PRESCRIBED CANNABIS TREATMENTS

OVERVIEW

“Cannabis” is a plant family which includes plants such as hemp and marijuana (similar to how the aster plant family includes the daisy and chamomile). Cannabis sativa is a therapeutic herb in the cannabis family which has a lot of stigma attached to it due to it's popularity as a recreational drug. Other common names it is known by include: Marijuana, grass, weed, and ganja. By United States Federal Law Cannabis sativa products are illegal; however, in recent years individual states have been allowing the use of C. sativa strictly for medical purposes. Because C. sativa has proven to be valuable for medical reasons Herbal Outpost recognizes it as a valid treatment only under the lawful oversight of a licensed physician. We do not support any recreational use for this herb. Because it is illegal to use in many areas you must check with your local laws before using this herb for medical reasons.

Cannabis plants contains psychoactive2 substances known as cannabinoids; research has shown that these cannabinoids have strong medical applications when properly used, especially when treating patients with cancer. The primary cannabinoids in this herb are known as THC3 (a psychoactive substance which activates areas in the brain that regulate nausea, appetite, and pain sensations) and Cannabidiol, (a.k.a. CBD, a non-psychoactive substance which activates areas in the brain that regulate pain sensations). These two substances have been shown to be effective in reducing nausea and vomiting caused by cancer treatments4 and reduce cancer-related pain that isn't sufficiently controlled by other medications.5 Other research has found that both THC and CBD induce cell death in breast cancer cells,6 and that CBD inhibits tumor blood vessel formation.7 Both cannabinoids have also been found to have synergistic effect with chemotherapy agents such as gemcitabine8 and temozolomide9 creating a more effective outcome than with the chemotherapy medications alone (be aware that there is the risk of your cancer cells developing a resistance to the cannabinoids which may render the cannabis useless after a while.)


SMOKING vs. ORAL USE

Although one of the more popular ways to consume C. sativa is to inhale its smoke you need to know that the chemical changes caused by the heat when burning the herb creates new substances which are very damaging to the lungs and can promote other cancers. One such substance created is benzo-alpha-pyrene (BAP), a chemical known for changing the tumor-suppression gene (known as p53), thus resulting in potential for allowing your cancer to grow. What's worse, the THC combines with the BAP in the smoke, strengthening BAP's ability to alter the p53 gene! A secondary problem with smoking cannabis is that it significantly increases your risk for a heart attack by constricting your blood vessels; this can cause a blockage of blood flow which leads directly to the heart attack. Since certain cancer treatments may weaken your heart you do not want to play in that minefield either. Therefore, instead of smoking the herb it is much safer for you to consume it in edible form where it is legal to use medically. Take note that oral consumption of cannabis-based products may take up to an hour to feel the therapeutic effects. In order to reduce the risk of over-consuming cannabis edibles you should buy only from reputable, legal, manufacturers who have standardized doses, and do not consume more than the amounts recommended by your licensed physician. Overdose symptoms include: disorientation, decreased coordination, dizziness, changes in heartbeat, panic attacks, loss of contact with reality, and seizures. To prevent overdose here are some general guidelines (use only with competent professional guidance):

Because cannabinoids are fat soluble I strongly advise that you consume cannabis products that contain a little bit of fat in order for the cannabinoids to absorb properly in your system. If you are concerned about gauging your dosage, even if you are living in an area where cannabis is legal, you should discuss with your doctor about using cannabis-based prescription medications which are precisely measured. Again, take these medications with a little bit of heart healthy fats such as a handful of seed, nuts, a slice of avocado, a small piece of fatty fish, etc. after you have swallowed them with water.


CANNABIS-BASED PRESCRIPTION MEDICATIONS

As of this writing the United States Food and Drug Administration (FDA) has approved of two cannabis-based medications that contain these cannabinoids: Dronabinol (a.k.a. Marinol) and Nabilone (a.k.a. Cesamet). These medications are legal, even by United States Federal Law standards. Let's take a look at these two medications:

DRONABINOL, a.k.a. “Marinol.” This medication contains both THC and CBD, is taken orally, usually in capsule form, and should be stored in the refrigerator. The capsules may contain sesame oil therefore you should not take this medication if you have a sesame allergy. Dronabinol acts on the area of your brain which controls nausea and vomiting in order to reduce these symptoms caused by cancer treatments. Typically a patient will take a dose 1-2 hours before treatment and then 2-4 hours after treatment for a total of up to six doses per day, however individual circumstances may vary. Your oncologist will likely start you off on a low dose first and only increase it if needed. This medication will only work if you take it as directed, therefore you should not discontinue use – even if you feel better – without your physician's advice. Dronabinol may be habit forming, so be sure you do not take any more than what is prescribed. Do not stop taking it suddenly as you may experience withdrawal symptoms if you do. Withdrawal symptoms may include sleeplessness, irritability, restlessness, sweating, diarrhea and loss of appetite. Do not take Dronabinol if you are pregnant or breastfeeding. Tell your physician if you have heart disease, high blood pressure, epilepsy, depression, schizophrenia, dementia or mania. Inform your doctor of all other medications you are taking, including over-the-counter products. Side effects of this medication may include (but are not limited to) sleepiness, dizziness, unsteadiness, confusion, hallucinations and memory loss.

NABILONE , a.k.a. “Cesamet.” This is an oral medication which is taken in capsule form and contains synthetic THC. Nabilone is typically given 1-3 hours before the first dose of treatment and then for 48 hours after the last dose in the chemotherapy cycle, however individual circumstances may vary. This may vary in cases of radiation treatments. This medication has numerous similarities to Dronabinol regarding usage, dosing, associated precautions and side effects. Nabilone should be stored at room temperature in a cool, dry environment (do not store in your bathroom medicine chest; too much heat and humidity from your shower will weaken the medication). It may also be habit forming, therefore do not use more than what is prescribed to you. Be sure you let your physician know about all medications you are taking including over-the-counter products.

Although the above are currently the only two available cannabis-based medication available in the United States there are other cannabinoid medications currently being researched for approval:

CANNABIS OIL

Cannabis oil is sometimes referred to as marijuana oil, hemp oil, or CBD oil. Although these names are often used interchangeably it is important to know that there are definite differences among them. As I stated earlier “Cannabis” is a plant family and within this cannabis family lies two particular members: Hemp, and marijuana. Although they are similar, they are not the same. Notably, hemp is lower in THC and higher in CBD and marijuana has higher levels of THC. Because there are differences you need to be aware that buying the wrong product may put you in jail, depending upon your location. I highly recommend that you visit the website Healthy Hemp Oil, which fully explains this matter in easy language.

Cannabis oil is an essential oil which means it is a highly concentrated substance much like other essential oils. Although it is available in varying strengths (depending upon the strains of plants used) usually this kind of product has a larger amount of CBD compared to the amount of THC in the preparations. Cannabis oil is frequently touted as a strong treatment against cancer and is usually taken by mixing with vegetable oil and applying under the tongue (sublingually), adding to the patient's food, or using the oil as a therapeutic inhalant. Before buying or using any cannabis products, including oil, check to be sure it is legal to use in your location.

PRECAUTIONS

In spite of all the potential good that cannabis has in the management of cancer there are still some issues related to its usage. For example, under the right conditions THC may actually encourage cancer cell growth19 and may also inhibit your body's own immune response to the cancer, resulting in increased metastasis.20 It has also been shown that the dosages and the levels of cannabinoid receptors in the cancer cells also affect the outcome of the treatment.21 There is also evidence that some substances in cannabis may change your body's metabolism of anti-cancer drugs which may result in either an increase of side effects or a weakening the agents, depending upon the anti-cancer agents used. Because of these things you must not try to self-medicate through whole herb marijuana or “borrowing” someone else's cannabis prescriptions. You need to speak with your licensed physician to learn whether cannabis treatment is advisable for your unique situation.

1Cannabis sativa is commonly known by other names such as: Marijuana, weed, herb, "grass," and ganja.
2Psychoactive, a.k.a. psychotropic substances are those which alter your perception or mood.
3 a.k.a delta-9-tetrahydrocannabinol, a.k.a. Δ9-Tetrahydrocannabinol
4 Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. (Duran, 2010)
5Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients With Intractable Cancer-Related Pain (Johnson, 2010)
6 Δ9-Tetrahydrocannabinol Inhibits Cell Cycle Progression in Human Breast Cancer Cells through Cdc2 Regulation (Caffarel, 2006)
7 Cannabidiol inhibits angiogenesis by multiple mechanisms (Solinas, 2012)
8 Gemcitabine/cannabinoid combination triggers autophagy in pancreatic cancer cells through a ROS-mediated mechanism. (Donadelli, 2011)
9 A combined preclinical therapy of cannabinoids and temozolomide against glioma. (Torres, 2011)
10Journal of Pain and Symptom Management, Aug. 2013, Vol.46, No.2 “An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics.” (Johnson, 2013)
11GW Pharmaceuticals press release, “GW Pharmaceuticals Announces that Sativex Receives Fast Track Designation From FDA in Cancer Pain” April 28, 2014
12 If you wish to follow this study its official title is “A Phase I, Sequential Cohort, Open-Label, Dose-escalation Study of the Safety and CNS Pharmacokinetics of Dexanabinol in Patients With Brain Cancer
13 If you wish to follow this study its official title is “A Phase 1b Study to Assess the Safety and Anti-tumour Activity of Dexanabinol Monotherapy and Dexanabinol in Combination With Chemotherapy in Patients With Advanced Tumours
14 If you wish to follow this study its official title is “A Phase 1, Pharmacokinetically-Guided, Dose Escalation Study to Assess the Safety and Tolerability of Dexanabinol in Patients With Advanced Solid Tumours”
15 Antitumor Effects of Ajulemic Acid (CT3), a Synthetic, Non-psychoactive Cannabinoid (Recht, 2001)
16Pain Measurements and Side Effect Profile of the Novel Cannabinoid Ajulemic Acid (Salim, 2005)
17Ajulemic Acid (IP-751): Synthesis, Proof of Principle, Toxicity Studies, and Clinical Trials Sumner (Burstein, 2005)
18 Two cannabinoid receptors are known: CB1 and CB2. The CB1's are primarily located in your brain and spinal cord but can also be found in lesser numbers in certain organs, glands, white blood cells and the spleen. The CB2's are primarily associated with your immune system organs such as the white blood cells, spleen, and tonsils.
19Cannabinoids induce cancer cell proliferation via tumor necrosis factor alpha-converting enzyme (TACE/ADAM17)-mediated transactivation of the epidermal growth factor receptor. S (Hart, 2004)
20Delta-9-tetrahydrocannabinol enhances breast cancer growth and metastasis by suppression of the antitumor immune response” (McKallip, 2005)
21The Expression Level of CB1 and CB2 Receptors Determines Their Efficacy at Inducing Apoptosis in Astrocytomas (Cudaback, 2010)