Palliative care is one of the areas that may benefit the most from the therapeutic effects of medicinal cannabis. Cannabis is reported to have analgesic, anxiolytic, anti-emetic, anti-nausea and appetite stimulant effects as well as aid sleep. In the palliative care setting, patients are often affected by many if not all of the above conditions.
Anecdotal evidence, surveys and clinical trials investigating nausea in HIV/AIDS patients and chemotherapy induced nausea and vomiting (CINV) patients, indicate that cannabinoid medicine may assist in the control of nausea and vomiting (1 -3). Patients have been self-medicating with cannabis to help control their nausea brought on by chemotherapy for years, however, clinical trial data from large scale trials still remains relatively scarce. A trial currently running underway in NSW is investigating the effect of Tilray THC:CBD (1:1 ratio) in CINV and will hopefully provide us with some much needed data.
Cannabis has also been reported to stimulate appetite and many of us have heard of the term “the munchies”, which refers to the hunger recreational users report after taking cannabis. This has also been investigated in studies and both smoked cannabis and dronabinol (synthetic THC) have been reported to increase daily calorie intake and weight in a dose dependent manner (4). In NSW there is a trial currently ongoing that is looking at the effect of vaporized cannabis from Bedrocan on appetite stimulation in palliative care patients.
Cannabis also has analgesic properties and may be useful for cancer pain as well as non-cancer pain. Compelling work on animal models have demonstrated the existence of a biochemical link between central cannabinoid receptors, THC and pain pathways (5). Much of the human data comes from small studies with n numbers under 100 and so are difficult to interpret, however, from the evidence available cannabinoids appear to be modestly effective and safe.
Overall, the multiple effects of cannabis and its large safety profile make it an attractive therapy for palliative care patients that have poorly controlled symptoms.
- Cannabinoids As Potential Treatment for Chemotherapy-Induced Nausea and Vomiting. Rock EM, Parker LA.Front Pharmacol. 2016 Jul 26;7:221.
- Philippe Lucasa, Zach Walsh. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy 42 (2017) 30–35
- Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. Martin R Tramèr, Dawn Carroll, Fiona A Campbell, D John M Reynolds, R Andrew Moore, Henry J McQuay. BMJ 2001;323:16–21
- Haney, Gunderson, Rabkin, Hart, Vosburg, Comer and Foltin. Dronabinol and Marijuana in HIV-Positive Marijuana Smokers Caloric Intake, Mood, and Sleep. J Acquir Immune Defic Syndr Volume 45, Number 5, August 15, 2007
- Manzanares, Julian and Carrascosa. Role of the Cannabinoid System in Pain Control andTherapeutic Implications for the Management of Acute and Chronic Pain Episodes. CurrentNeuropharmacology, 2006, Bentham Science Publishers Ltd.