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Cannabis as an Adjunctive Treatment for AIDS Related Illness.
By Tod Mikuriya
I interviewed Ken at the San Francisco Cannabis Buyers' Club, an illegal medical speakeasy where he comes to buy his marijuana.
Ken D. is in a protracted war. For the last nine years this thirty eight year old married mainframe computer programmer with a degree in accounting has fought the human immunodefficiency virus in his body one skirmish, one battle at a time. He is a long term survivor, beating the odds. A wiry intelligent man with a neatly trimmed beard to hide the lesions of Kaposi's Sarcoma, KS, a form of cancer with many small colonies growing slowly in his skin and mouth with itching and discolored patches. His beard also protects from irritating the inflammation of the skin erupting from the side effects of medications.
Mycosis Fungoides is another cancer that primarily affects the skin. Colonies of T lymphocyte type white blood cells turned cancerous by viruses they ingested grow slowly causing intense itching. They are killed off by low level localized radiation and chemotherapy.
Ken also holds a fungal pneumonia at bay. Pneumocystis Carinii, a fungus that is found most everywhere, including normal healthy lungs without causing symptoms, becomes invasive and toxic when the immune system is weakened. This is one of many opportunistic infectious diseases taking advantage of a weakened immune system.
Oral "thrush", another opportunistic infection from the yeast Monilia, causes recurrent sore throat which also decreases food intake.
He wishes he could work but the terms of his disability status would cost him his benefits that see him through his periods of immobilization. The chemotherapies are specific designer poisons to target specific enzyme systems of the cancer cells or the fungus but are debilitating to the body. A major symptom is loss of appetite. Anorexia is a major threat to the body when fighting these invaders. In order to summon the strength to stimulate the immune system to resist, there must be nourishment. Otherwise, the body must consume itself to support the immune system. Thus loss of appetite, and thus weight, represents a major threat to survival.
The weakness from inadequate nutrition leads to immobilization, stasis, and other complications. Ken, in his fight against depression, a major component, finds cannabis to be an effective ally as both an appetite stimulant and antidepressant. The itching from the KS and MF, however, is intensified by cannabis, reports Ken, because it makes him more aware of it.
Many of the therapeutic agents cause anorexia as a side effect, further suppressing an already poor appetite.
Ken had used cannabis 20 years but only occasionally in social situations. Since then, he has come to rely on using it daily to maintain his appetite while taking the various chemotherapeutic drugs. Not one to run from a fight, he has been a "guinea pig" in many therapeutic research trials that have had varying success in beating back the cancer or the fungal infections.
Despite the sensitivity of his lungs from the PCP infection that caused him to be hospitalized three years ago for four days, he prefers to smoke cannabis.
Two or three puffs of high grade Northern California sinsemilla using a water pipe twice or three times a day is sufficient to maintain his appetite and provide the antidote to the unwanted effects of the antibiotic and other chemotherapeutic agents. He has tried oral preparations including Marinol but found that he had difficulty controlling the dose. He was incapacitated by both cannabis baked in brownies or 10 milligram Marinol capsules. Ken describes himself as being sensitive to cannabis' effects as compared with other social users. For him, the effects of the brownie and Marinol were the same.
Having had lengthy association with fellow cannabis users in his twenty years of experience he acknowledged that it is an individual thing; the impact of the drug on one's mental state for some may be adverse. For him? Definitely salutary.
The appetite stimulation and antidepressant effects help Ken maintain his rational, if laconic, intelligent, I'll take it as it comes attitude in his continuing internal lethal war of immune system versus virus with opportunistic infectious invaders ever seeking to gain advantage. The KS may be seen as a viral invader causing a specific disseminated cancers that will slowly advance unless poisoned or radiated.
Despite different causes of infectious assault upon the immune system be it the Human Immunodefficiency Virus or other viral, parasitic, or bacterial agents, cannabis has a long history of reputed efficacy in traditional medicine for increasing resistance to endemic infectious diseases in India.
In its massive study performed a century ago the Indian Hemp Drugs Commission took note:
"There is a large body of evidence showing that hemp drugs, both as smoked and as drunk, are used as a febrifuge or preventive of diseases common in malarious tracts or arising from bad water. Cannabis continues to be used in contemporary Ayurvedic Medicine to treat malarial fever."
The IHDC in its review of medicinal uses of cannabis discussed one possible mechanism as to utilizing it to ward off febrile illnesses in areas in India reputed to have high danger of infection. Cannabis was recommended to be used by manual laborers to promote appetite, enhance endurance, and protect against illness. Again, the raising of the spirits, or inspiriting provide a psychic component that accompanies the physical effects of the drug.
The Indian Hemp Drugs Commission reviewed Other beneficial effects:
"The drugs are said to be cheering in their effects, and to be prized by many on this account. An interesting illustration of this may perhaps be found in the popular belief existing in many parts that these drugs protect against cholera and other epidemic diseases. One very intelligent witness, who had seen much of this use, explains it to as due to the stimulating and inspiriting* nature of the drugs."
Expectations and attributes in the language entwine with the pharmacology of the drug in producing its therapeutic (or adverse) effects. This affirmative "popular belief" may be seen as a factor that favorably affects the physiology of the user including the immune system in optimizing its resistance to stress. Psychogenic factors play a significant role in the mediation of the immune response.
Linguistically the Sanskrit and Hindi references are to the attributes of healing, strength, and success:
Trailokyavijaya victorious in three worlds
Indracana Indra's food
Virapattra leaf of heroes
Capala the light hearted
Ajaya the unconquered
Ananda the joyful
Harsini the rejoicer
vakpradatava speech giving
medhakaritva inspiring of mental power
creshadipanatva a most excellent excitant
These Indian cultural images from a century ago are in bright contrast with the vulgarized and argot of code, intoxication and incapacitation where the drug is illegal.
To a worshiper of Shiva, many of the contemporary terms for cannabis applied to this holy sacrament would be perceived as unintelligible blasphemy if not barbarous obscenity.
Notwithstanding today's prohibition language of deviance and intoxication, individuals self-medicating for a variety of conditions make independent discoveries that affirm attributes described in the medicine of a different culture. This independent discovery in a prohibitionist society seems to support pharmacology over placebo effect.
Ken has always known his antidepressant and appetite stimulant as marijuana, becoming acquainted with it in a social rather than therapeutic context. He didn't get to know it as a traditional medicine Vijaya or Capala but nevertheless obtains benefit from cannabis.
Postscript: Ken died peacefully ten months later at home with his wife Mary in attendance who had helped him during his long fight. He began to significantly decline in his energy a month after the interview. His legs became increasingly weak and painful. Morphine was begun six weeks later. Ken managed a trip to Florida but needed to to be in a wheelchair.
A month after our interview his anorexia was so severe that Total Parenteral Nutrition (TPN) was begun. A permanent tube was inserted into a large vein for injecting a mixture of nutrients.
Six months after the interview the PCP worsened his condition with increasing weakness and fatigue. It was felt that the fungus had breached the blood-brain barrier and invaded Ken's brain.
Mentally, Ken was free from dementia until six weeks before his death with intermittantly but increasingly severe disorientation and confusion. He would be clear for days at a time before becoming totally disoriented and confused. He would recognize that someone was familiar but misidentify as someone else.
Three weeks before he died he stopped smoking cannabis which continued to ease his nausea and anorexia. Ken became too confused and disoriented to light his pipe.
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