Weed Land. Peter Hecht
May 12, 1998, the first patients were enrolled for the study. In total, 67 confirmed HIV patients—89 percent men—who used protease inhibitors were selected for the study from 603 research volunteers. Five dropped out within two weeks. For twenty-one days, the others were kept in the hospital without visitors. One group smoked three marijuana joints daily that had been prepped in a humidifier and which contained 3.95 percent THC. Another group smoked cannabis-fragrant placebo joints with the THC removed. A third group took oral applications of Marinol. The sixteen-member research team led by Abrams monitored the weight, cell counts, and viral health of the patients.
The study concluded that use of cannabinoids, the natural THC in pot or synthetic THC in Marinol, neither increased the viral load of individuals with HIV infection nor interfered with their protease inhibitor drugs. Anecdotally, the researchers noted that patients given Marinol were more lethargic and spent more time in bed, while those smoking pot were more active. The research, Abrams wrote, failed to demonstrate “clinically significant interactions with cannabinoids that would warrant dose adjustments of protease inhibitors.” He delivered the conclusion that marijuana was a safe medicine for people with HIV. It didn’t interfere with anti-AIDS drugs. And there was something more. Patients using marijuana and Marinol saw increased production of healthy cells, with marginally higher levels for the pot smokers. People in the marijuana group also put on an average of 7.7 pounds in twenty-one days, compared to 7 pounds for the Marinol group and 2.9 pounds for the placebo group. Though there were no wasting patients in the study, the clinical trial signaled that pot could boost the immune system for people with HIV and AIDS.
Despite the results, no leading medical research journal was eager to publish a medical marijuana study. Abrams was rejected by the prestigious medical journal Lancet, by the New England Journal of Medicine, and by the Journal of the American Medical Association. Ultimately, after an initial denial, the Annals of Internal Medicine of the American College of Physicians interviewed Abrams on his study. In 2003, it published his research. Clinical evidence of the efficacy of cannabis with HIV patients was now part of accepted medical literature. In the study and with the media, Abrams was politic about the conclusions. He wrote that the findings meant “placebo-controlled studies of the efficacy of smoked marijuana could be considered in the future.” He called for more research.
After the death of Mark Henry, Abrams had found a new life partner in Clint Werner, with whom he began a relationship in 1994 and later married. Years after Abrams’s clinical trial on cannabis and patients with HIV infection, Werner revealed the doctor’s internal sense of triumph. What Abrams mostly refrained from broadcasting, Werner, a natural-foods chef devoted to the dietary prevention of disease, all but shouted out. “The clinical trial was a Trojan horse, finally allowing researchers to get the data they had been seeking for years,” Werner wrote in his book Marijuana Gateway to Health. Abrams’s “true purpose” in the study, Werner wrote, “had been to ascertain whether marijuana helped improve the appetite of AIDS patients—and it did.” Abrams’s husband concluded with a flourish: “Science had spoken. THC really did cause the munchies.”
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After Donald Abrams’s breakthrough clinical trial, state assemblyman John Vasconcellos sought to make medical cannabis research a fully funded priority of the state. Vasconcellos championed legislation calling for creation of a California “Center for Medicinal Cannabis Research.” Its mission would be to provide answers—affirmative, negative, or both—to the question “Does marijuana have therapeutic value?”
Vasconcellos set out to develop the concept in consultation with some of the top medical and research professionals in the University of California system. One of them was Dr. Igor Grant, a renowned neuropsychiatrist at the University of California, San Diego. Grant directed the UC San Diego HIV neurobehavioral program, which used brain imaging and neuropsychological studies to research the effects of HIV and AIDS on the brain. Grant also had a long-standing interest in the impacts of alcohol and drug abuse, going back to when, as a young faculty member at the University of Pennsylvania in the 1970s, he analyzed literature on whether long-term marijuana use could cause brain dysfunction. Grant looked at rodent studies suggesting that high-dose exposure to THC in young rats could produce learning and performance deficits. He extrapolated the data to humans. To achieve the same effect, Grant would later conclude, a 154-pound man or woman would have to smoke 420 joints day.
Grant believed the discovery, in the early 1990s, of receptors in the brain that reacted to marijuana had opened the door to new medical research for pot. Researchers looking at the effects of THC named the first of these molecular neurotransmitters anandamide, using the Sanskrit word for bliss. They discovered that THC would bind itself to these receptors, found on the surface of cells throughout the central nervous system. The receptors were later named cannabinoid receptors, after the cannabis plant. Natural compounds produced by the body and acted upon by marijuana were named endocannabinoids. For Grant, identifying a molecular signaling system for pot—a system that worked much like the different receptors in the body that reacted to opiate drugs such as morphine or codeine—meant researchers could look at pot’s potential for treating conditions such as multiple sclerosis, glaucoma, gastrointestinal disorders, cancer, and chronic pain.
Such research on pot was not possible in California unless Vasconcellos could get a marijuana research bill through the legislature. Vasconcellos, a self-described “old-time liberal,” found an unexpected ally during the 1998 election season in a law-and-order conservative, Dan Lungren, who was then attorney general. Lungren, who had been an ardent opponent of Proposition 215, ran for governor in 1998. He drew a Republican primary challenge from Dennis Peron, whose cannabis club had been targeted by the attorney general. With no shot at winning, Peron served as an antagonist to remind people that Lungren opposed the will of voters on medical marijuana. Looking to find middle ground on pot for the November general-election race against Democrat Gray Davis, Lungren endorsed research on the medical use of cannabis. Vasconcellos saw a political opportunity. He reached out to the attorney general. Their staffs began drafting legislation for unprecedented medical marijuana studies.
Lungren was gone from office, defeated in the governor’s election, and Vasconcellos had moved to the state senate when the pot legislation—Senate Bill 847—reached the floor in 1999. Lungren’s endorsement helped pry loose crucial Republican votes. Vasconcellos needed twenty-seven votes—a two-thirds majority of the forty-member senate—to pass the appropriation. With no votes to spare, Vasconcellos offered procedural cover to three Republican senators—Jim Brulte, Tim Leslie, and Pete Knight—who were skittish about being the twenty-seventh vote on a pro-marijuana bill. The GOP trio agreed to shout “aye” in unison so that no individual got the blame as California lawmakers voted to spend $8.7 million in state tax dollars to study weed.
The Center for Medicinal Cannabis Research was created in 2000 and headquartered at UC San Diego, with Dr. Igor Grant as its director. Research proposals began streaming in by 2001. Over the next decade, the center would approve and oversee fifteen California clinical studies, including seven trials directly testing pot’s effect on research subjects. The center established an exhaustive peer review process and used the legislative clout of the most populous state in the nation to win research approval from multiple federal agencies. Grant, who didn’t conduct any research himself, saw to it that the center handled all research applications and that his clinicians didn’t have to fight the government to do cannabis work. Meanwhile, Grant demanded rigorous, modern trials that could be published in medical research literature. He figured there was no point in wasting California tax money on studies “that wouldn’t see the light of day.”
One of those applying for a research grant, Dr. Barth Wilsey, a pain management physician at the University of California, Davis, sought funding for a study on whether cannabis provided relief for people with neuropathic pain from spinal cord injuries, diabetes, strokes, and other conditions causing life-disrupting discomfort from nerve damage or injury. Earlier in his career, Wilsey was a fellow in pain management at UC San Francisco, seeing patients in a small clinic in the city. People coming in would tell him they turned to marijuana when nothing else seemed to work. Wilsey, a licensed acupuncturist, was interested in alternative therapies. As a pain doctor, he figured that 40 to 60 percent of his patients didn’t get adequate relief from prescriptions he