In the formulation of new medicine, techniques are employed which are used to determine the capacity of the chemical components of a mixture to serve specific biological or chemical purposes. The development of a pharmaceutical drug involves many stages of testing and may fall within the range of 10 to 15 years of systematic testing before the drug itself is released to market for application (Phrma 2007). Considering how long the drug approval process takes, there is a strong argument that early investigation into compounds and molecules which show any potential for effectively treating medical ailments or conditions should be employed. Both the applications of medical marijuana in treating the various symptoms associated with cancer, and the treatment of symptoms that arise due to the side effects of current cancer treatments are topics that should be considered important areas of research investigation. This suggestion arises from the fact that there already exists preliminary evidence to show value for both medical marijuana, and for cannabinoid compounds (derived from marijuana and alternatively hemp), in relation to symptoms of cancer and cancer treatments.
The focus that this article will take will be in serving as an investigative template for the need to conduct direct medical research and chemical investigation into the purposeful use of various cannabinoids to treat antiemetic symptoms (symptoms of nausea and vomiting) and additionally, appetite stimulation (Cancer 2014). In spite of developments, that have been made to treat cancer, it could be inferred that there has not been enough effort put forth to reduce the horrific symptoms that arise due to the treatments such as chemical compounds that serve to destroy cancer cells, and consequently cause such agony to cancer patients (Cancer 2014). Symptoms of nausea, vomiting, and appetite loss are factors that lead to a decline in patient metabolism and eventually lead to a wasting away of their bodies. A cancer patient must fight alongside treatments in other ways because the immune system is busy fighting infection, assisting breakdown of cancer cells via apoptosis and ensuring that the protection of healthy cells takes place. The immune system must be strong enough to be able to sustain an individual throughout the cancer treatment trials and must be sustained in part by the patient’s additional work.
The treatment of antiemetic symptoms via cannabinoids is already proven and yet not widely applied due to the legality issues surrounding marijuana. That being said, the pharmaceutical industry abuses this legality to create a medicine artificially derived from the main psychoactive component of marijuana. This artificial compound is marketed as Dronabinol or Marinol which is synthetically produced delta-9-THC (Cancer 2014). Another compound Nabilone is formed by generating a synthetic derivative of delta-9-THC (Cancer 2014). These compounds serve to treat antiemetic symptoms such as nausea and vomiting and yet, the natural compounds (marijuana and THC) remain illegal and classified as a Schedule I drug (Cancer 2014; DEA n.d.). This classification creates considerable barriers for research purposes, and because of this the research is extremely limited (yet the artificial derivates exist and are marketed!).
A review of 30 randomized preparations involving delta-9-THC with placebo in comparison to other antiemetic drugs were compared revealed that among the 1366 patients included in the review cannabinoids were found to be more effective than conventional antiemetics (Cancer 2014). The trials compared the effect of delta-9-THC in comparison to domeridone, alizapride, prochloroperazine, metoclopramide, chlorpromazine, thiethylperazine, and haloperidol (Cancer 2014). To the contrary though, cannabinoids were not found to be more effective in patients subjected to very high or very low doses of emetogenic chemotherapy (Cancer 2014). Emetogenic chemotherapy refers to chemotherapy treatments that induce vomiting (Medilexicon 2006). There is therefore preliminary reasonable grounds to investigate the potential of delta-9-THC (both natural and artificial) and derivatives, to serve as a means of reducing antiemetic symptoms in cancer patients, and potentially on a grander scale for other disease states where treatments induce antiemetic symptoms (Cancer 2014). At this point in time there is obvious purposeful application for artificial and artificially derived cannabinoid compounds in treating antiemetic symptoms, but far more effort needs to be put forth to investigate the many cannabinoid forms.
Another means of applying cannabinoids to treat symptoms of cancer (or act as cancer treatment supplementation) considers their application in appetite stimulation. It should be made clear that when referring to appetite stimulation the reference is to patients who experience weight loss and wasting due to the body succumbing to the various symptoms, and due to the constancy of antiemetic symptoms (nausea and vomiting). It should be distinguished that the goal of appetite stimulation is to help manage weight-loss in patients who may otherwise lose weight during their treatment (thus suggesting that they lack the energy to fight their ailment).
Three studies are recognized as investigating oral cannabis extract and Dronabinol for the purpose of inducing appetite stimulation. The first study investigated whether Dronabinol or Dronabinol with megestrol acetate showed any different in managing cancer-associated anorexia (Cancer 2014). The study was formed to be randomized and double-blind involving 469 adults with advanced cancer (Cancer 2014). These patients were experiencing weight loss (Cancer 2014). Patients received 2.5mg of oral THC twice daily, 800mg of megestrol orally per day or both (Cancer 2014). The results of this study suggested that megesterol alone served as a better means of appetite stimulation in which 75% of the group increased their weight by 11% compared to the THC alone group that increased appetite in 49% and increased weight in 3% over an 8-11 week period of treatment (Cancer 2014). This experiment was found to exhibit statistical significance and megesterol showed superiority as a treatment (Cancer 2014). The combined therapy did not offer improved results (Cancer 2014). These results suggest a small reason to investigate the use of cannabinoids since strong appetite stimulating properties appeared to have existed. But the more interesting component of this trial exists in one of the smaller placebo-controlled trials (Cancer 2014). This trial involved dronabinol in cancer patients and “demonstrated improved and enhanced chemosensory perception in the cannabinoid group” (Cancer 2014). These patients found that food tasted better, appetite increased, and the patients consumed a larger portion of protein in their diet than placebo recipients (Cancer 2014).
The second trial involved an examination of the safety and efficacy of appeitite stimulation by orally administered cannabis extract (2.5mg THC and 1mg cannabidiol), THC or a placebo (Cancer 2014). The treatments groups were combined with placebo groups among 243 patients who received treatment twice daily for a period of 6 weeks in length (Cancer 2014). The treatments were found to be well tolerated by the patients, but no statistically significant improvement was observed in the patient appetite or quality of life among any of the three groups during the observed period (Cancer 2014).
A third trial examined 139 patients with HIV or AIDS experiencing weight loss, but was extrapolated to compare weight loss and appetite stimulation in cancer patients (Cancer 2014). A statistically significant increase in appetite was observed after 4-6 weeks of treatment and patients receiving Dronabinol tended to show weight stabilization relative to the placebo group which continued to experience weight loss (Cancer 2014).
Collectively, these trials and early services of research should serve as very early investigations into potential treatments for antiemetic symptoms and in order to stimulate appetite. I encourage deeper investigation into topics involving the livelihood of patients experiencing symptoms of cancer or cancer treatment and I encourage doctors to take the plunge and to change the way that marijuana is viewed.
There are many modern drugs and treatments formulated by the use of plant extracts and derivatives, and with the changing legalization of cannabis, and with marijuana and cannabinoids on the doorstep of political agendas, I strongly encourage thoughtful, unbiased investigation into the livelihood of American, Canadian and collectively citizens of the world.
We encourage readers to keep an eye out for the next instalment of this investigation and together we will push forward and break the barriers of scientific inquiry regarding marijuana – one step at a time.
Cancer. (2014). Cannabis and cannabinoids: human clinical studies. National Cancer Institute and the National Institutes of Health. Accessed on April 2nd, 2015. Retrieved from http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page5
DEA. (n.d.). B. Drug fact sheet: marijuana. Drug Enforcement Administration. Accessed on April 2nd, 2015. Retrieved from http://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf
Medilexicon. (2006). Definition: emetogenic. Medilexicon. Accessed on April 26, 2015. Retrieved on http://www.medilexicon.com/medicaldictionary.php?t=28590
Phrma. (2007). Drug discovery and development: Understanding the R&D process. Innovation. Accessed on April 26, 2015. Retrieved from http://www.phrma.org/sites/default/files/pdf/rd_brochure_022307.pdf