By Dr. Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
If you or someone you care about has cancer, you may be exploring the options for treatment of symptoms with medical cannabis. Marijuana is well-known as a pleasant and effective potential treatment for many of the symptoms of cancer and for the side effects of cancer treatment.
A November 2017 study of cancer patients using marijuana (in a US state where medicinal and recreational use of cannabis was legal), found that over half of the respondents reported its use to be of great benefit. Patients used medical marijuana for pain, nausea and to improve their appetite. It also made them feel better overall in the stressful situation that living with cancer can impose.
Good nutrition and taking pleasure in food are more important than ever when a person is living with cancer and can be so hard to achieve. Digestive problems, poor appetite, nausea and vomiting are all potential side effects of chemotherapy. Medical marijuana, specifically THC, is an appetite stimulant, which can be a great help at a time when a patient needs optimal nutrition and is disinclined to eat.
There is also a condition called cachexia, where the metabolism of the body is changed by disease and the tissues are consumed by disease. Medical experience shows that medicinal cannabis can treat cachexia, which cannot be treated by eating alone.
Nausea of cancer, caused by the disease, the medications used to treat it (or both) can be harder to deal with than pain, especially if the patient is vomiting or dry retching. Your doctor will readily prescribe medications (like metoclopramide or ondansetron) which work beautifully for some people. If they don’t work for you, medical cannabis is helpful for nausea and vomiting associated with chemotherapy.
Clearing nausea and stimulating appetite together makes medical marijuana for cancer something to seriously consider. It is a great match for some people living with cancer.
Effective pain relief is one of the most challenging aspects of cancer treatment. Cancer can cause all types of pain.
Shooting pain is often nerve (called also neuropathic) pain. Pain might be caused by pressure of a tumour or come from distressed parts of the body, distorted by the disease, or cancer invading bone. This can give you a dull, constant ache or a burning pain. Sometimes pain is felt in an area distant from the cause of the pain.
Your doctor will ask about the nature of your pain: is it like being stabbed? Is it constant or does it come and go? Is there anything that aggravates or relieves it? This information will help you and your treatment team find the right medication to relieve your pain. Keeping a pain diary—recording the intensity (on a scale from 1-10, where 10 is the worst pain imaginable), duration and other features of the pain, if you are well enough to do so, is very helpful to the doctor. Your treatment team may be unable to get you pain-free, but the right medication, potentially including medical marijuana from a cannabis clinic, can improve your comfort greatly.
Opiates (eg Morphine, Codeine, Oxycontin, Fentanyl) are commonly prescribed for cancer pain. They can be of great benefit. Humanity has evolved alongside the opium poppy. We have receptors in our bodies for opiates, just as we do for cannabinoids.
Constipation is the most common side effect of opiates. It can be severe, causing pain and upset in a weakened body. Your doctor or nurse will prescribe aperients (medicines to help with constipation, eg Coloxyl and Senna) alongside an opiate prescription. You do need to take them regularly when you are taking opiates.
Problems with the bowel are common in cancer and cancer treatment, including constipation caused by opiates. Cannabis can relieve abdominal cramping, constipation and diarrhoea, regulating the bowel.
Nausea and vomiting associated with opiates can be bad enough to stop some people using them altogether, particularly when chemotherapy drugs can cause the same problem. Cannabis as cancer pain treatment, with the bonus of its anti-emetic (anti-vomiting) effect, is a sensible choice in this context.
There are also some kinds of pain, including neuropathic pain, that opiates don’t help very much. Your doctor will prescribe other medications (for example Gabapentin) that usually work well for neuropathic pain. There is a role for anti-inflammatory medications and regular paracetamol in treating cancer pain, as well.
The role of cannabis in cancer pain management is becoming well documented. It should certainly be considered for pain not responding to regular meds. Cannabis-based painkillers, specifically cannabis medicines in which CBD predominates, can be effective against neuropathic (nerve), inflammatory, visceral and bone pain. You may use less opiates or neuropathic pain medication when you are using medicinal cannabis. Your Cannabis Access Doctor can help you reduce your other meds as you slowly optimise your medical marijuana. Finding the dose that suits you usually takes a week or two.
Whether you need relief from cancer symptoms or from side effects of cancer treatment, talk to your GP, who can work with your Australian medical marijuana clinic. Clinical staff there will work with your GP to find the best medical cannabis prescription for you.
Living with cancer focusses your attention on quality of life for you and the people you love. This powerful nature-based medicine may help you persevere and, in a while, flourish.