Harold Kalant, MD, Professor Emeritus at the University of Toronto and Amy J. Porath-Waller, PhD, Director of Research & Policy at the Canadian Centre on Substance Abuse stated in their 2012 report "Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids," available at www.ccsa.ca:
"There is sound evidence from animal experiments and well-designed clinical trials involving humans that cannabis and cannabinoids are effective for the relief of nausea/vomiting and certain types of pain, as well as for the stimulation of appetite. However, the evidence to date does not indicate that they are the best drugs to use for these purposes. Many studies have shown, for example, that for treating nausea and vomiting, cannabinoids are more effective than older medications such as phenothiazines (e.g., Stemetil®) or antihistaminics (e.g., Dramamine®), but appear to be less effective than newer antinauseants such as ondansetron and similar drugs (Machado Rocha et al., 2008; Soderpalm et al., 2001)."
Is Marijuana an Effective Treatment for Reducing Nausea and Vomiting from Chemotherapy?
Gil Bar-Sela, MD, Director of the Integrated Oncology and Palliative Care Unit at the Rambam Health Care Campus, Haifa, Israel, et al., stated in their June 2013 study "The Medical Necessity for Medicinal Cannabis: Prospective, Observational Study Evaluating the Treatment in Cancer Patients on Supportive or Palliative Care" published in Evidence-Based Complementary and Alternative Medicine:
"We followed patients with a medicinal cannabis license to evaluate the advantages and side effects of using cannabis by cancer patients…
All cancer or anti-cancer treatment-related symptoms, including nausea, vomiting, mood disorders, fatigue, weight loss, anorexia, constipation, sexual function, sleep disorders, itching, and pain had significant improvement... There were no significant side effects to the cannabis except for memory lessening in the 106 patients who continued cannabis use."
The United Patient's Group, a resource for alternative medicine, on its page titled "Nausea and Vomiting," available at www.unitedpatientsgroup.com (accessed Mar. 18, 2015), state:
"Medications that relieve nausea and vomiting are called antiemetics, and are frequently prescribed for patients suffering from cancer...
• There is strong evidence that the cannabinoids naturally produced in the body play a role in suppressing nausea in normal circumstances, and intake of cannabinoids from medical marijuana during episodes of nausea can also effectively relieve symptoms...
• Inhaled medical marijuana achieves superior results in reducing nausea and vomiting over synthetic alternatives (Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate, Chang, A.E. et al.)
• Vaporized, inhaled medical marijuana is a safe alternative to traditional smoked cannabis, and avoids many issues encountered with the ingestion of other medications, as swallowing medications during an episode of nausea or vomiting is uncomfortable and undesirable (Evaluation of a Vaporizing Device (Volcano) for the Pulmonary Administration of Tetrahydrocannabinol, Hazekamp, A. et al.)
• The body absorbs medical marijuana quickly because it is similar to the cannabinoids the body naturally produces. More cannabinoids are absorbed in inhaled form than in ingested form, since the body attempts to metabolize any ingested medication before absorption. This action also reduces the effectiveness of standard therapies, including synthetic cannabis (Physiochemical and pharmacological characterization of a delta(9)-THC aerosol generated by a metered dose inhaler, Wilson, D.M. et al.)."
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 26 of the world’s leading cancer centers devoted to patient care, research and education, stated in its 2013 "Guidelines for Patients Caring for Adolescents and Young Adults" available at www.nccn.org:
"If medications don’t seem to be working, you might want to consider asking your oncologist to prescribe medical marijuana. The active substance in marijuana—a chemical called THC (tetrahydrocannabinol)—has been shown to relieve nausea and stimulate appetite in people receiving chemotherapy. Your doctor can also prescribe a medication that contains THC such as dronabinol or nabilone. If you choose to go the more traditional route of smoking an occasional joint (or snacking on the occasional pot brownie), be sure to let your treatment team know, and educate yourself about state and federal laws related to the medicinal use of marijuana."
Cancer Monthly, a cancer treatment website, stated in its May 2006 e-newsletter article "Medical Marijuana - The FDA Loses More Credibility" available at www.cancermonthly.com:
"There are literally hundreds of articles that appear in the peer reviewed medical and scientific literature that discuss marijuana's effects in pain relief, control of nausea and vomiting, and appetite stimulation...
Obviously smoking marijuana is not risk-free especially to respiratory organs and tissue.
However, compared to the risks of a typical chemotherapy agent such as cytoxan which includes: urinary bladder, myeloproliferative, or lymphoproliferative malignancies, potential sterility, urinary system hemorrhagic cystitis, hematuria, cardiac toxicity, anaphylactic reactions, significant suppression of immune responses, and sometimes fatal, infections; the risks of marijuana pale in comparison.
And for cancer patients with advanced cancers who want to improve the quality of their life, a risk versus benefit analysis weighs heavily on the benefit side."
Kate Scannell, MD, Co-Director of the Kaiser-Permanente Northern California Ethics Department, wrote the following in the Feb. 16, 2003 article "Mr. Attorney General, Listen to the Doctors" published in the San Francisco Chronicle:
"I knew this woman was dying a prolonged and miserable death. And, from years of clinical experience, I - like many other doctors - also knew that marijuana could actually help her. From working with AIDS and cancer patients, I repeatedly saw how marijuana could ameliorate a patient's debilitating fatigue, restore appetite, diminish pain, remedy nausea, cure vomiting and curtail down-to-the bone weight loss. I could firmly attest to its benefits and wager the likelihood that it would decrease her suffering."
Jo Daly, late San Francisco Police Commissioner and lung and colon cancer sufferer, declared in sworn testimony on Feb. 14, 1997 in Conant v. McCaffrey :
"A friend then gave me a marijuana cigarette, suggesting that it might help quell my nausea. I took three puffs from the cigarette. One-half hour later, I was calm, my nausea had disappeared, my appetite returned, and I slept that evening.
…My use of medical marijuana had a secondary, though by no means minor benefit: I was able to drastically reduce my dependence on more powerful prescription drugs that I was prescribed for pain and nausea. With the help of medical marijuana, which I ingest only occasionally and in small amounts, I no longer need the Compazine, Lorazepam, Ativan and Halcion. No combination of these medications provided adequate relief. They also caused serious side effects that I never experienced with marijuana."
The Institute of Medicine published the following in its Mar. 1999 report titled "Marijuana and Medicine: Assessing the Science Base":
"The goal of antiemetic medications is to prevent nausea and vomiting. Hence, antiemetics are typically given before chemotherapy, in which case a pill is an effective form or drug delivery. However, in patients already experiencing severe nausea or vomiting, pills are generally ineffective because of the difficulty in swallowing or keeping a pill down and slow onset of the drug effect. Thus, an inhalation (but preferably not smoking) cannabinoid drug delivery system would be advantageous for treating chemotherapy-induced nausea...
It is possible that the harmful effects of smoking marijuana for a limited period of time might be outweighed by the antiemetic benefits of marijuana, at least for patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis."
Francis L. Young, former Administrative Law Judge for the US Drug Enforcement Administration (DEA), made the following statement in his Sep. 6, 1988 ruling:
"The overwhelming preponderance of the evidence in this record establishes that marijuana has a currently accepted medical use in treatment in the United States for nausea and vomiting resulting from chemotherapy treatments in some cancer patients. To conclude otherwise, on this record, would be unreasonable, arbitrary and capricious."
GW Pharmaceuticals stated the following on its website (accessed Jan. 2004):
"The anti-emetic properties of cannabis have been studied in humans more widely than any other indication. Nausea and vomiting following chemotherapy was felt to be one of the best supported therapeutic uses of cannabis and cannabinoids by the British Medical Association in their review of 23 studies, and was also supported by the American Institute of Medicine. This indication for cannabis has become common knowledge among patients, was the subject of a popular book, and has received some endorsement amongst American oncologists in a survey study.
A large body of knowledge has now been amassed in this context as a result of state-sponsored studies in the USA in cancer chemotherapy. Pooling available data in some 768 patients, oral THC provided 76-88% relief of nausea and vomiting, while smoked cannabis figures supported 70-100% relief in the various surveys."
The US Food and Drug Administration (FDA), in a Q&A section on their website "The FDA & Marijuana: Questions and Answers", published in Oct. 2014, stated:
"The FDA is aware that marijuana or marijuana-derived products are being used for a number of medical conditions including, for example, AIDS wasting, epilepsy, neuropathic pain, treatment of spasticity associated with multiple sclerosis, and cancer and chemotherapy-induced nausea. To date, the FDA has not approved a marketing application for a drug product containing or derived from botanical marijuana and has not found any such product to be safe and effective for any indication."
The National Cancer Institute (NCI), part of the National Institutes of Health (NIH) in the Department of Health and Human Services (HHS), stated on its website in the "Cannabis and Cannabinoids (PDQ)" section in Nov. 2014:
"At this time, there is not enough evidence to recommend that patients inhale or ingest Cannabis as a treatment for cancer-related symptoms or side effects of cancer therapy."
The American Medical Association (AMA), the largest association of physicians and medical students in the United States, stated in its June 2009 Report Number 3 of the Council on Science and Public Health (I-09) entitled "Use of Cannabis for Medicinal Purposes":
"Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis. These trials were short term and involved a total of ~300 patients. Results of these trials indicate…substantially better alternatives than smoked cannabis are available to treat patients with glaucoma or chemotherapy-induced nausea and vomiting."
The US Drug Enforcement Administration (DEA), in their Apr. 2013 document entitled "The DEA Position on Marijuana" states that:
"At present … the clear weight of the evidence is that smoked marijuana is harmful. No matter what medical condition has been studied, other drugs already approved by the FDA have been proven to be safer than smoked marijuana."
John Glaspy, MD, MPH, Professor of Medicine at the University of California at Los Angeles, was quoted in an Oct. 15, 2005 article by Michelle Caruso in New York Daily News titled "Medicinal Marijuana Helped Melissa Etheridge through Cancer":
"Medical marijuana has some effect on nausea and vomiting, but it is a weak effect, and it doesn't compete well with the targeted [pharmaceutical] drugs that have been developed."
Reese T. Jones, MD, PhD, Director of the Drug Dependence Research Center, stated in an Oct. 24, 2001 article in the San Francisco Chronicle:
"It is foolish to make it [marijuana] available for medical purposes. There is no evidence that smoked marijuana is better than Marinol and there are numerous over-the-counter remedies for nausea and vomiting. Most oncologists won't bother with marijuana because there are better treatments available."
Anna H.V. Söderpalm, PhD, Professor of Psychiatry at the University of Chicago, Alyson B. Schuster, MPH, MBA,
Research Associate at Johns Hopkins HealthCare, and Harriet de Wit, PhD, Professor of Psychiatry at the University of Chicago, stated in their Feb. 12, 2001 study "Antiemetic Efficacy of Smoked Marijuana," published in Pharmacology, Biochemistry and Behavior:
"...The effects of smoked marijuana on emesis were mild. Marijuana had a modest effect on nausea, queasiness and emesis in this model of nausea induced by syrup of ipecac. The comparison drug, ondansetron, totally eliminated both the subjective feelings of nausea and the emesis. These findings confirm clinical reports that smoked marijuana can reduce nausea, but relative to the potent effects of ondansetron and because of its psychoactivity, its usefulness in the clinical setting is likely to be limited."
Andrea Barthwell, MD, former Deputy Director for Demand Reduction at the Office of National Drug Control Policy (aka Deputy Drug Czar), told PBS's NewsHour on Oct. 14, 2003:
"...the constituent part of marijuana, which is useful in the treating of HIV wasting, nausea associated with chemotherapy, and potentially pain, is available to physicians to prescribe in the form of Marinol...
What we're saying is that 21st century medicine dictates that we pursue the avenues that would allow us to develop the medications that would be useful in these disorders rather than turning our medical care system back to the 19th century where plant products were in fact distributed by snake oil salesmen for the treating of a number of symptoms...
Physicians who are compassionate and practicing scientifically based, evidence based 21st century medicine would much prefer to use Marinol, which is available to them, than suggest that their patients smoke a plant. They would not want to engage in asking a patient to smoke opium to treat pain or to chew deadly Nightshade to stabilize their heart beat."
The Eagle Forum, a pro-family activist organization, stated in its Mar. 1, 2006 brochure "Facts You Need to Know About... Marijuana," on the Eagle Forum website:
"There is no legitimate need for marijuana as medicine. Pills containing THC are already available with a physician's prescription... Cancer patients receiving chemotherapy often die from infection because chemotherapy weakens the body's immune defenses. THC reduces the nausea experienced by chemotherapy patients, but can be dangerous to these patients because THC also damages the immune system."