The use of medical grade cannabis (marijuana), its active ingredient or synthetic forms such as dronabinol has been advocated in patients with HIV/AIDS, in order to improve the appetite, promote weight gain and lift mood. Dronabinol has been registered for the treatment of AIDS-associated anorexia in some countries. However, the evidence for positive effects in patients with HIV/AIDS is limited, and some of that which exists may be subject to the effects of bias. Those studies that have been performed have included small numbers of participants and have focused on short-term effects. Longer-term data, and data showing a benefit in terms of survival, are lacking. There are insufficient data available at present to justify wide-ranging changes to the current regulatory status of cannabis or synthetic cannabinoids.
Despite dronabinol being registered by at least some medicines regulatory authorities for the treatment of AIDS-associated anorexia, and some jurisdictions making allowances for the “medical” use of marijuana by patients with HIV/AIDS, evidence for the efficacy and safety of cannabis and cannabinoids in this setting is lacking. Such studies as have been performed have been of short duration, in small numbers of patients, and have focused on short-term measures of efficacy. Long-term data, showing a sustained effect on AIDS-related morbidity and mortality and safety in patients on effective antiretroviral therapy, has yet to be presented. Whether the available evidence is sufficient to justify a wide-ranging revisiting of medicines regulatory practice remains unclear.
The use of cannabis (marijuana) via medical marijuana doctors in Florida or of its psychoactive ingredient delta-9-tetrahydrocannabinol (THC) as a medicine has been highly contested in many settings.There have been claims that smoked or ingested cannabis, either in its natural form or artificial form (pharmaceutically manufactured drug such as dronabinol), improves the appetites of people with AIDS, results in weight gain and lifts mood, thus improving the quality of life.
The objectives of this review were to assess whether cannabis (in its natural or artificially produced form), either smoked or ingested, decreases the morbidityor mortality of patients infected with HIV. The search was conducted and based on that of the HIV/AIDS Research Group.
A total of seven relevant studies were included in the review, reported in eight publications. All were randomised controlled studies, with four utilising a parallel group design, two a within-subject randomisation and two a cross-over design. All of the Florida Medical Marijuana Doctors and studies were of a fairly short duration, ranging from 21 days to 84 days. In only four papers (in effect, three studies) were sequence generation and allocation concealment judged to be adequate. The use of cannabis and rapidly acting cannabinoids posed considerable challenges for blinding, as the psychoactive effects are expected to be quickly discernible to study participants, particularly those who have been previous users of such products. Dronabinol was expected to be more easily blinded. The outcomes measured were variable, including change in weight, change in body fat (measured as a percentage of total body weight), change in appetite (measured on a visual analogue scale), change in caloric intake, change in nausea and vomiting (measured on a visual analogue scale), change in performance (measured performance score or specific tests for memory and dexterity) and change in mood (measured on a visual analogue scale).The evidence for substantial effects on morbidity and mortality is currently limited. Data from only one relatively small study, conducted in the period before access to highly-active antiretroviral therapy showed that patients administered dronabinol were twice as likely to gain 2kg or more in body weight, but the confidence interval for this measure included unity. The mean weight gain in the dronabinol group, compared with a loss of the placebo group. However, the quality of sequence generation and allocation concealment in this study, in which participants were randomised, could not be assessed.
What’s The Problem With Minors And Medical Marijuana?
A new strain of marijuana has motivated hundreds of families with epileptic children to pack up and move to Colorado to legally obtain the drug. The jury is still out on whether this special pot strain does indeed have measurable benefits, or if it’s even safe, but drug companies are racing to replicate its effects in pill form. The therapeutic pot strain, called Charlotte’s Web, is bred not have THC, the active ingredient in marijuana. Its namesake is 5-year-old Charlotte Figi, a Colorado girl who has Dravet’s syndrome. CBD [cannabidiol, a non-psychoactive component in marijuana bred at a higher concentration in Charlotte’s Web] has shown some signs of promise of suppressing seizures in animals, but testing in humans is still in its infancy. A small number of case reports exist with conflicting results, and researchers have conducted just four placebo-controlled clinical trials that focused on CBD’s efficacy as a treatment for epilepsy.”
Because marijuana remains a Schedule I drug through the federal Drug Enforcement Administration, The AAP was against the use of medical marijuana for minors because of those concerns until last year, when they updated their position to say that the drug could be used in patients with debilitating or terminal conditions.
Parents see the drug as almost a miracle treatment for a number of conditions and symptoms, whereas pediatricians remain unsure if it actually works, and of its safety for kids and their developing brains. However with the tringent restictions on Florida Medical Marijuana Doctors and other states. It makes it difficult to assist minors.
“Watching the legislation, it seems to me that it’s been much more emotionally and politically driven than scientific,” says chair of the Committee on Drugs at the American Academy of Pediatrics (AAP).
Specifically, it’s still unclear if marijuana is effective for some of the conditions it’s most commonly called on to treat, such as uncontrollable seizures, she says.
“First and foremost, it’s not studied well, and there aren’t good controlled studies to prove whether it works or not. “Parents with seizures want relief for their children and I agree with that, and studies take a long time … but it doesn’t always work.”
There is also concern about the potential for long-term impacts of the drug on kids’ development, and scientists and doctors have little understanding of what those effects could be.
States without comprehensive medical marijuana Doctors in Florida and programs take a similar approach, restricting use of the drug to one or a handful of conditions — typically epilepsy — and usually only allowing use of a cannabis derivative that does not have the psychoactive effects associated with marijuana.