Is Medical Marijuana Appropriate for Patients with Cancer?

“Public opinion on the medical value of marijuana has been sharply divided. Some dismiss medical marijuana as a hoax that exploits our natural compassion for the sick; others claim it is a uniquely soothing medicine that has been withheld from patients through regulations based on false claims.”¹

Twenty-three U.S. states and the District of Columbia have legalized the use of medical marijuana—or Cannabis sativa—creating, in the process, a patchwork of state regulations and confusion among law enforcement agencies and placing prescribing physicians in a quandary.²

Potential benefits of medical marijuana for those with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep, with the majority of physicians considering its use primarily for symptom management.³

The majority of states include cachexia or wasting syndrome, cancer, nausea, and chronic pain as “approved conditions” for the use of medical marijuana, which may be smoked, eaten, inhaled, or topically applied. The U.S. Food and Drug Administration (FDA) has classified marijuana as a Schedule I controlled substance.

At the recent PAINWeek 2014 meeting in Las Vegas, NV, three presentations focused on the pros and cons of medical marijuana: one from a national policy perspective, one from a law enforcement perspective, and the third from a physician’s perspective.

Ethan Nadelmann, JD, PhD, executive director of the New York-based Drug Policy Alliance, who gave the Keynote Address, said that having a national policy wherein people are penalized for marijuana possession has resulted in the United States having the highest incarceration rate in the world.

John Burke, commander of the Warren County Ohio Drug Task Force, said that in California, which in 1996 was the first state to legalize medical marijuana, the 800 to 1,000 marijuana state-run dispensaries are little more than “head shops,” outnumbering McDonalds or Starbucks in Los Angeles, CA, for example, in some areas by 2 to 1.

One of the key issues related to medical marijuana is that no other medication is approved by the smoked route, with the inherent difficulty of delivering an exact dose. Burke pointed to the Institute of Medicine 1999 report, Marijuana and Medicine: Assessing the Science Base, which stated, “…the future of cannabinoid drugs lies not in smoked marijuana but in chemically defined drugs that act on the cannabinoid systems that are a natural component of human physiology.”¹

Since then, both the public and the medical field have taken marijuana use too lightly, leading to increased use and more casualties, Burke contends.

“Although we rely on the FDA for approval of all our prescription and over-the-counter drugs, why are we sidestepping the proven process when marijuana is involved?,” Burke asked. He estimated the cost of gaining FDA approval for medical marijuana to be $800 million to $1 billion and take 5 to 7 years, a risk no one would be willing to take.

In any case, according to the American Cancer Society, two chemically pure drugs based on marijuana compounds are currently approved for medical use. Synthetic THC (delta-9-tetrahydrocannabinol), as dronabinol, was approved in 1985 to treat chemotherapy-induced nausea and vomiting (CINV) and nabilone, also for CINV when other agents have failed. Currently, nabiximols, a buccal spray that contains both THC and cannabidiol to treat cancer pain, has been approved in Canada and parts of Europe, with clinical trials ongoing in the United States.⁴