In March, in a hospital room tucked in a quiet corner of San Francisco General Hospital, a 39-year-old AIDS patient made history of sorts when he lighted a marijuana cigarette -- legally. He is the first of 16 volunteers participating in a study of whether the illicit herb can relieve the pain in the hands and feet that afflicts people with HIV.
Although anecdotal stories abound about marijuana's therapeutic powers, there is no data to support such claims. Dr. Donald I. Abrams, who's heading the study at UC San Francisco, says his research -- and similar studies that are getting underway -- are an attempt "to inject some facts into this very emotionally charged debate."
Scientific interest in medicinal marijuana is blooming. It has been kindled, in part, by the recent discovery of a molecular signaling system in the brain and other parts of the body activated by cannabinoids, naturally occurring compounds that are chemical cousins to THC (tetrahydrocannabinol), the active ingredient in marijuana, according to Abrams. Research suggests this system affects movement and emotional excitability, appetite and the growth of cancerous tumors -- and may be as potent as morphine in reducing pain. These findings may explain why smoking marijuana has a calming effect, combats nausea or gives users the munchies.
Smoking, of course, is a crude and hazardous way of delivering THC, and scientists eventually hope to synthesize marijuana's medicinal compounds into a pill. But right now, Abrams' main objective is doing bulletproof science. Because of the tremendous controversy, he says, "we have a burden to do this correctly."
An AIDS doctor since the epidemic began, Abrams knew many of his patients smoked pot to curb nausea and stimulate their appetites, which is why he wanted to study its medicinal potential. In 1998, after a lengthy battle to get funding from the National Institute on Drug Abuse, Abrams conducted the first test of pot on people with HIV. That study showed marijuana helped patients gain weight without weakening their immune system.
If all goes well, his current study will be broadened to involve 100 subjects, half of whom will receive a placebo or dummy cigarette. Abrams is also in the initial phase of tests that use cannabis to ease pain in patients with bone metastases from advanced breast and prostate cancer. "We're looking to see if there is a beneficial interaction between cannabis and morphine, and if pot can decrease the side effects of these opiates," he says.
A potential powerhouse
The San Francisco study is the first sponsored by the Center for Medicinal Cannabis Research. Managed by the University of California, the center is funded by a 1999 state law that provides $3 million annually for three years to study marijuana's potential use.
The active ingredient in marijuana appears to be the Swiss Army knife of therapeutics: a powerful painkiller that also can combat cancer, curb nausea, stimulate appetite, reduce anxiety, ease joint stiffness and control muscle spasms.
The center has so far given the go-ahead to 15 projects, two-thirds of which have cleared many federal regulatory hurdles, including scrutiny from the Drug Enforcement Agency, the National Institute on Drug Abuse and the Food and Drug Administration. Four studies -- on AIDS patients, multiple sclerosis sufferers and people with metastatic cancer -- are already underway, and several more are gearing up, making this "the largest program ever done in the U.S. on this topic," says Dr. Igor Grant, a psychiatrist at UC San Diego.