Smoking marijuana reduces intense pain in HIV patients
February 12, 2007 - insidebayarea.com
HIV patients who smoked three joints of marijuana per day for five days experienced relief from chronic foot pain associated with the disease, researchers at the University of California, San Francisco reported Monday in a rare U.S. study on medical marijuana.
"These results provide evidence that there is a measurable medical benefit to smoking cannabis for these patients," said study lead author Dr. Donald Abrams, UCSF professor of clinical medicine.
The study involved 50 HIV patients with sensory neuropathy, a peripheral nerve disorder that causes intense, sharp pain, numbness and tingling in the hands and feet. The condition affects about one in three HIV patients.
Patients assigned to smoke cannabis experienced a 34 percent reduction in intense foot pain -- twice the rate experienced by patients who smoked a placebo.
The first cannabis cigarette patients smoked reduced chronic pain by a median of 72 percent compared to 15 percent for patients who smoked the placebo, according to the study, published in the journal Neurology.
Half the patients were assigned randomly to smoke cannabis while the remaining 25 patients smoked an identical-looking placebo that lacked the drug's active ingredient. They had to be off any medication to treat neuropathy, including private-use marijuana. The patients were required to have some prior experience smoking the drug but could not have substance abuse problems.
The patients were sequestered at San Francisco General Hospital for seven days, where they underwent frequent testing. Over five consecutive days, they smoked cannabis or a placebo three times per day in rolled cigarettes. The National Institute on Drug Abuse provided the identical machine-rolled marijuana cigarettes.
Diana Dodson, 50, of Santa Cruz was among the 25 patients who received cannabis. She contracted HIV after receiving tainted blood product in 1985 and has been living with AIDS for 10 years.
Dodson, who smokes marijuana on her own to control her pain and nausea associated with AIDS, said the drug has been a lifesaver. "I really attribute cannabis to why I am still alive today," she said.
Her neuropathy symptoms include an extreme burning on the soles of her feet. "It's like an electrical poker going through me," she said. "I'll scream in the kitchen. Sometimes it's like a jabbing ice-pick pain."
Just a few puffs gives her relief for two hours without the grogginess associated with taking opiates such as morphine, she said.
The UCSF study indicated that pain relief from cannabis was on par with that from morphine.
The quality of the marijuana used in the trial wasn't as good as what Dobson gets on her own, she said, but she still felt relief from pain.
"It gives me a quality of life I wouldn't otherwise have," she said.
By contrast, previous studies of marinol -- the FDA-approved drug containing a synthetic version of THC, the active ingredient in cannabis -- showed little promise in relief for HIV-associated neuropathy.
"There are other compounds in smoked marijuana besides THC," said UCSF study co-author Dr. Cheryl A. Jay, a professor of clinical neurology. "That's one of several explanations why our study had a positive result while previous marinol studies did not."
David Murray, chief scientist at the Office of National Drug Control Policy, said people who smoke marijuana are subject to bacterial infections. He added that the study, considering its small size is "not a convincing demonstration."
Treatment for HIV-related neuropathy includes antidepressants and seizure drugs, but these medications don't always work and some patients cannot tolerate them. Opiates such as morphine are also sometimes used. There are no drugs approved by the FDA specifically for the condition.
The study is the first of several clinical trials of medical cannabis being conducted through the University of California's Center for Medicinal Cannabis Research, based at UC San Diego.
Dr. Igor Grant, director of the cannabis research center at UCSD, said the findings in this study suggest that cannabis "may be useful" in treating HIV-associated neuropathy. He noted that it has been many years since clinical trials of cannabis have been conducted in the United States.
"As a result, there has been insufficient light shed on the possible therapeutic value of cannabis," Grant said.
A 1999 report by the Institute of Medicine reviewed the scientific literature on medical marijuana and found that though it is a powerful drug, it is safe and should not be excluded from some medical uses.
Studies have indicated that cannabiniod drugs could help with pain relief, control of nausea and vomiting and appetite stimulation, according to the IOM report.
Americans for Safe Access and the National Association of People with AIDS on Tuesday plan to call for congressional hearings to implement the IOM report findings, which include further scientific studies of cannabis.
"Bolstered by the preliminary findings in the Abrams (UCSF) study, we will go to Congress and familiarize them with the IOM report so we can move forward with the research," said Dr. Barbara T. Roberts, director of medical and scientific affairs at Americans for Safe Access.
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