Medical marijuana for cancer

Contents

Marijuana and Cancer

Marijuana is the name given to the dried buds and leaves of varieties of the Cannabis sativa plant, which can grow wild in warm and tropical climates throughout the world and be cultivated commercially. It goes by many names, including pot, grass, cannabis, weed, hemp, hash, marihuana, ganja, and dozens of others.

Marijuana has been used in herbal remedies for centuries. Scientists have identified many biologically active components in marijuana. These are called cannabinoids. The two best studied components are the chemicals delta-9-tetrahydrocannabinol (often referred to as THC), and cannabidiol (CBD). Other cannabinoids are being studied.

At this time, the US Drug Enforcement Administration (DEA) lists marijuana and its cannabinoids as Schedule I controlled substances. This means that they cannot legally be prescribed, possessed, or sold under federal law. Whole or crude marijuana (including marijuana oil or hemp oil) is not approved by the US Food and Drug Administration (FDA) for any medical use. But the use of marijuana to treat some medical conditions is legal under state laws in many states.

Dronabinol, a pharmaceutical form of THC, and a man-made cannabinoid drug called nabilone are approved by the FDA to treat some conditions.

Marijuana

Different compounds in marijuana have different actions in the human body. For example, delta-9-tetrahydrocannabinol (THC) seems to cause the “high” reported by marijuana users, and also can help relieve pain and nausea, reduce inflammation, and can act as an antioxidant. Cannabidiol (CBD) can help treat seizures, can reduce anxiety and paranoia, and can counteract the “high” caused by THC.

Different cultivars (strains or types) and even different crops of marijuana plants can have varying amounts of these and other active compounds. This means that marijuana can have different effects based on the strain used.

The effects of marijuana also vary depending on how marijuana compounds enter the body:

  • When taken by mouth, such as in baked goods, the THC is absorbed poorly and can take hours to be absorbed. Once it’s absorbed, it’s processed by the liver, which produces a second psychoactive compound (a substance that acts on the brain and changes mood or consciousness) that affects the brain differently than THC.
  • When marijuana is smoked or vaporized (inhaled), THC enters the bloodstream and goes to the brain quickly. The second psychoactive compound is produced in small amounts, and so has less effect. The effects of inhaled marijuana fade faster than marijuana taken by mouth.

How can marijuana affect symptoms of cancer?

A number of small studies of smoked marijuana found that it can be helpful in treating nausea and vomiting from cancer chemotherapy.

A few studies have found that inhaled (smoked or vaporized) marijuana can be helpful treatment of neuropathic pain (pain caused by damaged nerves).

Smoked marijuana has also helped improve food intake in HIV patients in studies.

There are no studies in people of the effects of marijuana oil or hemp oil.

Studies have long shown that people who took marijuana extracts in clinical trials tended to need less pain medicine.

More recently, scientists reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer.

There have been some early clinical trials of cannabinoids in treating cancer in humans and more studies are planned. While the studies so far have shown that cannabinoids can be safe in treating cancer, they do not show that they help control or cure the disease.

Relying on marijuana alone as treatment while avoiding or delaying conventional medical care for cancer may have serious health consequences.

Possible harms of marijuana

Marijuana can also pose some harms to users. While the most common effect of marijuana is a feeling of euphoria (“high”), it also can lower the user’s control over movement, cause disorientation, and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia.

Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke.

Because marijuana plants come in different strains with different levels of active compounds, it can make each user’s experience very hard to predict. The effects can also differ based on how deeply and for how long the user inhales. Likewise, the effects of ingesting marijuana orally can vary between people. Also, some chronic users can develop an unhealthy dependence on marijuana.

Cannabinoid drugs

There are 2 chemically pure drugs based on marijuana compounds that have been approved in the US for medical use.

  • Dronabinol (Marinol®) is a gelatin capsule containing delta-9-tetrahydrocannabinol (THC) that’s approved by the US Food and Drug Administration (FDA) to treat nausea and vomiting caused by cancer chemotherapy as well as weight loss and poor appetite in patients with AIDS.
  • Nabilone (Cesamet®) is a synthetic cannabinoid that acts much like THC. It can be taken by mouth to treat nausea and vomiting caused by cancer chemotherapy when other drugs have not worked.

Nabiximols is a cannabinoid drug still under study in the US. It’s a mouth spray made up of a whole-plant extract with THC and cannabidiol (CBD) in an almost one to one mix. It’s available in Canada and parts of Europe to treat pain linked to cancer, as well as muscle spasms and pain from multiple sclerosis (MS). It’s not approved in the US at this time, but it’s being tested in clinical trials to see if it can help a number of conditions.

How can cannabinoid drugs affect symptoms of cancer?

Based on a number of studies, dronabinol can be helpful for reducing nausea and vomiting linked to chemotherapy.

Dronabinol has also been found to help improve food intake and prevent weight loss in patients with HIV. In studies of cancer patients, though, it wasn’t better than placebo or another drug (megestrol acetate).

Nabiximols has shown promise for helping people with cancer pain that’s unrelieved by strong pain medicines, but it hasn’t been found to be helpful in every study done. Research is still being done on this drug.

Side effects of cannabinoid drugs

Like many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side effects and complications.

Some people have trouble with increased heart rate, decreased blood pressure (especially when standing up), dizziness or lightheadedness, and fainting. These drugs can cause drowsiness as well as mood changes or a feeling of being “high” that some people find uncomfortable. They can also worsen depression, mania, or other mental illness. Some patients taking nabilone in studies reported hallucinations. The drugs may increase some effects of sedatives, sleeping pills, or alcohol, such as sleepiness and poor coordination. Patients have also reported problems with dry mouth and trouble with recent memory.

Older patients may have more problems with side effects and are usually started on lower doses.

People who have had emotional illnesses, paranoia, or hallucinations may find their symptoms are worse when taking cannabinoid drugs.

Talk to your doctor about what you should expect when taking one of these drugs. It’s a good idea to have someone with you when you first start taking one of these drugs and after any dose changes.

What does the American Cancer Society say about the use of marijuana in people with cancer?

The American Cancer Society supports the need for more scientific research on cannabinoids for cancer patients, and recognizes the need for better and more effective therapies that can overcome the often debilitating side effects of cancer and its treatment. The Society also believes that the classification of marijuana as a Schedule I controlled substance by the US Drug Enforcement Administration imposes numerous conditions on researchers and deters scientific study of cannabinoids. Federal officials should examine options consistent with federal law for enabling more scientific study on marijuana.

Medical decisions about pain and symptom management should be made between the patient and his or her doctor, balancing evidence of benefit and harm to the patient, the patient’s preferences and values, and any laws and regulations that may apply.

The American Cancer Society Cancer Action Network (ACS CAN), the Society’s advocacy affiliate, has not taken a position on legalization of marijuana for medical purposes because of the need for more scientific research on marijuana’s potential benefits and harms. However, ACS CAN opposes the smoking or vaping of marijuana and other cannabinoids in public places because the carcinogens in marijuana smoke pose numerous health hazards to the patient and others in the patient’s presence.

Managing cancer symptoms with medical marijuana: What patients need to know

Even with more states implementing medical marijuana laws, questions remain about the legitimate use of marijuana for medical conditions. For cancer patients in particular, medical marijuana may offer an interesting symptom management option. But due to the lack of clinical evidence currently available, many health care providers advise patients to proceed with caution and thoroughly discuss available options with their physician prior to beginning treatment.

Below are answers to common questions that may shed some light on where the medical marijuana field currently stands.

Is there a place for marijuana in medicine?

The active component of marijuana (cannabis) is tetrahydrocannabinol (THC). In some people, THC has the effect of controlling nausea, increasing appetite and lessening pain. The synthetic derivative of THC (dronabinol) is manufactured and sold as a Schedule III drug, defined as having low to moderate potential for physical or psychological dependence, and may be prescribed by your physician. These medications are strictly regulated by the U.S. Food and Drug Administration (FDA) for purity, effectiveness and safety. The FDA approves the use of dronabinol for anorexia related to AIDS wasting syndrome, as well as for refractory chemotherapy-induced nausea and vomiting. THC may also be obtained by smoking or eating the marijuana (cannabis) plant. However, the dosage of these plant-based forms is variable and not regulated by the FDA. This variability may lead to decreased effectiveness or increased side effects among users of marijuana.

What are the side effects of marijuana use?

Although THC may help reduce nausea or increase appetite, its side effects may also include the inability to think clearly or concentrate and, over the long-term, may include mental disorders such as schizophrenia, depression and/or bipolar disorder. In addition, respiratory complications such as chronic bronchitis could develop as a side effect of THC.

How does marijuana interact with other medications?

As with any medicine, marijuana may amplify side effects of other medications. It is important that you discuss the use of medicines and supplements with your physician and ask about potential side effects or interactions.

Will my insurance pay for medical marijuana?

Although states have passed laws permitting the use of medical marijuana, under federal law, marijuana continues to be an illegal Schedule I drug, meaning that it is considered to have a high potential for abuse and is not recognized for medicinal use. Because of this, marijuana cannot be used in hospital settings or dispensed at licensed pharmacies. Insurance companies do not cover the cost of medical marijuana, but most will cover the use of the pharmaceutical dronabinol, which contains the active component THC.

What is the medical evidence supporting medical marijuana?

Aside from anecdotal reports, very little medical evidence is available to support the use of medical marijuana. Only a small number of controlled studies have examined the benefits and risks of marijuana use. At this time, it is difficult to make a medical judgement regarding the use of medical marijuana with so little evidentiary details on which to base it.

How do I obtain medical marijuana for medical use?

Regulation of medical marijuana possession and use varies from state to state. Ultimately, medical decision-making is shared between individual patients and their physicians. If a physician determines that a medical indication exists for its use, the method of obtaining the product varies depending on that state’s laws. It is up to you and your physician to determine and comply with all state and federal regulations.

Learn more about pain management therapies being used as alternatives to opioids.

A patient’s guide to using cannabis for cancer

How to obtain medical cannabis

If you live in a place with either legal cannabis or legal medical cannabis, you should have no problem accessing what you need through a dispensary. There may be some legal hoops to jump through to sign up for your state’s medical cannabis program, but as a cancer patient you most certainly qualify.

The Leafly app can help you locate the best dispensary within a reasonable distance from where you live, and then you can search their menu online to make sure they’ve got the specific products you’re looking for before you pay them a visit.

Find a cannabis shop

Everything you find on a dispensary shelf should be lab tested for purity and potency, but it’s still a good idea to seek out cannabis grown without the use of chemical pesticides and fertilizers. Federal law prohibits using the word “organic” when it comes to cannabis, but there are third party certifications that mean the same thing, and certain companies only work with growers using organic methods.

If you live in a place without legal medical cannabis, you’ll have to first carefully weigh the potential benefits of having this medicine in your life against the risk of legal consequences.

The medical cannabis movement has been built on civil disobedience, and the foundational belief that any law preventing the seriously ill from accessing a proven medicinal plant should be actively subverted. So feel no shame, and don’t be afraid to ask for help. Think of a person in your life whom you trust, and who already has access to cannabis, and let them in on your situation.

Dosing medical cannabis

(Gillian Levine for Leafly)

When it comes to identifying your ideal dosage, the most important thing to know is that you should start with very small amounts of cannabis and slowly increase them until you find what works best for you, without going overboard. This detailed dosage guide from Project CBD offers thorough information on how to optimize the benefits of medicinal cannabis.

It’s also vital to understand that different delivery methods will produce vastly different effects, including how quickly they onset and how long they last. Inhalation will have you feeling relief in less than a minute. Just start with a puff or two, see what happens in a couple of minutes, and then inhale more as needed.

Meanwhile, edibles can take up to 90 minutes to onset, and last for up to eight hours. That makes them ideal for long-term relief, but you run the risk of eating too much before you start to feel the effects. So until you get the hang of it, stick to low-dose edibles (five or ten milligrams of THC) and then slowly up your dose as needed—always waiting at least 2 hours between doses to account for the lag time.

Incorporating CBD-rich cannabis products into your regiment gives you access to another therapeutic cannabinoid, one that is also shown to reduce anxiety induced by larger doses of THC. (Note: small doses of CBD can enhance THC’s intoxicating properties, but large doses appear to counteract unwanted side effects.)

Be sure to remain well hydrated at all times, and ideally share the experience with a friend. Definitely stay home the first few times you use cannabis, particularly as you get used to the experience and while experimenting to find your optimal dose.

Mixing cannabis with alcohol is not a good idea. Mixing it with your favorite music and a game of stoned Scrabble, however, is really fun.

Choosing a delivery method

(Gillian Levine for Leafly)

Pharmaceutical cannabinoids

Several pharmaceutical drugs have been developed using either synthetic cannabinoids (like the THC drug Marinol), or plant derived blends of THC and CBD (like Sativex from GW Pharmaceuticals). What these products all have in common is that they’re inferior to whole plant cannabis (and whole plant cannabis derived products) in terms of efficacy and price.

As Dr. Lester Grinspoon, a retired Harvard Medical School professor and longtime leading medical cannabis researcher put it:

Needless to say, the pharmaceutical industry is increasingly devoting its massive resources to the development of cannabinoid analogs or other products which can compete with herbal marijuana. But none of these products will be as inexpensive or useful as herbal marijuana. Legality, not efficacy, is their major appeal.

Cannabis flowers

Also known as “buds,” the dried flowering tops of female cannabis plants are ideal for smoking and vaporizing. If possible, get yourself a high quality portable vaporizer. Vaporizing is a lot less work for your lungs than smoking and you’re much less likely to have a painful coughing fit. Here’s a recent consumer test done by The Wirecutter that will give you lots of options by price range.

If you’re sourcing dispensary cannabis, the label should tell you its levels of THC and CBD. Ideally, you want a range of strains at your disposal, including one that you find pleasantly uplifting (like Sour Diesel, Jack Herer, and Super Lemon Haze); one you find pleasantly sedating (like Blueberry, Purple Kush, and LA Confidential), and one that’s rich in CBD (like ACDC, Cannatonic, and Harlequin).

Concentrates

When dealing with extreme pain or nausea, it’s reassuring to have a way to quickly inhale a high dose of cannabis. Depending on how concentrates are made, they can have levels of purity from around 50% THC all the way up to 95%.

If you’re new to cannabis, a vape pen is a good option for exploring concentrates, as you can inhale small amounts of cannabis oil with ease, and they’re very discreet to use when out of the house. But make sure you research a reputable brand, as the quality of vape pens varies widely.

Dabs are definitely the most efficient way to inhale the most cannabinoids all at once, but they should wait until you’re fairly experienced with cannabis, as it’s a lot to take in. When you’re ready, here’s Leafly’s guide to dabbing.

Cannabis oil or RSO

Some cannabis patients ingest large doses of cannabis oil in an attempt to not only control symptoms, but to destroy existing cancer cells and prevent the disease’s spread. As mentioned before, research is beginning to show the specific ways cannabis may help control cancer growth. But it’s also led to a rash of overblown claims and “snake oil sales pushes” that target vulnerable patients, so be careful what you buy and who you believe.

Edibles

Again, edibles take up to 90 minutes to onset, and can potentially get you way higher than smoking or vaping because of a chemical conversion that takes place when THC is processed in the liver instead of the lungs. So it’s way easier to overdo it on edibles.

But edibles also have some big advantages: They provide relief for many hours, they’re discreet to carry and consume, you don’t have to inhale smoke, and they can really help you stretch your cannabis budget, particularly if you’re making your own edibles at home. Just follow proper safety protocols.

Tinctures

Prior to the Age of Pharmaceuticals, many prescriptions were delivered to patients via tinctures, a medicinal preparation where an active ingredient is dissolved into a solvent, typically alcohol.

Tinctures give you a smoke-free, vape-free option that still takes effect quickly, since the medicine can be absorbed under the tongue rather than in the stomach. They’re discreet and easy to dose, and you can either make your own at home or find a high quality tincture at a dispensary, including ones that offer a range of different cannabinoid ratios, and even blend in other medicinal herbs along with cannabis.

Topicals

Topicals can be applied directly to the skin wherever you’re feeling pain, so it’s a great way to get targeted all-natural relief of soreness and inflammation without getting high. At a quality dispensary, you can find a wide range of lotions, balms, bath soaks and massage oils, including lines that also blend in other therapeutic herbs.

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David Bienenstock

Veteran cannabis journalist David Bienenstock is the author of “How to Smoke Pot (Properly): A Highbrow Guide to Getting High” (2016 – Penguin/Random House), and the co-host and co-creator of the podcast “Great Moments in Weed History with Abdullah and Bean.” Follow him on Twitter @pot_handbook.

View David Bienenstock’s articles

Should You Use Medical Marijuana, AKA Medical Cannabis, if You Have Cancer?

Vincent Maida, MD, wants to be clear: He’s not some “hippie pothead.” But about 20 years ago, the Toronto-based palliative care physician realized that cannabis was worth taking seriously. At the time, cannabis — also known as marijuana — was not legal in Canada (or the United States). But, increasingly, he found his patients confiding in him about using it.

“They would say, ‘I’ve gone to my oncologist, they’ve given me all the drugs, but I’m still having pain, nausea, and vomiting. My friend got me some stuff from the local drug dealer, and it made me feel better,'” says Dr. Maida, who is an associate professor of palliative medicine at the University of Toronto. “I’ve heard that story hundreds of times.”

Although there may be a number of medical uses for cannabis, Maida says it’s especially beneficial for cancer patients and that it should be incorporated into their treatment regimen. In recent years, many western MDs who were previously skeptical have also started to come around to his thinking. A May 2019 study presented at the 2019 annual meeting of the American Society for Clinical Oncology, for instance, found that the overwhelming majority of surveyed oncology providers believe that medical marijuana can help cancer patients.

The catch: Less than half feel qualified to prescribe it.

Medical cannabis is now legal in the United States in most states, yet most healthcare providers haven’t received any education on it. Meanwhile, there’s little standardization. If you walk into any drugstore and buy a bottle of Advil, you know exactly what you’re getting. But cannabis strains (and their names) aren’t regulated and can vary from dispensary to dispensary. Strains also differ in terms of potency and specific effects (i.e., relaxing versus energizing) and, depending on your preferred delivery method, it can be difficult to measure a precise dose.

Despite these challenges, cannabis has many pros, especially when compared with the current FDA-approved options for treating cancer-related symptoms. It’s relatively safe — serious adverse effects are extremely rare — and it may ease nausea, pain, loss of appetite, and insomnia, says Jessie Gill, RN, a certified cannabis nurse. “Cannabis can also help prevent some of the nerve damage that’s often associated with chemotherapy and radiation,” she says. The fact that it’s one drug instead of several (one for nausea, one for pain, one for insomnia, etc.) also means that it might cut down on side effects and interactions.

Related: Why the Cleveland Clinic Will Not Recommend Medical Marijuana

How Medical Cannabis Works

If you’re looking for hard proof the cannabis really works, you’re going to be hard-pressed to find it. Thanks to a long history of prohibition as well as current federal restrictions, cannabis is extremely difficult to research, so most studies that pertain to its use in cancer have been small or conducted on animals. That may change as the laws evolve, but for now the best evidence is anecdotal.

Still, Maida says, you shouldn’t discount it: “Cannabinoids and other extracts have been used for thousands of years. The highest form of evidence is something that’s stood the test of time.”

Cannabis isn’t a cure-all, but it does seem to have the potential to work for a number of seemingly unrelated ailments. While that might seem suspicious, it’s hardly the only substance that has a myriad of effects, says Donald Abrams, MD, a professor of clinical medicine and integrative oncologist at the University of California in San Francisco.

“Aspirin is helpful for pain, inflammation, and fever, and some people like it for sleep,” he notes. In the case of cannabis, the wide-reaching effects can be explained by the fact that humans have cannabinoid receptors throughout the body.

Related: Are Medical Marijuana and Cannibidiol (CBD) Legal in the United States?

Medical Cannabis: Tips for Beginners

Everyone reacts to cannabis differently, says Gill, but if you have cancer and cannabis is legal in your state, experimenting with it might make sense. Not sure where to start — or what to expect? Here are a few useful pointers.

  • Consider it an add-on, not a cure. Test-tube and animal studies have shown that cannabis might impact tumor cells, but don’t bank on it to cure your disease, says Dr. Abrams. It’s best used as an adjunct to ease symptoms, not as a cancer cure, so don’t ditch your oncologist and mainstream treatment plan.
  • Go for the whole plant. The two most famous components of cannabis are CBD (cannabidiol) and THC (tetrahydrocannabinol). CBD is anti-inflammatory and seems to be the chemical that’s largely responsible for a variety of health benefits, but it’s not the only active ingredient. A variety of fragrant oils (terpenes) may also play an important role, says Gill. Meanwhile, THC is best known for making you feel “high,” but it, too, has some health benefits. In fact, two FDA-approved drugs that are synthetic versions of THC Cesamet (nabilone) and Marinol (dronabinol) have been shown to help with nausea and vomiting in cancer patients. Still, Abrams says, it’s better to use the whole plant, because if you isolate one compound you’re likely missing out on others.

It’s also worth noting that CBD tends to balance out the psychoactive effects of THC, which is why some patients who try THC-heavy strains or FDA-approved drugs like Cesamet and Marinol often feel dizzy and drowsy, says Ashley Glode, PharmD, an assistant professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. She says that in Canada, where marijuana is now legal for both recreational and medicinal purposes, all the products that are sold for health purposes have a one-to-one ratio of CBD to THC.

  • Vaping is the fastest delivery route. Cannabis can be used in a number of different ways, but vaping the whole flower (rather than concentrated oils, which are stronger) is often a good option. “The quickest way to deliver it is through vaping or smoking, but as a doctor I don’t recommend smoking” because the combustion releases carcinogens, says Maida. Vaping should yield results in 5 to 10 minutes, which is helpful if you need relief from severe nausea, vomiting, or pain. Tinctures that you put under your tongue are also absorbed quickly, says Glode. Edibles could take 40 to 60 minutes or longer to have an effect, so they’re best reserved for breakthrough pain or insomnia (take an hour or so before bed).
  • Expect some trial and error. It may take a while to figure out which doses, strains, and delivery methods work best for you, but don’t worry too much about making a major mistake (provided you don’t drive or do any other activity that could be dangerous while you’re under the influence of the drug). “This is a medicine that I don’t think requires a packaged insert,” says Abrams. “I think that most people can figure out how to use it to their benefit.”
  • Go slow. If you’re vaping, Gill suggests starting with a single puff of a low-THC flower and waiting at least 20 minutes to see how you feel. If you’re going with an edible, make sure the THC component is not greater than 2 milligrams (mg) or 2.5 mg and wait two hours to assess the impact. Maida adds that some patients who are new to cannabis don’t feel anything in the first 24 hours. His advice: “Start low, go slow, and be patient.”
  • Loop in your oncology team. If you’re lucky, they’ll be able to point you to a doctor, nurse, or pharmacist who’s knowledgeable about cannabis. But even if that’s not the case, it’s still smart to let them know that you’re using this drug. Cannabis doesn’t interact with most drugs used to treat cancer, says Glode, but taking it with two chemotherapy drugs — etopocide and paxlitaxel — could be problematic. At the very least, ask your oncologist if you’ll be using these drugs. If so, cannabis is best avoided. Glode adds that you shouldn’t use cannabis if you take a blood thinner like warfarin, either, as the combo may increase the risk of bleeding.
  • Do your homework. Before you set foot in a dispensary, do some more research so you can get a better grasp on the basics. Leafly.com and Healer.com are trustworthy sites that have a lot of information aimed at people who are new to cannabis, says Gill. Her own site, MarijuanaMommy.com, is also a good resource, especially the extensive FAQ section. You’ll also need to research your state laws.
  • Research your dispensary carefully. Ideally, your healthcare provider or a knowledgeable friend in your area will be able to refer you to a reputable dispensary. In some states dispensaries actually employ pharmacists. In others, you might find a well-trained professional with a health background — or someone who is totally clueless. Feel free to ask about an employee’s level of familiarity with using cannabis for cancer patients before deciding if it’s a good fit for you. If you feel comfortable with them and the establishment, tell them about your symptoms and ask them to recommend specific strains and products.

Related: Cancer Research News: A Weekly Roundup of New Developments in Cancer Research and Treatment

Introduction

Cancer patients often present with chronic pain, which may stem from direct tumour involvement, or present as a side effect of cancer treatment (1). As pain negatively impacts the physical, functional, and emotional domains of life, effective pain management strategies are essential for restoring and maintaining quality of life of cancer patients (2). Unfortunately, the current standard treatment regimens for chronic or neuropathic pain in end-stage cancer patients rely heavily on opioid analgesics, which are problematic for some patients (3,4). This can be due to a combination of factors, including differences in individual responses to these drugs, and the presence of serious side effects such as severe constipation, that may prevent the administration of sufficient doses for pain relief (3). In addition, imprudent dosing runs the dangerous risk of patients developing dependency, or overdosing on opioids (4). Therefore, identifying alternative classes of analgesics that can effectively manage pain in cancer patients is of great importance.

Alternative pharmacological interventions include prescription medications such as acetaminophen, or nonsteroidal anti-inflammatory drugs like ibuprofen (5). Non-medicated approaches include therapies such as acupuncture, physical therapy, in addition to psychological or behavioural approaches (6). In addition to the management strategies listed above, compounds derived from the plant species Cannabis Sativa L. have demonstrated the potential to alleviate pain. The most commonly studied examples include tetrahydrocannabinol (THC), and cannabidiol (CBD) from the family of compounds known as cannabinoids (7). These compounds are commonly administered via inhalation, orally as oils or oil-filled capsules, or oromucosally via sprays containing either THC alone, or a combination of THC:CBD (8). Several pre-clinical studies have been conducted in animal models, investigating the mechanism of cannabinoid modulation of pain pathways (9,10). One of the identified mechanisms is the interaction of these compounds with one of the body’s endogenous signalling systems, known as the “endocannabinoid” system (11). This system acts independently of the opioid pathway to control pain signalling, immune activation, and inflammation (11). While there is an abundance of existing anecdotal evidence of the analgesic properties of medical cannabis, its efficacy has not yet been validated through high-quality clinical studies that provide strong evidence supporting its utility in the clinical setting (12).

This selective review is an overview of clinical studies conducted historically and up until the present day that aimed to investigate the efficacy of medical cannabis in managing pain in advanced cancer patients.

Methods

A search of literature published on Medline between 1975 and 2017 through using key words including “cannabis”, “THC”, “CBD”, “Nabiximol”, “cancer”, and “pain” was conducted. Five clinical studies that evaluated the effect of THC or CBD on controlling cancer pain were evaluated for a selective review. Information regarding the study population, interventions, pain response, and side effects was reviewed and summarised.

Results

Patient populations and selection criteria

Five studies were selected based on their evaluation of cannabinoids to manage chronic pain in advanced cancer patients. An early pilot study conducted in 1975 by Noyes et al. assessed pain in ten advanced cancer patients (eight women and two men, average 51 years old) (13). In a similar pain management study, Noyes et al. compared the effects of THC and codeine in 36 cancer patients (consisting of 26 women and 10 men) (14). Non-study medications were withheld from patients from both studies by Noyes et al. during the study period (13,14). Johnson et al. conducted a multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of nabiximols and THC in patients with intractable cancer-related pain, using a well-distributed population of 177 advanced cancer patients, who recorded non-study breakthrough analgesics (15). In this study, the mean age, gender, primary disease sites, and pain classification were distributed similarly between the three treatment arms; THC, nabiximols, and placebo (15). In 2012, Portenoy et al. conducted a randomized, placebo-controlled, graded-dose trial involving 360 patients with advanced cancer, looking at the efficacy of THC or nabiximols. Patients were chosen based on having previously responded poorly to opioid analgesics, but were allowed to take breakthrough opioid analgesics as required (16). Patients who had received long-term methadone treatment for pain were excluded. Pain characteristics were categorized as mixed (48%), bone (24%), visceral (15%), and neuropathic (11%), and were distributed approximately equally across the study arms. Finally, Lynch et al. conducted a double-blind, placebo-controlled, crossover pilot trial including 16 cancer patients who had persistent neuropathic pain 3 months after their cancer treatment (17). These patients had an average 7-day pain intensity ≥4 on 0–10 NRS, stable concurrent analgesic treatment for 14 days prior to study initiation, and were not taking breakthrough analgesics.

Evaluation of pain

In the clinical studies of cannabinoids for cancer pain management included in this review, several methods of measuring changes in pain intensity were employed. Early studies by Noyes et al. used a 4-point pain scoring system in which 0= absent, 1= mild, 2= moderate, and 3= severe (13,14). Since then, many studies have employed the numerical rating scale (NRS) to evaluate pain on a 0–10 scale, with “0” representing “no pain” to “10” representing “pain as bad as you can imagine”. Patients with neuropathic pain studied by Lynch et al. completed the NRS at baseline, and the last day of each week of dosing (17). The change in NRS score from baseline to the week in which a stable dose was reached was used as the primary endpoint in determining cannabis efficacy. In the study by Johnson et al., patients used the NRS in addition to recording their long-term and break-through pain medications in a pain diary (15). Portenoy et al. asked patients to report their average pain on the brief pain inventory (BPI), as well as through an interactive voice recording system (16). The two remaining studies used the BPI to assess change in pain as the primary endpoint (18,19).

Efficacy of interventions

Overall, four out of the five studies found that cannabis was significantly associated with a decrease in cancer-associated pain. Table 1 presents a summary of the efficacy of THC or CBD on cancer pain.

Table 1 An overview of randomized controlled trials (RCTs) involving medical cannabis for cancer pain
Full table

THC oil capsules and THC, CBD oromucosal sprays

Studies included in this review assessed the efficacy of THC oil capsules, and oromucosal sprays containing THC extract, or THC:CBD extract, also known as nabiximols. Since nabiximols have CBD in addition to THC, they may potentially target more pain pathways when compared to THC extract alone.

Two early clinical studies on the efficacy of THC extract in sesame oil capsules were published by Noyes et al. in 1975 (13,14). The first was a pilot study that identified a correlation between higher doses of THC and increased pain relief (P<0.001) (13). The second study found a significant difference in pain reduction between placebo and 20 mg THC (P<0.05), in favour of THC treatment (14).

Oromucosal sprays have been a common method of administration for cannabinoid-based medicines in clinical investigations, to date (12). Both THC extracts and nabiximols, administered oromucosally, were studied by Johnson et al. (15). They did not observe a significant change in mean pain score from baseline for THC spray compared to placebo, but did report a statistically significant change in favour of nabiximols treatment compared to placebo (P=0.024). In addition, they reported that patients taking nabiximols required significantly fewer doses of breakthrough pain medications when compared to placebo (P=0.004). Portenoy et al. found that compared to placebo, nabiximols were significantly more effective for reducing average daily pain when comparing scores from baseline to the end of the study period (P=0.038) (16). These findings are in contrast with the study by Lynch et al. in which there was no statistically significant difference between placebo and nabiximols treatment groups amongst the 16 patients experiencing cancer-related neuropathic pain (17).

Dosage

Studies assessed the efficacy of different doses of medication, or allowed patients to self-titrate up to a maximum dose, as dictated by study protocols.

Evaluation of the effect of 5, 10, 15, and 20 mg of THC in oil capsules by Noyes et al. found that the amount of pain relief increased with dose (13). Out of 10 patients in each cohort, 5 received substantial relief from 15 mg, and 7 patients received substantial relief from 20 mg. In the second study by Noyes et al., two different THC doses of 10 and 20 mg were compared to placebo and 60 mg codeine (14). A 60 mg dose of codeine is a standard daily opioid analgesic regimen used in the management of many pain types, including cancer pain (20). A significant difference in pain reduction was observed with the administration of 20 mg THC when compared to placebo (P<0.05). Additionally, no significant difference in pain relief was observed when comparing the 10 mg THC cohort to those receiving 60 mg codeine (P<0.05). This suggests the non-inferiority of 10 mg of THC in comparison to a commonly used opioid treatment.

Evaluation of the efficacy of THC oromucosal spray by Johnson et al. followed a self-titration method of dosing (15). Patients who used THC sprays used an average of 8.3 sprays/day, corresponding to 22.5 mg of THC/day following dose titration up to a ceiling dose of 48 sprays/day. Patients were considered to have reached their optimal dose upon experiencing relief of pain, or the development of side-effects. The authors found the optimal dose of THC reached across patients provided greater pain relief compared with placebo as measured by the average NRS pain score reduction (THC −1.01 vs. placebo −0.69) however, statistical significance was not reached (P=0.245).

In the three studies on nabiximols included in this review, self-titration was recommended up to a maximum dose of 8 sprays/3-hour period (15), and 11–16 sprays/day (16,17). In one of the studies, patients were divided into three dose groups categorized by titration ranges of mild (1–4 sprays/day, or 2.7–10.8 mg THC, 2.5–10.0 mg CBD), moderate (6–10 sprays/day, or 10.8–16.2 mg THC, 10.0–15 mg CBD), and high (11–16 sprays/day, or 29.7–43.2 mg THC, 27.5–40 mg CBD) (16). The doses found to produce significant pain relief include an average of 8.75 sprays/day (15), 1–4 sprays/day (16), and 6–10 sprays/day (16). It was observed that the high dose group of patients who utilised 11–16 sprays/day did not experience significant pain relief compared to placebo. Similarly, Lynch et al. found that at a high dose of an average of 8 sprays/day there was no significant pain relief observed in comparison to placebo (17).

Side effects and adverse events

Side effects reported in studies included in this review were consistent with those reported in literature investigating the use of cannabinoid-based therapies for several other indications (7). Table 2 summarises the five most commonly reported side effects of the five studies. In both studies by Noyes et al., side effects of 15 and 20 mg of THC included mental clouding (60–70%), drowsiness (70–100%), and euphoria (40–50%) (13,14). Not all side effects were experienced by all patients, and side effects tended to become more prevalent with higher doses.

Table 2 Summary of most common side effects
Full table

Common treatment-related adverse events reported by Johnson et al. include somnolence (nabiximols 13%, THC 14%, placebo 10%), dizziness (nabiximols 12%, THC 12%, placebo 5%), confusion (nabiximols 7%, THC 2%, placebo 2%), nausea (nabiximols 10%, THC 7%, placebo 7%), and hypotension (nabiximols 5%, THC 0%, placebo 0%) (15). These were reportedly more frequent in patients receiving the nabiximols extract and the THC only extract, when compared with placebo. The adverse events identified by Portenoy et al. were significantly more frequent in the higher nabiximols dose group, whereas little difference was observed between the low dose and placebo groups (17). Lynch et al. identified fatigue (nabiximols n=7, placebo n=0), dry mouth (nabiximols n=5, placebo n=1), dizziness (nabiximols n=6, placebo n=0), and nausea (nabiximols n=6, placebo n=1) to be the most common side effects, which were more often observed in the treatment arm compared to placebo, although the significance of this difference was not assessed. However, patients also reported that the majority of side effects were transient and mild, and could be reduced through adjusting treatment dose. Side effects did not lead to any study drop-outs (13-17).

Discussion

The paucity of clinical data available on medical cannabis for treatment of cancer pain is partly due its classification as a schedule I agent by the Controlled Substances Act in 1970, which restricted its investigation as a potential medical product (8). However, the few studies that were produced on the use of medical cannabis for cancer pain management have results that suggest it does possess therapeutic potential, and is at least worthy of further investigation.

There is a lack of dosing guidelines for the use of cannabinoid-based therapies in clinical practice. The ideal dosage would be one that provides effective pain management, but does not produce intolerable side effects. However, there are challenges in establishing this optimal dose in the advanced cancer patient population. One of these is inter-patient variability, in keeping with results from studies on narcotics and other prescription analgesics. As optimal doses were found to vary from patient to patient, physicians need to understand how to determine the correct dosage when prescribing to a new patient. In addition, advanced cancer patients are likely to present with complex symptomologies that make it difficult to accurately assess side effects derived from cannabis treatments, and are often taking multiple concurrent medications. That said, a number of these studies reported that observed side-effects tended not to be treatment-limiting, and could be controlled through dose titration, with pain relief in as little administration of 2.7–10.8 mg THC in combination with 2.5–10.0 mg CBD (17). This highlights the importance of establishing and validating a titration protocol that will allow researchers to identify effective and tolerated dosages in a safe and controlled manner.

Several studies presented in this review were underpowered due to small sample sizes, with three out of the five studies reviewed enrolling less than 50 patients. Therefore, the generalizability of the results may be limited, and future studies on medical cannabis are warranted to establish its efficacy and side effect profile in the cancer pain population. This includes additional efforts to identify the efficacies of specific cannabis compounds and their combinations, as well as ideal methods of administration through the assessment of relevant endpoints. Subsequent clinical trials should also consider the differences in cannabinoid pharmacokinetics and pharmacodynamics among individuals. Moreover, standardized and validated evaluation and reporting of cannabis-associated side effects is warranted in order to enable more accurate comparisons across studies. Ultimately, this will contribute to the development of clinical guidelines for the dosing and administration of cannabis as a pain medication for the large population of cancer patients in need of pain management, particularly those for whom alternative analgesics are insufficient, intolerable, or unsafe.

Conclusions

Current research shows that there is a potential role for medical cannabis in cancer pain management. However, the scale and quality of studies conducted to date are somewhat limited (12). Therefore, further research is needed to establish the efficacy of medical cannabis, either as an alternative to opiates or as an adjunctive therapy, and to identify the most appropriate methods of administration to achieve optimal therapeutic efficacy with minimal side effects.

Acknowledgements

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund. This study was conducted in collaboration with MedReleaf.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Cite this article as: Blake A, Wan BA, Malek L, DeAngelis C, Diaz P, Lao N, Chow E, O’Hearn S. A selective review of medical cannabis in cancer pain management. Ann Palliat Med 2017;6(Suppl 2):S215-S222. doi: 10.21037/apm.2017.08.05

What is medical marijuana?

Marijuana, also called cannabis and quite a few other names, is a plant grown around the world that has been used in herbal remedies for centuries. There are a number of biologically active compounds in marijuana, which are called cannabinoids. The two most-studied compounds in marijuana are:

  • delta-9-tetrahydrocannabinol (THC), which causes marijuana’s high
  • cannabidiol (CBD), which doesn’t cause a high

Each cannabinoid offers different benefits. Many people diagnosed with cancer feel that CBD is better at controlling pain than THC.

While marijuana is federally illegal in the United States, more than half of the states, as well as the District of Columbia, have passed laws legalizing the use of marijuana to treat certain medical conditions.

So medical marijuana means using marijuana or its cannabinoids for medicinal purposes.

What conditions is medical marijuana used for?

It’s extremely important to know that marijuana is not a treatment for breast cancer. People use marijuana to ease the side effects of treatment and pain caused by the cancer.

Still, because marijuana is federally illegal, research on marijuana to manage cancer treatment side effects is limited.

Anecdotal evidence suggests that marijuana may ease:

  • pain
  • nausea/vomiting
  • hot flashes
  • loss of appetite
  • anxiety
  • insomnia

caused by a breast cancer diagnosis and treatment.

“It’s important for people to know that anything they ingest that produces a change in their bodies is acting like a drug, and it has the potential for side effects, interactions with other drugs, as well as benefits,” said Virginia F. Borges, M.D., MMSc., professor of medicine and director of the Breast Cancer Research Program at the University of Colorado Cancer Center. She specializes in treating young women diagnosed with breast cancer. “People have to be as diligent about researching medical marijuana as they would be with any other supplement or drug they were taking. The hard reality is that because marijuana is illegal at the federal level, your treating doctor, who works under federal guidelines, isn’t going to be your primary source for information on this topic. Your doctor will only be able to report what she or he has observed in patients, and that may be very limited information depending on where you live.”

Because marijuana has been legal for both medical and recreational use in Colorado for a number of years, Dr. Borges has a number of breast cancer patients who use or have used medical marijuana to ease treatment side effects.

“I’ve mainly seen it used in conjunction with prescription drugs to control pain and other side effects in patients living with metastatic disease,” she said. “It’s rare that a person living with metastatic breast cancer would have only one side effect to manage. 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. If she’s not feeling good, she may need three or four drops per day. Many of the prescription drugs don’t have this flexibility. Any time you can give control back to a person when their living with cancer, it’s a good thing.”

What to expect when using medical marijuana

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.

Medical marijuana products come in many different forms, including:

  • edibles, such as cookies, candy, mints, or brownies
  • dried leaves or buds for smoking
  • oils for vaporing or mixing into tea, honey, or other food
  • creams and other products that are applied topically
  • sprays or tinctures that are used under the tongue or along the gum line

Many oncologists would prefer that their patients not smoke anything. At the same time, many women diagnosed with breast cancer are trying to prevent weight gain/lose weight related to treatment. So, oils, sprays, or tinctures may be a better option than edibles or dried leaves or buds. Still, every person’s situation is unique and the best form of medical marijuana will vary from person to person.

Again, because research on medical marijuana and cancer is limited, information on side effects is also limited. Reported side effects of medical marijuana include increased heart rate, low blood pressure, dizziness, fainting, hallucinations, and paranoia.

Important things to consider before trying medical marijuana

  • Always tell your doctor about any vitamins, supplements, herbs, and over-the counter medicines you are using, including medical marijuana. If you live in a state where medical marijuana is legal and you’d like to talk to someone who is successfully using medical marijuana to treat breast cancer side effects, you may want to ask your care team if they can connect you with another patient.
  • Medical marijuana is NOT covered by insurance, Medicare, or Medicaid. The cost of medical marijuana can start at about $100 per month and can be much higher, depending on how much is needed. The bottom line is that medical marijuana can be expensive.
  • THC and CBD are present in different levels in different strains of marijuana. THC and CBD each offer different benefits. For example, CBD may be better at easing pain, while THC may be better at controlling nausea.
  • You will likely have to do a lot of research on your own to figure out the ratio of CBD to THC that works best for controlling your side effects. This can take quite a bit of trial and error. What works for someone else may not work for you.
  • You may have to go to several medical marijuana dispensaries until you find one that you’re comfortable with and has staff members that can answer all your questions about the levels of CBD and THC in the strains available. Depending on the laws in your state, some dispensaries may cater more to recreational users than medical users. Medical dispensaries tend to be more clinical and have staff members who are more likely to have experience helping people with cancer use medical marijuana to treat side effects. It can be helpful to call the dispensary and explain the side effects you’re having, as well as any experience you’ve had with marijuana, and ask if you can schedule a consultation appointment with a staff member. If you’re at all uncomfortable, go to a different dispensary.
  • Some doctors who regularly prescribe medical marijuana suggest asking the dispensary staff member some general questions before you start talking specifically about your side effects:
    • Is your marijuana grown using pesticides?
    • Are your items stored and handled properly to avoid spoilage and contamination?
    • Are your items tested for fungus and bacteria? What are the results?
    • Are your items tested for levels of pesticides?
    • What is your training and experience in recommending medical marijuana?
    • Have you worked with cancer patients before?
  • Some oncologists have recommended that their patients go to a medical marijuana dispensary, rather than an outlet that caters to recreational users. There is no research on whether recreational marijuana is just as safe and useful for cancer patients as the usually more expensive medical grade variety, though some dispensaries take extra care to ensure there are no pesticides or mold in their medical medical-grade cannabis.
  • If you work for the federal government, a federal government contractor, or an employer that conducts regular drug tests, you may face disciplinary action for using medical marijuana. Always check your employer’s medical marijuana policy before you start using it.
  • If you are part of a clinical trial, it is very much unknown how the compounds in medical marijuana may interact with any experimental drugs. It makes good sense to talk to the doctor coordinating the trial before you try medical marijuana.

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Last modified on January 19, 2020 at 4:37 PM

The SIO Research Committee is pleased to offer this fifth installment in a new blog series known as “Myths of Cancer”. In this series we will address some of the most common myths and misperceptions that arise around cancer risk and treatment related to diet and natural health products, as well as other complementary therapies such as yoga, acupuncture and meditation. If you have a question you’d like us to address or comments about the this post, please send your suggestions to: [email protected]

We hope you enjoy the series!
Linda Carlson and Eugene Ahn, Research Committee

“Disclaimer: The opinions expressed in this blog series are the authors’ own, and not necessarily those of the Society of Integrative Oncology or the authors’ host institution(s)”

Does Cannabis Cure Cancer?

By Eugene Ahn, MD

Quick Answer Box

In cell cultures and animal models, cannabis-derived cannabinoids, particularly THC and cannabidiol, can have activity against some cancers (but paradoxically also accelerate the growth of others). But none of these studies provide evidence that cannabis can cure cancer (many drugs look great in cell cultures and animal models but fail in definitive clinical trials). There are two early phase clinical trials published, one of which suggests it is possible cannabinoids might help treat a very aggressive type of brain cancer with few side effects. But it is irresponsible and harmful to say cannabis cures all types of cancer. Research also shows alternative medicine use may delay conventional treatment, resulting in worse cancer-specific outcomes. However, given its proven benefits helping treat cancer side effects such as loss of appetite, neuropathic pain, and nausea, it is reasonable to use as an integrative treatment for those indications, but not in lieu of conventional therapy, especially in curative intent situations.

I wish cannabis cured all cancers. I wish wishful thinking would make it true. As oncology health professionals, we are joyful when our patients are joyfully in remission, and we suffer when we see our patients suffer. If there is one thing we professionals have in common, it is that we welcome better cure probabilities and less side effects for our patients.

Over the past 18 years after having trained in both infectious diseases and oncology, I have taken care of many conditions that respond extremely well to cannabis or its psychoactive ingredient delta-9-tetrahydrocannibinol (THC), such as AIDS-related cachexia, chronic pain, nausea and loss of appetite from cancer or chemotherapy. I have also published case reports of extraordinary outcomes when they highlighted potential activity of an underappreciated intervention (for example, a case of Xeloda and graviola tea associated with a 5-year remission in a patient with metastatic breast cancer). I have a lot of patients who have utilized cannabis or its isolates in the hope it would cure their metastatic disease and assured them I would publish their case if they were successful. But I have yet to personally see a patient whose metastatic cancer went into miraculous remission with cannabis or cannabis products alone, although for most their quality of life was enhanced.

Dr. Donald Abrams, one of the earliest pioneers of cannabis research in supportive care, Professor of Clinical Medicine at University of California San Francisco and general oncologist at Zuckerberg San Francisco General Hospital, shared his clinical experience with medical cannabis in the state that first legalized it in 1996:

“As an oncologist in San Francisco for the past thirty-three years, I often say that I would venture to guess that the majority of the patients I have cared for have used cannabis during their treatment. Thus if cannabis cured cancer, I would have a lot more survivors. Granted, the plasma concentration of inhaled cannabis, as most of my patients have likely used in the past probably does not approach that which can be achieved with the highly concentrated oil preparations (no data available on this as of yet), but still, oncologists maintain that the plural of anecdote is not evidence! What saddens and disturbs me the most is when I see a patient in consultation with a potentially curable malignancy who is foregoing conventional cancer therapy in hopes that cannabis oil will be a kinder, gentler treatment. The fact remains that there is no evidence at this time to support such a decision.”

Dr. Abrams concludes, “That being said, what we do know is that cannabis is truly an amazing medicine for many cancer and treatment-related side effects — nausea, vomiting, loss of appetite, pain, depression, anxiety, insomnia.”

Dr. Abrams will be summarizing the scientific evidence of the benefits of cannabis and its isolates in an SIO webinar on Sept 13, 2018 in a way that only he can, having been on the leading edge of cannabis research in both HIV and cancer care. Not only will you learn about the science of cannabis, but also the sociopolitical challenges he navigated to research the plant’s benefits. I highly recommend signing up for this talk (link below) and it is free for SIO members and only $20 to register for non-members.

While cannabis is not a magic bullet for cancer, there is preclinical evidence in animal models and cell lines (cancer cells grown in petri dishes in the lab) to suggest cannabis might have an anti-cancer effect in humans. However, bear in mind that most drugs that perform similarly well in preclinical models turn out to not even shrink cancer or help people live longer when they are tested in definitive human trials.

To make sure the terminology in this blog is understood, allow me to run through a quick cannabis 101 review. The cannabis plant consists of primarily two species – C. sativa and C. indica – that contain more than 400 identified chemicals. For the sake of accuracy and relative simplicity, the relevant categories of its components are as follows:

Cannabinoids Non-Cannabinoids
THC Terpenoids

Cannabidiol (CBD) Flavonoids

And over 100 others

Cannabinoids are defined as chemical compounds that interact with the cannabinoid receptors, which in humans include CB1, predominantly expressed on neurons in the brain and central nervous system, and CB2 expressed in non-neuronal tissues such as immune cells. Cancer cells can express these receptors as well, and studies are mixed as to whether it can indicate a better or worse prognosis compared to cells that do not have the receptors. But the effects of cannabinoids on cancer are not limited to interaction with these receptors as several studies have documented effects that are not prevented by blocking these receptors. THC is the cannabinoid classically associated with the psychoactive and appetite-stimulating effects, although it is not exclusively so. Cannabidiol is another cannabinoid that also has been studied for anti-cancer effects and is often referred to as CBD.

The FDA has approved several drugs that we will call cannabinoid-based (i.e. they are not naturally derived but synthetic): dronabinol (Marinol and Syndros, delta-9-THC), and nabilone (Cesamet, THC-similar). As of June 25, 2018, the FDA approved Epidiolex (cannabidiol naturally derived from cannabis) for two rare and severe forms of epilepsy, marking the first time a non-synthetic cannabinoid has been approved in the United States. However, the first regulatory approval for a naturally-derived cannabis product in North America was given by Health Canada for nabiximols (Sativex) for symptomatic relief of neuropathic pain (2005) and muscle spasticity (2010) from multiple sclerosis. Nabiximols is a formulated extract of C. sativa with a THC:CBD ratio of 1:1 as well as other cannabinoid and non-cannabinoid components.

Terpenoids and flavonoids are responsible for the color and aroma of plants and also serve biological functions. Relative to cannabinoids, these two categories of chemicals are not as well researched for their effects on cancer and will be omitted for brevity except when we discuss the entourage effect at the end of this blog.

Regarding anecdotal evidence (and yes, I count anecdotal evidence as evidence, just not of very high quality if it is not reliably reproduced in others) for anti-cancer effects of cannabis, the case that is most often brought up by my patients is that of Rick Simpson. From the information that is available on the internet, Rick was diagnosed with several basal cell carcinomas of the skin (not metastatic) and based on preclinical studies decided to treat his skin cancer topically with a concentrated cannabis oil and left a bandage on the lesions for several days. The lesions disappeared. I acknowledge this is a pretty impressive result but we still don’t know if that was a placebo effect (keep in mind it is also well known duct tape can cure warts but no more so than placebo), correlation not causation (did he or those who have followed suit receive any other intervention?), and even if the oil really was the cause of the remission at best we can say the oil might be worthy of research in the treatment of basal cell carcinomas.

But to extrapolate from this case (and the preclinical evidence) that cannabis oil is a suppressed cure for all types and stages of cancer is, at best, an innocent inference (educated guess) and, at worst, a delusion that has gone viral on the internet and is endangering the lives of patients with curable cancer who might choose to take cannabis oil in lieu of conventional therapy without any scientific follow up with imaging or surgery. However, Rick Simpson’s case report does warrant further research, especially after cell line and animal model research suggests that skin cancers can have inhibited angiogenesis (blood vessel growth) mediated by CB1 and CB2 receptors (Casanova et al).

To date, we only have two prospective clinical trials where a cannabis preparation or its derivatives was tested for an anti-cancer effect. Guzman et al conducted a phase I (preliminary trial to establish safety of the new intervention) and showed that intracranial administration of THC into an aggressive brain cancer called glioblastoma multiforme had antiproliferative effects in some of the 9 patients who received it, but all patients eventually progressed and died (though not due to the THC).

The second study (Twelves et al) is to date only published as an abstract, not a full paper (which means it hasn’t passed the gold standard of rigorous peer review). In this randomized, double blinded placebo-controlled study (meaning the investigators and patients were blinded as to whether they were getting the real cannabinoid preparation or placebo, which is generally considered the best way to minimize bias/confounding factors) patients with recurrent glioblastoma multiforme received either temozolomide (Temodar) chemotherapy and placebo or temozolomide with a 1:1 THC:CBD oro-mucosal spray, nabiximols (Sativex). Only 20 patients were intended to be enrolled in the randomized part of the study. Safety not tumor response was the primary objective, so these results are not reliable to make any definitive conclusions. Also requiring caution is that the study randomized 12 to THC:CBD and only 9 to placebo without any explanation of the discrepancy between study arms. In a small study like this, one patient can radically change the significance of the results. Median survival in the placebo group was 369 days and >550 days for the THC:CBD group and 1-year survival (meaning odds of being alive 1 year after entering the study) were 56% and 83%, respectively. The combination of nabiximols with temozolomide appears to be safe, but a larger phase II study is indicated.

Another hypothesis that has received a lot of attention is that cannabis has benefits on cancer that is maximized by an ‘entourage effect’, meaning that all the individual components of the plant work together to create an effect that’s greater than the effect of any one component. Blasco-Benito et al published in 2018 a study that compared the antitumor effects of THC alone compared to a whole plant extract and found that the extract was more potent than THC in cell culture and animal models of ER+, HER+ and triple negative breast cancer. Likewise, the extract was synergistic with tamoxifen, lapatinib and cisplatin chemotherapy in those respective cancer types. The authors also identified that the enhanced potency of the extract did not appear to be due to the 5 most abundant terpenes in the extract, consistent with the theory that the potency was due to the cannabinoid content. Does this study mean all patients with breast cancer should be taking cannabis extracts? Hardly. Remember that most drugs that have great looking data in cell cultures and animal models do not pass the bar of human clinical trials, with only 10% ultimately getting approved, with over 50% of the failed cases due to lack of efficacy (Hay et al). That said, this study and additional ones provide reassuring data for patients with cancer who choose to integrate cannabis with their conventional treatment to reduce side effects from cancer treatment. For example, numerous preclinical studies have tested whether there would be antagonism or synergy combining cannabinoids with chemotherapy agents. Briefly, in studies on cell cultures of pancreatic, glioma, gastric, lung and colon cancers using gemcitabine, temozolomide, paclitaxel and 5 fluorouracil, synergy is the common theme (reviewed by Maida et al).

However, not all cannabinoid research points to harmlessness as some cancer cells grow faster with exposure and there could be immunosuppressive effects to reckon with as well. When cannabinoids interact with the CB2 receptor, which if you remember is mainly expressed on immune cells, interferon gamma production is inhibited, T-cell proliferation is suppressed, and the immune system shifts from a Th1 to a Th2 profile, which is generally believed to be less conducive to an effective anti-cancer immune response. The relevant studies are reviewed well by other authors (Sledzinski et al).

Until we have evidence of how these findings would interact with any type of immunotherapy (i.e. PD1/PDL1 inhibitors like nivolumab) intervention, discernment in the use of cannabis is recommended. In fact, Taha et al conducted a retrospective observational study and reviewed the charts of 140 patients with advanced melanoma, non-small cell lung cancer and renal cell carcinoma who received nivolumab. 89 patients received nivolumab and 51 patients received cannabis with nivolumab. The authors found that the only significant factor that lowered the response rate to immunotherapy was cannabis (37.5% for nivolumab, 15.9% who received both (odds ratio 3.13; 95% CI 1.24-8.13, p=0.02). However, progression-free survival and overall survival was not effected by cannabis. Since this is a retrospective study and subject to numerous confounding factors, it is mainly a precautionary study that warrants additional research before making any definitive conclusions.

In conclusion, we know more than ever through scientific research what cannabis and its cannabinoid compounds can do, and with more research it is possible we might be able to establish therapeutic indications for cannabinoids for certain types of cancer. Please attend the upcoming webinar by Dr. Donald Abrams to see in more depth the clinical research that has helped de-stigmatize cannabis by documenting its benefits in improving the quality of life of patients dealing with cancer and cancer treatment-related symptoms. You will at least walk away with a greater appreciation for the role of research in helping individuals make more informed decisions for their health. If you read this blog too late or are unable to attend, Dr. Abrams has published several excellent articles that are listed at the end of the references below. As legalization of medical marijuana shifts across North America, more research will continue to reveal how we can best utilize cannabis or its isolates/derivatives for medical purposes, and likewise assure a future of less treatment side effects, better quality of life, and better cure probabilities.

  1. 1. Abrams DI. Cannabis and cancer – decoding the connection. San Fran Med 89(5): 28-29 2016
  2. 2. Guindon J and Hohmann AG. The endocannabinoid system and cancer: therapeutic implication. Br J Pharm 163: 1447-63 2011
  3. 3. Casanova ML, Blazquez C, Martinez-Palacio J et al. Inhibition of skin tumor growth and angiogenesis in vivo by activation of cannabinoid receptors. J Clin Invest 111(1):43-50 2003
  4. 4. Guzman M, Duarte MJ, Blazquez C et al. A pilot clinical study of delta-9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br J Cancer 95:197-203 2006
  5. 5. Twelves C, Short S, Wright S et al. A two-part safety and exploratory efficacy randomized double-blind placebo-controlled study of a 1:1 ratio of the cannabinoids cannabidiol and delta-9-tetrahydrocannabinol (CBD:THC) plus dose-intense temozolomide in patients with recurrent glioblastoma multiforme (GB). J Clin Onc 35: 2046 (abstract) 2017
  6. 6. Blasco-Benito S, Seijo-Vila M, Caro-Villalobos M, et al. Appraising the ‘entourage effect’: Antitumor action of a pure cannabinoid versus a botanical drug preparation in preclinical models of breast cancer. Biochem Pharm published online 6/27/18
  7. 7. Hay M, Thomas DW, Craighead JL et al. Clinical development success rates for investigational drugs. Nature Biotechnology 32:40-51 2014)
  8. 8. Taha T, Talhamy S, Wollner M, et al. The effect of cannabis use on tumor response to nivolumab in patients with advanced malignancies. Oral presentation at: ESMO 2017 Congress; Abstract 1545PD 2017
  9. 9. Maida V, Daeninck PJ. A user’s guide to cannabinoid therapies in oncology. Curr Onc 23(6): 398-406 2016
  10. 10. Sledzinski P, Zyeland J, Slomski R et al. The current state and future perspectives of cannabinoids in cancer biology. Cancer Med 7(3): 765-75 2018
  11. 11. Abrams DI. Using medical cannabis in an oncology practice. Onc J 1-4 2016
  12. 12. Abrams DI. Integrating cannabis into cancer care. Curr oncol 23(S2):S8-14 2016
  13. 13. Abrams DI, Guzman M. Cannabis in cancer care. Clin Pharm Ther published online 2015

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What are the risks of using cannabis?

Every medicine has risks and side effects and we need to expect them. There’s no achievable lethal dose of cannabis, but that doesn’t mean cannabis can’t make you feel terrible if you overdose on it.

Intoxication or high for most of my patients is viewed as an unfavorable side effect. A lot of people approach me and say they want the kind of cannabis that doesn’t get you high. That doesn’t exist. The THC that’s causing the high is also what’s giving the benefit. The way I look at this is the intoxication is a side effect and we need to manage the side effects, like with any medication.

Is there a real difference between marijuana bought on the street and cannabis bought (at a higher price) from a licensed dispensary?

In a dispensary, all the cannabis is tested not only for potency, but for safety — so not only heavy metals, but pesticides and mold are all tested for. We have seen cases of people who have smoked street weed getting fungal infections that can be lethal. I can think of two cases over four years — one in Boston and one in San Francisco — so we have to realize this is a very small number, but it’s something that we need to be aware of.

There are so many different cannabis products and options. How can people choose among them?

Some of them are just plain old BS. Bath bombs may be fun, but cannabis isn’t really contributing to that. The same can be said of topicals: creams, lotions and patches. Cannabis doesn’t penetrate the skin unless you do some pretty significant pharmaceutical manipulation, which most of these manufacturers aren’t doing at this point. And then also they cause side effects that lead me to wonder why we want to go there in the first place.

So the real choice is between inhaled and edible forms of cannabis?

I don’t recommend people smoke, because obviously exposure to smoke is not good for you, so that leaves vaporization. The advantages of inhalation are important. It’s really rapid onset. It has a modest duration of intoxication, meaning three to four hours. In many instances that’s an ideal length of time. Between the quick onset and your usable duration, inhalation turns out to be ideal for the significant majority of my patients.

And edibles?

Oral stuff is much more complicated. First of all, most people don’t need a heck of a lot of extra calories in their life. “Take two brownies and call me in the morning” is not good medicine.

has a much longer time to onset. Usually we think of it as about an hour, but it can be two to three hours before it kicks in, and it’s unpredictable when and why. The same person, same medicine — one day it might be an hour, the next day it might be two hours. Why? I don’t know, but the point is, that makes it difficult to deal with.

Oral lasts longer. It has a duration that’s more like eight to 12 hours. In some instances, that’s good news. If someone has 24/7 debilitating pain, using oral to get better coverage is a great idea.

For most patients, their needs are more episodic, so the duration may be too long.

What about homemade products?

In the world of homemade, it’s very difficult to know what’s in that brownie. Even if you managed to do the math right, it’s squirrelly enough that it may not mix completely. This brownie on one side of the pan may be very stiff and the other very weak. If you have a brownie that’s an “I don’t know,” I wouldn’t advise taking it, at least from a medical point of view.

You’ve been very careful to use the word “cannabis” instead of “marijuana.” Why?

Marijuana is a slang term that has a racial stigma. It was used in early 20th century to stigmatize Mexicans and Mexican-Americans and to generate this idea that only seedy people use this stuff and “good” Americans wouldn’t touch this stuff. So, I try to avoid that kind of language.

Do you have a handful of tips to offer for cancer patients interested in considering cannabis?

  • It’s always important to start with a low dose and advance it only slowly.
  • It’s important keep in touch with your doctors, both your oncology team and your cannabis doctor.
  • It’s important to understand the difference between inhaled versus oral.
  • It’s also important to understand that the dispensaries are not a place to get information. The reality is there’s a lot of misinformation out there on the internet, which serves people poorly at this time. By and large, the people behind the counter at the dispensaries are simply parroting back a mixture of their own personal experience and that misinformation from the internet.

Best Cannabis Strains for Cancer Patients

Updated on August 28, 2018. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer

If you have cancer, you may be qualified to get a medical marijuana card in your state. All it takes is an appointment with a marijuana doctor who can approve your condition. Once you have your card, you can take advantage of the many benefits cancer patients are finding for their debilitating symptoms.

But a visit to a dispensary could leave you confused. There are many cannabis strains to choose from, and you may be wondering which one is right for you. Read on to find out how certain strains can target the cancer symptoms you struggle with.

Marijuana Strains for Cancer-Related Symptoms

There are more than 100 forms of cancer, and each type produces its own set of side effects that vary in severity. However, there are common symptoms that many patients exhibit.

As the medical marijuana industry grows, cultivators are producing strains that can pinpoint specific symptoms. As these symptoms are alleviated, you’ll be able to live a happier and healthier life.

Chronic Pain

The most common use for cannabis medications is as an analgesic (pain reliever). Patients with cancer sometimes face excruciating pain. Medical marijuana contains CBD and THC, two cannabinoid compounds in cannabis that act as natural pain reducers. These compounds work together to bring incredible relief, even to patients with nerve pain.

  • Blackberry Kush. This Indica strain is best used at night or on lazy days around the house. It’s high in THC and provides a tranquil feeling of euphoria.
  • Harlequin. If you need to maintain a clear head, this sativa may be the right option. Equal levels of CBD and THC provide impactful medication.
  • ACDC. This hybrid is sought after for its analgesic properties. It’s also perfect for avoiding the psychoactive side effects of THC.

Nausea and Vomiting

This symptom can keep cancer patients from living their lives to the fullest. Medical marijuana is proven to curb feelings of nausea and keep patients from vomiting. Whether it’s caused by chemo or the disease itself, cannabis can help. The presence of THC in a strain has been shown effective to treat this side effect.

  • Super Lemon Haze. If you need to get up and around, this sativa is worth a try. It gives you the energy and takes away nausea.
  • Northern Lights. If you prefer to relax, this indica will help you rest while eradicating your nausea.
  • Blueberry Diesel. A hybrid that is the best of both worlds — it doesn’t push your energy and doesn’t make you sleepy.

Loss of Appetite

If left untreated, cancer can lead to cachexia, or wasting illness. Cancer patients undergoing treatments find it hard to eat. Medical marijuana helps kick your appetite into gear so you can keep your strength up. Usually, indica strains high in THC are best for this.

  • Granddaddy Purple. A classic indica with a high THC content, this fruity strain will spur your appetite on.
  • Skywalker OG. If you want to avoid the sleepy side effects, this hybrid can help.

Depression

Because of the nature of cancer, patients often struggle with depression. Severe mood changes are also a side effect of some medications. Medical marijuana helps improve a patient’s outlook and boost mood and energy. The pungent oil — or terpene — limonene is known to help depression.

  • Super Silver Haze. Fights depression and provides a delightful citrus aroma.
  • Chernobyl. No matter what time of day, this hybrid strain is sure to lift your spirits.
  • Super Silver Haze. A sativa strain that provides invigoration and happiness.

Fatigue

Cancer patients need to feel well-rested and revitalized to fight the disease. Whether you need a good night’s sleep or a little boost to make it through the day, medical marijuana can help.

  • Strawberry Cough. This hybrid is the kickstart you need. You’ll feel an instant boost to your energy level.
  • Tahoe OG Kush. If it’s a good night sleep you’re looking for, this hybrid is the way to go. You’ll feel relaxed and quickly drift off into a peaceful sleep.

Before you try a strain, we recommend speaking with a marijuana doctor or a budtender at your dispensary to make sure it’s the right one for you.

Information on Medical Marijuana & Cancer

  • Medical Marijuana to Manage Cancer-Related Neuropathy
  • Opioids vs. Cannabis to Treat Cancer Pain
  • Medical Marijuana to Treat Cancer-Related Nausea
  • Best Cannabidiol Strains for Cancer Patients
  • What Forms of Cancer Can Be Treated with Medical Marijuana
  • The Effect of Medical Marijuana on Chemotherapy Side Effects
  • How Does Medical Marijuana Treat Cancer

How Cannabis Oil Helps With Cancer Treatment and Kills Cancer Cells

A cancer survivor native, , from British Columbia, Canada has a story that most people cannot imagine. In May 2007, the patient had a heart attack and afterward a double bypass surgery. As a result of the surgery, she experienced chronic pain from a maligned sternum and post-sternotomy neuralgia syndrome. The patient constantly took pain killers to try to ease the pain, but nothing seemed to work.

Fast forward four years, the cancer patient was diagnosed with anal canal cancer and was coping with two spots of skin cancer on her collar bone. After two surgeries, the doctors told her that they were not able to get all cancer and that she would have to go through radiation. She researched the procedure and discovered that there was potential for permanent damage and she would suffer second- and third-degree burns. There was also a good possibility that the affected areas would fuse shut from the burns and subsequent scarring.

Hesitant about the radiation treatments, she asked for some time to think about it. Her doctor then told her that she had 2-4 months to live, at most 6, and that she should highly consider the radiation treatment.

But instead, she decided to start exploring the use of cannabis oil for cancer treatment.

What is Cannabis Oil and where does it come from?

Cannabis oil is a thick, sticky substance composed of cannabinoids, such as THC and CBD, which is obtained from cannabis flowers using a solvent extraction procedure. It is the most concentrated form of cannabis products, which makes cannabis oil the most powerful. The oil can be vaporized into the lungs, ingested orally, applied topically or used as a suppository. It can also be mixed with creams or salves for beauty treatments and other external uses.

The cannabis plant originated from Central Asia and is one of the oldest, mental stimulating drugs known to mankind. The beginnings of its use are difficult to trace since the plant was cultivated and consumed long before the appearance of writing. According to archeological discoveries, the cannabis plant has been known in China at least since around 4000 BC.

Some of the diseases and conditions that cannabis oil has been used for include: Crohn’s disease, diabetes, gout, pain relief, glaucoma, migraines, Dravet syndrome, asthma, Doose syndrome, epilepsy, anorexia, rheumatoid arthritis, multiple sclerosis, psoriasis, opioid dependence, strokes, head trauma, Alzheimer’s disease, Parkinson’s disease, HIV dementia and what we will be focusing on cancer.

How do cancer cells form?

Every person’s body has cells. Certain cells multiply and divide to create new tissue, while others (such as nerve or muscle cells) do neither function. Does the body also contain specific genes called oncogenes that control a cell’s ability to grow and divide? On the other hand, there are genes called tumour suppressor genes that signal cells to stop growing.

When cancer occurs, the oncogenes are ‘turned on’ when they should not be or the tumour suppression genes are ‘turned off’ when they are not supposed to be. This occurrence results in the excess growth of cells in the form of tumours.

Cancer cells go through numerous stages as they divide and multiply to become a tumour. During the hypeplasia stage, normal cells divide at a heightened rate, therefore, increasing the total number of cells. During stage two, dysplasia, the new cancer cells look contorted. The cancer cells begin to form a growing ball of cells, known as the primary tumour. This tumour starts to push and suppress the surrounding cells. In the fourth stage, called invasion, the tumour grows bigger and starts to delve into and invade the cells around it. In the final process, called metastasis, the cancerous cells spread into a blood vessel or lymph node and within the blood or lymph fluid to other parts of the body where it can start the dividing stage again.

There exact cause of cancer is not known, but research shows that various factors likely play a role. These factors include tobacco smoking, ionizing radiation, certain viruses and chemicals, and prolonged exposure to sunlight.

How does CBD kill cancer?

Simply put, when THC connects to the CB1 or CB2 cannabinoid receptor site on the cancer cell, it induces an increase in ceramide synthesis that leads to cell death. A normal cell does not produce ceramide when it is near THC; therefore it is not affected by the cannabinoid.

The reason the cancer cell dies is not because of the cytotoxic chemicals, but because of thereof a small shift in the mitochondria. The purpose of the mitochondria within a cell is to produce energy for the cell to use. As the ceramide is produced, it turns up the sphingolipid rheostat. This production increases the mitochondrial membrane permeability to cytochrome c, which is a vital protein in energy synthesis. The cytochrome c is then pushed out of the mitochondria, which ultimately kills the source of energy for that particular cell.

The presence of ceramide leaves no possibility of cancer cell survival. This is because it causes genotoxic stress in the cancer cell that generates a protein call p53, which disrupts the calcium metabolism in the mitochondria. Ceramide also disrupts the cell’s digestive system that produces nutrients for all cell function, and actively inhibits pro-survival pathways.

The key to the cancer killing process is the accumulation of ceramide in the system. This means that by taking any amount of CBD and THC, at a steady rate over a period of time, the patient will keep metabolic pressure on these cancer cell death pathways.

Ongoing Medical Research

Cannabis has been the subject of numerous scientific and medical research studies over the past twenty years. Scientists around the world have been studying and learning about cannabis plant. The results are as follows:

  • “The combination of cannabidiol and 9-tetrahydrocannabinol enhances the anticancer effects of radiation in an orthotopic murine glioma model” (Molecular Cancer Therapeutics, 2014)
  • “Do cannabinoids inhibit the vascular endothelial growth factor pathway in gliomas?” (The Journal of Cancer Research & American Journal of Cancer, 2004)
  • “Cannabidiolic acid, a major cannabinoid in fibre-type cannabis, is an inhibitor of MDA-MB-231 breast cancer cell migration” (Toxicology Letters, 2012)
  • “Cannabidiol inhibits lung cancer cell invasion and metastasis via intercellular adhesion molecule-1″(The FASEB Journal, 2012)
  • “Cannabinoids Induce Apoptosis of Pancreatic Tumour Cells via Endoplasmic Reticulum Stress-Related Genes” (Cancer Research, 2006)
  • “Cannabis-based medicine reduces multiple pathological processes in APP/PS1 mice?” (Journal of Alzheimer’s Disease, 2015)
  • “Cannabis-based medicine reduces multiple pathological processes in APP/PS1 mice?”
  • from Journal of Alzheimer’s Disease, 2015
  • “Inhibition of skin tumour growth and angiogenesis in vivo by action of cannabinoid receptors?” (Journal of Clinical Investigation, 2003)

Research surrounding cannabis oil and the cannabis industry will continue to happen and likely will not see a stop any time soon since there is a trend emerging as you can see in the medical results above.

How can cannabis oil help you?

Cannabis oil can help you if you are a cancer patient who does not take “we have done all we can do” to heart but instead looks for an alternate method. Or maybe you aren’t convinced that Western medicine practices are right for you. With safe, high-quality cannabis oil, you are providing yourself with improvements in your well-being and your standard of living in regards to pain management. As mentioned above, there are numerous diseases and conditions that can be treated using cannabis oil. It is ultimately up to the patient to make the decision what route he or she wants to make: Western practices, alternative methods or a combination of both, like the Cancer patient did by undergoing surgery and then deciding the cannabis oil route was for her. And look at where she ended up.

Not only did she digest the cannabis oil, but she topically applied it to the two spots of skin cancer on her collar bone. She started to see notable differences on her skin within 48 hours, and in the patient’s case, the spots appeared to be gone in over a week. She continued to ingest the cannabis oil and two weeks later, the pain she been experiencing for years was almost non-existent. She continued to ingest cannabis oil on a daily basis and slowly started to increase the amount she was taking.

Just over one year later from her initial diagnosis, the patient returned to her doctor to see if the effects of the cannabis oil had been working like she had hoped it would. He examined her, not once, not twice, but three times before he told her the news. He said it’s gone! I can’t find anything at all. If it wasn’t for the scar tissue I would never have known you had ever had cancer.” Needless to say, the patient was in disbelief that cannabis oil had been the one to lead her back to her normal, everyday lifestyle.

The Cancer Patient is a success story of using cannabis oil to help kill cancer cells. When using any CBD International product there is no “guaranteed cure”, but our treatments give you an alternative to traditional Western medicine practices.

If you are seeking alternative treatment methods, get started today by filling out your application form.

Looking for real cannabis oil extract?

CBD International’s mission has been to help provide alternative treatment for non-curable diseases and symptoms. We just don’t provide cannabis and CBD oil to everyone as everyone’s conditions are different. To be eligible to order the real cannabis & CBD products please fill out our application form with your conditions.

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