Despite Feeling Unequipped, Many Oncologists Recommend Medical Marijuana for Patients

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Marijuana, also called pot, grass, cannabis, weed, hemp, hash, ganja, and a multitude of other names, has been used in herbal remedies for centuries. There are a number of biologically active compounds in marijuana, which are called cannabinoids. The two most-studied compounds in marijuana are:

  • delta-9-tetrahydrocannabinol (THC), which causes marijuana’s high
  • cannabidiol (CBD), which doesn’t cause a high

While marijuana is federally illegal in the United States, more than half of the states, as well as the District of Columbia, have passed laws legalizing the use of marijuana to treat certain medical conditions.

A survey of U.S. oncologists has found that most talked to their patients about medical marijuana and almost half recommended it, but only 30% of oncologists felt sufficiently informed about medical marijuana.

The research was published online on May 10, 2018 by the Journal of Clinical Oncology. Read the abstract of “Medical Oncologists’ Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study.”

It’s important to know that marijuana is NOT a treatment for breast cancer. It is used to ease the side effects of treatment and pain caused by the cancer. Still, because marijuana is federally illegal, research on medical marijuana is limited. Anecdotal evidence suggests that marijuana may ease pain, nausea, hot flashes, loss of appetite, and anxiety caused by a breast cancer diagnosis and treatment.

In this study, the researchers mailed a survey on medical marijuana to a random representative sample of 400 medical oncologists in the United States; 237 completed the survey. Of the oncologists who responded to the survey:

  • 65.8% were male
  • 57.9% were white
  • 36% finished oncology training more than 25 years ago
  • 52.8% practiced outside of a hospital setting
  • 40.8% saw more than 60 patients per week
  • 55.1% practiced in a state in which medical marijuana is legal

The survey asked about:

  • the oncologists’ discussions about medical marijuana with the patients and who started the conversation
  • the number of patients who were recommended medical marijuana for cancer-related issues
  • whether the oncologists felt they had enough knowledge about medical marijuana to make recommendations
  • how the oncologists rated the effectiveness of medical marijuana to treat cancer side effects such as pain, anxiety, depression, nausea, and poor sleep compared to standard treatments
  • the risks of medical marijuana compared to prescription opioids

Overall:

  • 79.8% of the oncologists had discussed medical marijuana with patients or the patients’ families; in most cases, the topic was brought up by patients or the patient’s family
  • 45.9% of the oncologists had recommended medical marijuana to at least one patient for cancer-related side effects; of these oncologists, 56.2% didn’t consider themselves knowledgeable enough to make recommendations about medical marijuana
  • 29.4% of the oncologists felt knowledgeable enough to make recommendations about medical marijuana
  • 66.7% of the oncologists said that medical marijuana is a helpful addition to standard pain treatments

As of May 2018, no randomized clinical trials have examined whole-plant medical marijuana’s effects in cancer patients, so oncologists have to rely on lower quality evidence, research on pharmaceutical cannabinoids, or research on medical marijuana's use in treating diseases other than cancer.

"In this study, we identified a concerning discrepancy: although 80% of the oncologists we surveyed discussed medical marijuana with patients and nearly half recommended use of the agent clinically, less than 30% of the total sample actually consider themselves knowledgeable enough to make such recommendations," said lead author Ilana Braun, M.D., chief of Dana-Farber Cancer Institute's Division of Adult Psychosocial Oncology. "We can think of few other instances in which physicians would offer clinical advice about a topic on which they do not feel knowledgeable. We suspect that this is at least partly due to the uncomfortable spot in which oncologists find themselves. Medical marijuana is legal in over half the states, with cancer as a qualifying condition in the vast majority of laws, yet the scientific evidence base supporting use of medical marijuana in oncology remains thin. The results highlight a crucial need for expedited clinical trials exploring marijuana's potential medicinal effects in oncology (e.g., as an adjunctive pain management strategy or as a treatment of anorexia/cachexia) and the need for educational programs about medical marijuana, to inform oncologists who frequently confront questions regarding medical marijuana in daily practice."

Medical marijuana comes in a variety of strains, and each has different levels of active compounds and potency. This means that the effects of medical marijuana will be unique to each person and can be hard to predict.

Medical marijuana products come in many different forms, including:

  • edibles, such as cookies or candy
  • dried leaves, or buds, for smoking
  • oils for vaporizing or mixing into tea, honey, or other food
  • creams and other products that are applied topically
  • sprays or tinctures that are used under the tongue or on the gums

Again, because research on medical marijuana and cancer is extremely limited, information on side effects is also limited. Reported side effects of medical marijuana include increased heart rate, low blood pressure, dizziness, fainting, hallucinations, and paranoia. Potential side effects depend heavily on the type of medical marijuana product you’re using and the amount of THC and CBD in it.

If you are considering using medical marijuana, there are several points to keep in mind:

  • Always tell your doctor about any additional therapies, including vitamins and supplements you are using. This includes medical marijuana. If you live in a state where medical marijuana is legal, you may want to ask your doctor if she/he can connect you with a patient who is using it successfully.
  • Medical marijuana is not covered by insurance, Medicare, or Medicaid. Costs can start at $100 per month and go much higher depending on how much is needed. The bottom line is that medical marijuana is expensive.
  • THC and CBD are present in different levels in different strains of marijuana and medical marijuana products and each offers different benefits. For example, CBD may be better at easing pain, while THC is better at controlling nausea.
  • You will likely have to do a lot of research on your own to figure out the ratio of THC to CBD that works best for controlling your symptoms. This can take much trial and error. What works for someone else may not work for you.
  • You may have to go to several dispensaries until you find one that you’re comfortable with and has staff members that can answer all your questions about the levels of THC and CBD in the strains available. Depending on the laws in your state, some dispensaries may cater more to recreational marijuana users than medical users. Other dispensaries are more clinical and have staff members who have experience helping people with cancer use medical marijuana to treat side effects. Explain what you need up front and see if you can schedule a consultation appointment with a staff member. If you’re at all uncomfortable, go to a different dispensary.
  • Dr. Braun said she would recommend that her patients go to a medical marijuana dispensary rather than one that caters to recreational users. There’s no evidence on whether recreational marijuana is just as safe and useful for cancer patients as the more expensive medical-grade variety, though some dispensaries take extra care to ensure there are no pesticides or mold in their medical-grade cannabis.
  • Here are some general questions you may want to ask the dispensary staff member:
    • Where does your marijuana come from?
    • How is your marijuana grown?
    • Are your items stored and handled safely?
    • Are your items tested for fungus and bacteria?
    • Are your items tested for levels of pesticides?
    • Have you worked with breast cancer patients before?
    • Which strains would you recommend for my symptoms and why?
    • What’s the best way to take each strain?
  • Before you go to a dispensary, it can help to write down the symptoms you would like to ease with medical marijuana. Describe what triggers the symptom and what, if anything, has worked in the past to relieve it. It’s also a good idea to tell the dispensary staff member if you’ve tried medical or recreational marijuana before and what your reaction was.
  • If you work for the federal government, a federal government contractor, or an employer that conducts regular drug tests, you may face disciplinary action for using medical marijuana. Always check your employer’s medical marijuana policy before you start using it.

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