Should Oncologists Recommend Cannabis?
January 9, 2019
This post was originally published on The ASCO Post on December 10, 2018. This excerpt is published with permission.
The National Academies of Sciences, Engineering, and Medicine (NASEM) 2017 review of The Health Effects of Cannabis and Cannabinoids ranked the evidence that cannabinoids are effective for chemotherapy-induced nausea and vomiting as among the strongest available in the medical literature.
A recent survey of 400 clinical oncologists found that 80 percent discuss the use of medical cannabis with their patients, and although nearly 50 percent recommend it, fewer than 30 percent consider themselves knowledgeable enough to make such recommendations. Oncologists are perhaps among the most evidence-demanding of all medical specialists, as we deal with a serious illness and use medications with significant potential for adverse effects. We prefer to make recommendations supported by published literature. Due to the essential prohibition against conducting clinical trials demonstrating the potential therapeutic effects of botanical cannabis, such data are largely unavailable.
On the other hand, pharmaceutical preparations of the main psychoactive component of the cannabis plant—delta-9-tetrahydrocannabinol (THC)—have been licensed and approved for the treatment of chemotherapy-induced nausea and vomiting since 1986, suggesting that oncologists have had access to becoming familiar with the use of a cannabis-based medicine longer than any other specialty group. Numerous studies conducted in the 1970s and 1980s demonstrated that dronabinol and nabilone were superior to placebo and comparable to the antiemetics available at that time. A more recent trial found dronabinol to be similar to ondansetron in the prevention of delayed nausea and vomiting, although ondansetron is no longer the standard of care for this indication.
For a patient's perspective on medical marijuana use, see a related post: Cannabis as Part of Cancer Care from the Patient’s Perspective