Cannabis Therapeutics in HIV/AIDS

Journal of Cannabis Therapeutics
Volume 1, Numbers 3/4

CONTENTS

Introduction: Cannabis Therapeutics in HIV/AIDS,
Plus, a Modest Proposal 1

Ethan Russo

Therapeutic Cannabis (Marijuana) as an Antiemetic
and Appetite Stimulant in Persons with Acquired
Immunodeficiency Syndrome (AIDS) 5

Richard E. Bayer

Medical Marijuana and the AIDS Crisis 17

Clinton A. Werner

The sudden emergence of the AIDS epidemic and the initial lack of effective treatments politicized the patient population into demanding quicker development of and access to promising medications. When numerous AIDS patients demanded marijuana to treat the anorexia and wasting syndrome resulting from both illness and medications, the federal government’s Public Health Service closed the only legal source of supply. The federal authorities’ abdication of compassion and repression of research spawned a grassroots political movement that repudiated federal regulations.

KEYWORDS. Acquired Immune Deficiency Syndrome (AIDS), HIV, cannabis, marijuana, medical marijuana, delta-9-tetrahydrocannabinol, AIDS-wasting syndrome, azidothymidine (AZT), dronabinol

Marijuana Use in HIV-Positive and AIDS Patients:
Results of an Anonymous Mail Survey 35

Stephen Sidney

While there is a great deal of anecdotal reporting regarding the medical use of marijuana in HIV-positive patients, there have been few systematic surveys performed. The prevalence of medical use of marijuana in HIV-positive and AIDS patients was assessed by an anonymous mail survey of 1970 attendees of HIV clinics in the San Francisco, Oakland, and South Sacramento medical centers of the Kaiser Permanente Medical Care Program (KPMCP) in California. Of 442 responders (22.4% response rate), 147 (33.3%) reported current use of marijuana for medical purposes. Among current users, the most common reasons for using cannabis were: to feel better mentally/reduce stress (79%), improve appetite/gain weight (67%) and decrease nausea (66%). Patterns of use were heterogeneous, with daily use of cannabis reported by 34% of current users. Nearly half of participants reported buyers’ clubs as a source for obtaining cannabis, a finding of particular interest because of recent successful government efforts in closing down these clubs in California. In combination with other reported surveys, these data suggest that the use of marijuana for medical purposes is relatively common in HIV-positive and AIDS patients.

KEYWORDS. Marijuana, cannabis, HIV, AIDS, epidemiology

Differential Effects of Medical Marijuana Based on Strain
and Route of Administration: A Three-Year Observational
Study 43

Valerie Leveroni Corral

Cannabis displays substantial effectiveness for a variety of medical symptoms. Seventy-seven patients took part in a study in California to assess the efficacy of organically grown Cannabis sativa and indica strains in treatment of various medical conditions via smoking or ingestion. HIV/AIDS was the most frequent condition reported, at 51%. Standardized rating forms provided 1892 records that were statistically analyzed. Results demonstrated that in the case of nausea and spasm, symptom expressions are definitely affected by various methods of cannabis administration. However, while Cannabis indica strains increased energy and appetite, it is useful to note that in treating nausea in HIV/AIDS and orthopedic diagnosis groups, Cannabis sativa and C. indica strains proved equivalent.

KEYWORDS. Cannabis, medical marijuana, Cannabis sativa, Cannabis indica, AIDS, HIV

Marijuana and Cannabinoids: Effects on Infections, Immunity,
and AIDS 61

Guy A. Cabral

Marijuana and its major psychoactive component, delta-9-tetrahydrocannabinol (THC), alter resistance to bacterial, protozoan, and viral infections in vivo and in vitro. These alterations have been accompanied by modifications in functional components of the immune system. In addition, marijuana and THC, as well as other cannabinoids, have been reported to directly affect functional activities of lymphocytes, macrophages, natural killer cells, and other immunocytes. These include effects on cytokine production resulting in a shift in the balance of Th1 versus Th2 cytokines. Both receptor and non-receptor mediated modes of action have been proposed as causative of cannabinoid effects. Reports that marijuana and THC alter anti-microbial activity in vivo and in vitro indicate that its use presents a potential risk of decreased resistance to infections. However, few controlled longitudinal epidemiological and immunological studies have been undertaken to correlate the immunosuppressive effects of marijuana smoke or cannabinoids on the incidence of infections or disease in humans.

KEYWORDS. AIDS, HIV, cannabinoid receptors, cannabinoids, delta-9-tetrahydrocannabinol, immunity, infections, marijuana, THC

Effects of Smoked Marijuana on the Lung and Its Immune
Defenses: Implications for Medicinal Use in HIV-Infected
Patients 87

Donald P. Tashkin

Habitual marijuana smoking may cause a number of potentially harmful effects on the lung, including the following: (1) acute and chronic bronchitis; (2) extensive histopathologic alterations in the cells lining the bronchial passages that could impair mucociliary clearance or predispose to malignancy; (3) increased accumulation of inflammatory cells (alveolar macrophages) in the lung; and (4) impairment in the function of these important immune-effector cells, including their ability to kill microorganisms and to produce protective pro-inflammatory cytokines. The major potential pulmonary consequences of habitual marijuana use are pulmonary infection and respiratory cancer. Infectious complications could be due to smoking-related damage to the mucociliary clearance mechanism, marijuana-related impairment in the antimicrobial function of alveolar macrophages and/or fungal or bacterial contamination of marijuana. Patients with pre-existing immune deficits due to AIDS could be particularly susceptible to pulmonary infectious complications of marijuana use.

KEYWORDS. Pulmonary function, cannabis, medical marijuana, HIV, AIDS

Cannabis and Cannabis Extracts: Greater Than the Sum
of Their Parts? 103

John M. McPartland
Ethan B. Russo

KEYWORDS. Cannabis, marijuana, THC, cannabinoids, phytocannabinoids, cannabidiol, cannabichromene, cannabibigerol, tetrahydrocannabivarin, terpenoids, essential oils, flavonoids, herbal medicine, medicinal plants, herbal synergy

Harm Reduction Associated with Inhalation and Oral
Administration of Cannabis and THC 133

Franjo Grotenhermen

Inhalation of carcinogenic combustion products associated with smoking is generally regarded as the major health hazard in connection with the medical use of cannabis products. Strategies to reduce respiratory and other adverse events resulting from this common practice include relinquishment of inhalation and replacement by other routes of administration, the use of plants with a high THC content allowing reduction of the amount of smoked plant material, usage of inhalation devices that improve the ratio of THC and tar, and avoidance of the Valsalva maneuver that may cause spontaneous pneumothorax. The major risk associated with oral cannabis use is accidental overdosage, especially in inexperienced users that can be avoided by appropriate dosing procedures. A combination of oral use and inhalation may be meaningful in several indications, decreasing the specific risks of both routes. Preliminary studies using rectal, sublingual and transdermal routes indicate that these alternatives to the two most common forms of ingestion may be utilized medicinally in the future, further reducing the possible risks associated with the administration of cannabis or single cannabinoids.

KEYWORDS. Cannabis, marijuana, THC, cannabinoids, smoking, inhalation, oral use, rectal use, sublingual use, transdermal use, therapeutic use, side effects, health risk, harm reduction, cancer, spontaneous pneumothorax, dosing, overdose, opium, opiates, pharmacokinetics

Cannabis "Vaporization": A Promising Strategy for Smoke
Harm Reduction 153

Dale H. Gieringer

The primary health hazard of medical cannabis is respiratory damage from marijuana smoke. Aside from oral ingestion and other non-smoked delivery systems not yet commercially available, strategies for reducing the harm of smoking include: (1) use of higher potency cannabis and (2) smoking devices aimed at eliminating toxins from the smoke. Studies have found that waterpipes and solid filters are ineffectual at improving the THC/tar ratio in cannabis smoke. The most promising alternative appears to be "vaporization," in which cannabis is heated to a point where cannabinoids are emitted without combustion. A feasibility study by NORML and MAPS has demonstrated that an electric vaporizer can successfully generate THC at 185°C while completely suppressing benzene, toluene, and naphthalene formation. Further studies are needed to evaluate how effectively vaporizers suppress other toxins, and how their performance varies using different samples, temperatures, and device designs.

KEYWORDS. Marijuana, cannabis, smoke harm reduction, vaporizers, vaporization

Susan L. Broom
Kenneth J. Sufka
Mahmoud A. ElSohly
Samir A. Ross

Prospects for New Cannabis-Based Prescription Medicines 183

Brian A. Whittle
Geoffrey W. Guy
Philip Robson

Cannabis is now emerging from a period of prohibition and being revisited as a potential source of treatments for conditions ill served by synthetic substances. Previous research focussed primarily on effects produced by synthetic cannabinoids such as THC, or cannabis of unknown cannabinoid content. Chemovars of cannabis characterized by high content of specific cannabinoids (primarily, but not only THC and CBD) have been developed. Clinical research using defined extracts from these chemovars is now underway in the UK.
Many diseases are multifactorial; a variety of receptors need to be targeted to produce a therapeutic effect. A defined botanical may better achieve this than a single synthetic compound as the components can act synergistically. A new generation of cannabis based medicinal products takes advantage of increasing understanding of the mode of action of cannabinoids, evidence-based research on clinical uses and new technology for realization of products, in anti-diversionary presentations.

KEYWORDS. Cannabinoids, cannabis, CB receptors, new chemovars, clinical research, multiple sclerosis, spinal cord injury, neurogenic pain, botanical extracts, secure dispensing, alternative delivery systems, harm reduction