Running head: THROUGH THE HAZE
Through the Haze:
Medicinal Cannabis Properties for Chemotherapy Patients
Phi David Hoang, Helen Jang, John Rhee,
Noel Kwok, & Tara Hooley
San Francisco State University
DFM 655 - Nutrition Education and Communication
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Introduction
Complementary alternative medicine is defined as using non-mainstream health systems
as opposed to conventional medicine ("Complementary, alternative, or," 2014). One ancient form
of plant medicine is the cannabis plant, otherwise known as marijuana. Modern use of medical
cannabis is generally used to provide pain relief and stimulate appetite for patients with cancer
and immune disorders. Over the past seventy years, there has been legal conflicts over the use of
medical marijuana with the passing of both the Marijuana Tax Law of 1937 and the Controlled
Substance Act of 1970. Currently, twenty-three states have legalized medical marijuana use.
Despite this, cannabis is still listed as a Schedule I substance, a substance not accepted for
medicinal use and has the potential of abuse ("Regulatory Information," 2009). However, each
decade there have been concerted efforts to repeal these acts. Dietitians are not encouraged to
advise marijuana usage; however, with further research being carried out to ascertain
effectiveness, perspectives on how we implement medical marijuana could change the future of
medical-care.
History and Description
Earliest findings of cannabis originate approximately five thousand years ago in China. It
was later incorporated into medical practice into most of the Western world. In America, there
was a social stigma suggesting cannabis usage with alcohol consumption were closely related;
therefore, congress passed the Marijuana act of 1937 stating all cannabis would be illegal, and
sales of medical cannabis from physicians would be taxed. This caused a decline in the use of
medical marijuana.
The focus of medical marijuana is on the phytocannabinoid constituent, trans-delta-9tetrahydrocannabinol (THC) which causes popular benefits such as: reduction of neuropathic
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pain, nausea and vomiting, increased ocular blood flow which helps with glaucoma, epileptic
episodes, improvement of muscle stiffness, suppression of autoimmune disease, and prevention
of cancerous tumors (Grant, Atkinson, Gouaux & Wilsey, 2012). Usage of medical marijuana
includes ingestion through pills, eating, smoking, sublingually, or inhalation through vapors.
Historical Usage
The first recorded medicinal use of cannabis was by Emperor Shen-nung of China, in
around 2,727 B.C. (Mikuriya, 1969). Dosage for medicinal usage at the time was not recorded.
However, there are records of the methods of usage indicating cannabis extracts were applied
topically, or consumed with foods (Mikuriya, 1969). Another popular of usage recorded later in
the nineteenth century was smoking. Cannabis became widely accepted by western medical
practitioners for treatment of burns however; its usage declined around the turn of the twentieth
century, as other method medicines were proven to be more effective. Until the 1930’s, cannabis
was readily available as an over-the-counter prescription as cannabis extract medicine (Mikuriya,
1969). Afterward, cannabis gradually lost its reputation for medicinal use and was criminalized
by many countries.
Modern Usage
Nowadays, medical marijuana is available in pill form such as Dronabinol and Nabilone
in which THC works as an antiemetic (Le Foll, 2010). Both are FDA approved medications used
to treat nausea and vomiting and stimulate appetite for cancer patients receiving chemotherapy
(Zanni, 2013). Nabilone is typically administered a starting dose of 1 to 2 mg twice a day and
effects can last from eight to twelve hours. The first dosage is usually given one to three hours
prior to chemotherapy, and then subsequent doses every two to four hours after treatment.
Dronabinol is usually presented in the form of a capsule containing 2.5mg, 5mg or 10mg of
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THC. The maximum recommended dosage to alleviate nausea and vomiting from chemotherapy
is 5 to 15 mg/m2, without exceeding four to six doses per day (Amar, 2006). The initial dose is 5
mg/m2 per day (Marinol, 2004). However, the dose may be increased by 2.5mg/m2 increments to
a maximum of 15 mg/m2 depending on patient’s reaction to the dose and its side effects.
Regardless, the drug can have an effect on the patient up to four to six hours long.
Effectiveness and Efficacy
The most unpleasant aspect of chemotherapy is induced nausea and vomiting, affecting
70-80% of cancer patients (Ware, Daeninck, & Maida, 2008). The interaction between Nabilone
and cannabinoid receptor 1 (CB1), a ligand, produces an antiemetic effect. Usually,
neurotransmitters are released from the axon terminal of presynaptic neuron to the postsynaptic
neuron. Exogenous cannabinoids, THC, and endocannabinoids like anandamide, created in the
postsynaptic region, have an affinity for CB1, located in the presynaptic neuron. This creates a
“reverse signaling process”, reuptake of cannabinoids back to the presynaptic neuron (Kovacs et
al., 2012). This activation of CB1 receptors by cannabinoids produces antiemetic effects by
decreasing neurotransmitters responsible for nausea and vomiting (Croxford, 2003). A study
with severe chemotherapy-induced nausea and vomiting (CINV) patients taking Nabilone
showed 77% had reduction in nausea and vomiting with more than half of the patients also
reporting “excellent condition” for resolution of CINV, and half had an increased appetite (Ware,
Daeninck, & Maida, 2008). Other crossover studies have shown patients preferred cannabinoids
as an antiemetic for future chemotherapy treatments over conventional medications (Machado,
Stéfano, De Cássia Haiek, Rosa Oliveira, & Da Silveira, 2008).
Nutrition Facts
Medical marijuana is rarely consumed for its nutritional content; however, the leaves of
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the plant actually contain a complex phytochemistry of over 480 compounds and are a source of
fiber in the form of lignans (Flores-Sanchez, & Verpoorte, 2008). Cannabis does not have any
psychoactive effect until it is heated, so can be consumed safely without altering the conscious
state (Russo, et al., 2008). Several primary metabolites have been identified, including amino and
fatty acids (Wang, Tang, Chen, & Yang, 2009). Analysis of the leaves indicates variations in
biosynthesis of these metabolites depending on growth conditions of the plant, age, and tissue
type (Flores-Sanchez & Verpoorte, 2008). Secondary metabolites including flavonoids are also
present in cannabis leaves. Flavonoids have no primary function for the plant, but provide high
levels of antioxidants, beneficial for human health (Kumar, & Pandey 2013).
An increasingly popular way of utilizing these nutritional benefits is through
consumption of hemp, derived from the same plant as cannabis. The main difference between the
two is marijuana’s higher content of THC. Hemp oil, often referred to as cannabis oil, is sold and
consumed legally when stripped of its THC. Cannabis oil is considered one of the most
nutritionally dense vegetable oils available, due to a high content of vitamin E, B vitamins, and
all nine essential amino acids (Vahanvaty, 2009). Cannabis oil also contains high levels of fatty
acids, the most abundant being polyunsaturated omega-6 linoleic (55%), omega-3 α-linolenic
(16%), and omega-9 oleic (11%) (Montserrat-de la Paz, 2014). Hemp is also readily available as
nutrient dense seeds with around 11g protein and 2g α-linolenic acids per two tablespoons,
making hemp an ideal choice for chemotherapy patients with cachexia (Vahanvaty, 2009).
Drug Interactions and Side Effects
Inhalation of cannabis can lead to rapid and predictable signs and symptoms. Ingesting
cannabis orally can produce slower, less predictable effects (Grant et al., 2012). Euphoria,
relaxation, and sleepiness are common effects of using cannabis. As dosage increases, so do the
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effects, including adverse effects. At low dosage, common side effects can include dry mouth,
momentary memory loss, increased heart rate, perception and motor skills impairment, and
blood-shot eyes (Marijuana intoxication, 2014). At higher dosage or with new users, more
serious side effects such as paranoia, panic, or even severe psychosis can occur. It is in the best
interest of the patient to be closely monitored for these side effects when taking these drugs. The
dose-dependent characteristic of cannabis can also cause short-term withdrawal syndrome. A low
dose of THC, 10 mg, will have withdrawal syndrome that usually lasts 48 to 72 hours. At higher
doses, 20-30 mg, abstinence syndrome can develop causing irritability, anxiety, restlessness,
insomnia, and poor appetite (Grant et al., 2012).
Discussion
The growing popularity of marijuana usage in modern society has resulted in numerous
research studies for its medical application. Studies continue to show that marijuana’s medicinal
properties can have a legitimate place in modern healthcare. However, its health and
psychological effects remains the subject of much debate. Due to concerns of negative side
effects and opinions on the legality of marijuana, it is difficult to implement a potentially useful
drug into a patient care plan without moral and legal conflict.
Recommendations for using medical marijuana as an alternative medicine, should only be
issued by legally qualified professionals. The Academy of Nutrition and Dietetics currently has
no positional stance on the usage of medical marijuana. In states where it is not decriminalized,
dietitians should not advise marijuana usage to patients. However, dietitians are not legally
required to report patients who are using marijuana and can prescribe nutritional therapy around
their usage without any legal repercussions (Academy Position Papers, 2014). For dietitians,
their primary focus is on helping chemotherapy patients or other patients receiving intensive
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medical treatments, to maintain their body weight and prevent the vicious cycle of malnutrition.
Evidence suggests that by alleviating nausea for these patients, marijuana does help to improve
health status.
Conclusion
The use of medical marijuana across America is proving to be an effective way to help
alleviate the side effects of chemotherapy by reducing nausea and vomiting and also stimulating
appetite in patients. Medicinal use of marijuana is seen in countries like the Netherlands, Spain,
and Uruguay as well as other countries where marijuana is both legal and decriminalized. The
majority of other countries such as Australia and about all the countries in Asia however, remain
skeptical and are yet to decriminalize marijuana or utilize it for medicinal use. The vast medical
benefits of marijuana should not be disregarded due to stigmatic and rash legislation. As
perspectives continue to change, marijuana’s slow integration into the modern medical system
can only be legitimized through further research and government legislation. Prescription of
marijuana should not be limited due to poor understanding or bad legislation. Both risks and
benefits of medical marijuana should be assessed adequately in order to maintain an
unprejudiced stance. Patient health should be the priority; therefore, medical marijuana need to
be further researched with due diligence.
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