Cannabis as an Anti-nauseant and Appetite Stimulant
Cannabis in modern medicine is perhaps most familiar to people as an anti-nauseant or antemetic (i.e. a treatment for severe nausea and vomiting). In particular, marijuana is widely used in connection with cancer chemotherapy and radiation therapy, both of which can cause extreme nausea.
Since its introduction to modern medicine in the 19th century, cannabis has been well-known to suppress nausea and promote appetite. This usually manifests itself as the “munchies” for recreational users who are often overtaken by a heightened appetite shortly after smoking.
On the other hand, high doses of cannabis can sometimes bring about nausea. Toxic reactions like this usually result from oral overdoses in which some adventurous hashish eaters took things a little too far.
Marijuana’s use as a treatment for anorexia (loss of weight and appetite) connected to radiation and chemotherapy was recorded in the early 1970s. At that time, both chemotherapy and marijuana were emerging into widespread use. “Normal” drugs used for radiation and chemotherapy are actually quite toxic and can produce a more intense nausea than before. After administration, patients can experience hours of gut-wrenching vomiting with attendant “dry heaves” so severe that they result in broken bones. Nausea can last for days and weeks leaving patients with no appetite whatsoever. To avoid the pain and distressing nature of the therapies, some patients might simply avoid it altogether. Several drugs are available by prescription that help control the side effects of radiation medicine and chemotherapy, but they’re not always effective and can be very costly.
Many patients have noted that marijuana can relieve the misery of radiation medicine and chemotherapy much better than any other drug. Marijuana’s remarkable value was discovered serendipitously by some young radiation and chemotherapy patients who had tried it recreationally. Harvard University doctors (including Dr. Lester Grinspoon whose son, Danny, used marijuana to treat himself during cancer chemotherapy) started to take notice. A slew of research came after that showed marijuana and oral THC’s effectiveness in reducing nausea and vomiting associated with chemotherapy. By the early 1980s, interest had peaked as a number of different states started sponsoring clinical research studies of medical marijuana.
In all, smoked marijuana was shown to be an effective anti-nauseant in six different state studies: New Mexico (250 patients), NewYork (199), California (98), Tenessee (27), Georgia (119), and Michigan (165) (Randall).
In New York, New Mexico, and Tennessee, smoked marijuana had a 90% efficacy rate while Georgia and Tennessee reported 70% effectiveness. Both New Mexico and Tennessee studies determined that smoked marijuana proved superior to oral THC. Michigan patients found that smoked marijuana was preferable to Torecan, a conventional prescription anti-nauseant. Patients in New York and Tennessee found marijuana to be effective even if they had not been treated with THC.
The California study, which focused mostly on oral THC, provided the weakest evidence for marijuana among all the studies. Regardless, patients reported a 59% efficacy rate for marijuana and 57% efficacy for THC. Only 17% considered marijuana to be “highly effective” versus 30% for oral THC. Around 11% of patients dropped out of the study because of side effects like anxiety, confusion, dizziness, depression, perceptual distortion, and others. (Interestingly, “euphoria” was listed as a side effect, as if cancer patients would not have welcomed euphoric feelings).
In addition, the California study was conducted under protocols that were not geared toward producing good results. One participating researcher, oncologist Dr. Van Silverberg suggested that, “’The conditions were rigid, smoking times were prescribed; patients were not allowed to self-titrate their dose and were forced to smoke marijuana too quickly-and they could only smoke marijuana in a locked room. These restrictions seemed senseless to me. . . To smoke marijuana under the conditions established in the California state program essentially placed the patient in a hostile environment,” (Silverberg).
Of all the state studies, California’s was the only one to report that oral THC was better than smoked marijuana. Ostensibly most patients opted to take capsules instead of smoking marijuana because of a distaste for smoking itself. Many subjects had never smoked before while others complained of the harsh quality of the marijuana provided by the government. Researchers noted, “The characteristics of the NIDA cigarettes may have been a factor in discouraging further use by experienced marijuana smokers. The cigarettes, even after proper storage, were dry and gave an acrid smoke. Their potency was noticeably low (1.2%-2.8%) at a time when street marijuana was increasing greatly in potency and availability.”
In spite of smoked marijuana’s general favorability in the state studies, official policy favored synthetic THC. Along with its taboo and illegal status, marijuana was docked for being a natural plant with no real controllable doses or ingredients. Synthetic THC pills, on the other hand, could be regulated, controlled, and filled with recommended dosages. In reality, oral THC’s controllability was a fallacy seeing as how patients could not self-titrate like they could with smoked marijuana. Regardless, the Reagan administration promoted the use of oral THC, and, in 1986, the FDA approved it for cancer chemotherapy under the name of Marinol.
To this day, many patients find smoked marijuana to be a more effective treatment that the legal synthetic alternatives. Marijuana’s real efficacy can be seen when chemotherapy patients are too ill to even swallow a pill. These patients can inhale smoke much easier than they can hold down a pill. Plus, inhaled marijuana works much faster, is more controllable through self-titration, and has a low likelihood of unpleasant reactions.
Chemotherapy patients have also been exposed to two other synthetic THC relatives: nabilone and levonantrodol. Both are much less psychoactive than THC and both are really on the outside looking in when it comes to chemotherapy treatment.
A different, naturally-occurring cannabinoid known as delta-8-THC was proven to be completely effective at preventing cmoiting in children who were cancer patients. Delta-8-THC is a lot like delta-9-THC, except that it has less psychoactive potency. Researchers reported “negligible” side effects in the children treated with delta-8-THC. Unfortunately, delta-8-THC isn’t easy to come by because it only occurs in trace quantities in natural marijuana and in Marinol (albeit as a byproduct of chemical synthesis).
Despite all this, smoked cannabis has remained the major choice as an anti-emetic. Demand for Marinol has diminished while thousands of cancer patients and their physicians have turned to marijuana—not the NIDA-supplied cannabis, but high-quality, non-government grass. Some hospitals in California allow cancer patients to smoke marijuana in designated areas or use smokeless vaporizers in their rooms. The judgment of oncologists is that marijuana is an eminently useful medicine. In a survey of oncologists by Mark Kleiman and Rick Doblin at Harvard University, nearly half of all respondents said they would prescribe natural cannabis if it were legal to do so.