Many cancer patients are using medical cannabis to combat the symptoms associated with their disease and the challenging treatment. These patients report a number of benefits, including rapid relief of the nausea and vomiting associated with chemotherapy, appetite stimulation, pain relief, better sleep and less anxiety and depression that often accompany the diagnosis and treatment of cancer.
The first report in the literature of the effective antiemetic benefits of cannabis appeared in the New England Journal of Medicine in 1975. Twenty cancer patients who did not respond to conventional antiemetics received either THC or a placebo two hours before chemotherapy. Patients reported that they had less nausea without any significant side effects.1
In the 1970s and 1980s, several states, including California, New York, New Mexico and Michigan, researched the use of cannabis to combat nausea and vomiting in cancer patients. The studies reported that cannabis was found to be an effective treatment and was equal to or better than the conventional medications available at the time.
In 1979, a study at the National Cancer Institute compared the antiemetic effects of oral and smoked THC with oral and smoked placebos. The findings reported that THC was very effective at reducing nausea and vomiting. Interestingly, the concentration of serum THC was measured, and when the concentration was low, 44% of patients suffered with nausea and vomiting; at moderate concentrations, only 21% had symptoms, and at high concentrations, only 6% had symptoms. Researchers reported that the effectiveness of THC depended on how much was absorbed into the bloodstream. They compared oral versus smoking delivery methods and were able to show that smoked THC was absorbed more reliably.2
In 1988, investigators found that out of 56 cancer patients who did not get relief from standard anti-vomiting medications, 78% were symptom-free after use of cannabis.3
In 1995, Israeli researchers found that delta-8-THC (a cousin compound of delta-9-THC with less psychoactive activity) was quite effective in preventing nausea and vomiting in a group of pediatric cancer patients with negligible side effects.4
Despite research that supports the efficacy of cannabis, its use has not been encouraged and it remains illegal in many states. In states with medical cannabis laws, a significant number of cancer patients are turning to it for prevention and treatment of nausea and vomiting. Newer medications have emerged that are very effective for chemotherapy-induced nausea and vomiting; however, there are some patients who do not respond to them or who cannot tolerate or afford them. For these patients, medical cannabis is a reasonable and viable alternative.
Many cancer patients report diminished appetite and significant weight loss associated with cancer and its treatment. Cachexia, weakness and wasting of the body, commonly results and is notoriously difficult to alleviate. The well-known side effect of the “munchies” – increased appetite – is often what drives cancer patients to seek out medical cannabis.
Over the past 20 years of research, investigators have shown that cannabis and the cannabinoid receptors have been shown to play an important role in the desire for food. A number of studies looking at the effects of cannabis and the cannabinoids on appetite and weight gain are summarized below:
Opioids remain the keystone for the treatment of moderate to severe cancer pain; however, some patients experience inadequate pain relief and unacceptable side effects are common.11,12 Many patients report that cannabis is quite effective at relieving cancer pain by itself and also in combination with opiates.
Cancer patients often report that they suffer with neuropathy (nerve pain). Cannabis as a treatment for the pain of neuropathy has been studied in HIV and MS patients and has been found to be quite helpful in alleviating symptoms (see section on analgesia). The numbers of studies on the use of cannabis for cancer pain in human trials is limited; however, results clearly show that cannabis treatment is helpful without causing adverse side effects.
In those cancer patients who are having difficulty controlling pain, cannabis is a viable option as it may be safely used alone or combined with opiates to give significant relief without adverse side effects.
I have evaluated hundreds of cancer patients using cannabis and many of them find enhanced appetite, better mood, pain relief, improved sleep and less fatigue. They report that cannabis has helped them tolerate chemotherapy and radiation and the difficult side effects they cause. Some patients reported that they didn’t think that they would have continued with treatment if they didn’t have cannabis available to provide desperately needed respite.
Cannabis as a cure for cancer is a controversial topic. Since cannabis is classified as a Schedule I controlled substance, research on the anticancer properties in human clinical trials has been prohibited. As of the writing of this book, there is one published human trial on cannabis use as an anticancer compound with a second trial in progress (both in Europe).
There exists, however, a significant body of scientific research that shows both THC and CBD have anti-cancer properties in certain cancers.
Both compounds have been shown to cause cancer cells to commit suicide (called apoptosis), inhibit tumor growth, inhibit metastasis and cancer cell migration, and inhibit angiogenesis, which is the growth of blood vessels that feed tumors.17,18 Additionally, recent research has also shown that phyto-cannabinoids can work synergistically with certain chemotherapies to enhance the anticancer effects.
The following is a short list of recent research that documents the anticancer effects of cannabinoids. This is by no means a complete review of the scientific literature as there are thousands of articles that have been published in the last two decades exploring the potential of cannabis as an anticancer agent. It is important to note that these are not human trials.
In the only published human trial, researchers in Spain directly administered THC into glioblastoma multiforme cancer cells in terminal patients and found that it inhibited tumor cell proliferation without any adverse side effects.28
Because cannabis remains federally illegal in the United States, research in humans is prohibited. However, in states that have legalized medical cannabis, many desperate cancer patients are using cannabis not only to treat symptoms, but also to treat the cancer directly. There are thousands of anecdotal reports of cancer patients using concentrated cannabis oils containing THC or CBD or both resulting in complete resolution of cancer. Cannabis for cancer treatment is not FDA approved nor is it considered standard of care by regulatory medical boards. However, patients who are not responding to standard cancer treatment are seeking it as an alternative therapy. The main concerns for these patients are dosage, whether to take CBD or THC or both, and the duration of treatment. All of these questions remain unanswered and continue to be a roadblock to those seeking life-saving cannabis therapy.
As a cannabis physician I have many patients use concentrated cannabis oil for cancer treatment, with or without conventional chemotherapy and/or radiation. Some of my patients have had incredible results with complete resolution of the cancer. A number of my patients with advanced cancers who were told that they only had a few months to live are living months or years beyond their prognosis. I believe that cannabis treatment can extend life and possibly cure cancer when given early in the course and in relatively high doses.
Although I am overjoyed when my patients improve, as a scientist I am quite frustrated by the lack of research. We must find the answers to these crucial questions so that patients who are suffering with aggressive and advanced cancers can have cannabis therapy as an option. If research on dosing, duration of treatment and cannabinoid profile to treat specific cancers can be performed, we will be able to use cannabis as a non-toxic chemotherapy and save lives.
Sallan, S., et al. Antiemetic effects of delta-9-tetrahydocannabinol in patients receiving cancer chemotherapy. New England Journal of Medicine (1975) 293: 795-797
Chang, A., et al. Delta-9-tetrahydrocannbinol as an Antiemetic in Cancer Patients Receiving High-dose Methotrexate: A Prospective, Randomized Evaluation. Annals of Internal Medicine (1979) 91: 819-824
Vinciguerra, V., et al. Inhalation marihuana as an antiemetic for cancer chemotherapy. New York State Journal of Medicine (1988) 88: 525-527
Abrahamov, A., et al. An efficient New Cannabinoid Antiemetic in Pediatric Oncology. Life Sciences (1995) 56: 2097-2102
Foltin, R., et al. Effects of smoked marijuana on food intake and body weight of human living in a residential laboratory. Appetite (1988) 11: 1-14
Williams, C., et al. Anandamide induces overeating: Mediation by central cannabinoid (CB1) receptors. Psychopharmacology (1999) 143: 315-317
Volicer, L., Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. International Journal of Geriatric Psychiatry (1997) 12: 913-919
Gorter, R., Management of anorexia-cachexia associated with cancer and HIV infection. Oncology (1991) 5:13-17
Brisbois, T., et al. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Annals of Oncology (2011)
Fairmond, J., et al. A low delta-9-tetrahydrocannabinol cannabis extract induces hyperphagis in rats. Behavioural Pharmacology (2010) 21: 769-772
Scottish Intercollegiate Guidelines Network. Control of pain in patients with cancer: A National Clinical Guideline. Edinburgh, Scotland (2000) 44: 1-79
Cleeland C., et al. Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine (1994) 330: 592-596
Noyes R., et al. The analgesic properties of delta-9-tetrahyrocannabinol. Journal of Clinical Pharmacology (1975) 15: 139 – 43
Noyes R., et al. The analgesic properties of delta-9-THC and codeine. Clinical Pharmacology and Therapeutics (1975) 18: 84 – 9
Johnson, J., et al. “An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics.” Journal of pain and symptom management 46.2 (2013):207-218
Johnson, J., et al. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management (2010) 39: 167-179.
Velasco, Guillermo, et al. “The use of cannabinoids as anticancer agents.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 64 (2016): 259-266.
Ramer, Robert, and Burkhard Hinz. “Chapter Two-New Insights into Antimetastatic and Antiangiogenic Effects of Cannabinoids.” International review of cell and molecular biology 314 (2015): 43-116.
Armstrong, Jane L., et al. “Exploiting cannabinoid-induced cytotoxic autophagy to drive melanoma cell death.” Journal of Investigative Dermatology 135.6 (2015): 1629-1637.
Donadelli, M., et al. “Gemcitabine/cannabinoid combination triggers autophagy in pancreatic cancer cells through a ROS-mediated mechanism.” Cell death & disease 2.4 (2011): e152.
Shrivastava, Ashutosh, et al. “Cannabidiol induces programmed cell death in breast cancer cells by coordinating the cross-talk between apoptosis and autophagy.” Molecular Cancer Therapeutics 10.7 (2011): 1161-1172.
McAllister, Sean D., et al. “Pathways mediating the effects of cannabidiol on the reduction of breast cancer cell proliferation, invasion, and metastasis.” Breast cancer research and treatment 129.1 (2011): 37-47.
Preet, Anju, et al. “Cannabinoid receptors, CB1 and CB2, as novel targets for inhibition of non–small cell lung cancer growth and metastasis.” Cancer Prevention Research 4.1 (2011): 65-75.
Mc Allister, Sean D., et al. “Cannabinoids selectively inhibit proliferation and induce death of cultured human glioblastoma multiforme cells.” Journal of neuro-oncology 74.1 (2005): 31-40.
Greenhough, Alexander, et al. “The cannabinoid δ9‐tetrahydrocannabinol inhibits RAS‐MAPK and PI3K‐AKT survival signalling and induces BAD‐mediated apoptosis in colorectal cancer cells.” International journal of cancer 121.10 (2007): 2172-2180.
Powles, Thomas, et al. “Cannabis-induced cytotoxicity in leukemic cell lines: the role of the cannabinoid receptors and the MAPK pathway.” Blood 105.3 (2005): 1214-1221.
Nabissi, Massimo, et al. “Triggering of the TRPV2 channel by cannabidiol sensitizes glioblastoma cells to cytotoxic chemotherapeutic agents.” Carcinogenesis 34.1 (2013): 48-57.
Guzman, M., et al. “A pilot clinical study of 9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme.” British journal of cancer 95.2(2006):197-203.