Medical Marijuana for HIV/AIDS

In New York Medical Marijuana has been approved for the treatment of individuals with HIV/AIDS who have nausea, pain, muscle spasms or wasting. While Medical Marijuana has just been legalized in New York, its use for medical purposes in HIV patients is not new. The best evidence supports using medical marijuana for weight loss in HIV. Other benefits of medical marijuana in HIV patients have also been reported. A 2003 report found that 37% of HIV patients used cannabis to treat their symptoms. Medical cannabis can offer varying forms of relief for symptoms experienced by HIV patients. A 2005 survey of HIV positive individuals who used cannabis showed that more than 50% reported improvements to appetite, nausea, depression, anxiety, muscle pain and nerve pain. Signiant improvement was also reported for numbness, tingling, weight loss, headaches, tremor, constipation, diarrhea, and interestingly, sleepiness and memory. This may be surprising as marijuana has listed side effects that include sleepiness and memory loss. But many drugs which can relieve something may also cause it. For example, anti-anxiety medications may increase anxiety and antidepressants may increase the risk of suicide in some patients.

Side effects of medical marijuana

The reported side effects for medical marijuana are comparable to other drugs. Some might claim, it is relatively safe compared to other drugs and even safer than some OTC medications that may cause liver failure or other deadly side effects with overdose. However, it does have the risk of addiction affecting around 9% of users. Long term data with high potency medical marijuana is still lacking. There is also conflicting data about drug adherence in people living with HIV/AIDS. Several studies have shown improved adherence while others have demonstrated reduced adherence. Given the importance of anti-retroviral drugs in prolonging the life of HIV positive individuals, monitoring adherence and close follow up of individuals who are using medical marijuana is important.

Alternative treatments to medical marijuana for HIV/AIDS

There are many FDA approved medications that should be used before considering medical marijuana to manage symptoms of HIV. These drugs, either over-the-counter or prescribed may be more effective at relieving associated symptoms than medical marijuana. For example, the over-the-counter anti-diarrhea medication Imodium was rated by HIV patients as being more effective than marijuana. Alternatively, FDA approved medications containing synthetic THC, the active psychoactive component in medical marijuana, can be tried even though anecdotal evidence suggests more side effects occur with these medications compared to medical marijuana.

Hitting multiple targets with the same marijuana

While some first line treatments might work as well as medical marijuana to treat a single disorder, it might be ideal to use marijuana to treat patients affected by several disorders. For example, while Imodium might work better to treat diarrhea, it is unlikely to provide as much total relief to a person who has diarrhea, anxiety, chronic pain and insomnia.

 Bar chart: The x-axis reflects Annual Household Income (in U.S. Dollars) and the y-axis reflects Percent HIV-positive. The first bar starts at zero $0-9,999 ends at 2.7%, the second bar $10-19,999 ends at 2.5%, the third bar $20-49-999 ends at 1.2% and the last bar $ greater than $50,000 ends at .4%.Medical Marijuana is expensive

Another advantage of traditional medication is cost. Doctor visits related to treatment with medical marijuana as well as the medical marijuana products are not covered by health insurance. Considering HIV is more likely to affect individuals with lower incomes, it might be difficult for many people living with HIV to afford the medical marijuana or consultations with a professional that is able to provide them appropriate follow up.

Conclusion

Medical marijuana has the potential to help individuals manage HIV associated symptoms. There are arguments for and against the use of medical marijuana. Medical marijuana may work better for certain symptoms, does not have a risk of overdose and can often help more than one problem at once. On the other hand, utilizing traditional medications is more cost effective, may work at least as well as medical marijuana in some circumstances and generally does not have the reported side effect of addiction. Marijuana may also affect Anti-HIV medication adherence requiring close follow up. Given these considerations using first line medications first is prudent.

Author: Michael Morgenstern M.D.

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