Photo credit: bigstock.com/Melica73 My friend and colleague, Donald I. Abrams, MD has been practicing hematology and oncology for over 35 years. Abrams is a noted integrative oncologist, and acclaimed expert and go-to media darling for all things cannabis for cancer patients.
He recently delivered a members-only webinar on Cannabis and Cancer for the Society for Integrative Oncology, and was kind enough to share the latest research that informs the writing of this post. Years ago, when Abrams shared with me that weed kills CLL cells in a petri dish, it got my attention because that was the disease I was hosting. But the scant evidence and potential ‘disease management upside’ of returning to using—since I had what I considered a precarious past relationship with cannabis—did not outweigh my reality and previous experience with cannabis.
Specific to the use of medical marijuana in the cancer setting, Abrams had this to say in a paper published in the May 2016 edition of The Oncology Journal:
“If I have a single medicine that I can recommend to assist with nausea, anorexia, insomnia, depression, and pain rather than prescribing five or six pharmaceuticals that may interact with each other or the patient’s chemotherapy, I consider it an attractive option for my patients.” ~ Donald I. Abrams, MD
A Little Refresher
THC (tetrahydrocannabinol) and CBD (cannabidiol) are two types of cannabinoids found in the resin of the marijuana plant, cannabis sativa. While both of these naturally-occurring chemicals interact with the cannabinoid receptors found in the human body, the effects of each are exclusive. THC is the primary psychoactive agent in the marijuana plant that produces the ‘high’. CBD hanaturally occurrings the same chemical formula as THC; however, the atoms are arranged differently, and therefore it lacks the psychoactive effect of THC.
Back in the day, or should I say ‘my day’—the ’70’s and ’80’s—most pot from Mexico and Columbia was under 3 percent THC. And it was often compromised in terms of chemical sprays, mold, and other contaminants. Remember paraquat? These days, the stuff is mostly grown hydroponically indoors, and can contain extremely high percentages of THC—25 percent and more.
Available in a variety of strains—with exotic names—cultivated for different psychoactive effects, it can be consumed in numerous ways. Today, cannabis, cultivated for distribution within the U.S. states where it is legalized for medical and recreational use, undergoes rigorous testing and a stringent regulatory process.
Here’s what NIH’s National Center for Complementary and Integrative Health has to say about medical marijuana: (I’ve edited for clarity)
The U.S. Food and Drug Administration (FDA) hasn’t found marijuana safe or effective for treating any health problems.
Several states and the District of Columbia allow its use for certain health purposes; these states have legalized medical marijuana because of decisions made by voters or legislators—not because of scientific evidence of its benefits and risks.
It’s challenging to study the health effects of marijuana because of legal restrictions and variability in the concentration of the plant’s psychoactive chemicals.
Recently, the Federal Government eased some research restrictions, and began providing researchers with more strains of marijuana. Currently, the quality of research on marijuana and its components for ‘health impact’ varies widely by disease (other than two FDA-approved medications*).
In January 2017, the National Academies of Sciences, Engineering, and Medicine published a report on the health effects of marijuana and products derived from it. The report summarizes the current evidence on both therapeutic effects and harmful effects, recommends that research be done to develop a comprehensive understanding of the health effects of marijuana, and recommends that steps be taken to overcome regulatory barriers that make it difficult to do that research.
The National Institute on Drug Abuse (NIDA) has more information on many aspects of marijuana, including how likely people are to abuse it and how chemicals in marijuana affect our brain and body.
In Europe, the United Kingdom, and Canada, a mouth and throat spray called nabiximols, which is derived directly from the marijuana plant, and contains two of the plant’s components, has been licensed and approved for the relief of pain and spasticity associated with multiple sclerosis, and as an addition to pain treatment for cancer patients.
Studies of nabiximols are in progress in the United States.
*The FDA has approved two prescription drugs, dronabinol and nabilone, based on a component of marijuana. Dronabinol and Nabilone are synthetic forms of THC. They are typically prescribed to counter cancer side effects, specifically nausea and loss of appetite. In my discussions with oncologists, most feel that these two synthetic drugs are largely ineffective, whereas their experience with cancer patients using cannabis is almost uniformly positive.
First FDA Sanctioned Marijuana-Based Pharmaceutical
The FDA recently approved UK-based GW Pharmaceuticals’ Epidiolex drug for a rare form of childhood epilepsy. It is the first marijuana-based medicine approved in the U.S. Like many forms of medical marijuana, Epidiolex has been engineered so there is no ‘high’. Clearly, the U.S. is not a leader in the worldwide investigation of the medicinal benefits of cannabis. As long as the U.S. Drug Enforcement Agency continues to classify marijuana as a schedule 1 narcotic in the U.S., it will continue to cede research leadership to countries such as Israel, Spain, Canada, Czech Republic, Uruguay, and the Netherlands.
State-By-State Adoption of Cannabis Over Opioids?
Governor Bruce Rauner of Illinois recently signed into law a measure that could dramatically expand access to medical marijuana in his state, making it available as an opioid painkiller alternative, and easing the application process for those who qualify. It is inevitable that others will follow.
Where We’re Going
Potential Medical Applications for THC This list exists because there is evidence or often positive clinical outcomes correlation.
Cancer treatment side effects—to decrease pain and nausea, and stimulate appetite
Potential Medical Applications for CBD This list exists because there is evidence or often positive clinical outcomes correlation.
Epilepsy and seizure disorders
Pain and inflammation
Schizophrenia—to reduce psychotic symptoms
Social anxiety disorder and PTSD—to reduce level of anxiety
Depression—to reduce level of depression
Cancer treatment side effects—to decrease pain and nausea, and stimulate appetite
[Handpicked Content of Interest: A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy]
Evidence for Cannabis and Cancer
Though clinical observations and the growing literature base support the use of cannabinoids for cancer supportive care (to combat side effects such as nausea, vomiting, weight loss, pain, anxiety, depression, and insomnia), there is far less evidence that THC, CBD, or combinations thereof, are effective as anticancer agents that actively kill cancer cells. An increasing body of in vitro (test tubes, petri dishes) and animal-model studies support a potential direct anticancer effect of cannabinoids through various mechanisms involving apoptosis (programmed cell death), anti-angiogenesis (preventing the spread of cancer through blood vessels), and inhibition of metastatic disease.
Despite a lack of clinical trials, especially in the U.S., myriad anecdotal reports describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency, orally-ingested concentrate. More human studies are vital to address critical questions related to the potential of cannabinoids as an anticancer agent. There are many claims made on the Internet about highly-concentrated forms of cannabis oils being used to cure cancer. This may be possible, but, as yet, no solid, supporting evidence exists. Worse, there are too many situations—one is one too many—where people with curable, early onset disease choose to forgo effective conventional cancer care in favor of cannabis (or other ‘natural’) products alone. This is when alternative cancer care can kill. [Handpicked Content of Interest: Association of Marijuana Use With Psychosocial and Quality of Life Outcomes Among Patients With Head and Neck Cancer]
Waiting for the Evidence
In previous writings I have been clear on my thinking as it relates to waiting for more evidence to properly and safely integrate botanicals and other natural agents into a cancer treatment management protocol. If it:
Is generally recognized as safe;
Does not create contraindications with other drugs;
Is well-sourced in terms of quality, purity, handling;
Is used, to the extent possible with your particular situation, under the supervision of a medical professional;
Is not used as an alternative to conventional cancer care, when that treatment has been shown as largely effective and curative;
…then go for it. What do you really have to lose? If you or a loved one is dealing with cancer in the here and now, why wait for more evidence to become available?
Cannabis: Not For Me, Maybe For You
I did not write about my history of cannabis use in my book n of 1. I carefully considered mentioning my usage, but there remains a stigma—albeit a quickly dissipating one. I had not used marijuana as part of my treatment, per se, which is what my book chronicled. Candidly, between thoughts of my kids reading about it, and my growing professional reputation in healthcare, I took a conservative approach. A lot has changed these last few years regarding the perception and stigma of weed. The prohibition of cannabis is likely ending.
I began smoking pot in the ’70’s; it was my thing for decades. I stopped for a ten-year span, then began anew. I was a highly functioning and productive ‘user’, and quite creative, yet I knew I had a dependency issue, because whenever I stopped, I became depressed. The withdrawals were beyond nasty and, though THC leaves the bloodstream within about 30 days, my blues would last two months. So I stopped. THC-based products are not for me…but well-sourced CBD oil may just be. Turns out that just under 10 percent of users will become addicted. The rate is higher for adolescents and younger users. This phenomena is correlated based on the human brain’s pattern of growth until age 26. This is mentioned as a note of caution for those undertaking a THC-based approach to dealing with the side effects of cancer.
Considering the deleterious side effect of treatment itself, and the often multiple pharmaceutical agents (see Abrams’ quote above) prescribed to mitigate these issues, a dependency on THC may not be a patient’s biggest concern. To be clear: mine is absolutely not a ‘Just Say No’ to cannabis position, just because the psychoactive variety did not pan out for me. On the contrary, I say proceed with caution and facts in hand, because we have entered a fascinating and long overdue period of investigating various cannabinoids. Many people from around the world are reporting remarkable clinical outcomes across a number of health conditions. And clearly many folks—consumers, scientists, politicians, and drug companies—are paying close attention. Though I do not have active, detectable cancer—so I’m not dealing with treatment side effects—I will soon be experimenting with CBD oil for inflammation for the nagging aches and pains I get as a very active 55 year-old man who walks 20 miles each week, lifts weights every day, and sprinkles in yoga and Pilates. It has become a challenge not to miss workouts considering my underlying inflammatory issues. With my clean, predominantly plant-based diet, and the daily ingestion of the usual anti-inflammatory agents—such as EGCG, turmeric, and omega-3 fatty acids—CBD oil seems the logical next step so I can stay in the gym.
The science supporting the use of cannabinoids for cancer side effects and various other conditions is gaining momentum, and is worthy of your consideration.
The science supporting the use of cannabinoids as a bona fide anticancer agent to be used as a primary or adjuvant cancer treatment does not yet exist.
Consider human clinical studies as your core guide, and do your own research as you are able.
If possible, work with a medical professional trained in cancer and cannabinoids, ideally an integrative oncology or functional medicine physician with exposure to various products, and expertise in dosing.
Consider only CBD, THC, or hybrid products that have been tested for quality and purity.
Communicate with your core medical team about what you are taking because there are potential contraindications for CBD and THC products when used with various prescription drugs.
Think very carefully before utilizing cannabinoids as an alternative to conventional cancer treatment. After all, this is your life.
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