The health and psychological consequences of cannabis use - chapter 8


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8. The therapeutic effects of cannabinoids

8.8 Cannabis and AIDS

One of the areas of greatest contemporary interest in the therapeutic uses of cannabinoids and cannabis has been their possible roles as an anti-nausea agent, an appetite stimulant and an analgesic in patients with AIDS (Randall, 1989). The development of this interest seems to have replicated the earlier discovery of the anti-emetic effects of cannabis in young cancer patients in the 1970s. AIDS patients often experience nausea and weight loss, either while receiving cytotoxic drugs to suppress HIV, or as a direct effect of the AIDS spectrum diseases. Many patients have been recreational cannabis users, and so have reported that the smoking of marijuana produces a diminution in their nausea, an increased appetite, reduced pain, and general improvements in well being. AIDS advocacy groups have accordingly argued that marijuana should be made legally available to AIDS patients (e.g. Randall, 1991).

So far the bulk of evidence for these therapeutic claims has been provided by case reports (see Randall, 1989). There has been one small uncontrolled study of 10 symptomatic AIDS patients which suggested that dronabinol (synthetic THC) may be effective in reducing nausea and stimulating appetite (Plasse et al, 1991). The evidence of its anti-emetic properties in cancer patients seems to support its potential application in AIDS treatment, and is deserving of further investigation.

A potential concern with the use of cannabinoids in HIV positive individuals and AIDS patients is the possible immunosuppressive effects of cannabinoids. Although, as argued above, this effect is likely to be small and of limited concern when used intermittently incancer patients, it is of potentially greater significance in AIDS patients, since cannabis would be used regularly by patients with a major immune system disorder. Even a small impairment in immunity may have major consequences for HIV and AIDS affected individuals. Recent epidemiological evidence does something to allay this concern. A large prospective cohort study of HIV/AIDS in homosexual and bisexual men recently failed to find any relationship between cannabis use, or any other psychoactive drug use, and the rate at which HIV positive men developed clinical AIDS (Kaslow et al, 1989). Nonetheless, the issue of immunosuppression needs to be explicitly investigated in any research which is undertaken into the therapeutic uses of cannabinoids in the treatment of AIDS.