Dronabinol, a pharmaceutical form of THC, and a man-made cannabinoid drug called nabilone are approved by the FDA to treat some. Cannabis has been used medicinally for millennia, but has not been approved by the U.S. Food and Drug Administration to treat any medical. “We observed that when we treated [astrocytoma, a type of brain tumor] cells with cannabinoids, the THC was killing the cells in our Petri.
Cancer Treatment Tetrahydrocannabinol
Their small study 9 patients showed the safety of intracranial administration of thc and demonstrated antiproliferative effects in some of the patients. All patients eventually progressed and died, but not because of any effects of the extract.
The investigators are actively continuing their clinical and research work, focusing on tumours of the central nervous system Oncologists might be concerned that cannabinoids could reduce the effectiveness of established chemotherapy agents. Several authors have investigated cannabis extracts used in tandem with a variety of chemotherapy agents in vitro and in animal models, showing synergism in reducing cell numbers, and no negative effect on anticancer function.
Cell cultures from pancreatic 64 , glioma 65 , gastric 66 , lung 67 , and colon 68 cancers have been investigated using a range of antineoplastic agents, including gemcitabine, temozolomide, paclitaxel, and 5-fluorouracil. Synergism in inducing cancer cell death is a common finding, which bodes well for the possibility of human clinical trials in future Despite the emerging evidence of antineoplastic activity, some older in vitro studies demonstrated cancer cell proliferation and loss of immune-mediated cancer suppressor activity after treatment with cannabinoid preparations 58 , Some studies have even shown discordant results depending on the concentration of cannabinoids: Thus, conflicting evidence points to the need for sober second thought before outright recommendations of cannabinoids for cancer patients can be made.
But again, mice and rats are not people, and what is observed in vitro does not necessarily translate into clinical medicine. The preclinical evidence that cannabinoids might have direct anticancer activity is provocative as well, but more research is warranted.
Currently, several clinical studies using cannabinoids in cancer therapy are registered at http: When a patient is referred to our outpatient clinic with a request for medical cannabis, several questions come to mind:. Most of our patients have either tried medical cannabis or read about its role in symptom control. Those who have tried it recreationally or for medical purposes can accurately reflect on the benefits or the adverse effects experienced, which makes the discussion somewhat easier.
Those who have little knowledge and less experience require a complete discussion with respect to the benefits, the possible adverse effects, the process of application and authorization, and the cost which is borne by the patient, because it is not covered by provincial or private medical insurance. Table iii lists our contraindications to authorization, which are similar to those published by Health Canada 70 , the College of Family Physicians of Canada 71 , and the Canadian Medical Protective Association It should be noted that no special license or additional certification is necessary to authorize the use of medical cannabis, but a working knowledge of cannabis as already presented is helpful for oncology professionals who are considering a patient request.
Once the decision is made to support authorization, the choice of which licensed producer and product to use can be somewhat difficult for some patients.
The more than 30 licensed producers list more than products for sale, which can be a problem for those who do not have experience with cannabis or patients who might be elderly or excessively fatigued.
We do not advise that patients smoke the dried product; rather, they should vaporize, which is likely safer in the long run We also advise neophytes to choose a product that has a balanced thc: Cannabinoid proportions can be guided by available efficacy data summarized in Table iv. Once patients have started to use the product and document the effects, the thc: Conditions potentially responding to cannabinoid therapies 74 — Titration of dose should follow the effect on the symptom in question for example, pain reduction, nausea control.
Follow-up with patients is essential to determine benefits and any adverse effects, questions about use or strain selection, and outcomes. Certainly, if the adverse effects are not tolerable, then an alternative therapy should be considered. If the patient is not getting the desired symptom control, then some dose modification might be necessary. Discontinuation of cannabis should be considered if an adequate trial does not result in the desired outcome as determined by the treating team or the patient.
Inter-professional collaboration is the new paradigm under which modern health care operates Research has demonstrated that inter-professional collaboration is enabled and promoted by inter-professional education, especially at the undergraduate level 79 , Although physicians ultimately authorize and prescribe cannabinoid therapies, valuable insights and inputs about achieving optimal patient outcomes can be derived from other members of the health care team, including nurses, social workers, rehabilitation therapists, and pharmacists.
Furthermore, pharmacies are designed to ensure proper storage and security of medical products. Pharmacists are also well positioned to comprehensively counsel patients and caregivers on the optimal methods of opioid and by extension, cannabis storage and disposal so as to limit diversion and unintentional exposure Moreover, given the emergence of cannabinoids as a novel therapeutic class, cannabinoid education for medical professionals as well as for patients and caregivers should be conducted per the principles of inter-professional education Industrialized countries are experiencing exponential increases in the utilization of opioids 84 , Major public health issues are emerging as a result, not the least of which relate to drug diversion, opioid addiction, and death from opioid overdose 84 , Currently, opioids remain the mainstay of cancer pain management, and increased cancer survival translates into patients using opioids for longer periods of time High-dose and long-term opioid therapy in cancer patients is becoming a concern, given observed risks such as poly-endocrinopathy, osteoporosis, and immunosup-pression Preclinical studies have demonstrated that certain opioids—such as codeine, morphine, methadone, and remifentanil—are associated with increased morbidity and mortality attributable to worsening of cancer and infections Opioid-induced hyperalgesia syndrome is also being reported with increased incidence, especially in patients with advanced cancer and escalating pain Thus, it behooves physicians to explore options that will allow for improved overall pain relief while curbing the overuse of opioids.
Observational studies in advanced cancer cohorts have demonstrated that cannabinoid therapies are associated with opioid-sparing and improved analgesia Published data on the addiction potential for recreational cannabis reflects a risk of 9.
Finally, a British study showed that the overall harm score for user and society for recreational cannabis score: Because medical cannabis generally tends to have a higher ratio of cbd to thc , it would be expected to be associated with a lower predilection to diversion, less addiction potential, and lower overall harm scores than those for recreational cannabis The integration and broader utilization of cannabinoid therapies within the domain of oncology including palliation carries the potential not only for improved health care outcomes for patients but also for economic savings and greater safety for society 90 , Patient reports of improvement in quality of life, especially for those undergoing intensive treatment regimens, could be key to patients continuing with lifesaving or life-prolonging therapies.
Cannabinoids might be able to help patients throughout their disease trajectory, but evidence about the ideal timing for cannabinoid initiation is lacking. More research will guide oncology and palliative care teams in their pursuit of excellence in cancer and symptomatic care. VM has presented educational activities supported by Tweed, Bedrocan, and Mettrum. National Center for Biotechnology Information , U. Journal List Curr Oncol v. Published online Dec Find articles by P.
Author information Copyright and License information Disclaimer. Copyright Multimed Inc. This article has been cited by other articles in PMC. The Endocannabinoid System The endogenous opioid and cannabinoid systems are the only chemical systems in the human body that have survived more than million years of human evolution 1 — 4.
Cannabinoid Pharmacology In Canada, more than strains of medical cannabis are available from licensed producers 5. Open in a separate window. Cannabinoids for Medical Use Although the assessment and treatment of pain and other symptoms in patients with advanced cancers has become a standard of care, many patients still have incomplete symptom control Pain Cannabinoids, including herbal cannabis and extracts, have been used for the treatment of pain for centuries.
Nausea and Vomiting Controlling nausea and vomiting was one of the initial uses of cannabinoids documented in the modern scientific literature. Appetite Stimulation The data supporting cannabis and cannabinoid use in appetite stimulation is less conclusive than it is in pain or nausea.
The Importance of Inter-professional Collaboration Inter-professional collaboration is the new paradigm under which modern health care operates Cannabinoid Therapies As a Harm Reduction Strategy Industrialized countries are experiencing exponential increases in the utilization of opioids 84 , Oxford University Press; The Medicinal Uses of Cannabis and Cannabinoids.
Grotenhermen F, Russo E, editors. Pharmacology, Toxicology, and Therapeutic Potential. The Haworth Therapeutic Press; Medical cannabis in the palliation of malignant wounds—a case report. J Pain Symptom Manage. Programming of neural cells by endo cannabinoids: Endocannabinoid signaling at the periphery: Cannabinoid receptors and their ligands: Cannabinoids for symptom management and cancer therapy: J Natl Compr Canc Netw.
Mitochondrial cb 1 receptors regulate neuronal energy metabolism. A critical review of the antipsychotic effects of cannabidiol; 30 years of a translational investigation. Zhornitsky S, Potvin S. Cannabidiol in humans—the quest for therapeutic targets. Pharmaceuticals Basel ; 5: Romano LL, Hazekamp A. Pharmcokinetics and pharmacodynamics of cannabinoids.
The pharmacology of cannabinoid receptors and their ligands: Int J Obes Lond ; 30 suppl 1: Cytochrome P enzymes involved in the metabolism of tetrahydrocannabinols and cannabinol by human hepatic microsomes.
Identification of cytochrome P enzymes responsible of cannabidiol by human liver microsomes. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: Interindividual variation in the pharmacokinetics of delta9-tetrahydrocannabinol as related to genetic polymorphisms in CYP2C9. Pharmacokinetic drug interactions with tobacco, cannabinoids and smoking cessation products.
Our funding committees have previously received other applications from researchers who want to investigate cannabinoids that have failed to reach our high standards for funding. If we receive future proposals that do meet these stringent requirements, then there is no reason why they would not be funded — assuming we have the money available to do so. But whole plants or other organisms are a complex mix of hundreds of chemicals not all of which may be beneficial and contains low or variable levels of active ingredients.
This makes it difficult to give accurate doses and runs the risk of toxic side effects. Foxgloves — a source of medically useful chemicals. These drugs are now used to treat many thousands of people around the world with heart failure and other cardiac problems. But the entire plant itself is highly toxic, and eating just a small amount can kill. But this naturally-occurring chemical causes severe stomach irritation, which led to the German company Bayer developing an alternative version — acetylsalicylic acid — which was kinder to the tummy.
Aspirin is now arguably one of the most successful drugs of all time, and is still being investigated for its potential in preventing or even treating cancer. As we said above, there is no good evidence that natural cannabinoids, at the doses present in simple cannabis preparations, can treat cancer in patients.
There is a strong and persistent presence on the internet arguing that cannabis can cure cancer. Despite what the supporters of these sources may claim, videos and stories are not scientific evidence for the effectiveness of any cancer treatment.
We know nothing about their medical diagnosis, stage of disease or outlook. People who make these bold claims for cannabis only pick their best cases, without presenting the full picture.
This highlights the importance of publishing data from scientifically rigorous lab research and clinical trials. Firstly because conducting proper clinical studies enables researchers to prove that a prospective cancer treatment is safe and effective. And secondly because publishing this data allows doctors around the world to judge for themselves and use it for the benefit of their patients.
Internet anecdotes and videos prove nothing and benefit no-one — we need reliable, scientific research, which as discussed above is exactly what is going on. Not only to the thousands of our scientists, doctors and nurses who are working as hard as they can to find more effective treatments for the complex set of challenging diseases we call cancer, but also the hundreds of thousands of people in the UK and beyond who support this life-saving work through generous donations of money, energy and time.
Our aim is to beat cancer, and we believe that the best way to do this through rigorous scientific research aimed at understanding cancer on a biological level and working out how to prevent, detect and treat it more effectively. As a research-based organisation, we want to see reliable scientific evidence to support claims made about any cancer treatment, be it conventional or alternative.
This is vital because lives are at stake. If someone chooses to reject conventional cancer treatment in favour of unproven alternatives, including cannabis, they may miss out on treatment that could save or significantly lengthen their life. They may also miss out on effective symptom relief to control their pain and suffering, or the chance to spend precious time with their loved ones. Furthermore, many of these unproven therapies come at a high price, and are not covered by the NHS or medical insurance.
And, in the worst cases, an alternative therapy may even hasten death. 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.
If someone is feeling good, she may only need to take one or two drops per day. Medical marijuana comes in a variety of strains and each has different levels of active compounds and potency.
This means the effects of medical marijuana will be unique to each person and can be hard to predict. Many oncologists would prefer that their patients not smoke anything.
Cannabis, Cannabinoids and Cancer – The Evidence So Far
Cannabinoids for Cancer Treatment: Progress and Promise. Cancer The Combination of Cannabidiol and Δ9-Tetrahydrocannabinol Enhances the Anticancer. Keywords: Cancer, Cannabidiol, Cannabinoids, Cannabis, CBD, Nabilone ( THC synthetic analogue) is allowed for the treatment of nausea. Thus, it was found that treatment with thc results in enhanced with cannabinoid treatment in other types of cancer cells, an observation which.