Wellkasa’s ™ Sumit Mehrotra met with Donald I Abrams, MD, Integrative Oncologist, to have an afternoon chat about cannabis and cancer. Dr. Abrams clarifies the differences between cannabis, marijuana, THC, CBD, and simplifies the medical research about their health benefits and risks.
What Is the Difference Between Marijuana and Cannabis?
Cannabis is the Latin name for the plant species which contains cannabis sativa and cannabis indica. The plant has 450 or 500 different chemicals—of which around 150 are called cannabinoids. The most famous cannabinoid is delta-9-tetrahydrocannabinol (THC). As the most psychoactive component of the cannabis plant, THC creates the high in users. Marijuana is best used as the name of the cannabis plant that contains THC. On the other hand, hemp refers to the plant that contains less than 0.3 % THC.
Why Do Cancer Patients Consider Using Cannabis?
Cannabis is a botanical that has been used as medicine for millennia. It has only been demonized in the United States since 1942 when it was removed from the US Pharmacopoeia. Before that, physicians could prescribe cannabis to patients. Cannabis is useful as an anti-nausea medicine, and delta-9-tetrahydrocannabinol has been approved and licensed as medications dronabinol and nabilone since 1986.
Though the main ingredient (THC) is licensed and approved for chemotherapy-induced nausea, restrictions against cannabis have led to limited data from controlled clinical trials of the plant in the published medical literature. In the United States, cannabis is considered a Schedule 1 substance, meaning there is a high potential for abuse and no accepted medical use. It is difficult to get funding for a clinical trial examining the potential therapeutic efficacy of cannabis. Still, many of Dr. Abrams’ patients have opted for cannabis instead of standard anti-nausea medications. Cannabis is the only anti-nausea medicine that increases appetite. Increased appetite is vital for cancer patients because many lose a lot of weight before their diagnosis.
Dr. Abrams believes one of the main reasons we have cannabinoid receptors throughout our brain and body is likely because we make our own endogenous cannabinoids called endocannabinoids like we make our own endorphins. Dr. Abrams believes that the whole system is in place to facilitate our response to pain. The medical literature backs this up, with many findings indicating that cannabis and cannabinoids help to decrease pain. A recent article reports that newly diagnosed cancer patients in states where medical marijuana is available have reduced their opiate use. Dr. Abrams believes cannabis and opiates can work together synergistically. Cannabis indica is known to improve sleep. Cannabis may also help cancer patients deal with anxiety or depression. However, cannabis causes some patients to become paranoid.
Cancer patients may experience loss of appetite, nausea, pain, insomnia, anxiety and depression. Doctors often must prescribe several medicines to treat these symptoms, which may cause interactions with one another or the cancer treatment itself. On the other hand, one can recommend one extremely safe botanical- cannabis! Another upside is that patients can grow the plant themselves, which can be very empowering.
Are There Scenarios Where Cannabis Use Is Concerning?
Many people are paying a lot of money for highly concentrated THC oil, cannabidiol (CBD) oil, or marijuana extracts promising to treat their cancer. Dr. Abrams does not think there is enough evidence in the scientific literature to conclude that cannabis treats or cures cancer, as many people claim. He discourages people from using cannabis as a sole cancer treatment. Dr. Abrams recommends using scientifically backed cancer treatments and warns that the highly concentrated THC oils and CBD oils can interfere with the system in the liver that breaks down pharmaceutical medications and, once they enter the bloodstream, could potentially reach levels higher than the prescribing physician intends.
Dr. Abrams encourages older people with heart disease to practice caution when using Cannabis. Cannabis can increase the heart rate and cause blood pressure to fluctuate. It can be especially problematic when people switch from sitting to standing or lying down to standing because they could become hypotensive and fall. Falls can be disastrous for older people—even fatal if they break their hip. Anybody who has had a bad reaction to cannabis in the past should also be cautious when considering using it.
Dr. Abrams believes inhalation gives people better control over the onset, depth, and duration of the effect. When people ingest cannabis orally, such as with edibles or gummies, the THC gets broken down into an even more psychoactive metabolite when it goes through the liver. Therefore, people experience a stronger high from eating cannabis than from inhaling it. The peak concentration in the plasma of the THC occurs in 2 and a half minutes when cannabis is inhaled and 2 and a half hours when cannabis is eaten.
What Do You Think of Tinctures?
Tinctures are liquids that go in one’s mouth and are held under the tongue for a few seconds before swallowing it. Some immediate absorption occurs when holding it under the tongue, reproducing oral inhalation, while swallowing it mimics oral ingestion. In this sense, it is like a hybrid of inhalation and ingestion. Dr. Abrams recommends tinctures to most of his patients.
What Do You Think of CBD?
Dr. Abrams is not a fan of cannabidiol (CBD). He believes CBD is popular because it is not “psychoactive”. However, people who claim CBD works say it decreases anxiety and helps with sleep—both of which sound psychoactive to Dr. Abrams. People really mean that CBD does not induce a high, which people fear because euphoria is looked down upon in the United States. In a recent study, patients with advanced cancer who received palliative care were given CBD or a placebo. Ultimately, CBD did nothing compared to the placebo in treating symptoms like anxiety, depression, and overall quality of life in the patients. Dr. Abrams believes one of the reasons it is in the plant is to decrease the high caused by the THC. Dr. Abrams also thinks CBD decreases some of THC’s therapeutic benefits.
Are There Other Risks of Cannabis?
Dr. Abrams points out that, unlike tobacco, cannabis use does not increase the risk of lung cancer or head/neck cancer. There is a statistical association between cannabis use and testicular cancer, but Dr. Abrams explains it is merely a statistical association rather than causation because young men are the primary users of cannabis and the demographic most likely to develop testicular cancer. While some oncologists fear that cancer patients may get fungal infections in their lungs, Dr. Abrams has not seen this in his 40 years as a San Francisco oncologist working with many patients who have inhaled cannabis. Some literature suggests some patients on checkpoint inhibitors—the new immunotherapy treatment used for cancer—have decreased response to the treatments to shrink their tumors if they use cannabis, which could impair their overall survival. Since the studies were retrospective and observational rather than prospective, randomized, placebo-controlled studies, the baseline characteristics of the patients in the trial could account for the difference in survival. Dr. Abrams notes many of the patients opting to use cannabis also had more advanced disease, which could dictate the decreased survival rather than the cannabis use itself. Dr. Abrams believes cannabis is extremely safe and quite effective, especially in relation to many of the other medications used in people with cancer.