Is marijuana an effective treatment for reducing nausea and vomiting from chemotherapy?
PRO (yes)
CON (no)
Cancer Monthly, a cancer treatment website, stated in its May 2006 e-newsletter article "Medical Marijuana - The FDA Loses More Credibility":
"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 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."
Debasish Tripathy, MD, Professor of Medicine at the University of Southern California, declared on Feb. 13, 1997 in Conant v. McCaffrey:
"I have prescribed Marinol to some of my patients and it has proven effective in some cases. However, scientific and anecdotal reports consistently indicate that smoking marijuana is a therapeutically preferable means of ingestion. Marinol is available in pill form only. Moreover, Marinol contains only one of the many ingredients found in marijuana (THC). It may be that the beneficial effects of THC are increased by the cumulative effect of additional substances found in cannabis. That is an area for future research. For whatever reason, smoking appears to result in faster, more effective relief, and dosage levels are more easily titrated and controlled in some patients."
The Institute of Medicine published the following in its Mar. 1999 report titled "Marijuana and Medicine: Assessing the Science Base":
"Most chemotherapy patients are unlikely to want to use marijuana or THC as an antiemetic. In 1999, there are more effective antiemetic agents available than were available earlier. By comparison, cannabinoids are only modest antiemetics.
However, because modern antiemetics probably act through different mechanisms, cannabinoids might be effective in people who respond poorly to currently used antiemetic drugs, or cannabinoids might be more effective in combination with a new drug than is either alone...
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."
Mitch Earleywine, PhD, Associate Professor of Psychology at University at Albany at the State University of New York, wrote in a March 5, 2009 article titled “Medical Marijuana Benefits” published at CBSNews.com:
“Opponents of medical marijuana often point to dronabinol, the synthetic version of one of marijuana’s active ingredients that is available in pill form. The use of only one active ingredient makes dronabinol less effective than medical marijuana. Many ailments respond better to a combination of marijuana’s active ingredients rather than just one. In addition, because dronabinol is a pill, it is difficult for people with nausea and vomiting to swallow. Finally, like any medication that’s swallowed, dronabinol takes a long time to digest and have its effects. Inhaled marijuana vapors can work markedly faster."
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."
The American Medical Association (AMA), the largest association of physicians and medical students in the US, stated in its June 2001 online report titled "Medical Marijuana":
"When directly compared, oral THC was preferred to smoked marijuana, but only 20% to 25% of patients receiving either drug achieved complete control of emesis. Oral and smoked THC were ineffective in older patients (median age = 41 years) who were inexperienced in the use of smoked marijuana....
In summary, substantial progress has been made in controlling chemotherapy-induced nausea and vomiting.... Although there have been few formal studies of smoked marijuana, its reported efficacy for complete prevention of acute emesis is less than what normally would be considered sufficient to warrant a formal trial given the efficacy of available agents."
The Crohn's & Colitis Foundation of America (CCFA) stated in "Cannabis and IBD: A Fragile Connection," published on its website (accessed Oct. 15, 2009):
"While marijuana might temporarily reduce pain and nausea... CCFA's expert consensus remains: The harmful side effects of marijuana far outweigh its potential benefits."
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 US Drug Enforcement Administration (DEA) stated in the article "'Medical' Marijuana - The Facts" published on the DEA website (accessed Oct. 14, 2009):
"Medical marijuana already exists. It's called Marinol.
A pharmaceutical product, Marinol, is widely available through prescription. It comes in the form of a pill and is also being studied by researchers for suitability via other delivery methods, such as an inhaler or patch. The active ingredient of Marinol is synthetic THC, which has been found to relieve the nausea and vomiting associated with chemotherapy for cancer patients and to assist with loss of appetite with AIDS patients.
Unlike smoked marijuana -- which contains more than 400 different chemicals, including most of the hazardous chemicals found in tobacco smoke -- Marinol has been studied and approved by the medical community and the Food and Drug Administration (FDA), the nation's watchdog over unsafe and harmful food and drug products."
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."
