Patients keep asking if they should take cannabis for their cancer. The answer is still no

[Joolz]

Ranjana Srivastava

 

Cannabis is not a treatment, let alone a cure for cancer. It is not a substitute for chemotherapy and can cause significant side effects

 

Mon 1 Apr 2024 15.00 BST
Last modified on Mon 1 Apr 2024 15.02 BST

 

 

It’s fair to say my patients were using cannabis long before I knew it was a “thing”.

 

My first memory of encountering the drug was a decade ago at the bedside of a dying patient. I was about to commence a morphine infusion when a burly man quietly asked me to step outside. Moments later, my apprehension turned to surprise when, tears streaming down his face, the son begged me to wait while his brother procured some cannabis from an underground supplier, “just in case it works”.

 

“Works for what?” I asked, surprised.

 

“As a cure for cancer,” he stammered.

 

My heart melting, I counselled the son that nothing would rescue his actively dying father who deserved to die with dignity. Shortly afterwards, the inevitable happened but I vividly recall the fervour with which the son believed in cannabis as a cure for cancer.

 

Tackling cancer treatment myths, from clean eating to cannabis

Today, cannabis is no longer a back-channel substance evoked in hushed tones. Indeed, cancer patients openly ask to access it and expect proper help. Oncologists pride themselves on handling questions about interventions proven and debunked, but when it comes to cannabis, most doctors won’t prescribe it and most hospitals don’t allow it. So the most common attitude patients encounter is “we don’t do that here”, leaving them feeling dismissed, or worse, judged.

 

Recently, when my elderly patient announced her intention to try cannabis for pain, I hesitated, preferring she try conventional analgesics. Nevertheless, when she insisted, I let her find her own way to an online doctor since I didn’t know how to prescribe or monitor the drug. Soon, her family reported her more confused and forgetful before she fell over, bringing the experiment to an end. I had a nagging sense of guilt that I didn’t do better by her.

 

Up to 40% of cancer patients report using cannabis. For a psychoactive substance that vies with caffeine, alcohol and nicotine for global popularity, to ignore cannabis is to do patients a disservice. Therefore, I was glad to see the American Society of Clinical Oncology release some evidence-based guidelines to help oncologist steer their patients.

Here are some key points.

Cannabis is associated with significant side effects

The body absorbs about 10% of oral and 30% of inhaled cannabis. The psychoactive effects of inhaled cannabis occur within seconds while oral cannabis can take up to two hours to work. Acute side effects include sedation, euphoria, dizziness, vertigo, mood changes and hallucinations. Long-term toxicity can affect the liver, heart and brain.

There are potential drug interactions, but we don’t yet have evidence-based answers about which ones. Meanwhile, every cannabis user and prescriber must be aware of these pitfalls.

It is not a cure for cancer

Cannabis is not a treatment, let alone a cure for cancer. It is not a substitute for chemotherapy and can cause significant fatigue, confusion and mood disturbances.

The advent of immunotherapy has led patients to experience unprecedented responses. Despite the anecdotal reports of cannabis demonstrating anti-inflammatory properties, researchers warn that cannabis consumption could interfere with immunotherapy. This has resulted in a recent recommendation to avoid cannabis while undergoing any form of immunotherapy.

Cannabis may slightly improve nausea and sleep

For patients who are severely nauseous despite using the many strong medications now available, oral cannabis may provide relief. However it should not be used as a first-line drug to treat nausea and vomiting or as a preventative agent during chemotherapy or radiotherapy.

In relation to sleep, cannabis is associated with a very small improvement in adults with cancer pain, but it may come at a cost of other troublesome symptoms, so caution is warranted. The bottom line is that for most patients, there are better agents to curb nausea and aid sleep.

It does not reduce pain

In four randomised controlled trials focusing on cancer pain, cannabis did not provide a significant benefit. This is why, outside of a clinical trial, guidelines do not recommend using cannabis for cancer pain relief.

The effect of cannabis on anxiety and depression is unclear

In a systematic review, no study addressed psychological symptoms in a robust way. Hence experts make no recommendation about cannabis and patients should try other means of managing the psychological sequelae of cancer.

It does not benefit appetite and weight

Loss of appetite and weight is a disturbing fact for many cancer patients. Unfortunately, cannabis does not provide a benefit in either instance and hence should not be used.

All products are not the same

Synthetic cannabis products are more powerful than natural ones and may lead to more heightened toxicities. If prescribing, doctors and patients should adopt a “start low, go slow” approach while constantly reviewing risks and benefits.

Chronic users can develop serious problems

Early cannabis use is a predictor for future dependence and chronic users are at higher risk of psychiatric illness. Long-term daily cannabis users may experience severe withdrawal symptoms including irritability, insomnia, anxiety and pain.

Cannabis users should avoid driving

A meta-analysis found that cannabis users are at significantly higher risk of being involved in car crashes. The percentage of car crashes involving cannabis and alcohol has risen sharply, turning this into a serious issue for oncologists to discuss with their patients.

There is a lot we don’t know

For a drug so ubiquitous, there are many gaps in our knowledge. Are there preparations with meaningful anticancer activity? Could some forms mitigate the feared side effects of cancer therapy? How do we spare patients stigma and financial toxicity while helping them derive benefits? Acknowledging what we don’t know is the first step to asking relevant questions in patients’ interest.

 

There was a time when oncologists balked at the idea of discussing cannabis, therefore leaving patients no choice but to find unscrupulous providers. But when their peak body publishes guidelines on the subject, it signals a new attitude of openness.

 

Cannabis isn’t going away and I am looking forward to learning more about its role, if any, in cancer. When patients ask, “Doctor, should I take cannabis for my cancer?” the answer is still no. But at least we are talking.

Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death

 

https://www.theguardian.com/commentisfree/2024/apr/01/patients-keep-asking-if-they-should-take-cannabis-for-their-cancer-the-answer-is-still-no

 

[ratdog]

12 minutes ago, Joolz said:

Long-term toxicity

 

i stopped reading there

 

stopping someone who maybe dying from a bit of weed is fucking insane

 

 

15 minutes ago, Joolz said:

I counselled the son that nothing would rescue his actively dying father who deserved to die with dignity.

 

 

so now weed smoking is undignified?

 

i bet she wouldn't have refused the dying man a drink

[awesomesauce]

Cannabis is only officially known to help with nausea in general and that includes the nausea associated with chemo. As far as I am aware no one has ever made the claim that cannabis solves cancer. I have heard some rumours that CBD helps cancer but never seen any evidence of that. 

[stu914]

On 01/04/2024 at 20:20, Joolz said:

There is a lot we don’t know

Some statement to make after all the previous unproven negative claims in this same article...

[Shumroom]

Beware,

using cannabis might improve your life significantly.

 

Atb

 

 

 

[Boojum]

On 01/04/2024 at 20:20, Joolz said:

There is a lot we don’t know

 

 

There's clearly a lot you don't know Ranjana

 

I feel sorry for your patients if that's the kind of shit you tell them

[Military Grade]

On 01/04/2024 at 20:20, Joolz said:

Ranjana Srivastava

[Slippy One]

Patients keep asking their GP’s who (like the government) are entirely funded by massive corporations completely against plant based medicine if they should take cannabis for their cancer. The answer is still no, they’d upset their largest shareholders and paymasters. Sorry hippies. Stick to rum punch. 

[darXound]

I often try to empathize with GPs and the medical establishment on this. Any claims really should be put through years of testing the science, application and effectiveness of any drug. After all, it's not our GPs fault that medical science on Cannabis isn't realistic during prohibition. You can't just go around telling people you found a cure for cancer based off of anecdotal evidence and a few extremely limited lab tests, after all.

 

But then I remember that the NHS was funding homeopathy up until 2017 then I just think nah fuck that. There are dark forces in this this world.

[darXound]

3 hours ago, awesomesauce said:

Cannabis is only officially known to help with nausea in general and that includes the nausea associated with chemo. As far as I am aware no one has ever made the claim that cannabis solves cancer. I have heard some rumours that CBD helps cancer but never seen any evidence of that. 

It's anecdotal, thanks to the illegality of it. Proper study's are starting to happen though, just not in the uk

Linda coxon, breast cancer https://youtu.be/EL25nbWqHpc?si=OH4fh6ME3P9X93St

Sharon Kelly, stage 4 lung https://unitedpatientsgroup.com/blog/survivor-the-sharon-kelly-story-terminal-stage-iv-cancer-goes-kaput-after-cannabis/

Joy smith, alongside chemo https://youtu.be/3nF8AdX9vio?si=Xfd6ZuzTCUnaZQm_

Bone cancer https://youtu.be/xvOEzUvjP94?si=j0xTXpJetVtcpA5o

New study on melanoma https://www.cdu.edu.au/news/new-study-reveals-kill-order-melanoma-cells-cannabis-extract

 

The way I see it, looking at what cancer is and how the endocannabinoid system works - how can cannabis possibly not be useful in its treatment. The problem is, we don't really know how to use it

[Boojum]

I don't know if cannabis actually cures cancer, but dismissing it like she has is not the way to go. And the other shit she spouts is simply wrong, claiming that cannabis doesn't help with appetite when everyone who has ever smoked a spliff knows about the munchies for fuck's sake , parroting the old 'harmful' bullshit (particularly since chemotherapy and radiotherapy - bombarding the body with toxic chemicals and radiation - is harmful, even if cannabis were harmful just because something is harmful doesn't mean it can't also be helpful, like chemotherapy and radiotherapy), saying it doesn't help with pain when it does for some people (not in the same way as analgesics, opioids etc, which is how they are testing it and coming to the false conclusion that it doesn't help with pain, it doesn't block pain signals or that kind of thing, what it does is allow you to compartmentalise the pain, it's still there but cannabis, at least for me, allows you to take your focus off the pain so it's not always at the front of your mind, allowing you to get on with other things despite the pain). To reject it out of hand, to tell people not to take cannabis for cancer (perhaps alongside conventional treatments, I'm not saying just take cannabis), particularly people like the person she talks about at the beginning (if he's dying anyway then why not try cannabis for fuck's sake, there's no loss of 'dignity' in dying stoned to go with the morphine) is anything but helpful

Edited April 8 by Boojum

[Simple Jack]

On 01/04/2024 at 20:20, Joolz said:

It does not benefit appetite and weight

Loss of appetite and weight is a disturbing fact for many cancer patients. Unfortunately, cannabis does not provide a benefit in either instance and hence should not be used.

 

As an oncologist working in Australia, is she not aware that Dronabinol has been available on prescription for this very purpose as well as for chemo patients for over thirty years?

[junglehaze]

No one is trying to prove that cannabis cures cancer or any serious illness. Most ailments and diseases in the modern world are caused by prolonged exposure to stress. The build up over time of the stress hormone cortisol can cause anything from anxiety and depression to heart disease. Probably cancer and everything else.

 

Cannabis relieves stress and reduces cortisol levels. The issue is there's a multi billion pound industry in selling synthetic drugs to treat illnesses that could have been avoided with a bit of weed!

 

And all this psychosis bollocks... some brains are presdisposed to a condition and it would have developed anyway with or without the cannabis. They have used the weed as a crutch for whatever issues have caused their illness. It is the stigma and misinformation surrounding cannabis that causes the internal mental conflicts and I have seen it run away into paranoid and borderline psychosis. You have to realise that you have found the benefits of weed and the world needs to learn and catch up!

 

Edit: the world has caught up, its just this cUntry!

Edited April 8 by junglehaze