are in Research
Medical Marijuana Issue Among PWAS
Reports of Therapeutic Use and Attitudes
Toward Legal Reform
Working Paper Series, University of Hawaii at Minoa. June, 1996(3).
pilot study provides an initial examination of the possible therapeutic uses of
marijuana by persons with AIDS/HIV (PWAs) living in Honolulu, HI. Its original
purpose was to determine the existence of a group of medical marijuana users in
Hawaii, and estimate their degree of political support for a legal reform campaign.
A sample of one hundred twenty three PWAs living in Honolulu, HI, answered a questionnaire
survey about their knowledge (1)
of medical uses of marijuana, especially in connection with AIDS/HIV, their patterns
of marijuana use, their preference for marijuana or Marinol for treating symptoms,
their attitudes toward legal reform, and their level of political motivation on
the marijuana issue. Knowledge about medical marijuana was high: 98.4% had heard
of medical uses for marijuana, and 86.9% had heard of marijuana being used specifically
to treat AIDS-related symptoms. Moreover, at least one third (36.9%) had themselves
used marijuana as therapy for AIDS/HIV, and of those who had used both marijuana
and prescription antiemetics, marijuana was preferred by 80%. Nine of every ten
respondents favored legal reform to allow medical use of marijuana, even in the
absence of conclusive testing. Respondents considered the therapeutic marijuana
issue to be important to them (74.8%), and indicated a high level of political
motivation: 72% were registered voters, 58.5% had voted in the most recent gubernatorial
election, and 89% said they would actively support legal reform. The most striking
finding was that respondents were more than twice as likely to have spoken with
their friends (65.9%) as their doctor (31.7%) about medical marijuana. This pattern
of communication held even for the 45 PWAs who have used marijuana to treat themselves,
although to a lesser degree: 97.8% of this group had spoken with their friends,
66.7% with their doctor.
of demographic questions and a control group are a limitation of this study. No
claim is made about the relationship of the sample population to either the clientele
of the AIDS outreach and casework organization from which the sample population
was drawn, or to the population of persons with HIV at any other location or scale.
issue of therapeutic uses of marijuana is mired in political controversy [Hollister
1992; Grinspoon and Bakalar 1993, Hall et al. 1994], and key agencies of the U.
S. federal government have resisted facilitating a clinical assessment of marijuana
efficacy [Lehrman 1995, Grinspoon et al. 1995, Abrams 1995]. Even in the absence
of such studies, however, a growing body of ethnographic evidence exists to support
the assertion that marijuana can be a safe and effective treatment for a variety
of medical conditions, including pain, glaucoma, muscle spasticity, nausea and
the diminished appetite associated with AIDS Wasting Syndrome [cf. Randall 1991;
Grinspoon and Bakalar 1993]. With or without government sanction or regulation,
some people are using marijuana to treat symptoms of their medical conditions.
Marijuana is reportedly being used by some PWAs to control nausea and increase
their appetites [Randall 1991, Grinspoon and Bakalar 1993]. Under the current
system of marijuana prohibition, quasi- legitimate marijuana "buyers clubs" have
sprung up around the country to distribute marijuana to clients who demonstrate
a medical need, and grassroots organizing has begun to introduce "compassionate
use" legislation into some states that would allow persons with medical need to
possess, purchase, and even grow marijuana for personal consumption.
study sought first to identify if there was a group of PWAs who are informed about
marijuana's possible use as medicine, who use marijuana themselves to treat their
symptoms, and who are politically motivated. A secondary aim was to find out how
these people share information about medicinal marijuana.
a. Subjects, sampling design and response rates
were contacted through a large Honolulu-based AIDS outreach and casework program.
Four hundred questionnaire surveys and stamped return envelopes were distributed
inside a monthly client newsletter. 374 newsletters were delivered through the
mail to 310 PWAs and to 64 HIV- persons also on the mailing list. Of these, 4
were separated from the newsletter in transit and returned by the post office
undelivered. An additional 26 newsletters were distributed directly from the organizational
offices of the outreach program, primarily to HIV- persons. It is not known with
certainty how many of those questionnaires distributed at the office were received
by PWAs and how many by other non-PWAs, although an organization representative
estimated that very few were distributed at the office to PWAs who would have
already received a copy of the client newsletter through the mail. Thus the total
number of questionnaires distributed through the mail and from the office was
396. Overall, 140 questionnaires were returned, a response rate of 35.4%. Moreover,
it is estimated that between 306 and 336 PWAs received a copy of the questionnaire
(taking into account losses in mail transit and the unlikely possibility that
all surveys from the office went to PWAS). One hundred twenty-three PWAs returned
the questionnaire for a response rate of somewhere between 36.6% and 40.2 % among
the target PWA group.
instrument asked simple yes/no questions concerning PWAs' awareness of the medical
marijuana claims, their patterns of communication with friends and doctors, whether
they had taken prescribed antiemetics or marijuana to treat their symptoms, whether
they had used marijuana non-medically, and their voter status. Respondents were
also asked to complete five questions on a Likert-type scale about their attitudes
toward various kinds of legal reform, the importance of the medical marijuana
issue to them, and the estimated likelihood that they would use marijuana themselves
if it were made legally available. A final question asked what level of activity
they might take on to support a legal reform campaign. The instrument included
a section for optional comments where respondents could make a personal statement
of some sort.
primary limitation to this study is the absence of demographic data. Because of
the precarious social position of PWAs, and the currently illicit nature of the
activity being studied, no demographic information was gathered. The primary concern
of this study was to make an initial investigation into medical use of marijuana
among PWAs. Although some demographic data could have been gathered without jeopardizing
a person's identity, it was decided that the combined issues of AIDS and illicit
drug use was so delicate that asking any personal questions might scare off respondents.
questionnaire sought inforrnafion in four general areas: awareness and communication
about medical marijuana, patterns of therapeutic use and use for pleasure, attitudes
toward legal reform, and political motivation. Descriptive statistics of their
responses are presented below, along with some added remarks given by respondents
in the optional comments section of the questionnaire. Fifty-six PWAs (45.5%)
provided such comments.
a. Awareness and Communication
first four questions deal with respondents' knowledge about medical marijuana
and the people with whom they speak about their knowledge. Of the sample, 121
(98.4%) had heard it asserted that marijuana could be used for some medical purposes,
and 107 (87.0%) had heard of marijuana being used specifically in connection with
AIDS/HIV. Respondents were more than twice as likely to have spoken with their
friends (65.9%) than their doctors (31.7%) about potential medical uses of marijuana.
Even persons treating themselves with marijuana were less likely to have spoken
about it with their doctor (66.7%) than with their friends (97.8%).
of the comments offered that pertained to this section were informational items
about marijuana's medicinal value. For instance one respondent said: "I believe
the use of marijuana with HIV/AIDS victims is sometimes to offset the negative
effects of medication, not symptoms of the disease directly ." Another commented
about marijuana that it "certainly has less side effects than AZT and does seem
to help friends feel and eat better ." Several respondents suggested the
use of marijuana to elevate the mood of the sick person:
is the only drug that takes the place of an aid for appetite, mood elevation,
relaxation, or motivation. Used as a medication it's doctor-recommended, and in
moderation a very unique, fast-acting, and useful helper. When depressed from
knowing you're dying, it really moves your mind to a better location .
that marijuana has psychological benefits in addition to any physiological benefits.
You just feel better; so many AIDS patients find it hard to cope with the general
feeling of not being healthy on a constant basis. Relief like pot is a temporary
godsend. They can feel "normal" for a few hours of their stress-filled life [7;
emphasis in original].
b. Use Patterns
use of marijuana was more prevalent among respondents than use of prescription
antiemetics like Marinol. More respondents with HIV had used marijuana as a medicine
(36.9%) than Marinol or other antiemetics (27.3%). A relatively small number (25),
comprising 23.6% of the marijuana-infonned respondents, had tried both marijuana
and Marinol or another prescribed antiemetic drug. Of those who reported a definite
preference (23), 20 (87%) reported that marijuana produced the more desirable
effect. Two thirds of respondents (66.7%) reported having used marijuana for non-medical
purposes at least once in their lives.
respondents discussed further the relative worth of marijuana and Marinol (specifically)
in their comments. For example:
suffering could be eased if marijuana could be furnished. Instead the [government]
charges the taxpayer $400 a month for Marinol which 8 out of 10 times does nothing
but intoxicate .
I am suffering from nausea or cannot eat, marijuana is the only thing thus far
that has an immediate result and does not contribute to unpleasant side effects.
Marinol has made me sick several times [39; emphasis in original].
is not an adequate substitute for marijuana. I had to stop taking it in the hospital.
All it did was make me very groggy without enhancing my appetite .
c. Attitudes Toward Legal Reform
recipients were asked to give their opinions about legal reform issues on a Likert-type
scale. Respondents expressed strong or some support for making marijuana legally
available by doctors' prescriptions (91.1%) and even in the absence of conclusive
tests on marijuana (93.5%). A majority of respondents (68.3%) anticipated that
they would be either "very likely" or "somewhat likely" to use marijuana if it
became legal. Another 8% were uncertain about how their use might change. A majority
(59.0%) either strongly favor, or favor somewhat, legalization of marijuana for
there was overwhelming support for legal reform. Most of the comments addressed
this issue, and several mentioned that this issue has broad appeal that crosses
political boundaries. This respondent put it best:
believe there are quite a number of people who oppose marijuana as a recreational
drug but would support the use of marijuana for medical purposes--as long as there
is some evidence to substantiate the claim [that marijuana is] medically beneficial.
Even my straight-laced conservative mother would approve of using marijuana--"whatever
it takes to make you better," as she put it one day .
commented on why they make an exception in the case of marijuana. For example:
consider marijuana an addictive drug that, when used for recreation, can very
easily lead to more serious drug use. I am a recovering drug addict (11 years
sober) and have seen this happen. However, I think special circumstances require
special actions. Marijuana used medically could relieve suffering and should be
legalized for that use .
others expressed exasperation about the difficulties of using marijuana as a medicine,
and their support of making it legal:
that can be done to help those who suffer should be available to them. Marijuana
is used extensively by well persons, so why not legally for those who could benefit
feel in my heart that if this could help people like myself and my husband who
have HIV, then it should by all means be legal for treatment only. We really must
open our minds to what can be done for this disease .
respondents also explicitly referred to a perceived hypocrisy in the law. For
find it crazy that thousands die each year ftom legalized alcohol--marijuana is
a nature drug, which is a blessing for those of us who benefit from it .
really support the legalization of marijuana. It has helped me to sleep, relax,
and eat more. There are legal things that are more harmful and that effect your
mind worse than marijuana (e.g. cigarettes, liquor) .
the other hand, some respondents expressed ambivalence on the issue and concern
that medical use would not be properly regulated:
am a recovering alcoholic and drug addict. I also work in the AIDS field. I feel
the legalization of marijuana (medical) would be beneficial for some but feel
many would use their HIV status to perpetuate existing addictions for which I
am very unsupportive .
concern is with all the alcohol and drug abuse is that legalizing [marijuana]
would only make it more available for the trade through unethical practices by
patients and medical care persons. I know of persons using Marinol who don't need
it but have found the access. Anything that would make my life seem better would
be good, but I am more concerned about the masses than myself as a person .
in one notable exception to the norm, a respondent writes that:
are other medications that treat nausea and other complications just as well if
not better than marijuana. Marijuana is simply a drug to get high with. [People
who] are seeking to get it for medical use are using their ailments for an excuse
to get marijuana .
d. Political Motivation
indicated a high level of political motivation: 92 (74.9%) claimed to be registered
voters, although only 72 (58.5%) had actually voted in the most recent election
for governor. Most (56.9%) considered themselves to be Democrats. Another 35 (30.2%)
claimed to be "Independent" voters, and only 13 (11.2%) consider themselves Republicans.
Two respondents (1.7%) were members of another political party. On the issue of
medical marijuana, 92 people (74.8%) answered that it is either very (37.4%) or
somewhat (37.4%) important to them personally. Moreover, 107 (89.1%) indicated
that they would actively support a legalization campaign by "signing a petition"
(38.3%), "calling representatives, writing letters to the editor or carrying a
petition" (33.3%), or by some higher level of activity such as "organizing others,
designing pamphlets, talking to groups," etc. (17.5%).
respondents explained why they considered this to be an important issue to them
personally. For example:
issue of marijuana used for medical purposes is an extremely important one. Those
who say it's not might want to watch a close friend turn from a vibrant human
being into a walking skeleton; they just might change their opinion. Anything
that works is fine by me .
respondents suggested ways they would specifically like to help a legal reform
campaign. Here are some notable examples:
an entertainer in Hawaii and around the world. I'd love to do fundraisers and
anything else to help .
a member of PWAC [Persons with AIDS Coalition], I would like to publish articles
in our newsletter to show medical value re HIV, and in support of legalization
have a place in San Francisco called the Buyers Club on Market Street that deals
in this as a medical problem. Maybe we could get a program started here .
is an issue that my company will support (2).
pilot study succeeds in identifying a group of informed, politically motivated
population of persons, many of whom are using marijuana illicitly for self treatment
of their medical condition. Further study should be attempted to determine whether
this group is representative of PWAs in Honolulu and Hawaii as a whole.
This research was completed
with the assistance of the Drug Research Unit of the Social Science Research Institute,
University of Hawai'i, Manoa. Address correspondence to Ben Wesner, Department
of Geography, University of Hawai'i at Manoa, 2424 Maile Way, Room 445, Honolulu,
HI 96822. Email firstname.lastname@example.org.
- This report
does not presume to answer the question of efficacy or possible health hazards
associated with marijuana use by persons with HIV. By "knowledge" the study means
the simple awareness among respondents that there is an ongoing debate concerning
the use of marijuana as a medical therapy. (Back)
respondent is not a PWA, but claims to use marijuana medically for another condition
associated with Gulf War Syndrome. (Back)
D. 1995 Marijuana, the AIDS Wasting Syndrome, and the U. S. Government. (Response
to letter) In New England Journal of Medicine Vol. 333(10): 670-671.
L., Bakalar, J., and Doblin, R. 1995. Marijuana, the AIDS Wasting Syndrome, and
the U. S. Government. (Letter to ed.) In New England Journal of Medicine Vol.
L., and Bakalar, J. 1993. Marihuana: The Forbidden Medicine. New Haven: Yale University
W., Solowij, N. & Lemon, J. 1994. The Health and Psychological Consequences
of Cannabis Use. Australia National Drug Strategy Monograph Series No. 25. Hollister,
L. 1992. Marijuana and Immunity. Journal of Psychoactive Drugs Vol. 24(2): 159-164.
S. 1995. U. S. Stalls Over Tests of Marijuana to Treat AIDS Patients. Nature Vol.
374 (March 2): 8-9.
R. 1991. Marijuana & AIDS: Pot, Politics & PWAs in America. Washington,