cbd oil for chemo side effects

What about medical marijuana?

The marijuana plant itself has not been approved as a medicine by the federal government. However, the plant contains chemicals—called cannabinoids—that may be useful for treating a range of illnesses or symptoms. Here are some samples of cannabinoids that have been approved or are being tested as medicines:

  • THC: The cannabinoid that can make you “high”—THC—has some medicinal properties. Two laboratory-made versions of THC, nabilone and dronabinol, have been approved by the federal government to treat nausea, prevent sickness and vomiting from chemotherapy in cancer patients, and increase appetite in some patients with AIDS.
  • CBD: Another chemical in marijuana with potential therapeutic effects is called cannabidiol, or CBD. CBD doesn’t have mind-altering effects and is being studied for its possible uses as medicine. For example, CBD oil has been approved as a possible treatment for seizures in children with some severe forms of epilepsy.
  • THC and CBD: A medication with a combination of THC and CBD is available in several countries outside the United States as a mouth spray for treating pain or the symptoms of multiple sclerosis.

It is important to remember that smoking marijuana can have side effects, making it difficult to develop as a medicine. For example, it can harm lung health, impair judgment, and affect memory. Side effects like this might outweigh its value as a medical treatment, especially for people who are not very sick. Another problem with smoking or eating marijuana plant material is that the ingredients can vary a lot from plant to plant, so it is difficult to get an exact dose. Until a medicine can be proven safe and effective, it will not be approved by the federal government. But researchers continue to extract and test the chemicals in marijuana to create safe medicines.

Legal Issues

A growing number of states have legalized the marijuana plant’s use for certain medical conditions, and a smaller number have voted to legalize it for recreational use. So, in some cases, federal and state marijuana laws conflict. It is illegal to grow, buy, sell, or carry marijuana under federal law. The federal government considers marijuana a Schedule I substance—having no medicinal uses and high risk for misuse. It is important to note that because of concerns over the possible harm to the developing teen brain, non-medical marijuana use by people under age 21 is against the law in all states.

CANNABIS AND CANCER

In the latest edition of our advice column on medical marijuana, Dr. Allan Frankel shares his experience using cannabinoids to heal cancer patients.

Frankly, marijuana doctors don’t always have the best reputation. Before the days of recreational cannabis, getting a medical marijuana recommendation from a strip-mall “420 doc” was often the only way to legally access the sweet leaf (in states that allowed it).

Now, as public acceptance of the plant grows through the expansion of medical and adult-use cannabis programs across America, a wider range of medical professionals are taking marijuana seriously as a treatment for epilepsy, brain damage, chronic pain, and a number of other ailments. More so, the science behind marijuana as medicine is evolving rapidly, with research institutions and Big Pharma making large investments in learning more about the medicinal power of pot. Forget about picking some Bubba Kush to help you sleep — now doctors are breaking down cannabis into its chemical components to find new medications and therapies personalized for individual patients.

Dr. Allan Frankel is one of these pioneers. As the founder of GreenBridge Medical in Santa Monica, California, Dr. Frankel is on the cutting edge of cannabis medicine, developing treatment plans for his patients that entail measured doses of particular cannabinoids targeted towards specific maladies. In doing so, Dr. Frankel aims to give patients an experience closer to that of a traditional doctor’s visit, but without the numerous side effects of conventional pharmaceuticals and procedures.

In his latest column for MERRY JANE, Dr. Frankel shares his experience and expertise in using cannabinoids to treat cancer: directly combating the disease itself, as well as treating the debilitating side effects of conventional cancer therapies in his patients.

Over the years, I have written many articles about cannabis cancer therapies. There is growing evidence that medical cannabis is effective in helping patients manage certain types of cancers at various stages, in conjunction with and as an alternative to traditional medical treatments. Medical cannabis is also effective in managing the side effects of cancer therapies and the symptoms of the disease.

Unfortunately, most people wait too long after diagnosis to begin cannabis therapies. They begin looking for alternative therapy when conventional treatments haven’t worked, and the disease is already advanced, sometimes with a terminal diagnosis.

When first diagnosed with cancer, I highly recommend that individuals consult a major cancer center for diagnosis confirmation, staging assessment, and recommendation of treatment protocols. Following assessment and treatment recommendations, medical cannabis should be considered as a complementary therapy.

My first concern is that a patient has the best medical care. Whatever the type of cancer or its stage of development, I recommend that any use of medical cannabis be undertaken with advice of a medical doctor experienced in cannabis treatments for cancer. If there is solid evidence regarding chemotherapy, radiation, or immunotherapy for treating a particular type of cancer — and you believe the risks are worth the potential gain — then using a combination of chemotherapy and cannabis should be seriously considered. Just because I am a medical cannabis specialist does not mean that I believe all standard therapies are of no value. However, there are situations where a patient’s response rate to chemotherapy is very low and the risks high. In such a scenario, I would skip the chemotherapy and look to cannabis as well as other complementary treatments.

I always tell my patients to consider any therapy that seems safe and has some rationale for its use. Keep an open mind.

About 20% of the patients I see are seeking help with cancer. They may experience pain, appetite loss, anxiety, depression, and insomnia, along with other symptoms of the disease and treatment side effects. The cannabis formulations I recommend can be very effective dealing with these issues as well as treating the cancer itself.

When I discuss the patient’s treatment at the time of their initial visit, I review several major areas:

  1. Treatment of the cancer itself, or “anti-proliferative” therapy.
  2. Treatment to prevent serious long-term side effects of chemotherapy, such as severe neuropathy and osteoporosis.
  3. Treatment of chemotherapy side effects, such as nausea.
  4. Treatment of cancer-related symptoms, such as pain or mood disorders. Anxiety and depression are also very common.

So, the overall therapy includes direct anti-cancer therapies, but must include the other areas as well. All four areas of treatment are critical for every patient and must be reviewed at every visit.

Speaking about “visits,” I must emphasize the plural. While an initial examination and treatment plan is critical, close follow-up with personal messaging, phone calls, and in-person visits is part and parcel of any good medical therapy. Without this close monitoring and ongoing review of scans and lab reports, proper care for the patient is compromised.

DIRECTLY TREATING CANCER WITH CANNABIS

I have always been impressed with the number of cannabinoids and terpene molecules that have anti-tumor effects. In reviewing the various methods by which cannabis kills cancer cells, it is remarkable how many of the mechanisms by which cannabinoids combat cancer are very similar to how chemotherapy functions to suppress the disease, but without the debilitating side effects.

Our endocannabinoid system, in particular anandamide, our “internal THC”, is a powerful mechanism in killing cancer. When we intake plant-based cannabinoids (or phytocannabinoids), our internal cannabinoids (or endocannabinoids) are activated, and our internal screening mechanism is now on high alert for any cancer cells.

Cannabinoids decrease blood flow to cancer cells, thereby killing many of them. Various chemotherapy drugs work in a very similar manner.

There are cannabinoid receptors on most cancer cells, and both our endocannabinoids as well as ingested phytocannabinoids attach to these receptors, with the effect of causing either cell death or “apoptosis,” meaning cell suicide.

Cannabis also increases our immune system’s responsiveness by activating our T-cells, which have direct and indirect effects on cancer cell growth.

Another powerful mechanism demonstrated in breast cancer cells and others as a result of cannabis-based treatments is making the cells “sticky” — this means that the cancer cells are less likely to metastasize or spread to other areas of the body.

PREVENTING LONG-TERM TOXICITY FROM CANCER THERAPIES

There are many short-term and long-term toxicities for patients that can result from chemotherapy. The short-term toxicities, such as nausea, will be discussed in the next section, but there are also some very serious long-term complications of chemotherapy where cannabis can be a very helpful treatment.

Two of the most significant long-term side effects of chemotherapy are osteoporosis (a weakening of bone strength) and neuropathy (pain, weakness, or numbness caused by nerve damage). Neuropathic pain can be very severe and last a lifetime; it’s often referred to as “suicide pain” due to its intensity. Steroids are often used in combination with chemotherapy to treat inflammation caused by cancer, or to directly to suppress tumors in combination with radiation therapy or chemo. However it’s the use of such steroids for cancer patients that also yields the painful side effects of brittle bones and nerve pain.

Often by using CBD (cannabidiol) at the time of chemotherapy administration instead of steroids, neuropathy and osteoporosis can be prevented or lessened. There are animal studies demonstrating this effect as well as a lot of anecdotal evidence. As doctors such as myself commonly use CBD in the treatment of the cancer, I’ve noted along with others that neuropathy seems uncommon in these patients, also indicating the potential prevention of neuropathy by using CBD in conjunction with anti-cancer treatments.

By decreasing the incidence of neuropathy with CBD, it is then possible to administer full courses of chemotherapy to the patient, instead of being forced to discontinue care due to the worsening neuropathy, enhancing a patient’s overall chances at beating their disease.

TREATMENT OF SHORT-TERM SIDE EFFECTS OF CHEMOTHERAPY

Those of us who’ve grappled with cancer personally or in our friends or family are aware that chemotherapy is very difficult to tolerate. Nausea and vomiting are usually the most severe side effects, and often are severe enough to warrant hospitalization for a day or more. Cannabis has many anti-nausea effects — in fact, all of the major cannabinoids have anti-nausea properties. CBD helps with nausea associated with anxiety, and clearly, having to deal with cancer and chemotherapy generates a lot of anxiety!

THC has been used as an anti-nausea medication for many years. In 1972, prior to President Nixon’s crackdown on cannabis, it was available for glaucoma studies. I remember stopping by the cancer wards at times when I was on call late at night, to see if any patients were experiencing unceasing vomiting. The nurses were eager to have any intern or resident grab a joint and wheel a patient outside to give them some relief; none of this would have happened if THC were not effective when everything else failed. Even today, with so many improved pharmaceutical medications for nausea, often it takes some cannabis to end the discomfort.

The “acid” or “precursor” molecules CBD-A and THC-A are also excellent anti-nausea molecules. These molecules also have significant anti-cancer effects which I will discuss below.

TREATMENT OF CANCER-RELATED SYMPTOMS

It is easy to understand how and why a patient with cancer would be afraid; troubled with anxiety, depression, pain and other symptoms that complicate the course of the illness, while leading to much despair in the patient as well as their family.

Working with cannabis for over 12 years has certainly taught me many ways of using cannabis in the treatment of pain and mood disorders. CBD helps with pain and anxiety. THC will often elevate their mood and help with pain. Combinations of CBD and THC are often superior to either alone. Usually these are administered under a patient’s tongue as it works more rapidly, avoiding a cancer patient’s typically inflamed gastrointestinal tract.

Keep your eyes open for THC-V. This is another ancient cannabinoid that is now working its way into the formularies of dispensaries. They’re currently derived from very rare strains, but as with CBD, in another year or two they will likely be readily available. THC-V offers a lot of promise with mood, osteoporosis, and pain — particularly neuropathic pain.

The reader must be wondering, so what type of cannabis should patients use? I wish we knew as much as we think we do. There are many who believe high dose THC to be the best answer. This has been promoted by Rick Simpson and many others. No doubt, there are many patients who do very well with this type of dosing. However, ingesting a gram of THC oil daily, for many, is extremely difficult, if not impossible.

Personally, I don’t believe a dose of a plant medicine should be so high that it makes a person ill.

If you follow studies using doses of CBD with THC in the 30 milligram range of each, there is definitely early clinical trial information demonstrating this to be a reasonable dose for treating various serious brain tumors.

I believe that any cannabis regimen for cancer treatment is better than not using any cannabis. Over time, standardized cannabis regimens will be development and there will be different protocols for different cancers. I know we would like to believe we know what is best for everyone, but we are just not yet there.

So, what do I do when a cancer patient asks me how to treat their ailment? In general, I suggest doses of around 120 milligrams, evenly divided by CBD, THC, CBD-A and THC-A.

I believe cannabis will play a major role in the treatment of cancer, and I can’t wait to see what happens next!

Disclaimer: This column is not intended to be a substitute for personalized medical advice, diagnosis, or treatment from a certified professional. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical ailment or treatment and before undertaking a new health care regimen.

Flower Power: Medical Cannabis for Cancer Side Effect Management

Nearly two decades have passed, but Stacy Sklaver still remembers the overwhelming nausea. Her doctor was treating her breast cancer with a six-month course of the chemotherapies doxoru­bicin, cyclophosphamide and paclitaxel, and she thought the drugs were more likely to kill her than the disease.

“I remember the stuff was so toxic that nurses wore gloves to prevent it from burning the skin on their hands,” says Sklaver, now 60, who typically became nauseated a couple of days after treatment and got no relief from Zofran (ondansetron), the anti-nausea drug her doctor prescribed. “I remember getting up a couple hours after going to bed and spending four hours or more doubled over my toilet and vomiting.”

That was long before the days of legal medical marijuana, but a friend had read that cannabis could help ease nausea, and her doctor said it might work, so Sklaver decided to give it a try. She now regards that as one of the better decisions in her life.

“It didn’t entirely eliminate the nausea and vomiting, but it got pretty close. I could make myself eat,” says Sklaver, who typically smoked a joint before bed a few times a week during the worst part of each chemotherapy cycle and then gave it up after treatment. “It also eliminated the pain that bad nausea creates in every part of your body. I wasn’t functioning normally because I still had the exhaustion, but at least I wasn’t miserable.”

Sklaver’s experience vividly illustrates the one proven effect of cannabis’s most active ingredient in patients with cancer: control­ling nausea and vomiting. Her strong belief that any sick adult should be able to access marijuana legally illustrates why medical marijuana laws have become common in the years since her chemotherapy.

STACY SKLAVER found that cannabis relieved nausea from chemotherapy that prescribed drugs did not.

Thirty-three state legislatures have legal­ized medical marijuana for a wide variety of conditions, and their counterparts in 13 other states allow its use in limited circum­stances. Their actions stem from a growing belief that for patients struggling with symptoms such as pain, anxiety, insomnia and loss of appetite, the positive effects of cannabis outweigh any negatives associated with the drug.

With the exception of data about its anti-nausea and appetite stimulating powers, there is, however, surprisingly little evidence, either positive or negative, regarding the medical uses of cannabis or its active ingre­dients, collectively known as cannabinoids.

Studies of marijuana are relatively few and weak. It’s next to impossible to conduct large, randomized, controlled trials on a substance that the federal government bans, so the research consists mostly of small, short trials; user surveys; and statistical analysis of information collected for other purposes. It might still be possible to make some broad assertions about medical marijuana if most of those researchers had reached similar conclusions, but they didn’t. Some findings, for example, suggest that whole cannabis or individual cannabinoids control cancer pain about as well as opioids; others find no significant effect on pain.

Currently, patients with cancer have just two thoroughly researched, fully validated options for adding marijuana derivatives to their treatment regimens: the medications Marinol or Syndros (dronabinol) and Cesamet (nabilone). Both are standardized, synthetic oral cannabinoids that have been approved by the Food and Drug Administration (FDA) for treating nausea and vomiting caused by chemotherapy. Patients considering the use of other cannabinoids need to talk to their physicians, read the research, consider other relevant factors (like cost) and make their own decisions.

Those who decide in favor of the drug are not alone. “The rise of medical marijuana is much more of a political and popular movement than a medical movement. No dramatic new research justifies the wave of legislation on this issue. It was popular sentiment,” says Mellar Davis, M.D., who wrote a research review on cannabinoids and cancer treatment for the Journal of the National Comprehensive Cancer Network.

THE SEARCH FOR EVIDENCE

Cannabis is a flowering plant that originated in central Asia. The greatest concentrations of cannabinoids typi­cally occur in the flowers and the resin, a viscous goo the plant secretes. (The substance called marijuana, weed or pot consists of dried flower buds, whereas the substance called hashish consists of resin.) People in far-flung parts of the world have been using cannabis flowers and resin for both recreational and medicinal purposes since early in the human experience. Its use as a medicine likely started in Asia around 500 B.C., according to history.com.

A cannabis plant contains more than 400 chemical entities, including more than 60 cannabinoids. The vast majority of research to date has focused on just two of them: tetrahydrocannabinol (THC) and cannabidiol (CBD). Both THC and CBD contain 30 hydrogen atoms, 21 carbon atoms and two oxygen atoms, but they’re arranged a bit differently, so they bind to different receptors in the body. THC binds directly to canna­binoid receptor 1, which sends signals to the brain, creating the psychoactive effects that are gener­ally described as “getting high.” CBD binds to cannabinoid receptor 2, which does not get users high.

These receptors are there to bind to the natural cannabinoids (similar to plant cannabinoids) that our bodies manufacture. These cannabinoids are among many neurotransmitters (such as dopamine, for instance) made by our brains and other tissues, which bind to receptors and enable different aspects of brain physiology related to mood, emotion and more.

Most studies done on the subject agree that THC significantly reduces nausea, vomiting and weight loss due to chemotherapy and other conditions. The largest of those trials led to the FDA approvals of dronabinol and nabilone. (Dronabinol is identical to the THC in cannabis, although it’s made in a factory rather than extracted from a plant, whereas nabilone is a man-made molecule that acts very much like THC in the body.) An analysis that combined results from 30 trials involving a collective 1,366 patients found that among patients taking chemotherapy, THC better controlled nausea and/or vomiting than the anti-nausea drugs prochlorpera­zine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone or alizapride.

The evidence that THC can safely reduce cancer-related pain is decidedly more mixed. Positive results include those of an observational study that found significantly less cancer-related pain in 47 nabilone users than in 65 nonusers. A review of nine pain-reduction trials, five of which focused on cancer pain, concluded that THC controlled pain about as well as codeine but noted that depressant effects on the central nervous system often limited the use of THC; the researchers described most of its side effects as “psychotropic.” Other analyses of multiple trials, however, revealed just a small benefit, and THC, used in conjunction with opioids, did no better than placebo and opioids in a trial that randomly assigned 177 opioid-using patients with cancer to take THC, placebo or Sativex (nabiximols), which combines THC and CBD.

Sativex, which is approved in many countries but not the U.S., significantly reduced cancer-related pain in that study, but it’s no magic bullet. Other randomized trials of the drug found few significant benefits for pain stemming from cancer and other conditions in more than 500 patients.

Researchers looking into dronibanol, nabilone and every other form of THC all conclude that it has significant mind-altering properties. Some patients find that these improve mood and spur relaxation. Though there is little evidence of patients becoming addicted to or abusing either FDA-approved drug, these effects come with significant drawbacks: Some patients hate them, they render all users unable to legally drive a car, and they leave some unable to work productively.

None of those downsides come with CBD, which is regulated in many states like a supplement such as echinacea or green tea extract. Would-be users can find dozens of formulations on Amazon.com that are advertised as able to reduce pain or improve sleep, all for under $50. However, as with many other supplements, there is little regulatory oversight to guarantee that the bottles’ contents match their labels, and little scientific evidence supports their efficacy. That may change, however. The FDA recently approved Epidiolex, a pharmaceutical company’s version of CBD, for the treatment of seizures related to two rare conditions. Researchers have also begun to study a range of possible benefits of CBD usage, including pain relief and immuno­modulation, but right now, scant published data suggests that isolated CBD can help any of the symptoms associated with cancer.

DOES CANNABIS FIGHT CANCER?

Some preliminary work does suggest that CBD may help stave off some types of cancer. Researchers have found that CBD induces programmed cell death in breast cancer cells cultivated in the lab; inhibits expression of the Id-1 gene, interfering with the proliferation and invasion of breast cancer cells; and protects against induced colon cancer in mice.

Findings from studies of lab samples and animals also showed that CBD and THC can slow the progression of brain tumors called glioblastomas, which have a very high number of cannabinoid receptors. The exact mechanism of tumor growth inhibition is unknown. What’s more, a 2018 study in 23 patients with glioblastoma noted that those who used at least 50 mg of cannabinoids per day for at least a month were more likely than other patients to be alive both one year (80 percent versus 74 percent) and two years (73 percent versus 65 percent) after beginning treatment.

On the other hand, preliminary evidence suggests that cannabis may reduce the efficacy of the immunotherapy Opdivo (nivolumab), so patients need to weigh potential costs and benefits and keep their doctors informed of their choices. Opdivo is approved to treat colorectal cancer and is being tested in glioblastoma and breast cancer in clinical trials.

“I’m continuing to track my two groups of glioblastoma patients, and outcomes among the patients who used the higher doses of cannabinoids continue to be good by the very poor standards of glioblastoma patients,” says Nicholas Blondin, M.D., an assistant professor of clinical neurology at Yale School of Medicine. “Is the data from this small observational study proof of benefit? No, not even close. But I believe it’s definitely interesting enough to justify more research.”

THE CHALLENGES OF STUDYING CANNABIS

Blondin’s study illustrates one way that recent laws allowing the use of medical marijuana increase our ability to research its effects: They provide the chance to observe differences in outcomes among patients who do and don’t seek access to dispensaries. Unfortunately for those who wish to perform cannabis research, state laws don’t eliminate the many remaining obstacles to well-controlled trials. The Drug Enforcement Agency (DEA) still classifies cannabis as a schedule 1 drug — it’s considered to have high potential for abuse but no proven medical uses. As a result, researchers who wish to conduct clinical studies of it must file an investigational new drug application with the FDA, obtain a schedule 1 license from the DEA and get approval from the National Institute on Drug Abuse.

Some researchers work through this process to perform quality studies, but not many. A scholarly article that appeared in 2015, just before CURE ® published its last over­view of cannabis in cancer care, sought to round up all the quality research that had been performed on the medical effects of cannabis or natural cannabinoids in human subjects. Its authors scoured 50 years of academic journals and found just two trials that merited inclusion.

In the first study, 50 HIV patients received either three marijuana or three placebo cigarettes daily for five days. (Researchers made the placebos convincing by removing the active ingredients but not the distinctive smell or taste from marijuana.) The actual cannabis reduced the daily pain that patients reported by 34 percent, whereas the placebo reduced pain just 17 percent. For the second study, 39 patients with neuropathic pain took 12 puffs of 1.29 percent vaporized cannabis, 3.53 percent vaporized cannabis or placebo. Both doses of cannabis performed better than placebo and similar to widely used pain medications, but the higher dose produced no better results than the lower dose.

Because of the lack of data and FDA approvals, health insurers generally don’t cover cannabis, even in states where medical marijuana is legal. None of the experts interviewed for this story had heard of a patient getting reimbursed for cannabis expendi­tures, which are significant. Prices vary by state, but estimates online put the monthly cost of medical marijuana above $200.

Still, neither cost nor uncertainty about effectiveness deters a significant percentage of patients with cancer from using medical marijuana. An anonymous survey of adult patients at a large cancer center in Washington state, where medical marijuana is legal, found that 24 percent of 926 respondents had used cannabis in the past year and that 21 percent of them had used it in the past month. Looking just at active users, 70 percent consumed inhaled cannabis products and 70 percent consumed edibles.

Those patients with cancer who do use medical marijuana seem to be pretty satisfied with it. An analysis of data that providers collected from about 2,970 cancer patients who used medical marijuana between 2015 and 2017 looked at why patients turned to cannabis and found the most common symptoms they hoped to treat were sleep problems (78.4 percent), pain (77.7 percent), weakness (72.7 percent), nausea (64.6 percent) and lack of appetite (48.9 percent). After six months of follow-up, 902 patients had died and 682 had stopped the treatment. Of the remaining 1,211, almost all —96 percent — reported an improvement in whatever condition they were trying to treat with cannabis.