Vincent Maida, MD, wants to make sure: He’s not some “hippie pothead.” But about 20 years ago, the Toronto-based palliative care physician understood that Cannabis was worth taking seriously. At the time, cannabis — also known as marijuana — wasn’t legal in Canada nor the United States. But, progressively, 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 [legal] 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.”
Though there may be a numerous medical uses for cannabis, Maida says it’s especially beneficial for Cancer patients and that it should be included in their treatment plan. In recent times, many western MDs who were previously skeptical have also began 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 aid 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 many healthcare providers haven’t received any enlightenment 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.
Even with 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.
How Does Medical Cannabis Work
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 [cannabis] 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.
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.
- 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.
- 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.
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.
- 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.
- 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.”
- 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.
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