Bay Area Reporter - July 12, 2007
Liz Highleyman, liz@black-rose.com

Marijuana versus Marinol

In the first study, which appeared in the June 21 advance online edition of the Journal of Acquired Immune Deficiency Syndromes, researchers from Columbia University compared whole smoked marijuana, the THC pill dronabinol (Marinol), and placebo in 10 HIV-positive participants with prior marijuana-smoking experience.

Many people with HIV use medicinal cannabis to manage symptoms such as wasting, nausea, and peripheral neuropathy pain. Dronabinol is approved by the Food and Drug Administration for the treatment of nausea and appetite loss associated with HIV and cancer. Federal officials who oppose medical marijuana laws often tout dronabinol as a legal substitute.

A drawback to dronabinol is its slow rate of onset, which makes it hard for patients to use only the amount they need. Disadvantages of marijuana include its illegal status, the variable potency of cannabis obtained from buyers clubs or on the street, and the negative respiratory effects of smoking.

While staying at an in-patient facility, study participants received smoked marijuana with either 2 percent or 3.9 percent THC, 5 mg or 10 mg dronabinol pills, and placebos for both drugs. Using a "double-dummy" design, they did not know whether they were receiving active or inactive pills or marijuana cigarettes.

Participants were asked to record when and how much they ate and drank. Each day, they completed questionnaires asking about appetite, sleep, mood, and physical symptoms, and performed tests measuring cognitive performance, motor skills, memory, and learning.

Compared with placebo, both smoked marijuana and dronabinol significantly increased daily calorie intake and body weight. While marijuana increased calorie intake slightly more than dronabinol, the difference did not reach statistical significance in this small study. Both marijuana and dronabinol increased the number of times participants ate in a day, but not the average number of calories consumed per occasion.

Participants using either marijuana or dronabinol made fewer requests for medication for gastrointestinal symptoms, but only marijuana with 3.9 percent THC improved sleep ratings.

Both smoked marijuana and dronabinol were associated with "significant intoxication" - which most users rated as positive - but neither led to impaired cognitive performance.

According to the study authors, "both dronabinol (at doses eight times current recommendations) and marijuana were well tolerated and produced substantial and comparable increases in food intake," refuting past reports suggesting that dronabinol is too poorly tolerated or unreliable to be clinically useful.

But medical cannabis advocates were quick to point out that the study offered no evidence that dronabinol is superior to whole smoked marijuana.

The recommended total daily dose of dronabinol for appetite stimulation is 5 mg (2.5 mg twice daily), while this study used doses ranging from four to eight times that amount. In addition, the study used relatively weak cannabis obtained from the National Institute on Drug Abuse. According to the White House Office of National Drug Control Policy, the average THC content of marijuana seized by law enforcement during the first quarter of 2007 was 8.5 percent.

"What's striking about this study is that it took a huge dose of Marinol to even roughly equal the benefit of low-grade, government-issued marijuana," said Marijuana Policy Project spokesman Bruce Mirken. "The researchers called the effects of marijuana and Marinol 'similar,' but they had to work pretty hard to make that case. Even a very high dose of Marinol didn't do as well as low-quality marijuana at stimulating appetite and at helping patients sleep."

State laws and marijuana use

In the second study, published online in the International Journal of Drug Policy, researchers from Texas A&M Health Science Center analyzed two sets of data designed to monitor emerging drug-use trends from areas that have instituted medical marijuana laws.

The Arrestee Drug Abuse Monitoring System (ADAM) is based on urine tests from adult and juvenile arrestees, while the Drug Abuse Warning Network (DAWN) tracks mentions of drug use in hospital emergency department records. The researches compared data obtained before and after implementation of medical marijuana laws in California, Colorado, Oregon, and Washington state.

In both sets of data, the researchers saw no change in cannabis use trends after medical marijuana laws went into effect.

"Consistent with other studies of the liberalization of cannabis laws," they concluded, these results "indicate that medical cannabis laws do not increase use of the drug."

"In every state that considers medical marijuana legislation, opponents try to frighten parents by saying that a medical marijuana law would unleash a flood of marijuana and other drug use in their communities," said Mirken. "It's increasingly clear that that's false, and we need to be ready to step up and call a lie a lie."

"Science continues to demolish the objections raised by opponents of medical marijuana," added MPP Executive Director Rob Kampia. "Thoughtful [legislators] should base their votes on science rather than myth and superstition."

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