Is Cannabis The Answer to Cancer Pain?

Cannabis continues to be sought after, especially with cancer patients as an effective way to treat chemotherapy-induced side-effects, such as nausea and lack of appetite.

Cannabis is currently still categorised as a Schedule One drug under the Controlled Substances Act in the U.S., meaning that the drug is considered to be highly addictive with no medical benefits.  

Despite the lack of clinical evidence supporting the benefits of medicinal cannabis, its use to help relieve cancer-related side-effects is becoming increasingly common. In fact, according to the data from a National Health and Nutrition Examination Survey, approximately forty percent of cancer patients use cannabis as an alternative to opiates to help alleviate symptoms of cancer and cancer treatment. 

Medicinal cannabis already has strong links to effectively treating chronic pain, insomnia and loss of appetite, so it's no surprise that patients have been relying on cannabis to assist with the after-effects of cancer treatment. 

Although medical marijuana is accessible in Australia and thirty-three states across the U.S., there is still a struggle within the medical community to obtain and recommend it – most likely due to the previously-mentioned lack of clinical data. This leaves patients at the detriment of either enduring the average six-week waiting period or seeking it themselves illegally. 

Cannabis and Chemotherapy

Chemotherapy is an anti-cancer drug that is used to eliminate cancer cells and can be administered orally, via injection, or in the form of a cream. Chemotherapy is a proven course of treatment in shrinking tumour size, curing cancer and is one of the primary factors associated with long-term cancer remission. However, it is also usually accompanied by several nasty side-effects such as nausea, weight-loss, loss of appetite, muscle weakness and diarrhoea. The downside is that while chemotherapy is successful in targeting cancer cells, it also damages and kills healthy cells in the process. 

Cannabis, on the other hand, is proven to be able to counteract the side-effects of chemotherapy such as nausea, insomnia and pain without harming the efficacy of chemotherapy itself. Making it a safe option for cancer patients seeking to relieve their symptoms. 

Cancer Pain, Cannabis and Opioids

Cannabis has been branded as being a 'gateway drug', theorising that people who use cannabis are more likely to progress to using 'harder' drugs such as cocaine or heroin. This theory, although it has some evidence behind it, is dated back decades ago and the 'Gateway Theory' surfaced during the midst of Ronald Reagan's the 'War on Drugs' in the 1980s. Since then, the theory appears to get less relevant in today's culture with cannabis becoming increasingly legalised for medicinal and personal use; with a growing body of evidence supporting its treatment for chronic pain and cancer pain. 

Cancer patients experience an array of side-effects stemming from the disease itself as well as from the treatments themselves. Cancer pain can occur when a tumour pushes against the nerves' bones or organs; or if cancer spreads to the bones, as a result of surgery or as a side-effect of chemotherapy. Cancer pain doesn't occur in all patients, however, and is dependent on the type of cancer and the severity of the diagnosis. Chronic cancer pain can also lead to other issues such as insomnia, depression and a lower overall quality of life. 

cannabis opioids

A common treatment method used to assist with pain management is opioids. Opioids directly interact with the body's opioid receptors, encouraging a release of dopamine, with the result being pain relief. Opioid use is common when experiencing chronic pain from sports injuries and other health conditions as well as to mediate cancer pain. It can, however, also result in the development of a high tolerance to the drug, addiction and, in many cases, overdose. 

The opioid crisis is the result of high volumes of opioid prescriptions as a painkiller. In fact, between 1990 and 2013, opioid medication prescriptions jumped from 76 million to 207 million. With this being said, an amalgamation of anecdotal evidence is suggesting that cannabis is acting more as an exit drug than a gateway drug. Patients are admitting to using medicinal cannabis to treat chronic pain and injuries, leading to overall decreases in addiction and lower opioid-related fatalities (47, 600 deaths in 2017 in the U.S. alone). States in which medicinal cannabis is legalised is also associated with fewer opioid prescriptions with the growing support of cannabis being used as an exit drug to help patient's phase-out their opioid dependency. 

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Cannabis currently holds an abundance of quantitative and qualitative evidence supporting the relief of chronic pain in cancer patients. The trick lies within the cannabinoids Tetrahydrocannabinol (THC) and Cannabidiol (CBD) and how they interact with the body's endocannabinoid system (ECS). Depending on the type of pain, these cannabinoids can numb the pain at the site of the injury and even stop the pain signals from reaching the brain. Pain, as a consequence of chemotherapy, can be alleviated when medicinal cannabis activates with serotonin receptors; specifically, cannabis with high levels of CBD. 

Subsequently, cannabis has become one of the principal treatment options for chronic pain, despite it only being approved by the Food and Drug Association (FDA) in 2018. Patients are opting for cannabis-based options overall traditional medications such as opioids, which will likely lead to a decrease in opioid-related addiction and fatalities. 

What Does the Evidence Say? 

Despite the limited clinical evidence supporting medicinal cannabis for the treatment for cancer-related side-effects, this doesn't see to scare people off. A 2017 Canadian study revealed that eighteen percent of cancer patients admitted to using cannabis to aid their symptoms even while having to illegally acquire the drug. 

Patients also reported that using medicinal cannabis throughout their treatment decreased symptoms such as nausea, reflux, insomnia, anxiety; and was able to increase mood, libido and ability cope. Several studies conclude that the use of synthetic cannabinoids – notably nabilone and dronabinol – has been used by cancer patients as an alternative form of medication. 

More recently, a new study performed by Southern Cannabis Holdings (SCH) in conjunction with Little Green Pharma (LGP) found that medicinal cannabis is sufficient treatment for chronic pain. MedLab Clinical Ltd. (ASX: MDC) is also undertaking an Observational Study to assess the effects of its drug, Nanabis, for the treatment of cancer-related chronic pain. 

400x170 Medlab

So, What's the Issue? 

The biggest concern with the concurrence of cannabis as an effective treatment option for chemotherapy-induced symptoms is the lack of clinical data. This is due to several reasons, the first being the restricted duration of these studies, including some studies being cut short due to insufficient findings and limited patient numbers. There is also an array of studies that have stated that medicinal cannabis did not improve pain, appetite or insomnia. Notably, this might also have to do with the levels of THC and CBD in the cannabis used in the trials themselves. 

This is not to say that cannabis does not affect these ailments; cannabinoids have been approved to assist with chronic pain since 1985 and the qualitative evidence of cannabis and cannabinoid treatment is overwhelmingly positive. However, overall, the results of the trial-based evidence appear to be very mixed. 

Another point of contention is the lack of education and confidence from within the medical community. One study concluded that the lack of proper education and awareness is creating a hindrance to providing confident recommendations for patients, causing patients to seek out cannabis treatment through illegal means. A primary concern of cancer patients is facing the legal ramifications of seeking out the plant illegally. 

On the bright side, we have already begun to make strides in developing the research and evidence to show how we can medicinally benefit from the plant. A primary indicator of this was the 2018 Farm Bill in the U.S. legalising the commercial sale of hemp and the U.K. Food Standards Agency (FSA) resetting the standards of CBD products being sold, ensuring that all CBD-based products are meeting regulative standards and higher safety standard for consumers. 

cannabis chemotherapy

Where to from Here? 

Despite the tremendous qualitative evidence supporting the benefits of cannabis-based medicine, there still appears to be a long road ahead until we begin to see solid quantitative evidence generated through clinical trials. 

It's clear that the use of cannabis is breaking the stereotypes of being a gateway drug and making strides into being an effective exit drug that can not only alleviate cancer-related pain but also be a safer alternative to opioid medications. 

The good news is that since 2018 there has been a spike of interest and research supporting the benefits of medicinal cannabis, leading to changes in regulation, increases in medicinal cannabis use and higher rates of support. This means that the prospect of more definitive quantitative evidence might be closer than we think. 

This is could go a long way to help remedy the lack of education from within the medical community and increase the awareness and confidence to prescribe it to all patients who could benefit from it. 

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Taylor Ridewood
Taylor Ridewood

Taylor is a Sydney-based writer with a background in psychology and professional writing. She has a keen interest in the benefits of medicinal cannabis and enjoys researching the multi-faceted effects of cannabis on the body and mind.

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