1. Question - "Is it (marijuana or Marinol) used for AIDS Wasting to increase appetite?"
Yes, according to California Health & Safety Code 11362.5, (A):
"To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief." Nov. 1996 CA H&S Code 11362.5
No, according to the US government's National Institute on Drug Abuse's (NIDA) November, 1998 publication, "Marijuana: Facts for Teens," which states:
"Animal studies have found that THC can damage the cells and tissues in the body that help protect people from disease. When the immune cells are weakened, you are more likely to get sick." 1998 NIDA
Yes, according to Unimed Pharmaceutical's website on Marinol:
"Based on extensive research, the United States Food and Drug Administration has approved MARINOL for two purposes:
The treatment of anorexia (loss of appetite) associated with weight loss in patients with AIDS ... [and]
The treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments..." 2004 Unimed Pharmaceutical's
2. Question - "Is it legal for general medical use and in patients under the age of 18?"
The Los Angeles Times wrote in a Feb. 23, 2004 article "Unorthodox uses for medicinal marijuana," by Daniel Costello:
"A spokeswoman for the Medical Board of California says that few doctors recommend marijuana as a treatment for children and that doing so isn't necessarily improper. The board's position, however, is that it should be done in only extreme cases, such as with cancer patients and only with careful doctor supervision." Feb. 23, 2004 Los Angeles Times
US DEA special agent Richard Meyer of the San Francisco field office stated in Alternet News on Apr. 16, 2002:
"Any cultivation, possession, and distribution of marijuana is illegal under federal law. It is our job is to enforce those laws and we will." Apr. 16, 2002 US DEA
Unimed Pharmaceuticals, the manufacturer of Marinol, states on it's website that Marinol is legal if prescribed by a physician. It notes:
"..the United States Food and Drug Administration has approved MARINOL."
Their website also states:
"MARINOL Capsules is not recommended for AIDS-related anorexia in pediatric patients because it has not been studied in this population. The pediatric dosage for the treatment of chemotherapy-induced emesis is the same as in adults.
Caution is recommended in prescribing MARINOL Capsules for children because of the psychoactive effects." 2004 Unimed Pharmaceuticals
3. Question - "What is the daily dosage usually used to increase appetite?"
Donald Abrams, MD et al., in their research paper "Medical Cannabis: Rational Guidelines for Dosing," published on the internet by CannabisMD, writes the following:
"...a patient-determined, self-titrated dosing model [patient calculated or estimated] is recommended. This self-titration model is acceptable given the heretofore-discussed variables as well as the low toxicity of cannabis. This construct is not unique to cannabis." 2004 Donald Abrams
The Los Angeles Cannabis Resource Center told ProCon.org in a 2004 interview:
"Usually a few puffs prior to each meal is sufficient for many patients. Some will require about half to a whole joint prior to each meal. These are usually thinly rolled, about 0.5 grams in weight.
Those who prefer non-smoked will often eat one quarter to half a brownie, or use about 0.25 grams in a vaporizer, prior to each meal." 2004 L.A. Cannabis Resource Center
According to Marinol's manufacturer, their website guide to Marinol dosage states the following for appetite stimulation:
"Initially, 2.5 mg MARINOL Capsules should be administered orally twice daily (b.i.d.) before lunch and supper.
For patients unable to tolerate this 5 mg/day dosage of MARINOL Capsules, the dosage can be reduced to 2.5 mg/day, administered as a single dose in the evening or at bedtime.." 2004 Unimed Pharmaceuticals
4. Question - "How long does it take to work?"
The Los Angeles Cannabis Resource Center told ProCon.org:
"For appetite, about 10-15 minutes, sometimes less. For stomach pain, nausea and vomiting, about 5 minutes.
Vaporized takes about the same time as smoked to take effect.
Unimed, the maker of Marinol, states on their website:
"Most people with HIV/AIDS in clinical studies noticed a significant improvement in their appetite within 4 weeks, but your response may be different. Even if you think it isn't working fast enough, do not stop taking MARINOL without talking to your doctor first." 2004 Unimed
The Los Angeles Cannabis Resource Center told ProCon.org:
6. Question - "What percentage of people feel "stoned" from it's medical (not recreational) use?"
The L.A. Cannabis Resource Center told MedMJProCon the following in Mar. 2004:
"Most medical users smoke until they feel the 'buzz' because that let's them know it's 'working.'
Many medical patients claim they don't feel high from using a few puffs, although a slight 'buzz' is usually felt. If used very moderately, a patient can titrate (calculate or estimate) their doses so that they reap the medical effects without the 'stoned' feeling.
With edibles, small doses can increase the appetite without the 'stoned' feeling. Larger doses will keep the person 'stoned' for up to 4 hours.
Marinol's manufacturer, Unimed Pharmaceuticals, states on their website, as of Apr. 2004:
"The most frequently reported side effects in patients with AIDS during clinical studies involved the central nervous system (CNS). These CNS effects (euphoria, dizziness, or thinking abnormalities, for example) were reported by 33% of patients taking MARINOL .
About 25% of patients reported a minor CNS side effect during the first 2 weeks of treatment and about 4% reported such an event each week for the next 6 weeks.
You should be aware that your body may be more sensitive to MARINOL when you first start using it, so you may experience dizziness, confusion, sleepiness, or a high feeling. These symptoms usually go away in 1 to 3 days with continued dosage. If these symptoms are troublesome or persist, notify your doctor at once." Apr. 2004 Unimed
7. Question - "What are some of the negatives?"
Donald I. Abrams, MD et al. in their 2004 article "Medical Cannabis: Rational Guidelines for Dosing," published on the internet by CannabisMD, wrote:
"Long-term cannabis users can develop tolerance but, as previously discussed, there is essentially no risk for overdose.
[When eaten] "...orally ingested THC is broken down in the liver to the by-product 11-hydroxy-THC, which, in and of itself, has potent psychoactive effects ... Thus, when THC is ingested orally, there tends to be considerably more sedation..." 2004 Donald I. Abrams et al.
The L.A. Cannabis Resource Center told ProCon.org the following in Mar. 2004:
"Small doses are less harmful for the lungs and other body systems. Patients are advised to use a pure (non-chemically enhanced, non-pesticides) potent blend. The stronger the cannabis, the less required for efficacy.
However, just because no adverse effects from long-term use has been established does not mean they don't exist. Always use with caution and moderation.
Vaporization is the safest known use for inhalation of the plant material. Vaporized works, or doesn't work, faster, and is easier to titrate.
With edibles, small doses, if too small, may not work, and often the patient will not know it's not working until 60-90 minutes after consumption. Then they must consume more, and wait another 45-60 minutes to feel the effects.
Also, sometimes when baking, some brownies in a batch may be stronger or weaker than others. Too strong a dose can produce extreme dizziness, sleep, nausea and vomiting." 2004 L.A. Cannabis Resource Center
Marinol's manufacturer, Unimed Pharmaceuticals, states on their website:
"MARINOL should not be taken by anyone with a history of hypersensitivity to any drug in the cannabinoid class or to sesame oil ...
Caution is recommended in prescribing MARINOL Capsules for children because of the psychoactive effects." 2004 Unimed
The L.A. Cannabis Resource Center told ProCon.org the following in Mar. 2004:
"Small doses can reduce the effects, such as dizziness, lethargy, and sleepiness.
Too small a dose may not work, and too large a dose may create nausea, vomiting and headaches. Patients should always start at the lowest dose, and work up if necessary." 2004 L.A. Cannabis Resource Center
"Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harm associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications. Thus, the safety issues associated with marijuana do not preclude some medical uses." 1999 IOM
The United States Drug Enforcement Administration (DEA) states in their November, 2001 publication "DEA Briefing Book, Drugs of Concern":
"Marijuana contains known toxins and cancer-causing chemicals that are stored in fat cells of users for up to several months. Marijuana users experience the same health problems as tobacco smokers, such as bronchitis, emphysema, and bronchial asthma.
Some of the effects of marijuana use also include increased heart rate, dryness of the mouth, reddening of the eyes, impaired motor skills and concentration, and frequent hunger. Extended use increases risk to the lungs and reproductive system, as well as suppression of the immune system. Occasionally, hallucinations, fantasies, and paranoia are reported." 2001 US DEA
The California Narcotics Officers' Association states in its position paper "The Use of Marijuana as a Medicine," available on its website as of Oct. 8, 2003:
"Common sense dictates that it is not good medical practice to allow a substance to be used as a medicine if that product is:
ingested by smoking,
made up of hundreds of different chemicals,
not subject to product liability regulations,
exempt from quality control standards,
not governed by daily dose criteria,
offered in unknown strengths (THC) from 1 to 10+ percent, and
Unimed Pharmaceuticals, the manufacturer of Marinol, states on its website (as of Apr. 2004):
"MARINOL should be used with caution in patients with cardiac disorders because of occasional hypotension, possible hypertension, syncope, or tachycardia.
MARINOL should be used with caution in patients with a history of substance abuse, including alcohol abuse or dependence, because they may be more prone to abuse MARINOL as well. Multiple substance abuse is common and marijuana, which contains the same active compound, is a frequently abused substance.
MARINOL should be used with caution and careful psychiatric monitoring in patients with mania, depression, or schizophrenia because MARINOL may exacerbate these illnesses.
MARINOL should be used with caution in patients receiving concomitant therapy with sedatives, hypnotics, or other psychoactive drugs because of the potential for additive or synergistic CNS effects.
Although no drug/drug interactions were discovered during clinical trials of MARINOL, cannabinoids may interact with other medications. 2004 Unimed
9. Question - "How does smoked marijuana compare with smoked tobacco?"
Pro Medical Marijuana
Con Medical Marijuana
Former US Surgeon General Joycelyn Elders, MD, stated in a Dec. 14, 2002 editorial published in The Globe and Mail [Canada]:
"...tobacco, through its direct physical effects, kills many thousands of people every year. So does alcohol. And it is easy to fatally overdose on alcohol, just as you can fatally overdose on prescription drugs, or even over-the-counter drugs, such as aspirin or acetaminophen (the active ingredient in Tylenol). I don't believe that anyone has ever died from a marijuana overdose." Dec. 14, 2002 Joycelyn Elders.
Colin Blakemore, PhD and Leslie Iversen, PhD, wrote in an editorial in The Times [United Kingdom] on Aug. 6, 2001:
"It is claimed that cannabis smoke is more harmful to the lungs than tobacco smoke because it contains much the same mixture of noxious substances, and because cannabis users inhale more deeply and deposit more tar in their lungs. On the other hand, cannabis users do not smoke 20 to 40 times a day, as many cigarette smokers do. There may be a health risk, and it is compounded by the combination of cannabis with tobacco, but there is currently no indisputable evidence for a link with cancer.
The reports of cancers of the throat, mouth and larynx in cannabis users were based on small numbers and did not rule out effects of the concomitant use of tobacco.
A much larger study in the United States monitored the health of a group of 65,000 men and women over a ten-year period. The 27,000 who admitted to having used cannabis showed no association between cannabis use and cancers, nor were there any other serious adverse effects on health." Aug. 6, 2001 Blakemore and Iversen
Eric Voth, MD, an internist in Topeka, KS, sent this response to ProCon.org:
"Marijuana is about comparable to tobacco in its effects and risks but it is intoxicating so the harmful effects are mixed. It is also not smoked the same way that tobacco is, so not quite the same respiratory risks and the science suggests slightly different effects than tobacco.
It does have comparable effects on driving skills to alcohol, but does not have the adverse effects on liver, etc. that alcohol does. In that regard, alcohol may be more physically harmful. The addictive effects and potential is comparable to alcohol.
Donald P. Tashkin, MD, in his 1997 article for the Center for Substance Abuse Prevention; Effects of Marijuana on the Lung and Its Immune Defenses stated:
"Analysis of the smoke contents of marijuana and tobacco reveals much the same gas phase constituents, including chemicals known to be toxic to respiratory tissue.
With regard to the carcinogenic potential of marijuana, it is noteworthy that the tar phase of marijuana smoke contains many of the same carcinogenic compounds contained in tobacco smoke, including polycyclic aromatic hydrocarbons, such as benz[a]pyrene, which was recently identified as a key factor promoting human lung cancer." 1997 Donald P. Tashkin, M.D.