CONTROVERSY ENVELOPES HIV PATIENTS USING MARIJUANA

This past September, I was in southern California to attend the U.S.
Conference on AIDS, held in Anaheim, Calif. While watching the news one
morning, a headline caught my attention about activists for the
distribution of medical marijuana. The activists at San Diego City Hall
were that very moment passing out small bags of marijuana to patients who
had a medical need for the substance and who had a physician's note to
obtain it.

Advocates for the use of medical marijuana say cannabis can assist in
reducing symptoms for patients who have cancer, AIDS and other chronic
ailments. In fact, the city was working on guidelines to provide
identification cards to medical users in case authorities ever confronted them.

Proposition 215, also known as the Compassionate Use Act of 1996, allows
Californians who are seriously ill to obtain and use marijuana for medical
purposes if recommended by a physician. A similar bill is on the books in
the states of Alaska, Colorado, Hawaii, Maine, Nevada, Oregon and Washington.

Marijuana, which is classified as a cannabinoid - known on the street as
"dope," "grass," "pot" and "weed" - continues to be controversial. Although
little is known about its direct interaction with human immunodeficiency
virus (HIV) medications or its effect on the progression of HIV, research
has shown there are plenty of negative effects associated with its use in
general.

Whether swallowed or smoked, marijuana can cause euphoria, slowed thinking
and reaction time, confusion, impaired balance and coordination, cough and
respiratory infections, impaired learning, and increased risk of heart
disease, anxiety, panic attacks and addiction. Among the more than 400
chemicals, marijuana also contains tetrahydrocannabimnol (THC), a drug that
alters the mind and body.

Marijuana has been classified in the most restrictive category of
controlled substances since 1970. Nationally, it is not accepted for
medical use; therefore, it is not a regulated drug and can be laced with
other dangerous drugs. Abuse is a high risk for people who use it. In
addition, impaired judgment and memory induced by the use of marijuana
could lead to unsafe sexual practices leading to exposure to sexually
transmitted diseases. For individuals already infected with HIV, smoking
dope could lead to the spread of HIV to their partners or lead to
reinfection. The bottom line is both the short- and long-term risks should
be considered as well as alternative options to its medical use.

Against medical use Claims marijuana use is effective in treating wasting
syndrome, pain of neuropathy - aneurological disorder often effecting the
limbs - and nausea associated with HIV are largely noted through personal
experience and not medical research; therefore, it is critical to assess
the usefulness of marijuana for medical use.

Medical options are available to treat side effects experienced from HIV
and HIV-related illnesses. There are several medications already available
to treat pain and nausea.

A common medication known to the HIV community is dronabinol (Marinol), a
synthetic form of THC. The U.S. Food and Drug Administration approved
Marinol in 1994 for its use in treating wasting syndrome. It is available
by prescription to act as an appetite stimulant and to reduce nausea.

One of the largest concerns of marijuana use for individuals living with
HIV is the effect that it has on the immune system. THC has been suggested
to negatively affect many of the immune functions causing the user to be
more susceptible to certain infections. Bacterial, viral, and fungal
infections may result in an increased viral load - the level of virus in blood.

Third, lung complications similar to those associated with tobacco smoke
can be harmful increasing the risk of lung cancer, heart disease and
asthma. Aspergillus, a fungus sometimes found in marijuana, has been found
in individuals with advanced HIV disease and can cause lung infections.
Smoking marijuana may inhibit the ability of cells to fight bacteria in the
lungs and increase the risk of lung complications.

Neurologically, marijuana is commonly known to affect the ability to think,
judge and perform tasks. The user will determine whether those short-term
effects are negative or positive. Individuals taking the highly active
antiretroviral therapy (HAART) have noted using marijuana impairs their
memory, leading to the hindrance of adhering to their treatment regimen.
Adherence is imperative to prevent drug resistance and to the success of
the treatment. To someone infected with HIV, that is crucial to living a
longer healthy life.

It is common knowledge individuals who smoke marijuana often get the
"munchies"; therefore, marijuana has been suggested to aid in reducing the
side effects of wasting syndrome. However, in many cases, the food consumed
during these moments are high in fat and often snack foods that cause
weight gain to consist of fat rather than muscle gain. Weight gain is also
contributed to marijuana leads people to sleep more and participate in less
physical activities.

The University of California at San Francisco is conducting a study on the
effects of marijuana use and its effects on Crixivan, an anti-HIV medication.

In addition, it will be studying the effects of Marinol and marijuana on
weight gain and loss, appetite, the immune system and hormone levels.
Advocates against marijuana for medical use hope the research data support
their stand that marijuana is harmful to people living with HIV.

For medical use Advocates for the medical use of marijuana claim it reduces
chronic pain, spasms, nausea and depression, and it decreases the
progression of wasting syndrome - the weight loss associated with HIV -
without having negative effects on the progression of HIV. Data from the
Multicenter AIDS Cohort Study found marijuana was not linked to a higher
rate of HIV progression or loss of CD4 cells. A short-term study conducted
by the University of California at San Francisco concluded marijuana did
not have a harmful effect on HIV levels - the viral load.

Although Marinol has been shown to increase appetite for as long as five
months, reports show it can be absorbed erratically, making managing its
psychological side effects, like euphoria and disorientation, difficult for
some people. Individuals who have used both marijuana and Marinol in pill
form report smoking marijuana allows them more control in how "stoned" they
get. In addition, the cost of a needed prescription for Marinol can be up
to $30,000 a year, making it financially unavailable to many and a
deterrent to others.

New studies show that marijuana may have antiinflammatory effects as it
reduces pain experienced by individuals with neuropathy. Clients with HIV
find smoking marijuana the only relief they receive from their daily
discomfort. Research and personal experiences have shown marijuana also
reduces nausea for people using the antiviral therapies. Many cancer
survivors credit marijuana for their survival. Taking marijuana during
chemotherapy allowed them to withstand the overwhelming nausea, which was
the cause for ending therapy for many others.

After California voted yes to the medical use of marijuana, physicians
noted positive outcomes relative to their HIV-positive patients' weight
gain and quality of their life. In addition, if medical marijuana is
combined with an extensive nutritional, weight maintenance and exercise
program, lean muscle gain can be increased.

Although indications that marijuana can help people experiencing nausea,
pain and wasting due to HIV, the political concerns and ramifications have
not provided researchers with much incentive to continue conducting studies
on HIV and marijuana use. There is a lack of studies suggesting marijuana
use has a negative long-term effect on HIV disease. More research could
benefit many people and may provide an alternative to existing treatments.

In summary, the medical use of marijuana for individuals infected with HIV
has had an enormous effect in the political arena and not such an enormous
effect in the research arena. Advocates for and against its use for
medicinal purposes each have examples of why it should or should not be
permitted, unfortunately with little concrete scientific data to support
their positions.

The idea that an individual could be healthier and more functional by using
another potentially dangerous drug has been proven true with the use of
methadone. However, the understanding is methadone is not necessarily a
permanent treatment but is rather a step toward abstinence, whereas medical
marijuana is intended as a permanent treatment for those suffering from
chronic or terminal illnesses.

Some HIV-positive individuals use marijuana to reduce nausea, reduce pain,
aid sleeping and increase appetites or gain weight. Many are aware of the
controversy and legality surrounding medical marijuana, but they are less
likely to be aware of the potential dangers to their bodies from prolonged use.

Others who are aware of the dangers overlook them, because they feel the
immediate relief they receive from using marijuana outweighs the possible
long-term effects from the drug. Yet others feel they will not be living by
the time the long-term effects catch up to them.

Sussex County residents have mixed feelings about the passing a law for
marijuana medical use. Recently, WGMD, a local talk radio station, prompted
a discussion led by host Sharon Kennedy. Callers who favored medical
marijuana stated: "I would vote in a heartbeat to legalize it", "I only
don't smoke it now because of drug testing at work" and "same will get high
legal or illegal - I believe in total legalization." Callers who opposed
stated: "a pot head is a pot head" and "it's just an excuse to get high."

For information relating to marijuana for medical use, drug and alcohol
use, support groups, or 12-step programs, call the SCAC Resource Center at
644-1094. As one recovering SCAC client stated: "I moved toward sobriety
because I realized HIV was not killing me; the drugs were. Now I realize
that HIV lives with me. I don't live with it."