Expert Advice on Using Cannabis Products to Alleviate the Symptoms of Cancer and Cancer Treatment

As more states have legalized recreational marijuana use, its popularity has rapidly grown. In 2019 alone, over 48 million people in the U.S. used it at least once. Its use in medicine has likewise continued to grow. Cancer symptom management is one common use, in part because research has shown that cannabis can successfully manage cancer symptoms like nausea and neuropathic pain. With increasing access to cannabis and many patients’ hesitation in using prescription opioids for pain management, it’s likely that more than 25-40% of cancer patients use some form of cannabis to manage symptoms today.

For these reasons, marijuana may be a safer option for symptom palliation for many patients. To learn more about the benefits, risks, and advice on consumption, we spoke to Brooke Worster, MD, director of the division of supportive oncology as well as the program director for the Medical Cannabis Science and Business certificate program. She focuses on cancer pain management and cannabis research.

What are some of the benefits of cannabis for cancer patients?

Cannabis is a supportive tool to manage the symptoms of cancer or side effects of treatment. It’s important to note that it cannot treat cancer, but it is incredibly helpful for a lot of the side effects that come with cancer and cancer treatment. Pain, loss of appetite, nausea, and sleep problems can all be improved by cannabis in some patients.

What is the difference between THC and CBD? Is CBD a good alternative for those who do not have access or do not feel comfortable with THC products?

THC and CBD are both biologically active compounds found in the cannabis plant called phytochemicals. Aside from their chemical structure, the biggest difference is that THC very easily crosses your blood-brain barrier causing psychoactive effects. This is the high people associate with cannabis, manifesting as pleasant euphoria and relaxation, heightened sensory perception, laughter, altered perception of time, and increased appetite. THC is beneficial for things such as appetite stimulation and nausea relief.

CBD, while it does have some psychoactive effects, does not cross the blood-brain barrier nearly as easily, making its effects milder and more peripheral in the body. CBD can have a calming effect, often referred to as a body high or body relaxation. Researchers believe it may have a similar effect on the brain as SSRIs (antidepressants) by altering serotonin levels. Early research around cannabis in the treatment of anxiety symptoms favors CBD. Additionally, CBD is a potent anti-inflammatory, helpful in reducing pain caused by inflammation. The key is understanding how THC and CBD can work together and in what concentrations.

Where can someone safely source CBD products?

Unlike medical marijuana, which has stringent regulatory guidelines, the CBD marketplace is driven by hemp-based products and is much less regulated. Just because you’re getting CBD at a gas station or a natural food store does not necessarily mean it’s entirely safe. Some products might contain kratom, a psychoactive component that can cause potent side effects, or artificially concentrated Delta-9 THC. It’s important to read labels carefully.

For well-produced, safe CBD, there are two options. One is to visit a state-regulated dispensary. States like Pennsylvania, New Jersey, and Delaware have dispensaries that offer good CBD and THC options. Look for products that prominently state they have undergone laboratory testing, have clear labeling, and use good manufacturing practices (GMP). High-quality products will mention GMP on their labels, ensuring quality in composition and manufacturing. Beware of products that make grand claims, as these might contain artificially added components.

Do the strains of cannabis matter for cancer treatment? Are there generalizable differences or do they depend on the individual?

It’s a bit of both. Generally, CBD-predominant products have more of an effect on pain, while THC-predominant products are more effective for nausea or appetite stimulation. However, individual reactions matter. Just like with other medications, certain cannabis strains may work better for some people due to their genetic makeup, receptors, and other factors. It’s important to consider each patient’s reaction and tolerance when determining effective dosages.

What are the greatest risks with using cannabis for symptom alleviation and what can patients do to minimize that risk?

The greatest risks include sedation, dizziness, rapid heart rate (tachycardia), and arrhythmia, mostly related to the concentration of THC in a product. Higher concentrations of THC can also cause anxiety, paranoia, or altered sensations.

To minimize risks, consult a healthcare professional who can guide you. Pay attention to the concentration of THC in a product, whether in milligrams for oral consumption or percent concentration for inhalation.

What is an ideal dose for cannabis products, especially for those who do not have any experience with them?

Determining the ideal dose is complex and depends on the form of cannabis ingested. Basic guidelines recommend erring on the side of a higher ratio of CBD to THC for new users or those concerned about feeling high. For oral consumption, a dose of THC between 2.5 and 5 milligrams is usually well tolerated. For inhalation, ensure the THC concentration is below 50%. These are general guidelines, and individual effects may vary.

What are the different methods for using cannabis products? Are there methods that should be avoided or might carry more risk?

Cannabis products vary in form: topical products, ingestion methods, and inhalation methods. Topical products, applied directly to the skin, are very safe and effective for pain or skin irritation.

Ingestion methods include food products, tinctures, concentrates, and capsules. These are safe, but it’s important to be cautious with dosage, especially with concentrates, which are very potent. Ingestibles take 30-60 minutes to take effect, so patience is key to avoid overconsumption.

Inhalation methods include smoking and vaporizing. Vaporization is considered safer than smoking as it involves fewer carcinogens. New users should avoid highly concentrated forms like sugar, snap, butter, or wax, which are used for dabbing and can be extremely potent.

Is there anything else patients should know before including cannabis in their cancer treatment?

Always have an open dialogue with your healthcare provider about using cannabis, even for relaxation. Discuss potential interactions with other medications, especially if you’re undergoing treatments like immunotherapy.

It’s also important to be aware that cannabis products are not covered by insurance, making them an out-of-pocket expense. Be mindful of upselling at dispensaries and purchase only what you need or are comfortable with.

By being informed and consulting healthcare professionals, patients can safely explore the benefits of cannabis in alleviating the symptoms of cancer and its treatment.

The information provided in this blog is for educational purposes only and should not be taken as medical advice. Always consult with a healthcare professional before beginning any new treatment or making changes to your current treatment plan.