Marijuana first became legalized for the treatment of severe nausea and other medical uses in the United States starting in 1996.1,2 While the legalization of marijuana has expanded to 20 states and Washington DC, so has the controversy around its use.

Since it may be difficult to separate politics from drug policy, recent studies examine how patients use marijuana to relieve a variety of medical conditions, leaving the quandary of legalization up to the lawmakers.

Prior to legalization of medical marijuana, the Food and Drug Administration (FDA) approved two cannabinoid derivatives, dronabinol (MARINOL®) and nabilone (CESAMET®), for the treatment of two of the most common and severe side effects of chemotherapy treatment—nausea and vomiting.2 These and other cannabinoid derivatives were approved for use when other medications were ineffective. Currently, the first-line standard of care is dexamethasone (DECADRON®), a synthetic steroid that curbs nausea. Cannabinoids are reserved for breakthrough nausea and vomiting.

Plant versus Synthetic Derivatives

There are many variables that impact the use of medical marijuana, including whether plants versus synthetic derivatives are better for the treatment of patients’ symptoms. Researchers at the Technion-Israel Institute of Technology, Haifa, Israel interviewed 211 patients who had a medical marijuana license to determine if medical marijuana relieved the cancer-related symptoms they were experiencing, including nausea, vomiting, mood disorders, fatigue, weight loss, anorexia, constipation, sexual function, sleep disorders, itching, and pain.

Approximately half (106 patients) continued the cannabis treatment and answered follow-up survey questions about efficacy. The results showed that patients reported a significant improvement of cancer-related symptoms (P < 0.001).3  Side effects included memory lapses in patients with prolonged use (P = 0.002), but no other significant side effects were noted in this study.3

Global Interest Grows

Earlier this year, the New England Journal of Medicine published results of a poll of 1,446 doctors in the United States and abroad about whether they would approve of patients using medical marijuana when traditional medications were ineffective. Seventy-six percent of respondents said that they were in favor of the use of medical marijuana, even though its use is illegal in many countries.4

Related: Most Clinicians Support Use of Medicinal Marijuana

Israel is one country that has approximately 10,000 licensed (ie, legal) medical marijuana users, and research studies are currently underway to study its efficacy for pain, and relief from symptoms of other diseases such as epilepsy, as described in a documentary that neurosurgeon Sanjay Gupta, MD, recently aired on CNN.5 One patient with cancer being treated at Israel’s largest medical center uses medical marijuana—via a hospital-issued vaporization device— to successfully treat pain and nausea. In addition, Dr. Gupta said that very early studies in Israel, Spain, and the United States are looking at the potential for cannabis to kill cancer cells, although he urges caution because the “research is still in its infancy.”5

Dr. Gupta’s documentary also talks about different strains of marijuana that are high in cannabidiol (CBD), which provides the analgesic effect and low in tetrahydrocannabinol (THC,) the chemical that produces the psychoactive effect, or the “high.”  CBD can be extracted for ingestion through droplets and a liquid medicine, or put into foods to eat, rather than smoke. Questions remain about providing correct dosages for different patient populations as the variations for this substance are many.

More large-scale research needs to be completed to show whether medical marijuana is a better option for patients who fail other treatment methods, and perceptions and classifications need to change. Marijuana is currently listed by the FDA as a “Schedule 1 Substance”, defined by the Drug Enforcement Administration as a drug “with no currently accepted medical use and a high potential for abuse” along with drugs like heroin.6

As with any psychoactive drug, there is potential for abuse, but there is also the promise of a better medicine.


References

1. Marijuana Resource Center: State laws related to marijuana. http://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana. Last accessed October 14, 2013.

2. Todaro B. Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting. J Natl Compr Canc Netw. 2012 Apr;10(4):487-92.

3. Bar-Sela G, Vorobeichik M, Drawsheh S, et al. The medical necessity for medicinal cannabis: prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care. Evid Based Complement Alternat Med. 2013;2013:510392.

4. Adler JN, Colbert, JA. Medical use of marijuana; polling results. N Engl J Med. 368:e30. http://www.nejm.org/doi/full/10.1056/NEJMclde1305159. Last accessed October 16, 2013.

5. Sanjay Gupta, MD. Documentary: Weed. http://www.youtube.com/watch?v=tShnVEmdS2o. Last accessed October 16, 2013.

6. DEA. Drug Scheduling. http://www.justice.gov/dea/druginfo/ds.shtml. Last accessed October 16, 2013.