Effect of Cannabis and Endocannabinoids on HIV Neuropathic Pain

Our objective is to assess 120 community-dwelling people living with HIV who have neuropathic
pain and are currently using cannabis. These participants will be enrolled in a study that
consists of two phases:

Phase 1) This will involve a cross over study involving three different doses of vaporized
cannabis that contain THC and varying concentrations of CBD:

- Low CBD session: 8 puffs of 1.6% THC + 0.09 CBD

- Medium CBD sessions: 4 puffs of 1.6% THC + 0.09 CBD plus 4 puffs of 1.73% THC + 5.4% CBD

- High CBD sessions: 8 puffs of 1.73% THC + 5.4% CBD

This phase will examine the acute effects of cannabis on pain intensity, blood
endocannabinoid levels, and the relationship of pain with heart rate variability (HRV).

Phase 2) This phase will involve the association between dispensary-obtained cannabis and
changes in pain reported via IMPACT, a mHealth text messaging program that will serve as a
useful tool to monitor the relationship between pain and cannabis use. Text messaging is an
effective method to modify health behaviors, monitor substance use, and track pain. Our group
has recently demonstrated the feasibility of using short message service (SMS) texting to
promote anti-retroviral therapy adherence and monitor daily methamphetamine (METH) use in
persons living with HIV neuropathy with bipolar disorder or METH dependence.

Inclusion Criteria:

1. the ability to provide informed consent

2. age 18 or older

3. HIV infection documented at the HNRP or assessed by an HIV test at screening;

4. a diagnosis of HIV sensory neuropathy

5. current use of cannabis

6. the ability to describe the THC and CBD content in the products they use, i.e.,
obtaining cannabis from dispensaries that list THC and CBD content

7. ability to respond to daily text message

Exclusion Criteria:

1. meeting criteria for current substance or alcohol dependence

2. traumatic brain injury

3. dementia or Alzheimer's disease

4. psychosis

5. a respiratory condition, i.e., pulmonary disease, that would be exacerbated by
inhaling vaporized cannabis

6. history of cardiovascular disease, including myocardial infarction or stroke;

7. uncontrolled hypertension, defined as a systolic blood pressure greater than 160 mm Hg
or a diastolic blood pressure greater than 100 mm Hg

8. pregnancy, breastfeeding, or unwillingness to prevent pregnancy during the cannabis
administration portion of the study (using birth control in female participants of
child- bearing age)

9. unwillingness or inability to receive or respond to text messages