Marijuana chemotherapy

The reduction of nausea in patients taking anti-cancer drug therapy is probably the most widely researched area for cannabis therapy. A number of these studies have shown that oral administration of isolated cannabinoids produce significant improvements, particularly for those patients who have failed to respond to standard antinausea treatments during chemotherapy (see Tortorice and O Connell, 1990 for a comprehensive review). Patients and oncologists have subjectively reported that smoked marijuana is as safe (in this patient group) and effective as isolated oral cannabinoids, but more systematic research trials are required. 

Increased appetite is frequently attributed to smoking marijuana. Cannabinoids are effective antiemetics, particularly in treating emesis arising during chemotherapy. A -THC has been reported to be as effective as codeine as an analgesic, although pronounced behavioral effects occur with analgesic doses. 

Cannabinoids Dronabinol is available for use in chemotherapy-induced nausea and vomiting, but is associated with CNS marijuana effects ... 

The Schedule I designation of marijuana has been disputed over the past 15 or more years. Some physicians would like to see it as a Schedule II drug so that it could be used therapeutically in the treatment of the nausea, vomiting and anxiety caused by cancer chemotherapy and as an antiglaucoma agent (lowers intraocular pressure). It should be noted that the neuroleptic prochlorperazine is an effective antinausea drug which can be used without producing the psychoactive effects of marijuana. 

A9-Tetrahydrocannabinol is the major psychoactive cannabinoid in marijuana (Cannabis sativa). Its synthetic form, dronabinol, became available in the U.S. in 1985 as an antiemetic for patients receiving emetogenic chemotherapy. However, it is seldom used as a first-line antiemetic because of its psychoactive effects, and its use is usually limited to patients who have a low tolerance or minimal response to other antiemetic drugs (see Chapter 18). 

A9-Tetrahydrocannabinol (A9-THC) is considered to be the predominant compound in preparations of C. sativa (marijuana, hashish, bhang) that is responsible for the central nervous system effects in humans. The recognized central nervous system responses to these preparations include alterations in cognition and memory, euphoria, and sedation. Potential therapeutic applications of cannabis preparations that are of either historical or contemporary interest include analgesia, attenuation of the nausea and vomiting of cancer chemotherapy, appetite stimulation, decreased intestinal motility of diarrhea, decreased bronchial constriction of asthma, decreased intraocular pressure of glaucoma, antirheumatic and antipyretic actions, and treatment of convulsant disorders. These effects have been reviewed recently (Howlett, 1995). 

Late in 1997, a group of experts who reviewed all the research available to date reported to the National Institutes of Health about marijuana s therapeutic value. In their forty-five-page report, they indicated that marijuana may counteract weight loss in people with AIDS, spasticity in those with multiple sclerosis and spinal cord injuries, and nausea among patients who are undergoing chemotherapy. They recommended controlled studies to find out if marijuana is useful, for whom, and how to use it. —... 

A booklet titled Using Marijuana in the Reduction of Nausea Associated with Chemotherapy discusses the timing of grass use with specific anticancer drugs and even supplies recipes and instructions (for advanced cases) for preparing suppositories. Priced at 2.50, it is shipped within twenty-four hours from Murray Publishing Co., 2312 Third Ave., Seattle, WA 98121, (206) 682-3560. The author, Dr. Roger A. Roffman, has just published the fullest account of recent uses of Marijuana as Medicine, and would like to hear from those who want to share their experience. He can be contacted at Box 5651, University Station, Seattle, WA 98105, (206) 543-5968. 

Cannabinoids Marijuana derivatives, including dronabinol [droe NAB i nol] and nabilone, are effective against moderately emetogenic chemotherapy. However, they are seldom first-line antiemetics because of their serious side effects, including dysphoria, hallucinations, sedation, vertigo, and disorientation. In spite of their psychotropic properties (see p. 105), the antiemetic action of cannabinoids may not involve the brain synthetic cannabinoids having no psychotropic activity, nevertheless are antiemetic. 

Tetrahydrocannabinol (THC), first isolated from Indian hemp, is the primary active constituent of marijuana. Although recreational use of cannabis is illegal in the United States, the FDA has approved THC in capsule form as an anti-nausea agent for chemotherapy patients and as an appetite stimulant for AIDS-related anorexia. Like other controlled substances,THC can be detected in minute amounts by modern instrumental methods. In Chapter 13, we learn about mass spectrometry and infrared spectroscopy, two techniques used for characterizing organic compounds. 

The FDA, in 1985, gave approval for the use of two psychoactive chemicals from marijuana to prevent nausea and vomiting after chemotherapy in cancer treatment. THC can be prescribed in capsule form for these patients. Research suggests that compounds, other than THC, inhaled when smoking marijuana can also be used for medicinal purposes. Marijuana may help stop the weight loss in AIDS patients, it might lower eye pressnre in people with glaucoma, it may control spasms in multiple sclerosis patients, and it could be used to relieve chronic pain. 

Marijuana has been used effectively to treat the nausea and vomiting often associated with chemotherapy in the treatment of cancer. 

Although marijuana is the most frequently used illicit drug, it does have some limited legitimate medicinal use. Dronabinol (Marmol) contains synthetic THC and is used to treat anorexia and nausea in AIDS patients, nausea and vomiting associated with chemotherapy, and asthma and glaucoma, ... 

The illicit drug best known for its medicinal use is marijuana (see Appendix A Paton etal. 1973 Roffman 1982 Zinberg 1979). This drug has shown many medicinally-valuable properties, but is best known as an anti-nausea agent for patients receiving cancer or AIDS chemotherapy, and as a treatment for glaucoma- a drug to lower... 

Several medicinal benefits of marijuana have been described. These include antinausea effects that have been applied to the relief of side effects of anticancer chemotherapy, muscle-relaxing effects, anticonvulsant effects, and reduction of intraocular pressure for the treatment of glaucoma. These medical benefits come at the cost of the psychoactive effects that often impair normal activities. Thus, there is no clear advantage of marijuana over conventional treatments for any of these indications. 

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