THC for HIV: Is smoking weed the only way?

The medical marijuana debate is still raging and I have little doubt that it will be around for at least a decade to come. In the mean time, there is little doubt that marijuana, and more specifically its most active ingredient THC, are useful for individuals suffering from a number of medical conditions (see medical uses of marijuana). One of those conditions is HIV, where THC is particularly useful for helping patients fight the anorexia that often goes along with the infection and treatment. While a number of states (15 and the District of Columbia at last count) allow for medical marijuana prescriptions, most others require that patients get their THC in a synthetic form known as dronabinol.

Synthetic THC in a capsule

I’m not getting into the discussion of whether putting THC in a synthetic form is the American government’s way of directing money towards the pharmaceutical industry. The bottom line is that smoking marijuana, like smoking cigarettes, causes pulmonary (as in lung) problems including an increased risk of cancer as well as a host of other diseases like emphysema and such. New(ish) devices like vaporizers may help reduce that risk, but until more data comes in, I doubt those are going to cause any movement in terms of legislation. And since smoking marijuana is still illegal in most states, patients are pretty much left with the dronabinol pill.

The only problem is that something like 30% of HIV patients report smoking marijuana any way for relief of disease-associated symptoms and no one ever assessed the effectiveness of dronabinol on these patients until now. In this recent study, researchers assessed the efficacy of a very high dose of dronabinol (10mg – twice the recommended daily dose and half of the allowed daily maximum dose) on HIV/AIDS patients who smoke marijuana recreationally. Not surprisingly these patients showed a reduced response to the drug and even this high dose was only effective for the first half (eight days – during which they consumed 350 more calories a day and slept better) of the experimental period, after which it was no more effective than placebo at improving caloric intake and sleep.

The researchers’ conclusion in this article is that is seems higher doses are necessary for these patients, although I wonder about the rates of lying about regular marijuana use by patients given its legal status in most states. The patients in this study all smoked marijuana but while some smoked sporadically (2 days a week), others were daily or near daily smokers. I would assume that those two groups reacted differently to the dronabinol, but this paper didn’t address any such differences.

So… Do you have to smoke weed to get the medical benefit of THC?

Overall this study, like a few others before it, shows that synthetic THC is effective in treating a number of the effects of HIV/AIDS infection and treatment. Nevertheless, there is little doubt that HIV patients who use marijuana require different dosing than patients who don’t smoke weed, an effect that was probably predictable. Given the high prevalence of marijuana smoking among HIV/AIDS patients, it seems that more research should be carried out in order to fully develop a recommended dose range for such patients.

For HIV/AIDS patients who live in states where medical marijuana use is legal, it is likely easier and more cost effective to get their THC from marijuana leaves, though given their increased risk of infection and the lung effects of inhaling smoke, they should likely play it safe and use a vaporizer rather using more traditional methods (as in joint, bowl, or bong). The last thing HIV patients need to do is to put their body at any increased risk of any sort of medical complication. However, since dosing can be an issue this way, and since not everyone objects to the notion of taking pills instead of smoking weed, dronabinol might be a good options for those who are simply looking to counteract their infection complications and not to light up.

Citations:

Gillinder Bedi, Richard W. Foltin, Erik W. Gunderson, Judith Rabkin, Carl L. Hart, Sandra D. Comer, Suzanne K. Vosburg & Margaret Haney (2010). Efficacy and tolerability of high-dose dronabinol maintenance in HIV-positive marijuana smokers: a controlled laboratory study. Psychopharmacology, 212, 675-686.

Arno Hazekamp, Renee Ruhaak1, Lineke Zuurman, Joop van Gerven, Rob Verpoorte (2006). Evaluation of a vaporizing device (Volcano®) for the pulmonary administration of tetrahydrocannabinol. Journal of Pharmaceutical Sciences, 95, 1308-1317.

Harm reduction – Why the bad press for addiction treatment that works?!

condoms can help protect again STDs

How many of you think that giving a crystal meth user condoms will increase their drug use? Probably not many. What if instead the question had to do with giving that same user clean needles rather than having them share a dirty one? Or having him reduce his drug use instead of stopping completely? I bet there would be a little more disagreement there.

Some of you may have heard of the harm-reduction approach to drug abuse counseling and treatment, but many of you likely haven’t because the term itself is essentially taboo in the United States. The idea is to approach the patient (or client) without the shaming or expectations of abstinence that normally come with drug treatment. Instead, the counselors hope to reduce as much of the negative things associated with the drug use.

For example, almost all drug injecting users end up with hepatitis C due to dirty-needle sharing. As in the above example, harm reduction practitioners would seek to provide users with clean needles, thereby reducing needle sharing and the transmission of disease. Risky sexual behavior is often associated with methamphetamine, and crack use; instead of targeting the use itself, often, interventions attempt to reduce unprotected sex, reducing HIV transmission in the process.

hypodermic-needleHarm reduction has many supporters, but unfortunately, there are at least as many people who are against it. The claim is that harm reduction doesn’t stop drug use, and that we shouldn’t be in the business of making drug use easier. In fact, though they have no data to support it, some people argue that giving users clean needles is likely to exacerbate their drug use. My argument is that life as a drug user is pretty difficult as is, and if we can provide a way to show drug addicts that people actually care about their well-being, we might help some of them see the light.

Even more to the point, my thinking is that HIV, Hepatitis C, and other conditions often helped by harm-reduction, have to be considered as additional societal costs of drug abuse. If harm reduction helps us tackle those collateral costs, I’m all for it as an additional tool.

The bottom line is this: If we can use multiple tools to solve a problem, why limit ourselves unnecessarily to only one? If harm reduction helps, why not use it in conjunction with abstinence treatment?

As I’ve mentioned in previous posts, it’s time for us to stop resorting to ridiculous moral judgments and start focusing on solving the problem. If we can help an addict use less, use fewer drugs, or use more responsibly, I say we should go for it!!!

About Addiction: Sex and Drugs, and Addiction’s impact on children and stress

Have questions about addiction? You should browse our content and check out the links in this article and all the others we’ve written. It’s a great quick stop for 30 minutes of information!

Sex and Drugs

Science Centric– What a great way to help others! A peer based outreach service have been developed to aid sex workers resolve their drug problems. The program is lead by current and former sex workers and is helping to increase entry to detox and residential drug treatment programs among women in sex work.

Take Part– A male porn star has tested positive to having HIV. This positive test has put a halt to production of new sex tapes. This article provides five things that individuals should know about the porn industry. It is a great read!

Addiction inbox- Spice has been marketed as a synthetic cannabis. It can get a person high but at the same time will allow individuals to pass a drug urinalysis. That fact is making spice very common in places like police stations, fire department, and army bases.

Breaking the Cycles– Everyone knows how hard it is to break a habit, it often takes time and it is a struggle to maintain the new behavior. This is the same when an addict or alcoholic successfully makes it through their rehab. The hard part however comes when individuals are trying to prevent relapse.  SAMHSA (Substance Abuse and Mental Health Services Administration) suggests that to prevent relapse individuals should think about doing something as opposed to not doing something. This allows individuals to create an anti-drug and anti-drink. This article follows the pattern of our earlier writing on relapse prevention by replacement.

Addiction’s impact on children and stress

Sober teens online- This is not a typical article post that we love to provide you, however it is no doubt very moving. This site displays artwork which depicts the emotions of foster children who are victimized by addiction.

Stress and addiction– Does stress cause addiction? Does addiction cause stress? That’s a popular question when people are trying to figure out the causes of addiction. It is no surprise that stress and addiction have a reciprocal relationship with each other. Stress can cause an individual to start drinking or taking drugs, and stress often triggers addict to use drugs or alcohol. Stress such as early childhood trauma may cause an individual to become an addict when they are older. This article examines the interplay of stress and addiction and also offers a great video about stress and addiction.

About Addiction: Drug use, Addiction Recovery, and smoking

We’re back with our weekly post about addiction news and research. We’ve got harm reduction in Australia, heroin ads that don’t work, the impact of drug abuse on children, and more. Get your 30 seconds of education for the day.

Using Drugs – Heroin, HIV, the law, and recovery

The Australian– There is a state approved heroin injecting room in Australia. The center opened to create a safer place for drug users to shoot heroin. 3500 individuals have overdosed on the premises without a single fatality, making for a very interesting way of combating drug addiction that would definitely fall under that harm-reduction model American hate so much!

Star Advertiser– When it comes to scaring individuals into not using drugs, specifically heroin, fear appeals do not seem to work in preventing future drug users. Fear appeals ads show drug users as violent, and often have missing teeth or skin problems. Apparently, audiences are smart enough to see these as not really representative of heroin users in general and they’re not buying it, making the ads useless in combating drug addiction.

Global Development– Eastern Europe and Central Asia have the fastest growth rate of HIV infection in the world (Russia accounts for between 60% and 70% of the epidemic). This may be due to sharing dirty needles when using drugs and the biggest problem is likely lack of prevention efforts for high risk groups.

Guardian– A senior police officer from Britain thinks that individuals should not be criminally prosecuted for possessing marijuana. By focusing less on drugs found among youth the police can focus on things they see as more important like hard core criminals. I’m sure our legalization friends will love this, although again, this isn’t legalization but decriminalization and parents will hate it.

Addiction Inbox– Meditation and exercise play a role in drug addiction recovery. Both methods apparently help to eliminate the panic and anxiety that plays a role in detoxification. Although it may not be the most popular method of recovery, we at A3 have already written about this and think you should give it a try!

Breaking the cycles–  A program called Partnership for a Drug Free America has five new drug programs in order to eliminate drug use among teens. These programs educate teens as well as their parents with a variety to drug information.

Smoking, pregnancy, and attitude

Science Daily- Women who smoke during pregnancy can hinder their children’s coordination and physical control (likely affecting boys more). Smoking during pregnancy can damage development in the fetal stage, so if you are expecting try not to light up (as our other post on pregnancy and smoking recommends).

Decoder– You are in for a good read on the changing attitudes of smoking. This blog gives an inside perspective on smoking and how it has evolved from the time it was considered “cool”.

Addiction’s impact on others

Philly Daily News- Addiction impacts not only the drug addict but their children as well. 15% of all children live in a household with an alcoholic and one in four children is exposed to a family member’s alcohol abuse or dependence. These children are often neglected when their parents are under the influence and that neglect can lead to some pretty terrible outcomes for the children themselves down the line.

Addiction Recovery– This is an excellent read on the importance of patience when it comes to addiction recovery. Rome wasn’t built in a day and neither will a drug addict’s wonderful new life. Recovery takes time so take a deep  breath and enjoy!

Women, Trauma and HIV Transmission

Co-authored by Jamie Felzer

Just how much can the events of a traumatic childhood affect the likelihood of contracting HIV or other serious diseases in later life? Unfortunately, recent research shows that the effect can be profound, especially for women.The silver lining may be in our ability to reduce later HIV transmission by providing better intervention services post-trauma.

Childhood Trauma, Women and HIV/AIDS

In ways both surprising and predictable, it seems that even very early childhood trauma can be firmly linked to high risk behaviors and a higher risk of contracting HIV. And with AIDS now reported by the US Department of Heath & Human Services as the leading cause of death for African-American women between the ages of 25-34 (and the perhaps even more sobering H&HS assessment that African-American women are a staggering 21 times more likely to die from AIDS compared to non-Hispanic white women), this crisis has a particular impact on women of color.

The obvious conclusion is that those subjected to childhood trauma are more likely to engage in risky behavior in an attempt to relieve some of the chronic stress that often accompanies such experiences. Drug use, unprotected sex, heavy drinking and other accompanying behaviors can all seem like appropriate responses to mental and emotional stress, but that stress can also inhibit one’s ability to make safe choices in this context. This naturally leads to an increased risk for contracting sexually transmitted diseases and blood-borne pathogens. Factor in the simple biological reasons why women may be at an elevated risk of contracting HIV through any one encounter, and it becomes clear that many at-risk young women are not receiving adequate education on how to protect themselves against this threat.

Many young women with a history of trauma and elevated lifetime stress from sexual assault, violence or any of the myriad stressors that accompany low socioeconomic status may be inadvertently putting themselves at greater risk for contracting HIV and AIDS. As mentioned, these risks can commonly come from unsafe sex and the abuse of unknown drugs, potentially with non-sterile needles. Without a strong support system to help them adequately process the short and long-term effects of trauma, many young women end up developing symptoms of chronic anxiety and depression, conditions that can alter behavior and even ultimately lead to demonstrated higher rates of mortality. That these conditions also often co-exist with other health issues linked to lower socioeconomic status such as obesity and heart disease serves to further compound this risk. Stress has even been shown to speed the progression of the AIDS virus, making the disease itself more deadly.

And with a full 1/3 of the female population having reported some form of sexual assault or similar violent trauma, the sad reality is that the risks for contracting HIV among young women are, if anything, growing. It seems that one way to attack the HIV pandemic is by improving prevention, as well as intervention, services, for women affected by such early trauma. It might be a way to kill two, or even more, birds with one stone.

About Addiction: HIV, smoking, obesity and steroids

We have some wonderful new links about addiction for you to explore and learn through:

Clinical Trials (for anyone interested in participating):  This is the description of a study which is currently recruiting participants to test the neurocognitive effects of buprenorphine among HIV positive and HIV negative opioid-users. The researchers hypothesize that the reasoning abilities of HIV positive participants will be lower than of HIV negative participants.

Science Daily: researchers have developed a technique to visualize the activity of the brain reward circuitry in addicts and non-addicts. This exciting development might help in finding the right treatment strategy for addicts.

Health Day: Three new studies find more evidence that smoking is affected by genes. One study found three genetic regions associated with the amount of cigarettes smoked per day by a person.

UCLA Newsroom: A new study at UCLA found that more than a third of drinkers which are 60 years old and older consume excessive amounts of alcohol. This might be potentially harmful in relation to diseases they may have or medication they may be taking.

Reuters: Obesity and smoking may raise blood clot risk.

Los Angeles Times: An article from the Los Angeles Times about steroid damage. According to the article, long-term use of anabolic steroids damages the heart more than researchers believed.

The benefits of marijuana: Things are far from all bad for weed

Marijuana can certainly be beneficial.

It’s true that essentially every drug has some abuse liability. However, somewhere in the vicinity of 85% of those who try any given drug will never develop abuse or addiction problems (yes there are probably variations based on specific drugs, but that’s a good estimate).  As we all know, marijuana is a drug that receives a lot of attention and drives intense debate when it comes to its benefits and harms.  While most of the posts on my site focus on the other 15%, there is, and continues to be, evidence for the benefits of marijuana and other drugs that directly activate cannabinoid receptors.

Some of the shown benefits of marijuana

THC, the active ingredient in cannabis, is known to cause sedation, euphoria, decrease in pain sensitivity, as well as memory and attention impairments.  But there are some aspects of the cannabinoid receptors that have been shown to be effective in AIDS, glaucoma and cancer treatments.

Stimulation of cannabinoid receptors causes an increase in appetite and therefore helps with the wasting syndrome often seen as a side effect in AIDS treatments or those with eating disorders. Since THC activation decreases intra-ocular pressure, another area in which marijuana has been proven to be effective is in the treatment of glaucoma.  THC’s anti-emetic (or anti-vomiting) properties also make it a very useful tool for combating the side effects of cancer treatments.

Still, the activation of cannabinoid receptors is not synonymous with smoking weed. In fact, there are a number of other possible ways to consume THC and other cannabinoid-receptor activators. Also, THC is a potent immune suppressing agent, so in someone who already has a compromised immune system, such as AIDS patients, marijuana and other THC compounds could increase the risk of infection.

Future promise for the use of THC in medicine

There is some evidence that of the 2 major THC receptors (CB1 and CB2), one is associated with the immuno-suppression that occurs after chronic usage and the other is associated with the the more beneficial aspects we’d discussed. In the future, we may be able to produce a compound that activate only the behavioral effects and could therefore be used more safely for AIDS patients. Marijuana lovers will say that we should leave things as they are, but I’m all for less immuno-suppression with my cancer therapy.

Again, just because activation of THC receptors can provide the above benefits does not necessarily mean one should smoke marijuana. As usual, the benefits and risks have to be considered and one has to reach an educated, informed, conclusion. Still, there’s little doubt that in some situations, the use of marijuana, or other THC activators is not only prudent, but indeed recommended.

Co-authored by: Jamie Felzer