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Anti-Nausea in Chemotherapy: The Use of Medical Marijuana and THC

 

Sara Safan

 

October 5, 2009

 

What are Cancer and Chemotherapy?

A general understanding of the disease Cancer is a circumstance in which foreign cells divide uncontrollably and have the ability to infect other tissues in the body.  Cancer cells are capable of spreading to multiple parts of the body through blood and the lymph (clear substance that flows through the lymphatic system) (www.cancer.gov/cancertopics/what-is-cancer).  There are many different types of cancer including breast cancer, lung cancer, and leukemia. 

Chemotherapy is the term used to describe the process of cancer treatment, including the radiation treatment, and the drugs one takes during this treatment.  Since there is no true “cure” for cancer, chemotherapy has an incredible element to those living with cancer.  However, chemotherapy has many terrible side effects, including the dreadful nausea effect. 

There are multiple FDA approved drugs on the market to control nausea in chemo patients, including Dexamethasone, Metoclopramide, Haloperidol, etc. (http://www.cancer.org/docroot/MBC/content/MBC_2X_Nausea_and_Vomiting.asp?sitearea=MBC). However, for some cancer patients, these drugs are simply not enough and their nausea is still an extremely prevalent nuisance.  From these reasons, many cancer patients have turned to medical marijuana, and drugs that contain synthetic THC such as Marinol, for the alleviation of their nausea. Some people admit that if they smoke marijuana before they even go in for chemotherapy treatment, they do not feel the anticipated nausea.  (http://www.420magazine.com/forums/medical-marijuana-facts-information/67782-marijuana-chemotherapy.html)

 

How Does Medical Marijuana alleviate nausea in cancer?

How marijuana is processed in the brain and what it does exactly involves an extensive background in neuroscience, thus the explanation given next is an overview of some of the main events that take place when marijuana is ingested, smoked, or inhaled.  The events focused on are the ones that are related to what causes the anti-nausea effect.

Remedies that are not THC or marijuana based to alleviate nausea in chemotherapy aim to block the serotonin release into the synapse and into the postsynaptic neuron.  Marijuana and THC do just that.  Both block serotonin release and reuptake, causing the nausea effect to be eliminated.  How this happens is explained further.

There are two types of Cannabinoid receptors (THC, the main psychoactive ingredient in marijuana binds to these), CB1 receptors which are present throughout the central nervous system, and CB2 receptors which are located in the periphery nervous system, primarily on immunocytes (white blood cell capable of producing antibodies) and mast cells (a cell in tissues that contains granules which aim to be protective). (Slatkin, 2007).  CBI causes the psychological outcomes of THC because when THC blocks the receptor, it stops many of the effects found in humans.  CB1 deals with mood control, motor function, memory, pain, immune function, etc.  Because CB1 deals with all of these functions, one must understand that when THC binds to CB1, it can stop nausea (Hall et al, 2005).

 

Scientific Research

Do medical marijuana and THC based remedies truly alleviate symptoms of nausea before, during, and after chemotherapy?  There are a limited amount of studies that show how medical marijuana is used as an anti nausea remedy during chemotherapy medical marijuana is not yet legal in all states.  The three studies discussed below give an overview of the studies available.

In a review of 30 studies in 2001 (1366 participants), 16 with nabilone, 13 with dronabinol, 1 with leconantradol (all THC based remedies for nausea in chemotherapy), results showed that nausea in chemotherapy was reduced at a higher rate for those using cannabinoids than those taking the placebo and active agents.  Patients in this study also commented that they would prefer using cannabinoids in future treatments to the placebo and active remedies.  (Tramer et al, 2001)

A smaller study, 71% had no nausea when taking dronabinol (Marinol), 64% when taking ondanstrron (a non-THC based remedy for nausea in chemotherapy), and 15% when taking the placebo.  The nausea severity was also much higher for those on the placebo and ondansetron in this particular study. (Meiri et al).

Doblin and Kleiman surveyed 1035 oncologists who were members of the American Society of Clinical Oncology.  About 70% of respondents had commented that at least one of their patients had used marijuana as a remedy for nausea during chemotherapy.  44% of all the respondents had reported that they had recommended marijuana to at least one of their patients.  89% believed that marijuana was effective in the control of emesis.  89% support the use medical use of synthetic THC and around 54% have prescribed Marinol (legal drug that is made up of synthetic THC) to their patients.  53% said that they wanted to have the option to prescribe marijuana legally to their patients, because smoked marijuana is highly more effective than synthetic THC drugs. (Doblin and Kleiman, 1991) In general, most oncologists would prescribe marijuana to their patients, as they believe that it is the most effective treatment to rid one of nausea. 

Overall, marijuana and THC based drugs seem like the better option for cancer patients going through chemotherapy who want to get rid of the nausea.

 

Side effects of Marijuana

        The reason that many people do not want use marijuana or THC based remedies for their nausea during chemotherapy is due to the many side effects these drugs present.  The main side effects associated with medicinal marijuana are dizziness, acute psychoactive effects, dysphoria, depression, hallucinations, paranoia, impaired psychomotor function, and when smoked presents a case for the possibility of lung cancer. (Hall et al, 2005)  Some ask whether all these side effects are worth it, especially for something so normal such as nausea.

In the Tramer et al study, 11% of the participants dropped out due to side effects from the cannabinoids, compared with 2% that dropped out due to side effects on the placebo.  However, even with the side effects of the cannabinoids an overwhelming amount of participants claimed that they preferred taking the cannabinoids to the placebo. (Tramer et al, 2001) The participants in this study chose the absence of nausea over a simple “high” feeling. One must think about the side effects associated with any type of drug on the market, and how many people keep taking these drugs despite the harmful side effects.  Every drug has side effects, and if the side effects of medical marijuana are technically not life threatening, then what is the harm?

 

Is medical marijuana the solution to nausea in chemotherapy?

          The fact that scientists and researchers are making these positive claims about marijuana in chemotherapy gives cancer patients hope.  The research is being presented to the FDA in hopes of finding an alternative solution to the side effects associated with chemotherapy.  However, there will forever be a stigma linked with medicinal marijuana.  If a state allows medical marijuana to be prescribed, the states are worried that people will abuse their new right.  However, one must think to all of the other drugs available for pain currently on the market such as morphine and vicodin, which are much more addictive, and highly dangerous. Not everyone has to take medical marijuana or Marinol (synthetic THC based drug) for the treatment of nausea during chemotherapy, but this does not mean that it should not be an option.  Marijuana is not addictive, and is on the whole pretty safe. (http://www.drugpolicy.org/marijuana/factsmyths/) Melissa Etheridge is a great example.  She claims that medical marijuana saved her life, and was her solution to alleviating nausea during her chemotherapy. (http://www.youtube.com/watch?v=fvGKZQQskLQ) Studies have proven medical marijuana as a great alternative to the common prescriptions given for nausea during chemotherapy. Oncologists support it, patients love it, and the FDA should accept it as an up and coming option for Cancer patients.   

 

References:

Doblin, R. E., & Kleiman, M. A. (1991, July). Marijuana as Antiemetic Medicine: A Survey of Oncologists' Experiences and Attitudes. Journal of Clinical Oncology, 9(7), 1314-1319.

 

Hall, W., PhD., Christie, M., PhD., & Currow, D., PhD. (2005, January). Cannabinoids and Cancer: causation, remediation, and palliation. The Lancet Oncology, 6(1), 35-42.

 

Meiri E, Jhangiani H, Vredenburgh J, et al. Dronabinol treatment of delayed chemotherapy-induced nausea and vomiting (CINV). J Clin Oncol 2005, 23(16S): 8018.

 

Slatkin, N. E., MD. (2007, May). Cannabinoids in the Treatment of Chemotherapy-Induced Nausea and Vomiting: Beyond Prevention of Acute Emesis. The Journal of Supportive Oncology, 5(5), 1-9.

 

Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review.  Br Med J 2001, 323, 16-21.

 

 

 

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