Drug Watch International

MARIJUANA RESEARCH REVIEW

Marijuana absent in 1993 scientific review of glaucoma  treatment

Glaucoma treatment was thoroughly reviewed in the New England Journal of Medicine, Vol.328, p.1103,1993, by Quigley. Marijuana was not mentioned in the review of effective medications for treatment of this disorder. For precise control of the intraocular pressure usually associated with this disease, frequent monitoring of patients receiving a drug that delivers uniform doses is necessary.

Commentary: Except in rare instances glaucoma is a symptomless disease until loss of eyesight begins. Most, but not all patients afflicted with glaucoma, experience increased intraocular pressure which, if left untreated, will lead to blindness. Since there are many effective medications, and since doses of marijuana by smoking cannot be controlled, using smoked marijuana to treat glaucoma is potentially dangerous.

Because the baseline (normal) pressure varies from individual to individual, this disease and its treatment must be carefully monitored and tailored to each patient. Though marijuana, like alcohol, can reduce intraocular pressure, the dose cannot be controlled and risk of damage due to either excessive or inadequate lowering of pressure could lead to blindness. Further, the side effects associated with marijuana use, such as impairment of motor skills, are not present with currently available approved therapies. To assure the best outcome for this disease, frequent monitoring of patients receiving a drug that delivers uniform doses is necessary. ##

Suppository form of Delta 9 THC better than oral form for treating appetite loss

Struwe et al, in the Annals of Pharmaco­therapy, vol.27, pp.827-831,1993, reported a double-blind, randomized placebo-controlled crossover trial with two 5-week treatment periods separated by a 2-week washout period. Patients received dronabinol (Marinol) 5 mg twice daily before meals, or a placebo. Twelve HIV-infected patients who had lost at least five pounds participated in the study. Only five patients were able to complete the protocol because of various side effects of delta 9 THC. In the subjects who completed the study, there was no statistically significant weight gain, increased serum proteins, or improved appetite.

Commentary: Smoking marijuana has been alleged to be good for the loss of appetite seen in AIDS patients. Because inhalation of irritants (which potentially could be contaminated with fungi) poses a needless and serious endangerment to the already compromised immune systems of AIDS patients, this practice would appear risky.

Oral delta 9 THC, the synthetic form of the most active cannabinoid in marijuana, would seem to be a better choice, but recent research on its efficacy was disappointing. Thus, in a selected group of HIV infected patients, a controlled study failed to support any effect of delta 9 THC to increase appetite.

Perhaps the recent report by Mattes and associates, in the journal, Pharmacology, Biochemistry, and Behavior, vol.44, pp. 745-747,1993, of a rectal form of THC which was well-tolerated, would be of benefit. This drug produced higher and more sustained plasma levels which should enhance its efficacy as an anti-vomiting drug in chemo-therapy and, perhaps, as an appetite stimulant. This would completely avoid the necessity to have a smoked form of the drug in which a variable amount of active drug is delivered with each cigarette and further compromises damaged immune systems. ##

Marijuana carries serious risk for those under treatment for mental illness

Tardive dyskinesia is a condition in which abnormal involuntary movements develop, producing serious neurologic disability. Some patients treated for schizophrenia with drugs such as chlorpromazine, develop this serious condition as a side effect of therapy New research published by Zaretsky in the journal, Schizophrenia Research, Vol.11, pp. 3-8,1993, shows that a major risk factor for development of this complication of neuroleptic therapy is current or past use of cannabis. A study of 51 chronic neuroleptic-treated outpatients with diagnoses of schizophrenia showed that current use of cannabis far outdistanced any other risk factor such as cigarette smoking, caffeine, or alcohol use. The authors concluded that even "recreational" use of marijuana or hashish in patients treated with these drugs was dangerous.

Commentary: This study adds to the current literature confirming that up to 60% of schizophrenic patients use non-prescription psychoactive drugs. ##

Marijuana components damage the ability of human immune cells to function

Recent work by Watzl et al, Drugs of Abuse Immunity and Immunodeficiency, 1991, and Djeu et al, published in the same journal, showed that the major psychoactive component of marijuana, delta 9 tetrahydro­cannabinol (THC) is able to interfere with the function of white blood cells taken from humans. Both neutrophils, which fight bac­terial infection, and mononuclear cells of the immune system, which fight viruses, were suppressed by various concentrations of THC.

Schwartz, in the Journal of Hospital and Community Psychiatry, Vol.38, p.531, May 1987, pointed out that marijuana use is a factor in preparing the ground for HIV infection and that in the list of risk-reducing behaviors for patients with HIV, a significant preventative step might be to discourage the use of marijuana among those at risk.

It is of interest, as pointed out by Pillia, in the Archives of Toxicology, Vol.65, pp.609-617, 1991, that drugs of abuse, as well as alcohol, have immunotoxic properties which include marked changes in the cellular, humoral, and other components of the immune defense mechanism.

Commentary: Applying this work to human beings would suggest that marijuana smoke would depress those immune cells which protect the body from viral or bacterial infections. This would be particularly dangerous in patients with already compro­mised immune systems, such as those with AIDS.

Thus, since a large majority of people with AIDS have a well-established history of drug and alcohol abuse, Such a compromise of the immune system can render the body more susceptible to the development of AIDS after HIV infection. ##

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Material used in this publication has been has been reviewed and commented on by William M. Bennett, M.D., Professor, Chief of Nephrology Clinical Pharmacology and Hypertension at Oregon Health Sciences University, Portland, Oregon

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