The Integration of Cannabis in Oncologic Care
The integration of cannabis into palliative care appears promising in terms of its therapeutic properties to assuage cancer-related pain.
Although cannabis is widely used throughout the world for medicinal purposes, it nonetheless remains the center of much controversy and argument. Yet, despite trepidation and uncertainty, studies have revealed an openness of the medical community to the legalization of marijuana for medicinal use. In a 2013 poll of 1446 physicians, 76% of respondents approved the use of marijuana for medicinal purposes, citing their “responsibility as caregivers to alleviate suffering” as the reason for their support.1
The integration of cannabis in oncology and palliative care appears promising in terms of its therapeutic properties to assuage cancer-related pain and physical discomfort. The underpinnings of medical marijuana for symptom management warrant special attention as a patient's quality of life is often impacted by neuropathy and chemotherapy-induced nausea and vomiting.
“Clinically, I have observed that many cancer patients benefit from adding cannabis to their pain regimen,” said Donald I. Abrams, MD, a hematologist-oncologist at San Francisco General Hospital, San Francisco, California, in a review of the medical benefits of cannabis.2 High doses of opiates administered by well-meaning oncologists or palliative care clinicians frequently alter patients' cognition, leaving them unable to communicate with loved ones at the end of their life. “Many [patients] have successfully weaned themselves down or off their opiate dose by adding cannabis to their regimen,” explained Dr Abrams.2
Although opiates are effective in ameliorating pain and discomfort, undesirable side effects of these medications can simultaneously, inhibit a patient's adherence to pain management. The use of cannabis conjointly with opioids may prove advantageous with regard to diminishing some of the side effects that impede a patient's quality of life. Further research is required, however, to determine the synergism of a cannabinoid-opioid interaction.
“If cannabinoids and opioids were shown to be synergistic in a larger follow-on controlled clinical trial, it is possible that lower doses of opioids would be effective for longer periods of time with fewer side effects, clearly a benefit to the patient with pain.”3 It is also important to recognize the employment of cannabis in cancer care as integrative. Patients should proceed with caution before interpreting its use as a “front-line” defense for pain.
“Moving forward to the present moment, I prefer that this type of care be termed ‘cannabinoid integrative medicine' (CIM), which better contextualizes cannabinoid use within the overarching trends in medicine today. Where integrative medicine blends conventional with complementary and alternative therapy such as botanicals, CIM emphasizes the integrated therapeutic use of the cannabinoid-rich botanical Cannabis,” Sunil Kumar Aggarwal, MD, PhD, of the MultiCare Auburn Medical Center and MultiCare Institute for Research and Innovation, Auburn, Washington, wrote in his article on use of cannabinoids in palliative cancer care.4