Can Marijuana Help Cancer Patients? Perspectives from an Expert
Many doctors have doubts about medical marijuana, even when their patients want to give it a try.
Rob Horowitz, M.D., chief of Palliative Care at the University of Rochester Medical Center, recently spoke to a group of head-and-neck cancer survivors at the Wilmot Cancer Institute to sort out fact from fiction on the use of cannabis among people in cancer treatment and for the management of pain and other symptoms.
His key message: “While medical marijuana and CBD may help some people, the boom is ahead of the science.”
Why is there controversy around medical marijuana?
The tensions are many, Horowitz says. For starters, federal law maintains that cannabis is illegal, classifying it as a Class 2 controlled substance with high risk of abuse and no acceptable medical use. However, many states have passed laws that contradict federal law, and have made it legal. California was the first in 1996 for medical use and then in 2012 it legalized recreational marijuana. In the states where it is legal, however, cannabis products have not been approved or regulated by the U.S. Food and Drug Administration (FDA). Each state has its own regulatory process, but not to the level of the FDA’s.
Another issue is a lack of evidence that cannabis helps patients. In 2015 a top medical journal published a thorough review concluding that only two studies contained the highest quality scientific evidence supporting the benefits of medical marijuana. The lack of research is one reason why medical providers — whose practices are driven by evidence-based data — tend to be skeptical, Horowitz says. He notes that a lack of evidence does not mean there is no benefit.
How does marijuana impact my body?
We all have cannabinoid (cannabis-like) receptors scattered throughout the body, involved in pain processing, digestion, emotions, and many other physiologic functions, Horowitz says. When a person ingests THC, he says, it can mitigate some types of pain symptoms in some types of individuals. THC can diminish the physical intensity of pain and act in other ways to relax the individual, making pain less prominent. THC is stored in fat tissue and stays in the body for several weeks.
CBD interacts with the body’s cannabinoid system in different ways than THC. It seems to enhance THC’s effects, and limit its side effects, as well as have a host of unique properties, including easing of seizures, he says. Pediatric neurologists have been using CBD for children who suffer from severe seizures for several years.
What are the risks of marijuana use?
The many known risks include:
- Neurodevelopmental problems for younger brains (most prominently through the teen years);
- Lung disease from smoking marijuana due to ingestion of tar and other chemicals;
- Lung disease from vaping. Horowitz notes recent news reports of lung damage and deaths of teens and adults due to vaping. In response, several states and the federal government have called for bans and investigations.
- Heart attack in people at high risk because marijuana causes the heart to work harder;
- Symptoms that can mimic psychosis in very heavy use, most often from ingesting multiple slow-release edible marijuana products in a short period of time;
- Interactions with other medications or supplements;
- Addiction as a condition in which frequent use causes the body to need marijuana to feel “normal.”
New York does not allow doctors to prescribe cannabis for anxiety — it’s a felony to do so — even though patients often want it to reduce anxiety.
What is the law in New York for medical marijuana?
In New York state, a patient must have a severe, debilitating, life-threatening disease and symptoms of that disease, such as pain or nausea, to qualify for a discussion with his or her physician about using medical marijuana. More details.
Patients must be legally certified by a physician, nurse practitioner, or physician’s assistant (PA) to try medical marijuana in New York. Once certified, he or she is not allowed to smoke it as part of treatment. State law says the drug must be ingested only as a liquid, oil, vapor, or capsule. The rationale behind this part of the law was to “legitimize” the product and make it similar to other prescribed pharmaceuticals, Horowitz says.
How do I choose a medical marijuana product?
It’s important to know there is no insurance coverage for medical marijuana in New York. Qualified patients can purchase it with cash or a debit card from one of two dispensaries in Rochester, Horowitz says. Typical cost is $50 per week for twice-a-day dosing, or $200 a month.
The conventional wisdom is that THC-based products are more suited for patients who have nausea and difficulty eating, surgical pain, or cancer pain throughout the body. CBD appears to be more useful in patients who have seizures and neuropathy. A “trial and error” process involving a qualified pharmacist is common before most patients find a product that fits their needs, he says.
Marijuana and CBD/hemp products often come with claims that are not supported scientifically, Horowitz warns. Over-the-counter CBD products are widely available without the required certification mentioned above, but these products are not regulated and often contain varying levels of THC and other unknown ingredients.
How do I become “certified” to use cannabis for cancer?
If you believe you have symptoms that might benefit from medical marijuana, discuss this with your primary care physician or oncologist, a nurse practitioner or PA. If your medical provider agrees, he or she must be registered with NY to prescribe medical marijuana; or they may discuss whether and how to refer you to a registered provider.
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