US CA: STUDY: MEDICAL MARIJUANA CAN HELP PEOPLE WITH HEP C

Medical marijuana can help people with hepatitis C stay on treatment
longer, leading to better outcomes, according to a study published in
the October 2006 issue of the European Journal of Gastroenterology
and Hepatology.

The standard treatment for hepatitis C virus (HCV), a combination of
interferon plus ribavirin taken for six months to a year, can cause
side effects such as flu-like symptoms, insomnia, nausea, loss of
appetite, and depression, which drive many patients to reduce their
doses or stop treatment prematurely. If left untreated, hepatitis C
can lead to cirrhosis, liver cancer, and death due to liver failure.

Although the federal government claims that medical marijuana has no
accepted medical uses, several studies - and ample anecdotal evidence
- indicate that cannabis helps reduce nausea and increase appetite in
people with AIDS.

"This study confirms what a lot of us have long understood but have
had trouble documenting: that medical marijuana does in fact save
lives by allowing people to stay on their medications and complete
treatment," said Bruce Mirken of the Marijuana Policy Project. "It's
time for the federal government to cut the crap and acknowledge that
for many people, this is a safe and effective medication." OASIS study

Dr. Diana Sylvestre, from the University of California at San
Francisco, and colleagues studied 71 recovering drug users with
hepatitis C treated at the Organization to Achieve Solutions in
Substance Abuse in Oakland, where Sylvestre serves as executive
director. All had been on methadone maintenance for at least three
months, and about a third used marijuana while being treated for
hepatitis C; according to the researchers, cannabis use during the
study was "neither endorsed nor prohibited."

HCV can be transmitted through shared needles and other
drug-injection equipment, and active or former drug users make up a
large proportion of patients with hepatitis C. In the past, experts
recommended against hepatitis C treatment for active or recent
substance users, but studies have shown that such individuals can
achieve good outcomes if they maintain adequate adherence.

In the OASIS study, participants were treated with an older form of
interferon plus ribavirin for 24 or 48 weeks. At the end of
treatment, 64 percent of cannabis users had undetectable HCV viral
load, compared with 47 percent of non-users. After an additional six
months of post-treatment follow-up, three times as many cannabis
users achieved a sustained response compared with non-users (54
percent versus 18 percent), indicating that the marijuana users were
less likely to relapse.

Most patients experienced some side effects, but the cannabis users
were more likely to adhere to therapy and less likely to stop
treatment early. Overall, marijuana users stayed on treatment for an
average of 38 weeks, compared to 33 weeks for non-users.

"Our results suggest that modest cannabis use may offer symptomatic
and virological benefit to some patients undergoing HCV treatment by
helping them maintain adherence to the challenging medication
regimen," the researchers concluded.

According to Mirken, this is thought to be the first published study
linking medical marijuana to improved cure rates for a
life-threatening illness.

Cannabis appeared to improve treatment outcomes by helping patients
stay on therapy. Response rates did not improve with greater
marijuana consumption; in fact, patients who used the largest amounts
did not show as much benefit.

"We can't judge whether there was an antiviral effect from this
particular study," Sylvestre told the Bay Area Reporter . "Patients
who smoked cannabis stayed on treatment a little bit longer, and it
was probably more of a side-effect management effect than an
antiviral effect, but we can't rule out the latter."

Brian Klein, a founder of the Hepatitis C Action & Advocacy Coalition
(who was not a participant in the OASIS study) credits medical
marijuana with helping him achieve a cure with his second attempt at treatment.

"One of the main reasons my treatment succeeded was that I was able
to stay on my medications," he said. "Medical marijuana allowed me to
successfully treat my hepatitis C and clear the virus." Safety concerns

While the OASIS results appear promising, there are concerns about
the safety of long-term marijuana use by people with chronic
hepatitis C. Some components of the cannabis plant may suppress
immune function, and, as reported last year in the July 2005 issue of
Hepatology , French researchers found that untreated hepatitis C
patients who smoked cannabis daily were more likely to have severe
liver damage than occasional users and non-users.

"We were looking at treatment outcomes, and they were looking at
people who smoked lots of marijuana over the long term," said
Sylvestre. "Our study suggests that using modest amounts of cannabis
for side effects management is not harmful."

However, the researchers acknowledged in their report, "We cannot
rule out the possibility that detrimental biological or immunological
mechanisms may be relevant at higher levels of consumption.
Obviously, further study is needed."

Unfortunately, federal drug laws make it difficult to carry out
well-designed research on the medical uses of cannabis. Efforts by
advocates to encourage the Food and Drug Administration to approve
controlled studies have been repeatedly rebuffed.

In an editorial accompanying the OASIS journal report, six hepatitis
experts from Canada and Germany suggested that medical marijuana may
be especially beneficial for individuals on methadone maintenance,
since methadone itself can cause some of the same side effects as interferon.

"Overall, cannabis use may thus even offer dual benefits, in
facilitating adherence to both methadone maintenance therapy and HCV
treatment in the HCV-infected drug user, and thus contribute to
public health benefits related to both these interventions," they wrote.

Until results from further research are available, they recommended
that "existing barriers to cannabis use [should be] removed for drug
users undergoing HCV treatment."