While the use of marijuana has been around for thousands of years, it has only become legal in 24 states and the District of Columbia within recent history. As more states continue to approve marijuana for medical purposes, it’s important to separate the myths from the facts surrounding this drug.
This blog is the third in this series. Read Part I and Part II.
Research Studies
Cannabis research policies vary across the world. For example, Canada and the Netherlands have government-run programs in which specialized companies supply quality-controlled herbal cannabis. The Czech Republic, Israel, Canada and the Netherlands have government-sponsored research programs.
Here in the United States, the Schedule I drug classification (classified with LSD and heroin) and legal roadblocks make it difficult to obtain cannabis for research. Clinicalconnection.com currently lists 28 cannabis trials being done in the United States. All but three of these trials are looking at psychosis and addiction/dependence:
- one is investigating vaporized cannabis in sickle cell disease
- one is looking at the treatment of spasticity in multiple sclerosis
- the other trial is looking at the effects of cannabis on brain morphology in aging
In short, there are no federal studies looking at the medical use of cannabis in cancer treatment or side effect management in this country. There are, however, several states, including California and Colorado, doing clinical trials at the state level.
Further hindering national cannabis research is the fact that only marijuana grown at the University of Mississippi is sanctioned for use in clinical trials in the United States. The operation and growing are overseen by the National Institute of Drug Abuse, which has come under fire for allegedly only funding research that focuses on the potential negative effects (Huffington Post, June 25, 2014).
The Food and Drug Administration (FDA) has submitted their recommendation to the DEA, but at this time, it has not been released to the public whether they are recommending a change.The Drug Enforcement Administration (DEA) has stated it will decide whether marijuana will be reclassified under federal law in in 2016. This issue has been in front of the DEA previously in 2001 and 2006 when they determined there wasn’t enough evidence to change the classification of marijuana (Huffington Post, April 5, 2016).
The Good and Bad of Medical Marijuana: What the Research Says
In an article published by the Journal of the American Medical Association, June 2015 Volume 313 (24), the authors reviewed the literature surrounding the benefits versus the adverse effects of cannabis and cannabinoids across a spectrum of diseases and conditions, including cancer.
A total of 79 trials were included, looking at:
- nausea and vomiting due to chemotherapy
- appetite stimulation in HIV/AIDS
- chronic pain
- spasticity due to multiple sclerosis (MS) or paraplegia
- depression & anxiety
- sleep disorder, psychosis
- intraocular pressure in glaucoma
- Tourette's syndrome
Levels of evidence were determined based on the type of study and the measured outcomes. Clinical trials are associated with the strongest evidence and uncontrolled studies, including anecdotal evidence and personal experience reported by an individual, have the lowest.
According to the National Cancer Institute Cannabis and Cannabinoids PDQ, a study must have the following to qualify for a level of evidence analysis:
- Be published in a peer-reviewed scientific journal
- Report the therapeutic outcomes, such as tumor response, increased survival or measured improvement in quality of life
- Describe the clinical findings in enough detail for a meaningful evaluation to be made
In Conclusion
As a doctor and stage IV survivor, I started this review biased against the use of cannabis in cancer treatment. But, through months of research, I have begun to see the potential benefit of marijuana as a complementary treatment, in some cases, for people receiving cancer treatment.
In an American Society of Clinical Oncology supplement, a physician spoke about his relief of nausea and vomiting from radiation for advanced stomach cancer by smoking marijuana (ASCO Connections, March 2016). There are many patients who report benefits from medical marijuana.
If you or someone you love is considering medical marijuana, do your research, look at the references we provide and talk with others. Most importantly, speak with your doctor.
Table: Medical Marijuana Research Studies Literature Review
|
|
Cannabis |
Cannabinoids |
|
Cannabis refers to the whole marijuana plant. There are variations of ingredients between different plants and species. There are over 545 chemical compounds; THC is the main psychoactive compound |
The active chemicals in the marijuana plant. Either synthetic, made in a laboratory, or extracted from the plant Concentrations are documented, tested, and standardized. |
|
|
Delivery mechanism |
Smoked |
Delta-9 tetrahydrocannabinol:THC: Dronabinol. Extract FDA-approved capsules: Marinol Nabilone: CBD or cannabidiol. Synthetic FDA-approved capsule: Cesamet Nabiximols 1:1 THC:CBD (Phase III trials |
|
Moderate clinical evidence |
Spasticity in multiple sclerosis and paraplegia |
Spasticity in multiple sclerosis, paraplegia |
|
Insufficient evidence |
Treating cancer |
Treating cancer |
|
Weak clinical evidence
|
Sleep problems |
Sleep problems |
|
Conflicting clinical data |
PTSD |
PTSD |
|
Adverse effects |
Withdrawals (not as severe as opioids) |
Withdrawals |
Recommended Reading
Cannabis and Cannabinoid Research volume 1:1 2016
Nature Outlook Cannabis Volume 525, September 24, 2015
Medical Marijuana JAMA Patient page June 23/30, 2015 Volume 313, (24)
Cannabis and cancer: reality or pipe dream? Lancet Oncology, October 2016 Volume 16
Medical Marijuana for Cancer, CA: A Cancer Journal for Clinicians March/April 2015 Volume 65 (2).
Cannabis in Cancer Care Clinical Pharmacolgy & Therapeutics June 2015, Volume 97 (6)
Medicinal Cannabis in Oncology European Journal of Cancer 2007, Volume 43
About the Author
Dr. Laura Porter, MD, stage IV colon cancer survivor and Colon Cancer Alliance Patient Advocate Medical Consultant.
Dr. Laura Porter’s medical background, battle with colorectal cancer, humor and honesty uniquely position her message of hope and her passion for sharing the message of survival. She disseminates the latest in colon cancer research in lay terms to other survivors and their family members. Dr. Porter currently serves on many national committees and task forces. Here are a few:
- Member of National Cancer Institute Rectal Anal Task Force of the Gastrointestinal Steering Committee
- Member of National Cancer Institute Patient Advocate Steering Committee
- Member American Society of Clinical Oncology’s (ASCO) Targeted Agent and Profiling Utilization Registry (TAPUR) Study Molecular Tumor Board
- Member ASCO working group Clinical Meaningful Outcomes in colorectal cancer
- Member National Quality Forum Palliative and End-of-Life Care Standing Committee
- Member of Patient-Centered Outcomes Research Institute (PCORI) funded project Improving Informed Consent for Palliative Chemotherapy
- Member Peer Reviewed Cancer Research Program (PRCRP), sponsored by the Department of Defense
Contributors
Jasmine Greenamyer, MPH
Eric Hargis
Jose Mendoza, MD
Jeannie Moore
The Colon Cancer Alliance does not endorse or recommend any specific treatment or screening method for colorectal cancer; rather we serve as a source of scientifically accurate medical information to help empower patients and their caregivers to make informed decisions in consultation with their health professionals.