass in that chamber, but were less certain of whether Governor Howard Dean would sign such a measure. Responding to the news that a “sunset” provision had been added to the bill requiring the legislation to be reconsidered in 2006, Dean, a physician, has been quoted as saying, “The bill sunsets when it hits my desk.”
      Dean has also said that he is not opposed to medical use of marijuana after it had been subjected to the same drug safety and efficacy testing that manufactured drugs undergo. The current economics of drug testing may make such a criterion impossible to meet. Manufacturers pay for drug studies in hopes of recouping their costs with a patentable drug they can later sell for profit. Marijuana has no drug company sponsors and the government has been reluctant to commission studies.
      The medical marijuana bill matters to the gay and lesbian community because of its potential to stimulate appetite for patients with a wasting disease, such as HIV/AIDS, or nausea from treatments for breast and other forms of cancer.

Responses from Affected People

     “As an RN I can see the medical benefits of marijuana’s use,” wrote Steven Pomainville, RN, replying to a request for responses to the issue. “T.H.C. (the active chemical in marijuana) has had a great impact on appetite stimulation and decreasing nausea in those of medical need who have used it. If medical marijuana can improve an ill person’s quality of life, or help a person in short term medical crisis get through their crisis … I am in support of this type of use. I must let it be known in all good faith that I do oppose the rampant misuse of this substance.”
      Rob Larabee, an advocate affiliated with the People With AIDS Coalition, responded that “the compassionate use of medical marijuana is extremely significant to people living with AIDS. Marijuana allows a person who may be having difficulty eating, a very common side effect from HIV itself and complicated by the many medications and their effect on taste buds, to eat. Marijuana relieves pain associated with HIV, stomach upset and helps in the gaining of weight in cases of wasting syndrome. Marijuana also relieves overall stress associated with HIV.
      “The mere fact that it is not legal only adds to the stress of using it and the fear of being caught,” Larabee continued. “The last thing we need when we are ill is to be made a criminal!”
      Larabee himself has been diagnosed with AIDS since 1995. “I have received verbal acknowledgement from ALL of my HIV specialists for the medicinal use of marijuana, [including] doctors from Massachusetts General, Beth Israel in Boston and even Dartmouth,” he wrote. “They have even gone as far as to warn me to be aware of certain bacteria that are found in the plant from its cultivation that may cause bronchial infection. They advise micro waving it for about one minute … do not burn.”
      Bruno Borowski is a program specialist with Vermont Cares who also thinks that medical marijuana should be legally available to those who need it. “It would be very helpful for those that have such pain to receive this for comfort without the side effects and addiction that follow long term use of narcotics” that would otherwise be used for similar purposes, he wrote. “It also increases the appetite for those who are wasting, and have no desire for food. As this is an illegal drug at this time, a person is either suffering or committing an illegal act.”

The Science

     According to a report on the medical uses of marijuana issued by the Institute of Medicine at the behest of the White House and Drug Czar Barry McCaffrey, “The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. … The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting.
      “Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes. Although cellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer, proof that habitual marijuana smoking does or does not cause cancer awaits the results of well-designed studies.”
      In other words, the jury is still out, and in the meantime, patients wait, suffer or break the law.

To read the full report by the Institute of Medicine or an executive summary, go to http://www.nap.edu/readingroom/books/marimed.