Medical Marijuana For People With Cancer Essay
This article questions the use of medical marijuana for children with cancer. “Experts at the University of California’s Center for Medical Cannabis Research cautions that effects of the drug on a child’s development is unknown” (Szalavitz). The article compares marijuana to opioids. Opioid drugs are used to suppress pain, examples include morphine and Oxycontin. Opioids can lead to addiction and can cause nausea and vomiting. The article also notes that the effect of opioids on child development is unknown. Marijuana on the other hand, suppresses pain and addiction rates are lower than for opioids. In addition to lower addiction rates, physical withdrawal symptoms are not seen in those who are addicted to opioids. Medical Marijuana For People With Cancer Essay.Opioids are legal in the U.S. whereas medical marijuana is legal in only 19 states. The argument is that while opioids and marijuana have unknown effects of child development, why is one legal and the other illegal?
The article includes the story of Mykayla Comstock, a 7-year old girl battling acute lymphoblastic leukemia. Mykayla’s mother, Erin Purchase, decided to give her cannabis oil in the form of the pill when chemotherapy response was poor. She has done research on marijuana’s effect on cancer cells and believes it is what caused Mykayla to go into remission. Even though medical marijuana use is legal in Mykayla’s state, Oregon, her doctors advised against it for the reason of not knowing how it could affect her development. Treatment for cancer pain and nausea already exist, but it is recognized by the Institute of Medicine (IOM) that some people do not respond well to those treatments and believe that marijuana can be helpful. Although there is no sufficient research to determine the effects on a child’s development, the Institute of Medicine (IOM) has decided that more studies of medicinal marijuana are needed.
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I think marijuana should be legalized strictly for medicinal use. If marijuana provides the same function as opioids but with less side effects, than I do not see a reason to ban marijuana. It should also be noted that some existing treatment to suppress pain does not always help the patient. As stated in the article, marijuana can be an alternative to those who do not respond to opioid drugs. The side effects that can occur while taking opioid drugs can cause you to take other drugs to counter those side effects. This happens often and people are paying more for extra medication. Marijuana can do the job of opioid drugs without side effects and can essentially save the individual and insurance companies a lot of money. Medical Marijuana For People With Cancer Essay.
This issue impacts the cost aspect of health care in a very dramatic way. If marijuana was legalized for medical use all over the United States, pharmaceutical companies would lose millions or even billions of dollars because people would be able to grow their own marijuana. The only other problem would be distribution and those using it recreationally instead of medicinally. In contrast, pharmaceutical companies could also make a lot of money selling medical marijuana to those in need. If it is controlled by pharmaceutical companies there would be controlled distribution ensuring that only those who have prescription can buy it.
Approximately 30 percent of all Americans will develop cancer in their lifetimes. Although two-thirds will eventually die as a result, many will live with cancer for years beforehand. For this reason, researchers not only seek medicines to prevent and cure the disease but also drugs to make life more comfortable for people with cancer.
Is marijuana such a medicine? Several patients and their relatives—many of whom had no prior experience with the drug—have claimed that it is. They include this woman, an author of a 1992 medical marijuana proposal that served as the basis for California’s Proposition 215 (see Chapter 11). At the time she was a member of the California Senior Legislature, an elected body that represents the interests of older Californians. Although she herself has never used the drug, she was convinced to take action by her husband’s experience, which she described to the IOM team:
He started chemo. He was ill. He was sicker from the chemo than he was from the cancer, because he wasn’t even aware how bad the cancer was. It was not only in the lung; it was in the liver and pancreas. He was given three months.
The oncologist agreed [that] he could use marijuana. I had to do the back alley bit to get some. The first I got wasn’t that effective. When I mentioned it to someone, I got a better grade [of mari juana]. Two puffs and my husband would go for chemotherapy with a smile and come home happy. He didn’t [need to smoke it] again until the next day.
This man died of his cancer but, according to his wife, using marijuana—a drug he would never have tried otherwise—made his last months bearable. Medical Marijuana For People With Cancer Essay.
People with cancer who use marijuana say that it benefits them in several ways: by quelling nausea, suppressing vomiting, increasing appetite, relieving pain, and soothing anxiety. Clinical studies indicate that marijuana does none of these things as well as the best medications available, but marijuana has the apparent advantage of treating several symptoms simultaneously. Medicines based on certain chemicals in marijuana could also be used to complement standard medications or to treat patients for whom such therapies have failed.
Considerable clinical evidence indicates that marijuana could yield a variety of useful medicines, especially for nausea, vomiting, and appetite stimulation. THC, in the form of Marinol (dronabinol), has already been used for more than a decade to treat these symptoms in cancer patients and for several years in AIDS patients as well. But other cannabinoids, or combinations of cannabinoids, may prove to be more effective than THC alone. If so, any pharmaceuticals that result from such discoveries could benefit people with AIDS as well as those living with cancer.
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING
Nausea and vomiting occur when one of several sensory centers, which are located in the brain and the digestive tract, becomes stimulated (see Figure 6.1). It is possible to become nauseous without vomiting or to vomit without feeling nauseous beforehand. Vomiting (also called emesis) involves a complex co-ordination of the digestive tract, respiratory muscles, and posture. Because all of these actions can be readily measured, scientists have been able to reconstruct the chain of physiological events that lead to vomiting.
FIGURE 6.1
Emesis pathways. Signals travel to the brain’s emesis center, which triggers vomiting, through a variety of routes. Each of these pathways represents a potential site of action for anti-vomiting medications. (Adapted from Bruton LL The Pharmacological (more…)
Conversely, little is known about the actual mechanisms that trigger nausea, which appears to result from brain activity alone. Since nausea lacks any observable action, researchers studying its origins rely on patients’ subjective descriptions of their own feelings. As a result of these limitations, most clinical research aimed at relieving the side effects of chemotherapy focuses on the ability of candidate compounds to prevent or curtail vomiting. Medical Marijuana For People With Cancer Essay.
Although researchers do not completely understand how chemotherapy agents cause vomiting, they suspect that the drugs or their digestive byproducts stimulate receptors in key sensory cells. Some agents, including cisplatin, cause nearly every patient to vomit repeatedly; others, such as methotrexate, produce this effect in a small minority of chemotherapy patients. Vomiting may begin within a few minutes of treatment, as is the case with the drug mustine, or up to an hour after chemotherapy, as occurs with cisplatin. Most clinical trials of antiemetics—medicines that prevent vomiting—tend to be conducted on patients being treated with cisplatin, because drugs that decrease vomiting following cisplatin treatment are likely to work at least as well as other chemotherapy agents.
Researchers have tested several cannabinoids for their ability to suppress vomiting, including two forms of THC (delta-9 and the less abundant delta-8-THC). Two synthetic cannabinoids (nabilone and levonantradol) that activate the same receptors as THC have also been examined as potential antiemetics. All four compounds have proven mildly effective in preventing vomiting following cancer chemotherapy, as will be described. Two additional clinical studies, also to be discussed, provide evidence that, to a limited extent, smoking marijuana helps suppress chemotherapy-induced emesis.
In clinical comparisons THC tended to reduce chemotherapy-induced vomiting better than a placebo. But few trials have used the same chemotherapy agent among all patients, and some contain substantial flaws. Medical Marijuana For People With Cancer Essay.For example, one trial tested THC’s effectiveness in patients who received methothrexate—a drug that only occasionally causes vomiting.1 Some experiments compared the efficacy of THC with prochlorperazine (Compazine), one of the most effective antiemetics available in the 1980s, and found that they were similar. With the advent of more effective medications, such as ondansetron (Zofran) and granisetron (Kytril), both serotonin antagonists, these results carry little weight. Even when administered together, THC and prochlorperazine failed to stop vomiting in two-thirds of patients.2
In one particularly well designed study, researchers compared THC with metoclopramide (sold in the United States under various brand names, including Clopra, Maxolon, Octamide PFS, Reclomide, and Reglan), an effective and widely used antiemetic. None of the patients in this study had previously received chemotherapy, so there was no danger that they would vomit simply because they had become conditioned to do so—a reaction that often occurs in people who have undergone several rounds of chemotherapy. Every patient in this study received the same dose of cisplatin; participants were also randomly assigned to receive either THC or metoclopramide. Seventy-three percent of the patients who received THC vomited at least twice following chemotherapy, compared with only 27 percent of the patients who received metoclopramide.3
Several additional but less rigorous studies reached similar conclusions: that THC reduces vomiting following chemotherapy, but is not particularly effective in doing so. Nevertheless, the U.S. Food and Drug Administration has approved the drug, in the form of Marinol, for use when chemotherapy-induced nausea and vomiting are not relieved by other antiemetic medications.
Participants in clinical trials of THC have reported several unpleasant side effects, including dry mouth, low blood pressure, sedation, and mood changes. Patients who had no prior experience with marijuana or related drugs were more likely to report psychological discomfort after taking it than those who had tried marijuana previously. On the other hand, advocates of marijuana use for medical purposes maintain that, when such patients receive prior guidance on marijuana’s effects, they rarely experience adverse psychological reactions upon using the drug for the first time. Although this claim has not been objectively tested, it may apply equally to the effects of THC, the main psychoactive component in marijuana. Medical Marijuana For People With Cancer Essay.
In some clinical trials of THC for antiemesis, patients who underwent the most dramatic mood changes tended to vomit least; other trials found no correlation between THC’s psychoactive and antiemetic effects. If they are linked, however, it may be possible to separate the two effects by creating synthetic analogs of the THC molecule. Researchers have found that 11-OH-THC—a breakdown product of THC that forms in the body—is a weaker antiemetic than THC but causes stronger psychological reactions. Perhaps, then, scientists could make additional chemical alterations to the THC molecule to create a chemical analog that controls vomiting better and is less psychoactive than THC.
In fact, such a compound may already exist naturally. Delta-8-THC is a less potent variant of delta-9-THC, the primary psychoactive ingredient in marijuana. In a study of eight children, ages three to 13, delta-8-THC was found to completely block their chemotherapy-induced vomiting. The only side effect reported was irritability in the two youngest children (ages three and one-half and four years).4
Of the existing chemical analogs of THC, two have been tested in chemotherapy trials.5 Nabilone (marketed in the United Kingdom as Cesamet) and levonantradol, neither of which is approved for sale in the United States, fared similarly to THC in these studies. Both were found to be somewhat effective in preventing vomiting following chemotherapy but not as effective as other antiemetics already on the market. Medical Marijuana For People With Cancer Essay.
Although many medical marijuana users claim that smoked marijuana controls nausea and vomiting better than oral THC, no rigorous studies that support this contention have yet been published. In a study that directly compared smoked marijuana with THC, researchers found that both prevented vomiting to a similar degree. Only one in four people in this study of 20 patients achieved complete control of chemotherapy-induced vomiting with either drug.6 Each underwent chemotherapy twice during the trial. During one session, patients smoked a marijuana cigarette and swallowed a placebo pill; at the other session they smoked a placebo cigarette and took a pill containing THC. Patients received the experimental treatments in random order, so approximately half tried marijuana before THC, while the others tried the drugs in the opposite sequence. When asked which form of treatment they preferred, 35 percent of the patients said they favored THC pills, 20 percent chose marijuana, and 45 percent had no preference.
Another preliminary study tested smoked marijuana in cancer patients who were not helped by conventional antiemetic drugs; however, serotonin antagonists—currently considered the most effective antiemetics—were not yet available in 1988 when this study was conducted.7 Nearly 80 percent of the 56 participants rated marijuana as “moderately effective” or “highly effective,” compared with other antiemetics they had previously used. Since this group of patients varied greatly in terms of their chemotheraputic regimen as well as with regard to their prior experience with marijuana, these results must be considered approximate at best.
Nevertheless, it does make sense that inhaling THC in the form of smoked marijuana would prevent vomiting better than swallowing a pill. If vomiting were severe or began immediately after chemotherapy, oral THC could not stay down long enough to take effect. Smoking also allows patients to take only the drug they want, one puff at a time, thus reducing their risk of unwanted side effects. But the long-term harms of smoking outweigh its benefits for all but the terminally ill, the IOM team concluded. Medical Marijuana For People With Cancer Essay. Instead, they recommended the development and testing of a rapidonset method of delivering THC, such as an inhaler. Similar devices are now used to administer medicine for asthma and other respiratory disorders and are being developed to deliver pain medication.
MALNUTRITION
Wasting and appetite loss affect most cancer patients. At best these conditions diminish quality of life; at worst they hasten death. Depending on the type of cancer, 50 to 80 percent of patients will develop cachexia, a disproportionate loss of lean body tissue. Cachexia occurs most often during the final stages of advanced pancreatic, lung, and prostate cancers. Proteins called cytokines, produced by the immune system in response to the tumor, appear to stimulate this wasting process.
Cachexia also occurs as a result of HIV infection (see Chapter 5), and both cancer and AIDS patients currently receive similar treatments for the condition. Standard therapies for cachexia include intravenous or tube feeding as well as treatment with megestrol acetate (Megace), an appetite stimulant. If the latter causes patients to gain weight, however, it is mostly in the form of fat—not the lean tissue they would have lost through cachexia.
Marijuana is renowned for its ability to stimulate the appetite, otherwise known as “having the munchies. Medical Marijuana For People With Cancer Essay. This effect is due in large part to the action of THC, which has been confirmed in several studies.8 For example, cancer patients who took THC in the form of dronabinol tended to experience a slowing of weight loss and an increase in appetite.9 A study of AIDS patients, however, indicated that megestrol acetate stimulated weight gain more effectively than THC; when used in combination, the two drugs failed to augment each other’s effects.10
Both megestrol acetate and dronabinol produce troublesome side effects in some patients. The former can cause hyperglycemia and hypertension; the latter can cause dizziness and lethargy. Because of these drawbacks, medical researchers are pursuing better treatments for cachexia. One promising class of compounds includes agents that can block the actions of the cytokines that promote wasting. Some patients might benefit from a combination therapy consisting of a cytokine blocker along with THC, to stimulate appetite and also, perhaps, to reduce nausea, pain (see Chapter 4), and anxiety. Medical Marijuana For People With Cancer Essay.
