Mar 16, Whole or crude marijuana (including marijuana oil or hemp oil) is not approved by the US Food and Drug Administration (FDA) for any medical. The U.S. Drug Enforcement Administration has labeled marijuana a Schedule I drug, which means it's illegal under federal law. But the use of medical marijuana . Nov 12, Some studies have found medical marijuana can ease some cancer symptoms and treatment side effects. Here's what to know if you're.
Cancer Medical Marijuana and
The two most-studied compounds in marijuana are:. Each cannabinoid offers different benefits. While marijuana is federally illegal in the United States, more than half of the states, as well as the District of Columbia, have passed laws legalizing the use of marijuana to treat certain medical conditions. People use marijuana to ease the side effects of treatment and pain caused by the cancer.
Still, because marijuana is federally illegal, research on marijuana to manage cancer treatment side effects is limited.
She specializes in treating young women diagnosed with breast cancer. Your doctor will only be able to report what she or he has observed in patients, and that may be very limited information depending on where you live.
Because marijuana has been legal for both medical and recreational use in Colorado for a number of years, Dr. Borges has a number of breast cancer patients who use or have used medical marijuana to ease treatment side effects. So, by adding in medical marijuana, it often allows me to cut back on the number of drugs I prescribe.
With a high-quality source for medical marijuana and knowing how it affects an individual, using medical marijuana can put more control back in the hands of my patient. Some agents, including cisplatin, cause nearly every patient to vomit repeatedly; others, such as methotrexate, produce this effect in a small minority of chemotherapy patients. Vomiting may begin within a few minutes of treatment, as is the case with the drug mustine, or up to an hour after chemotherapy, as occurs with cisplatin.
Most clinical trials of antiemetics—medicines that prevent vomiting—tend to be conducted on patients being treated with cisplatin, because drugs that decrease vomiting following cisplatin treatment are likely to work at least as well as other chemotherapy agents. Researchers have tested several cannabinoids for their ability to suppress vomiting, including two forms of THC delta-9 and the less abundant deltaTHC. Two synthetic cannabinoids nabilone and levonantradol that activate the same receptors as THC have also been examined as potential antiemetics.
All four compounds have proven mildly effective in preventing vomiting following cancer chemotherapy, as will be described.
Two additional clinical studies, also to be discussed, provide evidence that, to a limited extent, smoking marijuana helps suppress chemotherapy-induced emesis. In clinical comparisons THC tended to reduce chemotherapy-induced vomiting better than a placebo. But few trials have used the same chemotherapy agent among all patients, and some contain substantial flaws. For example, one trial tested THC's effectiveness in patients who received methothrexate—a drug that only occasionally causes vomiting.
With the advent of more effective medications, such as ondansetron Zofran and granisetron Kytril , both serotonin antagonists, these results carry little weight. Even when administered together, THC and prochlorperazine failed to stop vomiting in two-thirds of patients. In one particularly well designed study, researchers compared THC with metoclopramide sold in the United States under various brand names, including Clopra, Maxolon, Octamide PFS, Reclomide, and Reglan , an effective and widely used antiemetic.
None of the patients in this study had previously received chemotherapy, so there was no danger that they would vomit simply because they had become conditioned to do so—a reaction that often occurs in people who have undergone several rounds of chemotherapy.
Every patient in this study received the same dose of cisplatin; participants were also randomly assigned to receive either THC or metoclopramide. Seventy-three percent of the patients who received THC vomited at least twice following chemotherapy, compared with only 27 percent of the patients who received metoclopramide. Several additional but less rigorous studies reached similar conclusions: Food and Drug Administration has approved the drug, in the form of Marinol, for use when chemotherapy-induced nausea and vomiting are not relieved by other antiemetic medications.
Participants in clinical trials of THC have reported several unpleasant side effects, including dry mouth, low blood pressure, sedation, and mood changes. Patients who had no prior experience with marijuana or related drugs were more likely to report psychological discomfort after taking it than those who had tried marijuana previously. On the other hand, advocates of marijuana use for medical purposes maintain that, when such patients receive prior guidance on marijuana's effects, they rarely experience adverse psychological reactions upon using the drug for the first time.
Although this claim has not been objectively tested, it may apply equally to the effects of THC, the main psychoactive component in marijuana.
In some clinical trials of THC for antiemesis, patients who underwent the most dramatic mood changes tended to vomit least; other trials found no correlation between THC's psychoactive and antiemetic effects. If they are linked, however, it may be possible to separate the two effects by creating synthetic analogs of the THC molecule. Perhaps, then, scientists could make additional chemical alterations to the THC molecule to create a chemical analog that controls vomiting better and is less psychoactive than THC.
In fact, such a compound may already exist naturally. In a study of eight children, ages three to 13, deltaTHC was found to completely block their chemotherapy-induced vomiting. The only side effect reported was irritability in the two youngest children ages three and one-half and four years. Of the existing chemical analogs of THC, two have been tested in chemotherapy trials. Both were found to be somewhat effective in preventing vomiting following chemotherapy but not as effective as other antiemetics already on the market.
Although many medical marijuana users claim that smoked marijuana controls nausea and vomiting better than oral THC, no rigorous studies that support this contention have yet been published.
In a study that directly compared smoked marijuana with THC, researchers found that both prevented vomiting to a similar degree. Only one in four people in this study of 20 patients achieved complete control of chemotherapy-induced vomiting with either drug. During one session, patients smoked a marijuana cigarette and swallowed a placebo pill; at the other session they smoked a placebo cigarette and took a pill containing THC.
Patients received the experimental treatments in random order, so approximately half tried marijuana before THC, while the others tried the drugs in the opposite sequence. When asked which form of treatment they preferred, 35 percent of the patients said they favored THC pills, 20 percent chose marijuana, and 45 percent had no preference.
Another preliminary study tested smoked marijuana in cancer patients who were not helped by conventional antiemetic drugs; however, serotonin antagonists—currently considered the most effective antiemetics—were not yet available in when this study was conducted. Since this group of patients varied greatly in terms of their chemotheraputic regimen as well as with regard to their prior experience with marijuana, these results must be considered approximate at best.
Nevertheless, it does make sense that inhaling THC in the form of smoked marijuana would prevent vomiting better than swallowing a pill. If vomiting were severe or began immediately after chemotherapy, oral THC could not stay down long enough to take effect. Smoking also allows patients to take only the drug they want, one puff at a time, thus reducing their risk of unwanted side effects. But the long-term harms of smoking outweigh its benefits for all but the terminally ill, the IOM team concluded.
Instead, they recommended the development and testing of a rapidonset method of delivering THC, such as an inhaler.
Similar devices are now used to administer medicine for asthma and other respiratory disorders and are being developed to deliver pain medication. Wasting and appetite loss affect most cancer patients. At best these conditions diminish quality of life; at worst they hasten death. Depending on the type of cancer, 50 to 80 percent of patients will develop cachexia, a disproportionate loss of lean body tissue.
Cachexia occurs most often during the final stages of advanced pancreatic, lung, and prostate cancers. Proteins called cytokines, produced by the immune system in response to the tumor, appear to stimulate this wasting process.
Cachexia also occurs as a result of HIV infection see Chapter 5 , and both cancer and AIDS patients currently receive similar treatments for the condition. Standard therapies for cachexia include intravenous or tube feeding as well as treatment with megestrol acetate Megace , an appetite stimulant. If the latter causes patients to gain weight, however, it is mostly in the form of fat—not the lean tissue they would have lost through cachexia. Both megestrol acetate and dronabinol produce troublesome side effects in some patients.
The former can cause hyperglycemia and hypertension; the latter can cause dizziness and lethargy. Because of these drawbacks, medical researchers are pursuing better treatments for cachexia.
One promising class of compounds includes agents that can block the actions of the cytokines that promote wasting. Some patients might benefit from a combination therapy consisting of a cytokine blocker along with THC, to stimulate appetite and also, perhaps, to reduce nausea, pain see Chapter 4 , and anxiety.
Taken as a whole, clinical studies on cannabinoids and cancer pain have reached conclusions similar to those of comparable studies on nausea and malnutrition: The main advantage of cannabinoids lies in their potential to relieve several symptoms at once, but this versatility may come at the price of diminished potency.
For example, powerful opiate medications appear to relieve debilitating pain more effectively than cannabinoids. However, since they appear to reinforce the effects of opiates, cannabinoids may be useful as an adjunct to the stronger drugs.
Patients who achieve the same relief with lower doses of opiates should also experience fewer narcotic side effects, such as constipation, drowsiness, and slowed breathing.
Moreover, cannabinoids may counteract another common side effect of narcotics—nausea. Nevertheless, most chemotherapy patients probably would not choose marijuana or THC as an antiemetic. Compared with the highly effective agents currently available, marijuana-based versions appear to offer most people only modest relief. In addition, many patients in clinical studies—in contrast to accounts of several patients who spoke at the IOM's public sessions—have found the side effects of marijuana to be intolerable.
In particular, patients who have never smoked marijuana tend to react adversely to the drug's mood-altering properties.
Oct 10, She specializes in treating young women diagnosed with breast cancer. “People have to be as diligent about researching medical marijuana. Jan 17, Cannabis has been used medicinally for millennia, but has not been approved by the U.S. Food and Drug Administration to treat any medical. Jan 17, Cannabis and cannabinoid use during cancer is often done for symptom management. Learn more about use of cannabis and cannabinoids.