Cannabis is a known and effective treatment for cancer and naturopathic practitioners are exploring its benefits, especially now that Maryland’s full rollout of its medical marijuana program started this year, after passage of House Bill 881 in April, 2014. This past July is when the first dispensary opened in the state and, we at The Bodhi Clinic, where we treat a great deal of cancer patients, are excited that The Crossroads Building here in Ellicott City has opened a dispensary (greenhousewellnes.com). This is an exciting time for this herb, yet there is still much confusion and controversy over its use.
Different Cannabinoids and Their Effects
Cannabinoids are the main active constituents of the Cannabis species plants and there are at least 100 constituents. There are also about 400 non-cannabinoids compounds that also contribute to Cannabinoid’s biological activity. Cannabinoids activate receptors called CB1 and CB2 in the body, mimicking our body’ own endocannabinoids, which function to modulate mood, memory, appetite, and pain sensation. Delta-9-tetrahydrocannabinol, often simply referred to as THC, is the primary active ingredient in cannabis and its main psychoactive one. Cannabidiol, also called CBD, is one of the major secondary cannabinoids and may modulate THC. CBD has anxiolytic, antipsychotic, as well as anticonvulsive effects. Patients often confuse CBD and THC and refer to them interchangeably but they are not the same thing.
Cannabis is referring to the whole plant, whereas CBD and THC are referring to constituents (cannabinoids) of the plant, just like turmeric to curcumin or fish oil to EPA. All Cannabis species plants contain cannabinoids in the form of THC and CBD, but in varying amounts. Plants are now bred to have specific concentrations of THC and CBD molecules so their use can be customized for medicine. Hemp, for example, is a species of Cannabis that has naturally low amounts of THC, relative to CBD; hemp-derived CBD is a legal, safe product that is now sold more widely.
When patients refer to CBD, they are usually referring to hemp-derived CBD. Most of the CBD studies are still pre-clinical, meaning that they are in animals or cell models. These studies have shown a range of useful effects including anti-seizure, antioxidant, neuroprotective, anti-inflammatory, analgesic, anti-tumor, anti-psychotic, and anti-anxiety properties. The anti-tumor action may be related to its antioxidant and anti-inflammatory properties. We need more research to understand the short and long-term benefits. And to also understand what doses to give people for the different conditions, even though CBD is generally thought to be safe.
The bottom line for medical cannabis is that THC (the illegal, psychoactive component) and CBD need to be combined – the “whole plant approach” – as there is a synergy between the cannabinoids. The variances caused by different relative ratios of THC to the other cannabinoids (and other active molecules) is an active area of study to discover more areas for therapeutic use.
Medical Cannabis in Cancer Care
Medical cannabis has both THC and CBD, among other active components, and the dosage and relative ratios will depend on the patient’s symptoms and disease. When we are discussing medical cannabis in cancer care, it is necessary to point out that this could be used for symptom management and/or for anti-cancer effects. Naturopathic doctors cannot legally prescribe this herb in Maryland at this time, however this is likely to change in the coming year. Naturopathic doctors at The Bodhi Clinic are trained in herbal medicine and the safe and effective use of cannabis.
In terms of cancer care symptom management, there are human studies showing relief for chemotherapy-induced nausea/vomiting, pain, anxiety and appetite/weight loss. Cannabis has been found to benefit these conditions for patients with cancer, although the studies do generally call for additional research to illuminate differences in strains and dosing. Current qualifying medical conditions according to the Maryland Medical Cannabis Commission include: cachexia, anorexia, wasting syndrome, severe pain, severe nausea, seizures, severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder and chronic pain.
The anti-cancer and anti-tumor effects of cannabis represents newer research and we are waiting on human studies to further elucidate its effects. These cell and test-tube studies have been very exciting however research is limited in the US by its classification as a Schedule 1 drug. Naturopathic doctors at The Bodhi Clinic rely on European research for guidance with this herb, as drug-herb and nutrient-herb interactions are important to consider, especially in cancer care. Future studies will give us guidance on dosing, form, safety profile and expected outcomes. One last important note is that the medical use of this herb, for cancer or otherwise, will not involve smoking as the high heat combusts many of the medicinal ingredients and has possible implications in longer term lung damage.
If you are interested in medical cannabis, please check out the Maryland Medical Cannabis Commission mmcc.maryland.gov to get more information on how to become a patient.
By Dr. Elise Benczkowski, ND
Maryland Medical Cannabis Commission mmcc.maryland.gov
The Use of Medical Marijuana in Cancer. Shauna M. Birdsall & Timothy C. Birdsall & Lucas A. Tims. Current Oncology Reports. 2016 Jul;18(7):40. doi: 10.1007/s11912-016-0530-0.
Cannabis and Cancer: Cannabis In Context (The Thinking Patient’s Guide Series Book 1). Jonathan Treasure. Oncoherbs Press. 2016.