Medical Cannabis and Cannabinoids

Also known by these names

  • Cannabis indica
  • Cannabis sativa L
  • CBD
  • Dronabinol (brand name Marinol)
  • Hemp
  • Medical marijuana
  • Nabilone (brand name Cesamet)
  • THC

Cannabinoids derived from hemp generally have no psychoactive effects.

Key Points

  • Medical cannabis and cannabinoids may be made from the Cannabis sativa plant, varieties of which include marijuana and hemp. Some cannabinoids are also synthesized.
  • Some components of cannabis, such as CBD, are therapeutic but without the psychoactive effects of cannabis.
  • Cannabis is of interest to BCCT because good scientific evidence indicates it is useful in managing symptoms of cancer and cancer treatment, including nausea, vomiting and pain.
  • Some preliminary evidence shows anticancer effects of some cannabinoids in cell lines and animals. Research is not advanced enough to determine if or which cannabinoids have anticancer effects in patients.
  • Some side effects and adverse interactions are noted. However, some patients respond to cannabinoid therapies more favorably than to other antiemetic and analgesic therapies. Caution and medical supervision are advised.
  • Cannabis can lead to physical or psychological dependence in some people. Caution and medical supervision are advised.
  • Cannabis and cannabinoids derived from cannabis are Schedule 1 controlled substances ("drugs with no currently accepted medical use and a high potential for abuse") in the US, even though a majority of US states permit medical use.
  • Access to medical cannabis and cannabinoids varies by location, and both prescribers and patients may be subject to legal sanctions in some places. However, cannabis use for symptom management is accepted and practiced widely.

Medical cannabis is an extract or preparation for medical use from the herb Cannabis sativa L. Cannabinoids are substances that are found naturally in C. sativa—delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and others—or that are synthesized.

Different varieties of the C. sativa plant, including hemp, can contain widely different levels of the compound THC that produces the psychoactive effects of cannabis. Hemp has virtually no THC, and so cannabinoids derived from hemp generally have no psychoactive effects.1

Cannabis and cannabinoids are used with success in patients experiencing nausea and vomiting and to stimulate appetite. Cannabis and cannabinoids also reduce pain, showing effects comparable to weak opioids.

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

No evidence in humans or animals currently indicates that medical cannabis is a cure for cancer.

Clinical Evidence

Due to the legal controversy surrounding medical cannabis, studies of its anticancer effects in humans are lacking, although animal studies are encouraging. However, no evidence in humans or animals currently indicates that medical cannabis is a cure for cancer. BCCT cautions against foregoing conventional treatment to take medical cannabis in hopes of curing cancer.

Lab and Animal Evidence

CBD and other cannabinoids have shown anti-tumor effects in exploratory lab and animal research:2

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Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

How It Works

How Do Cannibinoids Affect Our Bodies?

All cannibinoids, whether natural or synthesized, interact with the endocannabinoid system in the human body, mimicking the effects of our endogenous cannabinoids (endocannabinoids, substances naturally occuring in our bodies). Cannabinoids activate specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function.7

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Cannabinoids have been promoted to exert palliative effects in cancer patients:10  

Clinical Evidence

Evidence is not clear-cut. A 2018 review and meta-analysis found no significant differences between cannabinoids and placebo for improving caloric intake, appetite, nausea/vomiting, a decrease in pain greater than 30 percent, or sleep problems in cancer patients.11 In contrast, a separate review from the National Academies of Sciences, Engineering and Medicine reported these outcomes related to cancer:12

  • Conclusive or substantial evidence that cannabis or cannabinoids are effective for treating pain in adults and chemotherapy-induced nausea and vomiting
  • Moderate evidence for secondary sleep disturbances
  • Limited, insufficient or absent evidence supporting improvement in appetite or anxiety

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Access

Finding Prescription Cannabis

These medical societies maintain resources for patients and practitioners:

The United Patients Group (UPG) website includes information on the Medical Cannabis Industry’s “Trusted Seal of Approval” for products, organizations, and healthcare professionals. The site lists UPG Seal of Approval recipients.

United States

As of 2018, 30 states and the District of Columbia have laws broadly legalizing marijuana in some form.17 Medical cannabis is moderately available in many locations in these states.

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Worldwide

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Choosing among Forms of Cannabis

To choose the formulation that is right for you, practitioners advise working with a healthcare provider experienced in prescribing and monitoring medical cannabis.24 Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.

Cautions

Cancer-promoting activity has been found in breast, bronchial, hepatoma, and lung cell lines in some studies.25 A review including a pooled analysis of three case-control studies, more than 10 years of marijuana use was associated with testicular germ cell tumor, but not with head and neck squamous cell carcinoma or oral cancer.26

Side Effects

According to CAM-Cancer, “A number of adverse events have been observed after the intake of medical cannabis and cannabinoids. Some may be welcome, such as mood enhancement or sedation.”27 Side effects include these:

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Medical supervision and monitoring is advised when using cannabis for medical reasons. Cannabis can also impair driving and other tasks requiring judgment and rapid response, and so caution is warranted.

To review possible adverse events, side effects, contraindications and drug

interactions, see CAM-Cancer Summaries: Medical cannabis and cannabinoids: Is it safe?

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Interactions with Other Therapies

CBD interacts with antiepileptic drugs, enhancing the serum levels of some and reducing the level of others.31

Dependence and Addiction

CBD shows no indications for addiction or dependence in humans.

World Health Organization's Expert Committee on Drug Dependence

Using cannabis can lead to substance use disorders such as physical and/or psychological dependence in some people:32

  • Psychological dependence occurs when a person cannot willfully stop using the drug even though use interferes with many aspects of life.
  • Physical dependence on cannabis can develop with sustained use.33 However, because THC is stored in fat and leaches out of the body fat to maintain a slowly diminishing blood level, users typically do not get an abrupt withdrawal reaction from sudden cessation of cannabis.34 Any withdrawal symptoms are typically mild and might include anxiety, insomnia, loss of appetite, migraine, irritability and restlessness.35

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Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Commentary

BCCT staff December 28, 2017: From Donald Abrams’ article Integrating cannabis into clinical cancer care:

“One of the more distressing situations that oncologists increasingly face is trying to counsel the patient who has a curable diagnosis, but who seeks to forego conventional cancer treatment in favor of depending on cannabis oil to eradicate their malignancy because of the large number of online testimonials from people claiming such results. Given my long practice in San Francisco, I can assume that a large proportion of my patients have used cannabis during their journey. If cannabis cured cancer, I would have a lot more survivors in my practice today.”

Non-cancer Uses of Cannabis and Cannabinoids

In some states, certain qualifying medical conditions are recognized for permitted medical use of marijuana:40

  • Amyotrophic lateral sclerosis (ALS)
  • Anorexia due to HIV/AIDS
  • Anxiety
  • Chronic pain
  • Crohn's disease
  • Epilepsy or seizures
  • Glaucoma
  • Multiple sclerosis or severe muscle spasms
  • Nausea, vomiting or severe wasting associated with cancer treatment
  • Terminal illness
  • Tourette syndrome

Cannabinoids are also used to treat HIV-related peripheral neuropathy.41 BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.

Written by Nancy Hepp, MS, and Laura Pole, RN, MSN, OCNS; most recent update on December 11, 2019. BCCT has not conducted an independent review of research of cannabis and cannabinoids. This summary draws from CAM-Cancer’s Summaries and other sources as noted. We are grateful to integrative oncologist and BCCT advisor Donald Abrams, MD, for his generous sharing of research articles and commentary.

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