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Donald I. Abrams, MD, is a leading expert on the use of medical marijuana for the treatment of AIDS. Interview with Dr. Donald Abrams: AIDS, Pain and Cannabis Expert
By Admins (from 15/08/2013 @ 08:08:01, in en - Video Alert, read 2504 times)

He has seen and experienced its benefits firsthand through his involvement with some of the first clinical marijuana trials to ever be conducted on patients with the painful, life-threatening disorder.

Dr. Abrams currently serves as the chief of Hematology and Oncology at San Francisco General Hospital. In 2006, Abrams took on an additional role as a cancer and integrative medicine specialist at the UCSF Osher Centre for Integrative Medicine at the University of California, San Francisco.

On top of his demanding and accomplished career, Dr. Abrams remains on the forefront of medical cannabis research. Widely respected by patients and doctors alike, was eager to speak with Dr. Abrams about his work in this exciting field of medicine. What sparked your interest and involvement with medical cannabis research?

Abrams: It goes back quite a while. I did my training to be a cancer specialist in the ‘70s, when we didn’t have a lot of anti-nausea drugs and many of our patients seemed to benefit from smoking cannabis at that time.

In 1989, I had a partner who died of AIDS after choosing not to take AZT – the only anti-retroviral drug available then – under my recommendation. I didn’t think that it was very good. But he found benefit from smoking cannabis, which he did daily.

In 1992, while I was in Amsterdam for the International AIDS Conference, I saw Mary Ratburn on the CNN headlines news being arrested for bringing cannabis brownies to our AIDS patients at San Francisco General Hospital. She was in her late 60s and brought brownies to our patients so they could eat their food and take their medicine.

When I got back to San Francisco, there was a letter from Rick Doblin – founder of the Multidisciplinary Association of Psychedelic Studies (MAPS) – suggesting that a clinical trial demonstrating the benefits of cannabis should come from Mary’s institution. I responded to the challenge and began discussions with the government in hopes of conducting clinical research on marijuana. Can you describe the results of the various medical marijuana studies that you’ve been involved with?

Abrams: The first study that I wanted to do was a study to show that marijuana improved appetite in patients with the AIDS wasting syndrome.

But what I learned was that the National Institute on Drug Abuse (NIDA) – which is the only legal source of cannabis in the country – has a mandate from Congress to only study substances of abuse as substances of abuse. Meaning that if they figure cannabis is a substance of abuse, they can’t provide cannabis or fund studies that are going to try to demonstrate that it has medicinal benefits.

By the time I came to understand this, we already had drugs that were effective in combating the AIDS wasting syndrome. But, there was a possibility that recreational drugs could interfere with the metabolism of the anti-viral therapies.

In 1997, I received funding for my first study which looked at a potential interaction between cannabis (we used dronabinol in this case) and protease inhibitors – the potent drugs that were saving AIDS patients’ lives. We looked at the level of the AIDS virus, the impact on the immune system, the levels of the anti-viral drugs and any changes in weight and appetite. We found that cannabis caused no real problem in any of these instances and, if anything, we saw weight gain in patients with HIV who did not have the wasting syndrome.

In California, we had the University of California Center for Medicinal Cannabis Research (CMCR), which had $3 million a year for 3 years to fund clinical trials investigating the safety and effectiveness of cannabis in various conditions. The first study I did with CMCR funding was again in patients with HIV who had painful nerve damage known as peripheral neuropathy. We did a placebo controlled trial that showed that inhalation of smoked cannabis lead to a decrease in the pain, both from the peripheral neuropathy as well as in an experimental pain model that we did on the patients.

The next study we did was to examine the Volcano Vaporizer as a smokeless delivery system because we knew that people were not enthusiastic about smoking a medicine. We took healthy cannabis smokers and subjected them to 3 different strengths of NIDA cannabis. We found that vaporization produced the same amount of active cannabinoids in the blood stream, that it was actually preferred by the patients, and that it was associated with less expired carbon monoxide, which is a marker of exposure to harmful gases.

The last study that we did was a pharmacokinetic interaction study which involved patients with chronic pain taking a stable dose of sustain-released morphine or sustain-released oxycodone. We subjected them to vaporized cannabis for 4 days and we measured the level of the opioids in their bloodstream before and after exposure to cannabis to see if there was any interaction. We found no significant change in the levels of opioids. If anything, the levels of morphine seemed to decline slightly. But we did see a boost in pain relief despite the slightly lowered levels of opioids. That suggested there was a synergistic interaction between cannabis and the opioid medications – that is, 1 + 1 = 5 as opposed to 1 + 1 = 2. Hopefully, the next study we do will be a larger study to confirm the synergistic interaction between the two. How do the synthetic cannabinoid medicines compare to vaporized cannabis?


Abrams: Delta-9-tetrahydrocannabinol (THC), which can be obtained in oral capsule form, is just one of over 400 components of the plant. I believe having all the other components of the plant provide the ‘ying’ and the ‘yang’ – that is, they balance out the negative effects of THC and enhance the positive effects.

Sativex is now also available in Canada and Europe and is in clinical trials in the US. This under-the-tongue spray is a whole plant extract that has some manipulation of the CBD and THC ratios, which some people find quite useful. Could the pain-mitigating effects of medical cannabis be applied to any other conditions or disorders?

Abrams: I’d recommend it to anybody with pain, the research has already been done there.

I think there’s good evidence for its use in helping with nausea and sleep. I often recommend cannabis to my cancer patients for nausea, pain, depression and insomnia, just because I know that it works – you don’t have to do a clinical trial to prove that. In your opinion, is marijuana a viable alternative to current legal substances such as alcohol and tobacco?

Abrams: It was certainly my alternative in college and medical school. I’d be a very different person today if I chose alcohol instead of cannabis at Brown University and Stanford University School of Medicine.


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