Medical cannabis, or marijuana, is the ideal antidote to the symptoms and side effects of chemotherapy treatment. Cannabis treats many of the discomforts that come along with the life-saving effects of chemotherapy. It controls nausea, reduces pain, increases appetite, and enhances sleep. There is also growing evidence that it works synergistically with chemotherapy drugs to increase their cancer-fighting abilities and increase what is known as cell apoptosis.
A mixture of THC and CBD, the two primary cannabinoids in marijuana, work together along with other cannabinoids, terpenes, and flavonoids in the plant to regulate the body's endocannabinoid and immune systems. The receptors of which are found throughout the brain, various organs, and peripheral nervous system. In the rest of this article, we will explore the science behind these claims, and look at how medical cannabis can be used to address so many of the symptoms and side effects mentioned in the account above.
7+3 Induction Treatment
The nurses enter your room dressed in blue plastic gowns, double-layered gloves, and a face mask reminiscent of some 1980's sci-fi movie. They attach two bags of liquid to an IV port that was placed directly into your brachial artery the day before. The first liquid, cytarabine is clear. The second bag, daunorubicin, is smaller and a menacing red in color. You can feel it burn a bit as the valves are released and the infusion pump begins to titrate the medicines directly into your bloodstream. The sight of the nurses in their protective suits has your brain reeling as you start to contemplate the precautions they are taking to not be exposed to the chemicals that are now flowing directly into every cell in your body.
The doctor assures you these chemicals will kill cancer, and you wonder if it is going to kill you in the process. As you lie there, you suddenly feel a hot lump in your chest, your stomach turns over, and before you can react you are vomiting violently. The nurses inject medicine into your IV to calm your nausea, and you slip off into a drug-induced slumber, which doesn't last nearly as long as you want it to. The next 7 days are spent attached to an IV pump, which is regulating the flow of chemicals into your body. When you try to get some respite, the pump' alarms are constantly due to a consortium of minor issues, and after constant 15-20 minute bouts of this throughout the day and night, you are ready to explode in anger or breakdown crying in frustration.
The first week is usually uneventful, and you may even start getting optimistic about your prognosis. You are still in the hospital, lying for long hours in your sterile bed under the cold glow of fluorescent lighting, but you don't feel anything is wrong with you. The patients who are on the later, less intense, rounds of chemo look at you with sympathetic eyes like veterans of war seeing new recruits march of the boat. At times they try to prepare you for what lies ahead by sharing their knowledge painfully earned through experience, but they know inside that they cannot protect you from what is coming next.
Unbeknownst to you, those chemicals are already going to work. The mature blood and immune cells flowing through your veins are slowly dying, and the stem cells that would normally replace them are being prevented from maturing. Then, day 7 hits. Now you have no immune system, and all hell breaks loose all at once. You suddenly come down with neutropenic fever. Your head is pounding and you can feel every beat of your heart as if it was a hammer banging on your temples. You try to eat some food, but your mouth and throat are full of painful sores caused by mucositis. Even a banana is too painfully acidic to attempt to put in your mouth and chew. The candida fungus that has lain dormant in your body since birth suddenly propagates itself and takes over all your mucous membranes. Latent viruses contained within your body from previous exposure suddenly awake with a renewed fury. With a severely compromised immune system, every day brings new symptoms and surprises. For the next three weeks you are under constant care, not sure if you are going to survive, or if you even want to.
This is what is known as 7+3 induction treatment, the first round of intense chemotherapy given to those suffering from blood cancers. It is the month of hell that all survivors can recall vividly, and some will suffer lifelong PTSD. This was my experience with chemotherapy, and it is far from atypical. In fact, from observing my roommates slowly passing away, and talking with other survivors I must say my experiences were relatively tolerable and subdued.
Cannabis and Chemotherapy-Induced Nausea and Vomiting
Ask about marijuana and pretty much everybody knows one major effect of it that has been immortalized by popular movies and TV shows – the munchies. It is still not known the exact mechanism for this effect, however, it is well established as one of the major benefits of cannabis use during chemotherapy, so much so that it has been approved in many countries despite other legal measures against the plant. Multiple synthetic cannabinoid drugs have also been patented for these purposes based on the action of THC, including Dronabinol, Sativex, and Nabilone. There are many reports going back centuries describing this effect, but the first scientific paper on the topic with regards to chemotherapy was published by Chang et al. in 1979. Subsequent reviews outlined the scientific merit of such findings. One such review published by the University of York in 2008 looked at 30 published randomly or placebo-controlled trials and concluded that synthetic cannabinoids were just as effective as available neuroleptic drugs used to treat nausea and vomiting. Although some studies found less dramatic results, they were generally poorly designed or gave too low doses to possibly be effective (in the case cited only 2.5mg of THC was given). In another review, published by the Journal of Cannabis Therapeutics in 2001, data from over 748 patients in 6 states was compiled. In the studies, patients were given marijuana or a placebo, and those who had marijuana experienced a 70-100% reduction in nausea and vomiting. Studies in animals have also shown that the non-psychoactive cannabinoid, CBN, also works to increase appetite and the quantity of food consumed.
The debate on whether or not cannabis works to provide relief from nausea and vomiting has mostly been settled, but how well does it work compared with available drugs given to cancer patients in hospitals? A 1982 study published in the Journal Cancer compared THC with the drug Compazine in a double-blind study of 214 patients and found that Compazine was no more effective than cannabis. A major review published by the US Government's Institute of Medicine in 1997 recognized that people vary in their responses to medications and that there will always be some patients who do not respond well to those approved for medical use. Furthermore, the combination of cannabinoid drugs with other medicines was well tolerated and even recommended by the report. They also mentioned the side effects of antiemetic drugs, which include acute dystonic reactions, drowsiness, diarrhea, hypertension, blurred vision, drowsiness, urinary retention, jaundice, and depression.
Many of the antiemetics (anti-nausea medications) on the market work through the brain's serotonin mediated pathways. Because THC works through the endocannabinoid pathways it does not interfere with those medications but can be complementary in assisting with their actions and improve patient's comfort and ability to recover from chemotherapy while adding few to no side effects. That same study also noted that "nausea ranks behind only hair loss as a concern of patients on chemotherapy, and many patients experience it as the worst side effect of chemotherapy." These side effects can be so devastating that many patients discontinue treatment and suffer a diminished quality of life, and that it is time to start developing better strategies of treatment.
Cannabis and Pain
The second most well-studied application of cannabis in medicine is addressing pain. Most sources of pain are caused by trauma or injury, and opioids or other analgesics are quite effective at addressing this type of pain. However, the pain associated with cancer and chemotherapy is known as neuropathic pain and is one of the hardest types of pain to treat. Neuropathic pain tends to be chronic and persistent and is another leading reason why patients undergoing chemotherapy have dramatically decreased quality of life and often suffer from PTSD and suicidal thoughts. Cannabis preparations have effectively been used for thousands of years to treat inflammatory and neuropathic pain, and over the last several decade's sciences has identified the mechanisms of this action.
The body's endocannabinoid system was first discovered in 1988, and since then we understand that there are receptors for both endocannabinoids (those made by the body) and endocannabinoids (those from plant or other sources) throughout the brain, nervous system, and many organs. The two main types of receptors are known as CB-1 and CB-2 type receptors, which are triggered by molecules in cannabis such as THC and CBD. It has been found that CBD modulates the inflammatory and neuropathic pain responses, and does so with no psychoactive effects nor any side effects that would be associated with common analgesics (drowsiness, constipation, liver and kidney damage, ulcers, and dependency/addiction). Whole-plant extracts from cannabis also contain terpenes such as caryophyllene which has also been shown to work synergistically with THC/CBD to relieve pain and inflammation.
According to both the US government's 1997 comprehensive review of cannabis use in medicine and a 2016 review published by the Journal of the American Medical Association, cannabis is believed to work on its own or synergistically with opioid-based pain medications (but through an alternate pathways in the body) to effectively treat pain associated with cancer and chemotherapy with little to no unwanted side effects.
Cannabis as a Sleep Aid
As described in the first few paragraphs, although sleep is essential for the body to heal and maintain mental health, it is something which cancer patients get very little. This can be due to the setting of the hospital (infusion pump alarms, nurses checking vitals, nightly blood draws, roommates, etc.) and the effects of the disease or treatments (pain, nausea, inflammation, hypertension, etc.). After multiple weeks in the hospital, this can begin to really take a toll on patient outcomes. Probably the third most well-studied use of marijuana is in sleep. Both THC and CBD have been implicated by dozens of well-designed studies to decrease the time it takes to fall asleep, increase the quality of sleep, and decrease the occurrence of nightmares (especially important in patients with PTSD). One of the most notable publications in this area is a 2007 Review in Chemistry and Biodiversity which looked at the results of many published studies from sleep laboratories and found that CBD along with THC worked on a wide variety of reasons for decreased sleep quality, and had no side effects nor developed any tolerance over a study period of 4 years. The review concluded that patients remarked to their physicians how cannabis (and its synthetic analogs) had "transformed their lives through its ability to allow them more restful sleep, increase their daytime level of function, and markedly improve their quality of life." Another major review published in 2017confirmed these effects, and further went on to recommend that a 1:1 CBD: THC mixture is most effective at improving sleep.
Other benefits of Cannabis
There exists a myriad of other benefits that cannabis can provide to patients undergoing chemotherapy for which the available science is building. This is due not only to the cannabinoids THC and CBD, but the other phytocannabinoids and terpenes in the plant such as caryophyllene and myrcene. These natural compounds are found to increase the anti-cancer and anti-tumor activity of chemotherapy, as well as provide antimicrobial and anti-fungal action, aiding in the survival of those with compromised immune systems. Studies on the treatment of Candida have shown both terpenes to be effective at preventing the attachment and growth of the fungus. Other studies have shown promising results in the treatment of antibacterial resistant agents such as Staph infections. As well as other difficult to treat infectious agents such as Aspergillus, Pseudomonas, and Bacillus subtilis.
Although the science is still developing, the results are clear. Cannabis use during chemotherapy is well-tolerated, safe has few side effects, and can greatly improve patient comfort, quality of life, and outcomes. We conducted an informal survey of patients in a Leukemia centered Facebook group. Out of 31 respondents, 58% had used cannabis during treatment, and all of them commented that it helped them. Of the 14 respondents who did not use cannabis during chemo, only 2 of them responded "No" when asked if they would have used it if given the chance. The benefits of cannabis are not only limited to the side-effects of cancer treatment, but growing evidence also shows that it can be a treatment for tumors and cancer in its own right, something we will explore in subsequent articles.
Chad Scott is a freelance science writer who specializes in the field of cannabis. He spent over a decade living in Thailand. He was diagnosed with Acute Myeloid Leukemia (a type of blood cancer) while living in Thailand in 2016. Upon diagnosis, Chad immediately began chemotherapy at a rural hospital in the country. He continued to use cannabis oil throughout his chemotherapy treatments for almost 1 year, and never again experienced any nausea or vomiting, and was able to sleep and eat normally. From his personal experiences, he has become an advocate for medical cannabis and believes that all cancer patients should have the right to access this natural medicine if they so choose.
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