The health department in San Mateo County, Calif., has engaged in an unusual partnership with federal research and law enforcement agencies to investigate the feasibility of distributing marijuana on an outpatient basis.
The National Institute of Drug Abuse -- which cultivates marijuana in Mississippi for research purposes -- will provide some 3,600 marijuana cigarettes to 60 AIDS patients in San Mateo County early this year. County health officials will distribute the drug through local clinics to study its effectiveness in alleviating AIDS-related pain in the extremities. The U.S. Drug Enforcement Administration has approved the project and will monitor the research.
The program makes San Mateo County the first local government in the country to distribute marijuana. Officials say the study is the first logical step toward widespread distribution of the drug for medical purposes. Other county-sponsored programs to study the use of marijuana in alleviating other AIDS-related symptoms are also in the works.
"In all the years of studying marijuana for medicinal use, there has not been one community-based outpatient study," said Dennis Israelski, M.D., the chief of infectious diseases and chief research officer for the San Mateo County Hospitals and Clinics. "Given all the potential for both marijuana use and abuse, we have to see if it's even feasible to provide it in an outpatient setting before we invest more time in further research."
Although San Mateo County has only 700 AIDS patients and its public health system handles just 200,000 outpatient visits a year, Israelski said its relatively small size makes it flexible and creative enough to tackle such a bold initiative.
That the DEA is cooperating with San Mateo County to such an extent represents a significant about-face for the agency. Although nine states have provisions for using medical marijuana, the DEA -- which licenses drug distribution in the U.S. -- has regularly threatened to prosecute any physicians who prescribe or provide the drug to patients.
A long treatise on the DEA Web site scoffs at using marijuana for medical use, concluding that "there is not one reliable study that demonstrates marijuana has any medical value."
But DEA officials noted in a written statement released to MODERN HEALTHCARE last week that the drug still can be used for approved scientific research.
"In the case of the research to be conducted by (San Mateo County), the Food and Drug Administration reviewed the protocol and found it to be scientifically meritorious," the statement declared.
Israelski and other public health officials noted that the movement encouraging the use of medical marijuana, fueled by recent studies indicating pot can alleviate symptoms in AIDS and cancer patients, has prompted the DEA to take a hard look at the drug. Along with the San Mateo County study, the National Institutes of Health is underwriting three other projects researching the medical benefits of marijuana.
"The political mood of the country has changed," said Mohammad Akhter, M.D., executive director of the American Public Health Association, a Washington-based organization that encourages public health initiatives.
"Virtually everything happens in the federal government after the states have taken the initiative on a particular issue. That has happened in this case," he said.
In the San Mateo County study, patients will be studied for 12 weeks -- six while smoking marijuana and six marijuana-free. Their use of the drug will be tightly monitored and will include in-home visits from county health officials.
Despite the tight regimen, some thorny peripheral issues won't be avoided. For example, only AIDS patients who have smoked marijuana in the past will be eligible to participate. "We don't want to introduce marijuana to someone who hasn't smoked it before," said study coordinator Jonathan Mesinger. Both he and Israelski acknowledge the drug is generally harmful to the respiratory system. That participants will have already been acclimated to the drug raises another conundrum -- government-grown pot is considered to be less potent than street pot. Israelski said participants likely would be smoking pot that's less powerful than what they're accustomed to but dismissed any notion that the factor would skew the results.
"Because we're not doing a (medical) efficacy study per se, it's not important," Israelski said. "It will be more important to get feedback on the potency, and see how it might influence how marijuana is grown on government farms."