San Francisco Chronicle - Friday, July 14, 2000
Sabin Russell, Chronicle Staff Writer

Dr. Donald Abrams, a researcher at the University of California at San Francisco, reported the results of the one-year, $1 million study yesterday at the 13th International AIDS Conference.

His findings may be less significant than the fact that research involving marijuana took place. Abrams secured funding for the experiment from the National Institute of Drug Abuse only after years of failed attempts to convince the government that research was needed on the medical effects of street drugs routinely consumed by HIV-infected patients.

"It's exciting. It's historic. It confirms that all the states that have allowed patients to use medical marijuana have not made a serious mistake," Abrams said.

In San Francisco yesterday, Dale Gieringer, the California director of the National Organization for the Reform of Marijuana Laws (NORML), which wants legalization of marijuana, said the Abrams report "certainly establishes what we've said all along -- that marijuana is safe and effective and that the government hasn't got a leg to stand on by preventing its medical use."

According to Gieringer, thousands of patients are already using marijuana "semi-legally" as a result of the solid victory that Proposition 215, the medical marijuana initiative, scored in 1996.

Medical uses of pot are theoretically legal in California as a result of that vote, but federal drug enforcement officials have insisted they would enforce the federal ban anyway.

At least half the Californians now using marijuana at the suggestion of their physicians are AIDS patients, Gieringer said, and they know it helps subdue the nausea and loss of appetite that are common side effects of the antiviral medicines they must take.

Medical marijuana is legal in seven other states besides California: Alaska, Arizona, Hawaii, Maine, Nevada, Oregon and Washington.

SPECIFIC PURPOSE

By design, and at the insistence of government funders, the Abrams study did not set out to prove or disprove the contention of medical marijuana advocates that smoking pot can improve the appetite, body weight and well-being of patients with AIDS, cancer and other wasting diseases.

Abrams' stated goal in this study was to determine whether the chemical components of marijuana in any way interfered with the body's ability to break down the components of protease inhibitors. These are the newest class of antiviral drugs that, taken in combination with others, have helped thousands of HIV-infected patients retain the health of their immune systems.

Previous lab tests had hinted that there could be a problem with drug- to-drug interaction, because the active ingredients of both pot and protease drugs are broken down by the same enzyme.

After examining results from 62 subjects who completed the trials, Abrams concluded that there was no change in the level of virus in the blood of patients who smoked marijuana or who took Marinol, a prescription drug containing the active ingredients of marijuana.

"We also took a little peek to see if there was any change in appetite, caloric intake and body composition," Abrams said. In simple terms, did the marijuana give the HIV-infected patients "the munchies," causing them to eat more and gain weight? The study results show that they certainly did.

The 20 patients who smoked marijuana -- three times a day for 21 days -- gained an average of 7.7 pounds during the study period while 22 patients taking Marinol gained 7 pounds, and the remaining 20 given a placebo gained only 2.9 pounds. The patients assigned to smoke pot were given three joints of what Abrams called "government grade" marijuana, which is about one-third as potent as marijuana commonly sold on the streets or purchased at buyers' clubs.

Patients taking either the Marinol or the placebo were given unlabeled pills. They did not know whether they were taking the active ingredient or the dummy pill. One of the curious findings of the study was that nine of the 20 patients given the dummy pill thought they were given Marinol.

21-DAY STUDY

By any standard, the marijuana study was an unusual event in the annals of science. Patients from all around the country who heard about the study volunteered to enroll in it. They were essentially locked up in a unit of San Francisco General Hospital for the 21 days of their trial. Those who smoked marijuana had to do so in a closed room with ventilation, so that secondhand smoke would not affect the test subjects taking the pills.

Each patient had a refrigerator loaded with snacks next to his or her bed. The refrigerators were locked at midnight.

Abrams acknowledges that the consumption of psychoactive substances produced some interesting behavior, but he said he will be reporting on that at a later time. "You saw what you might expect from people smoking marijuana in a confined setting for 21 straight days," he said. Typically, there were three patients being tested at the hospital during any given day.

The experiment did produce a number of adverse effects. One patient who smoked marijuana left the study after experiencing "neuropsychiatric symptoms." Among those taking Marinol, one left with neuropsychiatric symptoms; one quit after suffering headaches and nausea; and one patient died 58 days after completing the test from an internal hemorrhage that is believed to have been unrelated to the study.

San Mateo County health officials said yesterday that they have received "informal and conditional approval" for a somewhat similar marijuana study from the National Institute on Drug Abuse and are awaiting the required approval from the Food and Drug Administration plus authority to obtain the marijuana from the Drug Enforcement Administration.

According to Ron Robertson, chief operating officer at San Mateo Community General Hospital, the county's proposal would involve AIDS patients smoking marijuana or placebo as outpatients rather than being confined to a hospital setting during the controlled clinical trial.

E-mail Sabin Russell at russells@sfgate.com.

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