The argument for cannabis as medicine: Will ideology or science prevail?

In Saint Lucia and throughout the Caribbean, we at the Caribbean Harm Reduction Coalition have observed the therapeutic value of cannabis (marijuana) to address a number of mental and physical health issues. This has included cannabis as an alternative to alcohol consumption for problematic drinkers, and cannabis use as a substitute for smoking crack cocaine. I have also witnessed first-hand the ways that cannabis use can reduce community violence. Intrigued by these observations, we began to gather together scientific research related to the positive and negative impacts of cannabis use.

In particular, when we discovered a media article on cannabis that quoted a scientific study, we found the original peer-reviewed article in order to compare its actual findings with those reported in the media article – to assess the validity of any claims being made, and to include an accurate and unbiased representation of the original study mentioned below.

The task of separating the scientific facts from the ideological influence of the popular press is not always easy. In my opinion, the USA drug control mechanisms initiated during Richard Nixon’s Presidency in the 1960s and 1970s has led the US National Institute on Drug Abuse (NIDA) and the US National Institutes of Health (NIH) to pursue a 40-year quest to fund drugs research that discredits the therapeutic value cannabis. These agencies routinely made sweeping statements designed to convince the reader to shun the dangers of “reefer madness”.

As a result, research articles that report positive findings about cannabis are not as easy to locate as the more widely circulated articles that report negative findings. To confound matters, media reporting is often not an accurate account of the actual science. For example, a recent article published in the UK newspaper The Daily Mail was entitled “Teenagers who smoke cannabis damage their brains for LIFE and may be more likely to develop schizophrenia”, and reported that cannabis causes permanent damage to adolescent brains. This is different from the actual peer-reviewed article –the first line of which reads: “Regular marijuana use during adolescence, but not adulthood, may permanently impair cognition and increase the risk for psychiatric diseases, such as schizophrenia”. The findings that regular cannabis may cause permanent damage in adolescent human brains could also be said to support a regulated cannabis market – with the focus placed on delaying initiation of cannabis use until adulthood, or reducing the potency of the drugs available.

Despite the best efforts to portray cannabis use in the most negative way, some research findings have broken with the convention. Professor Carl Hart’s work at Columbia University in the USA quickly comes to mind as an example of NIDA-funded research that many hoped would yield negative findings – yet the findings were clearly at odds with the rhetoric of cannabis leading to permanent brain damage. In Professor Hart’s own words: “drugs are not the bogeyman that people said they were”!

Against this context, the scientific evidence in support of therapeutic cannabis use has largely been ignored by the scientific community. The Caribbean Drug and Alcohol Research Institute (CDARI) has compiled an overview of peer-reviewed articles from the scientific literature in the past decade. The findings are clear: cannabis is a valuable ally in reducing the progression of HIV in treatment naïve persons. The prescription of smoked or ingested cannabis for the treatment of AIDS-related symptoms has been approved in 18 US States. Despite the use of cannabinoids (the compounds present in cannabis) by HIV/AIDS patients, few studies have investigated the impact of these medicinal products – meaning that the challenge now is to bring the positive findings concerning cannabis use to policy makers, in order to influence changes in legislation that will allow for medical use, personal cultivation and the possession of cannabis.

So here comes the technical stuff!

Early studies suggested a positive correlation between the development of opportunistic infections, progression from HIV to AIDS, and marijuana use. An analysis in 2003 of HIV patients enrolled on a clinical trial of cannabinoids indicated that their use did not result in significantly reduced efficacy of the immune system. Yet both smoked marijuana and dronabinol (a cannabinoid medicine) were reported to increase total CD4+ T cell numbers and naïve T cell numbers over a 21-day period – both positive outcomes for people living with HIV. A decrease in the viral load of HIV was also observed in these patients, and similar findings have been reported in animal studies – including significantly increased survival over an 11 month period.

Despite these findings, we still didn’t understand exactly how cannabinoid drugs influenced HIV outcomes – until Cristina Maria Costantino and her colleagues at the Mount Sinai School of Medicine published in 2013, followed closely by Servio Ramirez and colleagues from Temple University. Thanks to these breakthroughs, we now have plausible scientific explanations to complement the positive outcomes reported more than two decades previous.

It is estimated that 34 million people are living with HIV, with only 8 million receiving antiretroviral therapy (ART) to treat the virus. New clinical research is suggesting that all people living with HIV should have the option of starting ART – rather than just the more advanced cases. But this is simply impossible given the present state of the response, the inadequate funding (especially in low and middle income countries), the criminalization of behaviours such as drug use, sex work and homosexual sex, the stigma and discrimination faced by people living with HIV, and the lack of awareness and testing in many settings.

Given this treatment gap and the evidence presented above, ethics alone should dictate that any sanctions against the therapeutic use of cannabis should be removed, especially for those people living with HIV but unable to access HIV treatments. Scientists have a moral obligation to advocate to their governments for the provision of medical cannabis. At the Caribbean Harm Reduction Coalition, we are committed to promoting the therapeutic value of cannabis, and we will continue to be outspoken advocates in the face of 40 years of ideology-driven anti-cannabis messaging.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.