Would you Like Some Marijuana with your Chemo?

I am frequently asked, as a pharmacist who specialises in cancer medicine, what do I think about the use of marijuana for medical conditions?

I often reflect back to dispensing dronabinol (a synthetic THC product) for chemotherapy induced nausea and HIV related wasting syndrome, when I first started working as a pharmacist in a hospital in the early 90s.  Back then it was no big deal, the hospital pharmacy imported the medication from overseas, just like we did many other medications which were not marketed in Australia, and supplied it on a doctor’s prescription.

We didn’t stop supplying it because it was difficult to get hold of, rather it just wasn’t very useful any more.  New anti-nausea medications came on the market, and these were much more effective at controlling the nausea and vomiting associated with chemotherapy, and, a new class of medications known as antiretrovirals became available and these were so effective at treating HIV we thankfully were no longer seeing the devastating effects of the disease.

So, as the current debate over the use of marijuana for medical conditions rage and health professionals seem pitted against consumers with politicians (unhelpfully) weighing in on the subject, what are the actual issues associated with prescribing marijuana?

• Firstly, the debate over medically prescribed marijuana has been hijacked by conspiracy theorists. Those who think that the big pharma has the cure for cancer and is just not telling us, and that we get a kick out of poisoning people with cancer drugs just to keep us in business. These people will frequently make claims that marijuana cures cancer. It is at this stage that I would like to point out that cancer is not just one disease, it is hundreds of different diseases, with a couple hundred different treatment options. And, in fact, we have cured a number of cancers already, just ask Simon O’Donnell (ex-cricketer), Delta Goodrem (musician) or Lance Armstrong (disgraced cyclist).
• Secondly, well-meaning patients and patient advocates will stand up and say how effective marijuana has been at treating their condition, without acknowledging the fact that they also used or are currently still on conventional medication. This does not mean that the marijuana they have used does not have a therapeutic affect, however it does make health professionals sceptical of such claims.
• Thirdly, health professionals just simply don’t know how to effectively use marijuana properly, yet. Health professionals are giant science nerds, when given a medication they want to understand what diseases or symptoms it is helpful in treating, what the medication does, the dose and how effective it is. Unfortunately, much of this information is unclear at present.
• Fourthly, health professionals take comfort in discussing unfamiliar issues with a colleague that has experience in that area. Unfortunately there are not many health professionals with experience in the use of marijuana to chat too.
• Lastly, and rather disappointingly, health professionals commonly discuss the use of marijuana in regards to how safe it is compared to other drugs, like alcohol, or use terms in presentations like ‘flying high’. It is not helpful to refer to, or play up, recreational substance use, be that alcohol, nicotine or marijuana. Being less harmful does not necessarily make it more effective.

So does that mean I don’t think marijuana is medically useful?

Of course not! I do believe it has a place in modern medical therapy.

Based on what we know at present marijuana may be useful as a mild to moderate pain reliever (when used in conjunction with other medications), and there is also some pre-clinical data on it’s use in combination with chemotherapy in cancer.

But by far the most interesting research is on it’s affect in neurological conditions. Data on reducing the frequency of seizures in refractory epilepsy is compelling and improvements in spasticity in MS are promising.

My hope is that we can address the gaps in health professionals’ knowledge so that we can increase the confidence in using marijuana effectively. You may have noticed that I have not used the common term ‘medicinal marijuana.’ Since we do not say ‘medicinal penicillin’ or ‘medical codeine’ I do not think it is necessary here either.

Chemo@home is committed to consumers and health professionals find the information they need, visit our website to find relevant information on access, supply and evidence of use.

With knowledge comes power, so let’s take a powerful collective step in the pursuit of relevant information regarding patient treatment and care.

Julie