Would You Like Marijuana with Your Chemotherapy?

I am frequently asked, as a pharmacist who specialises in cancer medicine, what do I think about the use of marijuana for medical conditions?

I often reflect back to dispensing dronabinol (a synthetic THC product) for chemotherapy induced nausea and HIV related wasting syndrome, when I first started working as a pharmacist in a hospital in the early 90s.  Back then it was no big deal, the hospital pharmacy imported the medication from overseas, just like we did many other medications which were not marketed in Australia, and supplied it on a doctor’s prescription.

We didn’t stop supplying it because it was difficult to get hold of, rather it just wasn’t very useful any more.  New anti-nausea medications came on the market, and these were much more effective at controlling the nausea and vomiting associated with chemotherapy, and, a new class of medications known as antiretrovirals became available and these were so effective at treating HIV we thankfully were no longer seeing the devastating effects of the disease.

So, as the current debate over the use of marijuana for medical conditions rages and health professional seem pitted against consumers with politicians waging in (mostly unhelpfully) on the subject, what are the issues?  Notwithstanding the difficulties in completing all the paperwork and processes necessary to prescribe marijuana, the problems, as I see it, are as follows:

• Firstly, and unfortunately, the debate over the use of marijuana is often hijacked by “conspiracy theorists”.  Those who think that big pharma has the cure for cancer and is just not telling us, and that we just get a kick out of poisoning people with cancer drugs because it keeps us in business.  These people will frequently make claims that marijuana cures cancer.  It is at this stage I like to point out that cancer is not one disease, it is hundreds of different diseases, with a couple of hundred different treatment options, and we DO, in fact, cure a number of cancers already.  Just ask ex-Australian cricketer, Simon O’Donnell, musician, Delta Goodrem and even the disgraced cyclist, Lance Armstrong.
• Secondly, well-meaning patients (and patient advocates) will stand up and say how effective marijuana has been at treating their condition, without acknowledging the fact that they have also used or are currently still on conventional medication. This does not mean the marijuana they are using is not having a therapeutic effect, but it does make health professionals sceptical of such claims.
• Thirdly, health professionals just don’t know how to use it properly, YET.  Health professionals are science nerds.  When giving a medication, they want to understand what diseases or symptoms it is useful in treating, what the medication does and what the effective dose is.  Much of this information is unclear at present.
• Fourthly, and particularly in the absence of above, health professionals take comfort in discussing unfamiliar issues with a colleague who has experience in the area.  This is not specific to marijuana, they do it for most things – uncommon conditions, new medications, or a new kind of diagnostic test.  A chat with a colleague is one of the most common forms of informal learning.  Unfortunately, there are very few health professionals with experience in the use of marijuana to chat to.
• Lastly, and rather disappointingly I think, some of the people providing educational offerings on the use of marijuana do not focus on points three and four, instead they discuss how safe it is compared to say alcohol, or they use terms in their presentations like “flying high”.  It is not helpful to refer to, or play up, recreational substance use – be that marijuana, alcohol or even nicotine in the argument for using marijuana for medical conditions. Being less harmful, does not make it effective.

So, does that mean I don’t think marijuana is useful?

No. I DO think it will have a place in therapy. 

Based on what we know at present it may be useful as a mild to moderate pain reliever (when used in combination with other medications), there is also some early pre-clinical data on its use in combination with chemotherapy in cancer, though pre-clinical data does not mean it will work clinically in patients.  But by far the most interesting research and the greatest hope is on its use in neurological conditions.  Data on reducing the frequency of seizures in refractory epilepsy is compelling and improvements in spasticity in multiple sclerosis are promising.

My hope is that we can address the gaps in health professional’s education so that we increase their confidence in using marijuana appropriately, so that those who may benefit from its use, can do so. chemo@home is committed to helping both consumers and health professionals find the information they need.  Our website now has relevant information on access, supply and evidence on use, which we will continue to add to.  There is also a form for health professionals to upload case studies on the use of marijuana in their patients, so we can all learn from the experience.  If you have feed-back on what you want included or ways to improve the information provided, please leave a comment.

Addit:  You will notice I have not used the popular term, medicinal marijuana. Since we do not say medicinal penicillin or medicinal codeine, I do not think it is necessary here either.  I have also used the term marijuana for simplicity, and not the more “pharmaceutically correct” terms cannabinoids, cannabidiol (CBD) or tetrahydrocannabinol (THC).

Julie