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What’s the Best Way to Use Cannabis for Cancer Symptoms?

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 of research that showed cannabis can successfully manage cancer symptoms like nausea and neuropathic pain. With increasing ability to access 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. I don’t want people to think that it can 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?

I wouldn’t say it’s an alternative, they are more like siblings. THC and CBD are both biologically active compounds found in the cannabis plant called phytochemicals. Aside from chemical structure, the biggest difference is that THC very easily crosses your blood brain barrier causing what we call psychoactive effects. This is the high people associate with cannabis that can manifest as a pleasant euphoria and sense of relaxation with various other symptoms such as heightened sensory perception, laughter, altered perception of time, and increased appetite. This makes THC incredibly beneficial for things such as appetite stimulation and nausea relief.

While CBD does have some of those psychoactive effects, it doesn’t cross the blood brain barrier nearly as easily, making the psychoactive affects more mild. CBD’s effects are more peripheral in your body. It can have a calming effect, which can be called a body high or body relaxation.  When CBD does cross the blood brain barrier, researchers believe it may have a similar affect on the brain as SSRIs, or antidepressants by altering the levels of serotonin in the brain. For these reasons, early research around cannabis in treatment of anxiety symptoms favors CBD. CBD is also a potent anti-inflammatory, so it can be helpful in reducing pain that’s caused by inflammation. I think the biggest thing to think about is how they can work together and in what concentrations.

Where can someone safely source CBD products?

Unlike medical marijuana, which is has stringent regulatory guidelines, the CBD marketplace is driven by hemp-based products and is a much less regulated marketplace. Just because you’re getting CBD at a gas station or a natural food store does not necessarily mean it’s entirely safe. Some of the things that have begun getting mixed in with CBD that to give the impression of THC is something called kratom, which is a psychoactive component of a plant that’s grown in Southeast Asia. Kratom can cause similar, if not worse and more potent, side effects than THC. There is also a component of the cannabis plant called Delta-9 THC, which is not regulated and gets artificially concentrated and often added to CBD products. Labeling is not always great on all these products, so really read the fine print as to what is in them.

For well-produced, safe CBD there are two options. One is at a dispensary in your state: PA, New Jersey, and Delaware all have state regulated dispensaries, and these have good CBD and THC options. With the CBD market growing at such a quick rate, companies are making products with higher CBD concentrations that are very well labeled. They are also required to have good laboratory testing.

Look for products that prominently state that they have laboratory testing, have very clear labeling, and use good manufacturing practices, or GMP. High-quality products will have labels that include mention of using GMP, which is a stamp of quality in terms of the composition and manufacturing. Beware of anything that touts hundreds of milligrams of THC or other large claims as that hints at something being artificially added in.

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

It’s a little bit of both. We can generally say things that are CBD-predominant have more of an effect on pain, while products that are THC-predominant will have more of an effect on nausea or appetite. But it’s nuanced like any therapeutic that we use. With antidepressants, for example, certain ones work better for certain people because of their genetic makeup, their receptors, and pain medicines that interact with them. When I prescribe an opioid, I know that not all opioids act the same in all bodies. Seeing someone’s individual reaction matters. While you can make some generalizations with cannabis products, we know that how it actually acts will depend on each patient, and dose at which it’s effective will depend on tolerance, or whether a patient has ever used a cannabis product before.

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

The greatest risks are sedation, dizziness, rapid heart rate that we call tachycardia, or an unhealthy heart rate called an arrhythmia which are mostly related to the concentration of THC in a product. Significantly higher concentrations of THC can also cause anxiety, paranoia, or altered sensations for the time period that it’s active in your system.

The biggest thing you can do to avoid these risks is talking to a healthcare professional who can help guide you because the market now has incredibly potent products. No matter what, it is always important to pay attention to the concentration of THC in a product – looking at either milligrams if it’s oral, or percent concentration if it’s inhaled.

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

That is sort of the million-dollar question right now that we’re all trying to figure out in the research world. For each indication, the right dosing also relies on what form of cannabis you’re ingesting. So we have a very different way of thinking about dosages for something that’s inhaled versus something that is orally ingested. It is also different when you’re talking about THC versus CBD.

But the very basic guidelines that I would recommend to all people is to err on the side of having a much higher ratio of CBD than of THC. For someone new to cannabis or who is concerned about feeling ‘high’. Having a higher ratio of CBD than THC will be tolerated much better. To avoid negative side effects, it is most important to look at the amount of THC when you are a new cannabis user. And if you’re taking anything that you are ingesting orally, whether it’s a liquid, an edible food product, a concentrate, or anything that you are going to swallow or put under your tongue, a dose of THC that is somewhere between 2.5 and 5 milligrams is usually very well tolerated. If you are inhaling something, look at the percent concentration of THC and make sure that that percent of THC is below 50%. Again, the effects in patients will vary, but these are rough guidelines that work for the average patient. It is also important to keep in mind that whether you are taking CBD and THC products in combination or separate will affect the best dosage practices. While we don’t have a great understanding why, research shows that the combination of the phytochemicals in cannabis have a greater effect than one alone. If you are using a product that has both THC and CBD, a dosage you may tolerate well when the phytochemicals are isolated may have increased side effects when combined.

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

There are many forms of cannabis products that vary from inhalation methods, ingestion methods, and topical products. Topical products are applied directly to the skin and are incredibly safe. They have been shown to be helpful for pain or skin irritation as they’ve been used for psoriasis and musculoskeletal pain.

Ingestion methods are used for any cannabis product that you eat, drink, or absorb. The most commonly found products for ingestion are food products, tinctures and concentrates. Concentrates are thick, tar-like substances that are a concentrated extract from the plant and can be very potent. Tinctures are more of an oil, like an olive or sunflower oil, that can be used in many applications. Food products can vary from baked goods, hard candy products, to beverages. Then finally, they make very medicinal looking things that are pills or capsules. Any of these products are fine in terms of safety, the biggest thing is to pay attention to how much you are ingesting. For people that are new to cannabis, or who haven’t used cannabis products for quite some time, I would say stay away from the concentrates because they can be trickier, since they are more potent. I would say, go for something that is a little less potent such as an edible, tincture, or capsule. It is also important to keep in mind that something that is ingestible takes anywhere between 30 and 60 minutes to be absorbed and become active in your bloodstream. So don’t get impatient and take another dose, bite, piece, or another swig right away because that is how you can overdo it. You just have to be more patient with ingestibles.

Inhalation forms involve a range of smoking or vaporizing. These include the more familiar methods of getting the dried cannabis flower and smoking a joint, a bowl, a bong, you name it. People also have more high-tech options that involve vaporization, which uses a concentrated oil extracted from the plant and then heated but not burned so that you can inhale the vapor. There is certainly evidence that vaporization is safer than smoking, as you inhale fewer carcinogens than when the plant is burned. A lot of the long-term impacts of vaping are not fully fleshed out, but I always encourage people to vape the flower or the oil itself, which tends to be a little less harsh on the lungs or upper airway.

The other options are a little more complicated and rarely employed by people that are new to the cannabis space. There are forms that are called sugar, snap, butter, or wax which are used for what is called dabbing, another form of heating these really concentrated forms of cannabis to inhale. Again, those are the products that can be extremely potent and extremely concentrated. I would steer people away from these products, especially for those who are new to this space, because that’s where you get products that can be 80, 90, even a hundred percent THC concentration.

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

I would always encourage people to talk to anyone that is involved in your care. No matter how you want to use it, even if it’s just for relaxation, have an open dialogue with your medical provider, in order to discuss concerns about how the cannabis could interact with other medication. For example, immunotherapy works through the activation of your immune system, and we know CBD is anti-inflammatory that dampens parts of the immune system. Anything that is suppressing your immune system could possibly make your cancer therapy less effective. We certainly need more research into this question, however, which is why I recommend having a conversation with your oncologist, your primary care doctor or your pain management doctor to know what the potential risks are.

It’s also important to understand that cannabis-product providers and dispensaries are for-profit businesses and unfortunately these products are not yet covered by insurance. So, this will be an out-of-pocket cost and you can get upsold if you go in unaware. Some shops may pressure you to buy larger quantities than you anticipated, so know that you do not have to purchase hundreds of dollars of product. Only get what you want to try or what you are comfortable with, both in terms of use and budget.

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