Should Oncologists Trust Cannabinoids?
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Should Oncologists Trust Cannabinoids?
People have been using cannabinoids for thousands of years. The oldest known use comes from China, around 2800 BC, when it was listed in Shen Nung’s pharmacopeia, or book of medicinal drugs and their applications. Cannabis was used therapeutically in the medical texts of the Hindu, Assyrian, Greek, and Roman civilizations. These ancient medical texts reported cannabis to help people deal with numerous health problems, including arthritis, depression, amenorrhea, inflammation, pain, lack of appetite, and asthma.
However, in the world of modern medicine, cannabis’s status as a helpful medical plant has largely been repressed due to the plant’s status as a controlled substance in the United States and abroad. This has led to a market of secondary importance, as cannabinoids have been relegated to the classification of alternative medicine.
And for many doctors, that’s a big problem. There are only a few FDA-approved medications derived from cannabis, including:
- Epidiolex, which contains a purified form of CBD derived from cannabis, is approved for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome, two rare and severe forms of epilepsy.
- Marinol and Syndros, which contain dronabinol (synthetic THC), are approved for nausea and vomiting caused by cancer chemotherapy. Dronabinol is also used to treat loss of appetite and weight loss in people with HIV/AIDS.
- Cesamet and Canemes, which contain nabilone (a synthetic substance similar to THC), are approved to treat nausea and vomiting caused by chemotherapy.
Outside of these limited cases, there are no FDA-approved uses of cannabinoids.
This brings us to the issue: Should oncologists trust cannabinoids? Nearly everything surrounding cancer is painful. The treatments are painful. The condition is painful. And it is increasingly difficult to get FDA-approved pain medications prescribed, and to get those prescriptions filled by pharmacists. And many patients don’t want the side effects of opioids on top of the side effects they’re already receiving from their chemotherapy. Cancer patients in pain are going to seek out alternative forms of pain relief, and for many, that means cannabinoids.
Because of the widespread use of cannabis for cancer, oncologists should stay informed of the most recent evidence-based data about cannabinoids and how they can help cancer patients. In a recent review article in Frontiers in Pharmacology, the authors set out to inform oncologists about how cancer patients use cannabinoids and what these compounds can do. Please note that these statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease, and this article is not intended to do anything other than keep people informed of research developments.
Cannabinoids and Cancer Pain
Pain, both physical and emotional, is a common and distressing issue in cancer patients, often leading to high healthcare costs. Chronic pain is especially prevalent among these patients. Current treatments, including opioids, have limitations due to side effects and dependence issues. Neuropathic pain, a type of chronic pain common in cancer, is often resistant to treatment.
Cannabinoids, compounds found in cannabis, have been studied for their potential in managing cancer-related pain. They interact with the endocannabinoid system in the body, affecting pain perception and immune responses. Animal studies suggest that cannabinoids can alleviate cancer-related pain, particularly neuropathic pain. Some clinical studies also show benefits, with cancer patients reporting reduced pain and symptom improvement with medical cannabis.
Cannabinoids may have an “opioid-sparing effect,” meaning they could reduce the need for opioids in pain management. Preclinical studies indicate that combining cannabinoids with opioids can enhance pain relief. However, clinical trials have yielded mixed results, with some showing benefits and others not. Currently, no cannabinoid-based medications are approved for cancer pain treatment by the FDA or EMA.
In summary, cannabinoids show promise in managing cancer-related pain, especially neuropathic pain, and potentially reducing opioid use. However, more research is needed to establish their effectiveness and safety in larger clinical trials before widespread clinical use can be recommended.
Chemotherapy-induced nausea and vomiting (CINV) is a significant problem for cancer patients, affecting up to 65% with nausea and 25% with vomiting. It’s a major concern because it can impact patients’ quality of life, hinder treatment, and lead to serious health issues like dehydration.
CINV happens due to the way chemotherapy affects various receptors in the body, triggering the vomiting process. Several drugs are used to manage CINV, but there are still unmet needs in treating it effectively, especially when it becomes resistant to treatment. That’s where cannabinoids, which use different signaling pathways than other types of pharmaceuticals, may come into play.
Researchers have explored the use of cannabinoids to manage CINV. The idea came from the discovery of cannabinoid receptors in areas of the brain involved in vomiting. Both animal and human studies have shown that cannabinoids, like THC and synthetic versions, can be effective in reducing CINV. In fact, synthetic THC called Dronabinol was approved by the FDA for this purpose.
Newer cannabinoid-based drugs that contain compounds like THC and CBD for cancer patients are also being tested and have shown promise in reducing CINV. These drugs can be a valuable addition when other antiemetic treatments fail.
While cannabinoids are often said to be safe, research shows that there are risks for certain groups of people. Senior patients with a history of heart disease can develop life-threatening cardiovascular side effects, such as myocardial infarction (heart attack). Most of the research on side effects and negative effects only focuses on the relationship between health and THC– which is only one of hundreds of cannabinoids. There has been comparatively little research done on the health impacts of CBD or THCV, for example.
Another major study focus has been on addiction. Addiction is one of the main concerns that doctors have about the medical use of cannabis, but not only is cannabis rarely addictive, many of the compounds that are used by cancer patients (like CBD) have no addiction potential.
Cannabinoids, known for their historical use as remedies, have faced research challenges due to strain variability and legal difficulties. With the increasing legalization of cannabis, especially for cancer patients, interest in these drugs has grown. However, aside from their effectiveness in managing nausea and vomiting, cannabinoids lack approval for cancer-related uses. The absence of standardized guidelines complicates the interpretation of real-world data.
Despite this, cannabinoids seem to have a positive impact on cancer-related pain when used alongside other pain medications and initiated early in treatment. They also appear to enhance patient well-being by addressing symptoms like mood, appetite, and anxiety. The debate regarding their anti-tumor properties continues, with some data suggesting potential benefits, especially in conjunction with other cancer therapies.
If oncologists want to best serve their cancer patients, they should consider integrating cannabinoids into clinical care. But prescribing cannabinoids requires careful consideration of the patient’s profile. Young patients, pregnant individuals, those with mental health or substance abuse histories, or elderly individuals with severe cardiovascular conditions should avoid them until more safety data is available. Additionally, selecting the right combination of active compounds, dosage, and administration method is crucial to prevent unwanted effects.
To fully understand the potential of cannabinoids, more data on their mechanism of action, dosing, interactions with other drugs, and adverse effects are needed. High-quality clinical trials are essential to boost oncologists’ confidence when recommending these drugs to patients.
At Myriam’s Hemp, we want everybody to have access to the information they need to make pain relief choices, especially when managing the devastating effects of cancer. Contact us today if you have any questions about our premium cannabinoid products and which ones we recommend.