Wesner, Ben, "The 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).
This 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.
Absence 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.
T'he 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
This 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.
II. a. Subjects, sampling design and response rates
PWAs 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.
II. b. Instrument
The 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.
The 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.
The 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.
III. a. Awareness and Communication
The 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%).
Most 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:
Marijuana 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 .
I believe 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].
III. b. Use Patterns
The 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.
Several respondents discussed further the relative worth of marijuana and Marinol (specifically) in their comments. For example:
Much 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 .
Whenever 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].
Marinol 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 .
III. c. Attitudes Toward Legal Reform
Questionnaire 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 non-medical use.
Clearly 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
I 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
Others commented on why they make an exception in the case of marijuana. For example:
I 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 .
Many others expressed exasperation about the difficulties of using
marijuana as a medicine, and their support of making it legal:
Anything 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 medically .
I 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 .
Several respondents also explicitly referred to a perceived hypocrisy in the law. For example:
I 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 .
I would 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) .
On the other hand, some respondents expressed ambivalence on the
issue and concern that medical use would not be properly regulated:
I 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 .
My 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 .
Finally, in one notable exception to the norm, a respondent writes that:
There 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
III. d. Political Motivation
Respondents 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.
Some respondents explained why they considered this to be an important issue to them personally. For example:
The 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
Several respondents suggested ways they would specifically like to help a legal reform campaign. Here are some notable examples:
I'm an entertainer in Hawaii and around the world. I'd love to do fundraisers and anything else to help .
As 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 .
They 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 .
This is an issue that my company will support (2).
The 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. (Back)
- This report does not presume to answer the question of efficacy or
possible health hazzards 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)
- This respondent is not a PWA, but claims to use marijuana medically for another condition associated with Gulf War Syndrome. (Back)
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Copyrighted material. Reprinted by permission.