For too long, conducting legitimate research on the medical benefits of marijuana was all but impossible. Kept out of the hands of doctors and scientists by an overzealous DEA, pot is still classified by the federal government as a Schedule I drug under the Controlled Substances Act—the strictest category available. This makes funding and access to research-grade, federally legal cannabis hard to come by; even in states where marijuana is legal, studies on the drug are still subject to approval by multiple boards, and samples must be procured from the only lab in the country approved to dispense research-grade marijuana.
Nonetheless, a burgeoning field of researchers have emerged to investigate the plant’s medicinal properties. Cannabis has shown promise in treating addiction, PTSD, chronic pain, brain disease and a slew of other medical conditions—and there is now cautious hope that pot may be useful in treating HIV, by helping to block HIV’s entry into cells, reduce chronic inflammation and prevent neurocognitive disorders that can occur as a result of HIV infection.
Robert L Cook, professor of epidemiology at the University of Florida, recently announced he is leading a 400 person study to scrutinize marijuana’s effects on people living with HIV. The five year, $3.2 million study is believed to be the largest of its kind, and will look not only at marijuana’s impact on the brains of HIV patients, but also whether the drug is able to help suppress the virus. Cook will also account for the specific amount of marijuana consumed or inhaled by participants, as well as the amount of THC and cannabinoids in those doses—something he said other researchers haven’t been able to do.
Cook spoke with VICE about how marijuana works on a cellular level, why Florida is an interesting place to do pot research, and what it’s like to research the plant in the midst of the DEA’s effort to block two dozen other medical marijuana proposals.
VICE: How did you first become interested in the effect of marijuana on people living with HIV?
Robert L Cook: I’m a primary care physician and I see patients with HIV all the time. I was looking to see what type of marijuana I should recommend—should my patients inhale it, ingest it, or should I recommend a specific type? There was no data on why a certain type might have a better health outcome for someone with HIV than another, and that’s why I wrote this grant.
In the study, we can compare those who use it daily to those who use it occasionally. We’re going to do urine toxicology screens to try to differentiate what’s in the marijuana, because most people told us they were getting, like, a dime bag a couple times a month, so they probably don’t really know what they are getting.
Ideally, by the end of the study, we can say "Wow, it looks like most people who are using it are using it for pain are using it in a certain pattern." Or that most people who are using it to help them with their stress are using it in a certain kind of pattern.
At the same time, you’re also interested in the effects of THC on the virus and its symptoms, right?
I’ve seen some very interesting data that looked at just how much of the virus is in people’s blood before they were treated with antiretrovirals. The research showed that those who used marijuana had a lower amount of the virus in their blood compared to those who didn’t use marijuana. That’s a good thing if there is a lower amount of the virus. But I haven’t seen any clinical trials looking at the direct effects of THC on the virus. We also don’t have a lot research comparing THC alone versus THC and CBD on people with HIV.
We’re also measuring the inflammatory response to marijuana in a much more carefully controlled way than in previous studies.
Measuring adherence to medications is also important. One of the reasons why marijuana might affect HIV is behavioral; the stereotypical scenario is that someone who uses marijuana becomes less motivated—they sit on the couch, watch TV and don’t take their medications on time. I’m not sure that’s true, but we will be looking into it.
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Can you tell me more about how THC, the chemical compound in cannabis, works on a cellular level?
THC almost exclusively hits CB1 receptors, cannabinoid receptors located throughout the body. This causes people to feel high or imbalanced, and also affects their short term memory. The CB1 receptors, in addition to being in the brain, are in a lot of our immune cells. There are 100 different cannabinoids in marijuana, and those that target this receptor seems to repress inflammation. The pharmaceutical industry is really looking to create synthetic analogs of THC or CBD and hit those receptors.
But I haven't seen too much research directly comparing THC and CBD on these clinical effects. While I believe THC is more likely to cause some of the high experiences, while the CB2 tends to repress inflammation, it’s hard to know what that translates to in terms of pain relief. You know, if people feel better, is it because their pain is really diminished or are they just high and don’t care as much?
Some folks are also excited about the fact that while antiretrovirals can’t cross the blood-brain barrier, compounds in pot are able to do so—and reduce inflammation in the process.
Yes, that’s very exciting. You know, we can control the virus mostly through medications and yet people with HIV still do age a bit more rapidly; they still get heart disease four to five years earlier, and a lot of people think that is due to chronic inflammation. So certainly a product that helps control inflammation could help people live longer, happier lives.
What makes Florida such an important place to do this research?
One in ten people with HIV lives in Florida right now. We have the most new infections in the country. Florida also has an older population and a lot of people using marijuana for the first time are over 50. We also have a lot of ethnic diversity, which helps us have a representative sample of people who could be living in other places, as well.
Interview has been condensed and edited for clarity.