We have reliable documentary evidence for medical cannabis that goes back almost 2,000 years. (And not-so-reliable evidence that points even hundreds of years farther back.) Among the various other medical properties first recognized in the plant, physicians of ancient India and the later medieval Islamic empire numbered cannabis’s power to stir the appetite and battle weight loss. But in an era of chronic food scarcity, there wasn’t great demand for a drug that made users even hungrier.
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A decline in appetite and subsequent weight loss, however, is a hallmark of AIDS wasting syndrome, a nasty condition that frequently marks the progression from HIV to full-blown AIDS. The syndrome is defined as a ten percent or greater drop in body weight, and it is accompanied by weakness, fever, and diarrhea. And so marijuana’s effect as an appetite stimulant has been a godsend for thousands of people living with AIDS.
Unlike some effects of cannabis that habitual users adjust to, such as intoxication and (for at least some) cardiovascular alterations, marijuana’s appetite stimulation seems constant. Therefore, cannabis has the potential to be a long-term treatment. As far as clinical efficacy goes, a 2015 JAMA meta-analysis of cannabis studies found “low-quality” evidence associating cannabis with weight gain. (Given the low numbers and limited nature of the studies analyzed, JAMA’s “low-quality” rating is not as damning as it appears, but is closer to a guarded endorsement.) The synthetic THC pharmaceuticals Marinol and Cesamet have both been granted FDA approval as appetite stimulants for the treatment of AIDS wasting syndrome. About 17 years ago, an estimated eighty percent of Marinol prescriptions were for HIV/AIDS patients.
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In terms of sheer weight gain, megestrol acetate, a synthetic version of the hormone progesterone, has had greater clinical success than cannabinoids. However, the additional ability to quell nausea and induce relaxation and feelings of euphoria has made cannabis a very attractive solution for both AIDS and cancer care.