AIDS, Cannabis & Courage: The Doctor On A Mission, part 2

293. AIDS, Cannabis & Courage: The Doctor On A Mission, part 2

[00:00:00] Ellen Scanlon: This podcast discusses cannabis and is intended for audiences 21 and over.

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[00:00:45] Dr Donald Abrams: I had a partner who died in 1989 before the availability of the highly active antiretroviral drugs, and he was my partner when he died. And in fact, the four men that I lived with from age 25 to 39 [00:01:00] in San Francisco are all dead. So that’s a lot of loss. But in San Francisco, aids was our problem and the unity and the.

[00:01:11] Unification in the community approach to it from the food banks to the Shanti Project to Pets are wonderful support. So many things developed to help the people living with hiv aids and also to help their caregivers and their loved ones.

[00:01:32] Ellen Scanlon: Welcome to How to Do the pod, the award-winning podcast, redefining canvas for your life today.

[00:01:38] I’m your host, Ellen Gaman.

[00:01:47] You just heard from Dr. Donald Abrams, a pioneering AIDS doctor and cannabis advocate who was on the front lines of the AIDS crisis in the 1980s. This is the second episode [00:02:00] in our three-part series, honoring Pride. We’re exploring how the AIDS crisis led to the birth of medical cannabis and sparked a national legalization movement.

[00:02:10] I. In last week’s episode, you heard the story of Medi Voles, the woman who ran the largest cannabis operation in San Francisco in the 1970s and eighties. Medi was selling pop brownies in the largely gay neighborhood of the Castro and found herself as the source of cannabis to help dying patients relieve symptoms related to aids.

[00:02:32] If you haven’t listened yet, please check that episode out. In today’s episode, you’ll hear from Dr. Abrams, who shares how losing his partner to the virus inspired his years long mission to secure the first government grant to study cannabis for medical use in AIDS patients. I first saw Dr. Abrams speak at an event a few years ago, and it’s such an honor to share his story with you today.

[00:02:59] In the early [00:03:00] 1980s, Dr. Abrams was truly at ground zero of the AIDS crisis bedside with patients at a time when very little was known about the disease and it was killing so many people around him. As I talked to him, I was reminded of the early days of COVID and how scary it felt to learn that we were in a global pandemic.

[00:03:21] A similar kind of fear was very strong around AIDS and the disease was specifically affecting and killing gay men in San Francisco. Dr. Abram’s story is a beautiful example of an expert physician serving his community and pushing for progress that has had a huge impact on how we treat patients today.

[00:03:43] As we learn about the medical relief people have found and continue to find through the consumption of cannabis, it’s hard to believe that this is still a Schedule one substance. That means that the government considers it to have no medical use. In 2024, the Biden [00:04:00] administration recommended that cannabis be moved to schedule three, which would allow for medical research into the plan.

[00:04:06] We are still waiting to see what will happen with the new leadership, and I’ll keep you posted. Before we jump in, a quick thank you if how to do the pot has helped you feel more confident about cannabis or made your day a little brighter. I’m really glad you’re here. If you’d like to support the show, please consider subscribing to my Substack newsletter.

[00:04:26] It’s $6 a month and helps me keep this work going, bringing you stories, tips, and thoughtful recommendations straight to your inbox. You can sign up@dothepot.com or through the Substack link in the show notes. Thank you so much.

[00:04:50] Dr. Abrams is currently a professor emeritus of medicine at the University of California San Francisco, and he’s the former chief of hematology [00:05:00] oncology at Zuckerberg San Francisco General Hospital. Back in the early 1980s, he was a young doctor starting to see patients with mysterious medical symptoms that required hospitalization.

[00:05:13] The patients were mostly gay men. I.

[00:05:16] Dr Donald Abrams: I, uh, started my fellowship at the University of California in San Francisco training to be an oncologist or a cancer specialist right at the beginning of aids. Actually, during my internship at the Kaiser Foundation Hospital in San Francisco, we saw a number of situations that we would consider pre-AIDS or AIDS related conditions.

[00:05:37] In the mid seventies, we took care of a lot of gay men hospitalized with terrible diarrhea. When we examined their stools, looking for things that would cause the diarrhea, we only found amoebas that were not felt to be pathogenic or disease causing. So we just let these guys run around with this diarrhea and finally I said, why don’t we treat it with the [00:06:00] anti parasite medications?

[00:06:01] And we did. And some of them got better. And that was called the gay bowel syndrome. That was in the mid seventies, so it was probably the beginning of what we were seeing with the evolution of the virus into the community. And then in the later seventies, I was working with a hematologist or a blood specialist.

[00:06:20] He knew I was a gay guy, and so we were referred a lot of young gay men with swollen glands. And the reason they were referred to the cancer specialists is because the infectious disease people couldn’t find any infectious causes of the enlarged lymph nodes. So they sent them to us to see if they had lymphoma or cancer of the immune system.

[00:06:41] And we biopsied four or five of these guys and none of them had lymphoma. They all had lymph nodes that were hyperactive. And as a gay guy and as somebody who took their history, I said, you know, I think you’re having too many sexual partners using too many substances and [00:07:00] having too many sexually transmitted diseases.

[00:07:02] Why don’t you move out of the fast lane and see if those lymph nodes go away? Unfortunately because I was not in an academic medical center that I didn’t realize that what I was seeing was a new entity that we probably should have written up for the medical literature, uh, that became known as the gay lymph node syndrome.

[00:07:20] I.

[00:07:21] Ellen Scanlon: Dr. Abrams encountered these lymph node issues during his internship and residency that ended in 1980. Yet the medical community didn’t identify AIDS or HIV until 1981. It was also in 1981 that Dr. Abrams started to look into retroviruses diseases that integrate their genetic material into the host cell’s, DNA, which is exactly how the HIV virus operates.

[00:07:49] Dr Donald Abrams: At that time, I had finished the first year of my training to be a cancer doctor, and they always wanted you to work in a lab and do basic science research, and I [00:08:00] really didn’t wanna do that at all. But I wound up working in Harold Varus lab and Harold Varus later went on to head NIH and get a Nobel Prize with his colleague Mike Bishop.

[00:08:11] Here I was in this lab and I was still working at Kaiser at night and seeing these gay men with swollen glands and getting tissues from them when they had their lymph node biopsies and taking it back to the lab and saying, I think we should look for a retrovirus here, because this was a retrovirus lab.

[00:08:32] And everybody said, good, go look for it. But I had no skills. In the laboratory, and I could not convince any of the laboratorians to help me out or to examine these lymph nodes. In 1981, we would’ve had a four year head start on the identification of the the virus. I went back to the clinic where I started seeing more and more gay men, and by now Kosi sarcoma.

[00:08:58] The cancer was here [00:09:00] and men were dying of the infections, particularly pneumocystis pneumonia. I was doing my research and collecting information on these men with the swollen glands in the cancer clinic, and it turned out that even though I had been offered a position to stay at UCSF, they asked me to please move to San Francisco General because one of my colleagues and friends was the first oncologist ever to be hired to work at San Francisco General, and he was gonna be the AIDS expert.

[00:09:31] And so they figured rather than have me seeing all these folks in the cancer clinic at UCSF, it would be better if we consolidated our efforts.

[00:09:41] Ellen Scanlon: It was 1983 when Dr. Abrams transferred to San Francisco General to support his community in the AIDS clinic.

[00:09:48] Dr Donald Abrams: Talk about being in the right place at the right time.

[00:09:51] Number one, I now knew what a retrovirus was because I had worked in the Varus lab and as a gay man, this was my community [00:10:00] and I really felt like I was on a mission. People were dying. As a young gay doctor, one of the hardest things for me was when, uh, patient’s parents came from the East Coast and they learned for the first time that their son was gay.

[00:10:15] That their son had AIDS and their son was dying. That was a very powerful experience as a 33-year-old young doctor to have to transmit that information to parents who were really quite devastated by learning that news. So fortunately, San Francisco pulled together, unlike New York, where I think AIDS was one of their problems.

[00:10:38] AIDS in San Francisco was our problem. We had a very active and resourceful gay community, uh, that really mobilized a lot of resources to help support people, uh, living with this terrible disease for the very short time that they lived. So it did turn out that many of the patients that I saw were, [00:11:00] were users of marijuana.

[00:11:02] And when I first started to do marijuana research. Those were the patients that I really thought would be most willing and able to participate in the clinical trials that we were gonna design.

[00:11:14] Ellen Scanlon: When I first heard Dr. Abrams speak at the event at uc, Berkeley, he mentioned a woman named Brownie Mary. It was the first time I had ever heard of her.

[00:11:25] We talked about her in last week’s episode, and Dr. Abrams worked in the hospital where she was bringing cannabis brownies to the patients. She called her kids. I asked Dr. Abrams about his interactions with Mary Rathbun, also known as Brownie Mary.

[00:11:42] Dr Donald Abrams: She was a volunteer in our AIDS clinic at San Francisco General Hospital.

[00:11:48] In fact, she won the Volunteer of the Year award two years in a row, and so she was pictured in our hallway of the AIDS clinic. She would take our patients to X-ray in their [00:12:00] wheelchairs, drop off their prescriptions at the pharmacy. And she also baked brownies for her kids, as she called them. Mary lost her only daughter to a drunk driver and was very anti-alcohol, but was very pro cannabis, and she would bake marijuana brownies and bring them to the clinic.

[00:12:19] Uh, we never really saw it happening, but she was distributing brownies to our patients. I was in Amsterdam of all places at the International AIDS Conference. In 1992, the conference was supposed to be held in Boston, but because the United States, uh, prohibited people with AIDS and HIV infection from entering the country, and here I was in Amsterdam, glancing at CNN Headline News in my hotel room, and I saw Mary Raffin being arrested in Sonoma for baking brownies for her kids.

[00:12:56] That was a motivator. To correct, uh, what I [00:13:00] considered to be, uh, something that was quite wrong.

[00:13:03] Ellen Scanlon: When Dr. Abrams arrived home from Amsterdam, he received a letter from Rick Dolin, a Harvard grad, and the founder of an organization known as maps, the Multidisciplinary Association for Psychedelic Studies.

[00:13:17] Dr Donald Abrams: It didn’t come to me immediately, but it was brought to me by one of my colleagues because I ran a group called the Community Consortium.

[00:13:25] Which was a group of physicians, many of them, gay and lesbian in San Francisco, who were taking care of the bulk of AIDS patients that we weren’t seeing at San Francisco General. And we had established this group to do research in the community, in the practices of the doctors who were part of the consortium.

[00:13:43] He gave me the letter from Rick Doblin that suggested that a, a clinical trial. Showing the potential benefits of marijuana should come from Brownie Mary’s institution, as if she were our dean. And he said, maybe you and the [00:14:00] community consortium should look into this. So that was the beginning in 1992 of my efforts to do a study in patients with HIV to show that marijuana might be useful.

[00:14:13] Ellen Scanlon: This was not accomplished. Quickly, Dr. Abrams and his colleagues were about to embark on a five year journey to try to conduct this study.

[00:14:23] Dr Donald Abrams: When I saw the Rick Dalin letter, I responded to him and I sent him the template. I. For submitting a proposal to the University of California Institutional Review Board, and I figured, well, he is not an md so it probably should take him months, but in a week he came back with a proposal to study three different strengths of inhaled marijuana versus the THC capsule binal that had been licensed and approved for treatment of AIDS wasting, as well as chemotherapy induced nausea and vomiting.

[00:14:54] So I said, okay, let’s go. Where are we gonna get the marijuana? So since I was doing a [00:15:00] study to demonstrate the potential benefit of marijuana, I needed to get approval from the FDA. So I sent them a letter and they said, no, no, you can’t. We import marijuana from out of the country. The FDA said I should seek a domestic source, and they said, well go to NIA, the National Institute on Drug Abuse.

[00:15:20] They’re the only legal source of marijuana for research in this country. So we sent them our proposal and it took about a year. But we got a letter back saying that they couldn’t support our study because it was not scientific.

[00:15:35] Ellen Scanlon: With this information, Dr. Abrams and his colleagues protested NIDA’s decision and were able to get a meeting with NIDA’s director, a man named Alan Lesner.

[00:15:45] He told them that NIDA would only supply cannabis if the proposal was scientifically sound.

[00:15:52] Dr Donald Abrams: So we went back to the drawing board and we designed a much more elegant. Inpatient study because one of their concerns was [00:16:00] if we did an outpatient study, how did we know that the participants were not gonna share their marijuana with their family and friends?

[00:16:08] So we were gonna do a study incarcerating, if you will, patients in our clinical research center at San Francisco General Hospital for two 15 day periods. During one, they would smoke. NI IDA Cannabis, and during the other, they would smoke placebo cannabis from Ida and we would compare all sorts of measurements and we submitted it to the government for peer review.

[00:16:31] That’s what Alan Ner said. If we were favorably peer reviewed, they would reconsider. I. So peer review means that review committee reads the proposals, and out of the proposals, they grade half of them and the other half they don’t consider worthy of discussion. And that’s where we were in the half that was not considered worthy of discussion, so we never got a grade, but they did send some reviewers comments and two of the [00:17:00] reviewers said, why would you consider studying such a toxic substance?

[00:17:05] The third reviewer said, aren’t you afraid that they’re gonna get atherosclerosis and heart attacks? And you know, these are patients with the AIDS wasting syndrome who had a survival of about three months. So, no, these weren’t really my peers. Obviously, reviewing this.

[00:17:21] Ellen Scanlon: These comments were happening in 1996, which was a very big year for cannabis legalization.

[00:17:28] California passed the Compassionate Use Act, which made cannabis available to medical patients. 1996 was also the year that treatment of AIDS took a big turn. Patients were able to access protease inhibitors, medications that help slow the progression of HIV

[00:17:47] Dr Donald Abrams: people were now rising from their deathbed.

[00:17:51] Having their immune system rebuild and no longer getting opportunistic infections. However, the drugs had a lot of side effects and one of [00:18:00] the biggest problems was that they were very exquisitely metabolized by the system in the liver. That’s also responsible for breaking down other pharmaceuticals and botanicals.

[00:18:14] So this gave me an idea. I had a meeting with Alan Lesner and I said, you know, if I do a study that shows that smoking marijuana is harmful and not beneficial, I think people are still gonna smoke. And if I do a study that shows it’s safe and beneficial, I don’t think it’s gonna make it any more widely available.

[00:18:36] And he said, that’s where you could be wrong. If you do do a study showing it’s safe and beneficial, then maybe we’ll have to reconsider the Schedule One classification, which is where it is until today, even no accepted medical use and high potential for abuse. Alan Lessner also told me we do not support studies looking at the beneficial effect of cannabis.[00:19:00]

[00:19:00] We are the National Institute on Drug Abuse, not for drug abuse. So their mandate is to study substances of abuse as substances of abuse and look for harm, not benefit. So I created a study to see if it was safe for patients on HIV protease inhibitors to inhale cannabis. And that was the study that we submitted that finally got accepted and I received a million dollars and 1400 of the government’s finest cannabis cigarettes to conduct that so-called Trojan horse study because in addition to looking to see if it was safe, we also wanted to see if it did increase appetite.

[00:19:44] Originally the study was gonna be in patients with the AIDS wasting syndrome 96. Disappeared. So the patients participating in our study didn’t have wasting, but we did demonstrate that number one, it was [00:20:00] safe. And number two, those who smoke cannabis compared to those who smoke placebo, cannabis gained a significant amount of weight, uh, during the 25 days of our inpatient clinical trial.

[00:20:13] Ellen Scanlon: After all of this tireless and collaborative work, the study was released to the public in 1999.

[00:20:20] Dr Donald Abrams: There were not a lot of papers published in the medical literature about cannabis. The Annals of Internal Medicine was interested that I was doing the study. So while we were doing the study, they ran a little perspective piece that the study was being done, and they just mentioned the efforts that I went through to be able to do it.

[00:20:41] Then when we got our results, I first submitted it, of course, to the New England Journal of. They rejected it, and then I submitted to Lancet and they rejected it. And then I submitted to the Journal of the American Medical Association, jama, and they rejected it. So then I said, well, maybe I should submit it to the Annals of Internal Medicine.[00:21:00]

[00:21:00] And I did, and they rejected it. And I spoke to one of my mentors and he said, Donald, they can’t reject it because they already did a perspective piece on it. Like a preview, and now they’re sort of obligated to publish your results. So tell ’em that. And I did, and they published it. It wasn’t easy. It was not easy

[00:21:23] Ellen Scanlon: as HIV and AIDS thankfully stopped being a death sentence.

[00:21:28] Dr. Abrams began to shift his focus away from AIDS and towards oncology, the branch of medicine that deals with the treatment and prevention of cancer. Yet he continues to see the benefits of cannabis and his career reflects his belief in the power of plants.

[00:21:44] Dr Donald Abrams: I was always doing some oncology at San Francisco General.

[00:21:48] I had an oncology clinic, although I had more AIDS clinics during the week. What happened was marijuana changed my life because. When I got Rick Goblin’s gauntlet to [00:22:00] study cannabis and people with the AIDS wasting syndrome, I developed a strong appreciation of the power of plants as medicine. And that took me to the Telluride Mushroom Festival in Telluride, Colorado in 2002, and that’s where I met Andrew Weil, the guru of integrative medicine.

[00:22:18] In Telluride, Andrew Wild described a two year online distance learning fellowship you could do with his program in the integrative medicine at the University of Arizona. So I said, aha, if I wanna do that. So I did, and when I finished in 2004, it changed my life. I’ve done hiv aids for 25 years now, and it’s very different from when I started.

[00:22:42] When I started, it had that urgency and that sadness, and now it was. You write people a prescription, they take one pill a day and you see ’em again in six months for their next T-cell and viral test. And it wasn’t quite as meaningful as a doctor [00:23:00] to to do that. And so I said what I want to do now is integrative oncology, working with people, living with and beyond cancer, and helping them to integrate these other modalities into their conventional care nutrition supplements, including cannabis.

[00:23:15] Physical activity, Chinese medicine, stress reduction, spirituality. I started doing that and for two years I became the director of the clinic at our Center for Integrative Health, the OSHA center. So in 2006, I stopped doing my HIV clinic because I just couldn’t do as many things as I wanted to, and that’s when I left the field.

[00:23:40] Ellen Scanlon: As a doctor and as a gay man, Dr. Abrams was serving his community literally in the epicenter of the AIDS crisis. I asked him to reflect on what helped him get through a period of time, filled with sadness, love, and desperation.

[00:23:58] Dr Donald Abrams: I felt like this was a [00:24:00] mission and that it was appalling and that this is what I was here to do.

[00:24:03] I certainly was not immune from loss. I had a partner that we started a relationship in 1986 who died in 1989 before the availability of the highly active antiretroviral drugs, and he died with me. I mean, he was in the hospice, but he was my partner when he died. And in fact, the four men that I lived with from age 25 to 39 in San Francisco are all dead.

[00:24:34] So that’s a lot of loss, but here I am today and I feel like I get a little PTSD thinking about it and talking about it. But in San Francisco, AIDS was our problem and the unity and the unification and the community approach to it from the food banks through Ashanti Project to pets are wonderful support.

[00:24:58] So many things developed to [00:25:00] help the people living with. HIV aids, and also to help their caregivers and their loved ones. The sense of being together as a community and being at war, if you will, because it was the war of our generation and looking forward and marching on, kept us going. Love is important.

[00:25:23] Ellen Scanlon: I’m very grateful to Dr. Abrams for talking about such a challenging time, and I’m happy to share that he recently celebrated 30 years together with his husband, the writer, Clint Warner. Happy anniversary and happy pride. Throughout this series, we’ve seen how AIDS has transformed from a death sentence to a manageable chronic condition.

[00:25:48] Don’t miss the final episode. In the series, we’ll delve into why one in four people living with HIV in the US are women, particularly women of color. We’ll get expert insights into how [00:26:00] cannabis is helping patients with HIV symptoms and learn what it will take to end new transmissions of the virus. Tune in next week to be part of the conversation and find out how you can make a difference.

[00:26:14] If you liked this episode, please share it with a friend. We love new listeners and are here to help everyone feel confident about cannabis.

[00:26:26] Thank you for listening to How to Do the Pot. For lots more information and past episodes, visit do the pot.com. Are you one of the thousands of people who love how to do the POTS newsletter? If you’re not getting it, please sign up@dothepot.com. And if you like how to do the pot, please rate and review us on Apple Podcasts.

[00:26:49] It really helps people find the show. Thank you to writer Joanna Silver and producers Maddie Fair and Nick Petri. I’m Ellen Scanlan and stay tuned for [00:27:00] more of how to do the pot.