Medical cannabis and cannabinoids
Abstract and key points
- Cannabis-based medicines are whole-plant extracts from Cannabis sativa L. or isolated substances found in C. sativa.
- The antiemetic effect of cannabis-based medicines in chemotherapy-induced nausea and vomiting, but only when compared to the standard antiemetics in use before 5-HT3 antagonists had been developed, has been established in a meta-analysis.
- At present, there is insufficient evidence to recommend the routine use of cannabis-based medicines for the symptomatic treatment of anorexia in patients with cancer cachexia.
- Cannabis-based medicines seem to have an analgesic effect comparable to weak opioids according to a systematic review; the use of these medicines for pain that is insufficiently relieved by opioids is still being investigated.
- The main limitation of cannabis-based medicines appears to be their side-effects on the central nervous system.
The term medical cannabis denotes extracts or preparations taken from the herb Cannabis sativa L. (hemp), used for medical purposes. The term cannabinoids covers the natural or synthetized substances (delta-9-tetrahydrocannabinol (THC), cannabidiol and others) that are found in C. sativa and that interact with the endocannabinoid system in the human body.
Medical cannabis and cannabinoids (i.e. cannabis-based medicines) are claimed to have an antiemetic effect in patients receiving chemo-/radiotherapy and in patients with advanced cancer who have nausea of various origins. They are also recommended for the stimulation of appetite and food intake in advanced cancer patients with cachexia. Furthermore, there have been claims that cannabis-based medicines have an analgesic effect in cancer patients. In experimental settings, the potential of cannabis-based medicines for anti-tumour activity (e.g. glioblastoma) has been suggested. However, at present there are no clinical data to support their use as anticancer agents.
The antiemetic efficacy of the cannabinoid dronabinol (THC), when compared to standard antiemetics that were in use before the development of 5-HT3 antagonists for chemotherapy-induced nausea and vomiting, has been established in a meta-analysis. The question of whether cannabis-based medicines have a place in the era of modern antiemetic medication, e.g. for patients with refractory nausea and vomiting despite antiemetic prophylaxis according to current standards, remains uncertain but warrants further research. Limited evidence is available to support the use of cannabis-based medicines in the therapy of radiotherapy-related nausea and multifactorial nausea in advanced cancer patients.
The use of cannabis-based medicines for appetite loss and other symptoms associated with cancer cachexia is still unclear at present, since trial results have not only varied widely but also been criticised for the methodology employed (including diversity in stages of cachexia in the patients included and possibly too a low dose of THC/medical cannabis).
For cancer pain, several randomised controlled trials of cannabis-based medicines in cancer patients with various pain syndromes have indicated an analgesic effect comparable to weak opioids. The role of cannabinoid medicines as add-on medication for pain that is insufficiently relieved by strong opioids is currently being investigated in several clinical studies and has shown some promising results so far.
The main limitation of cannabis-based medicines seems to be adverse effects on the central nervous system. Known contraindications and pharmacological interactions should be considered. In addition, cannabis-based medicines are subject to country-specific prohibitory legislation.
Although not seen as first-line drugs for the claimed indications, cannabis-based medicines might be beneficial in individual cases as adjuncts to other antiemetic or analgesic medication, or in patients with cancer cachexia to help improve taste and smell perception and/or appetite when standard treatment fails in control symptoms. The toxicity profile should be considered, however.
|Citation||Natalie Magaya-Kalbermatten, CAM-Cancer Consortium. Cannabis and cannabinoids [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Cannabis-and-cannabinoids. January 19, 2016.|
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