Q & A about Cannabis and Cannabinoids

June 27, 2021 / by / in HHC

Source: National Cancer Institute

Back to basics

  • Cannabis, also known as marijuana, is a plant grown in many parts of the world. It makes a resin (thick substance) that contains compounds called cannabinoids.
  • By federal law, possessing Cannabis is illegal in the United States outside of approved research settings. However, a growing number of states, territories, and the District of Columbia have passed laws to legalize medical marijuana.
  • Cannabinoids are chemicals in Cannabis that cause drug-like effects throughout the body, including the central nervous system and the immune system.
  • The main psychoactive cannabinoid in Cannabis is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain, lower inflammation, and decrease anxiety without causing the “high” of delta-9-THC.
  • Cannabinoids can be taken by mouth, inhaled, or sprayed under the tongue.
  • Cannabis and cannabinoids have been studied for relief of pain, nausea and vomiting, anxiety, and loss of appetite caused by cancer or the side effects of cancer therapies.
  • Two cannabinoid drugs (dronabinol and nabilone) are approved by the U.S. Food and Drug Administration (FDA) for the prevention or treatment of nausea and vomiting caused by chemotherapy.
  • The FDA has not approved Cannabis or cannabinoids for use as a cancer treatment.

Questions and Answers About Cannabis

  1. What is Cannabis?

    Cannabis, also known as marijuana, is a plant first grown in Central Asia that is now grown in many parts of the world. The Cannabis plant makes a resin (thick substance) that contains compounds called cannabinoids. Some cannabinoids are psychoactive (affecting your mind or mood). In the United States, Cannabis is a controlled substance and has been classified as a Schedule I agent (a drug with a high potential for abuse and no accepted medical use).

    Hemp is a mixture of the Cannabis plant with very low levels of psychoactive compounds. Hemp oil or cannabidiol (CBD) are products made from extracts of industrial hemp, while hemp seed oil is an edible fatty oil that contains only scant or no cannabinoids. Hemp is not a controlled substance, but CBD is.

    See the General Information section of the health professional version of the Cannabis and Cannabinoids summary for more information on medicinal Cannabis products.

    Clinical trials that study Cannabis for cancer treatment are limited. To do clinical trials research with plant-derived Cannabis in the United States, researchers must file an Investigational New Drug (IND) application with the FDA, have a Schedule I license from the U.S. Drug Enforcement Administration, and have approval from the National Institute on Drug Abuse.

    By federal law, possessing Cannabis (marijuana) is illegal in the United States unless it is used in approved research settings. However, a growing number of states, territories, and the District of Columbia have passed laws to legalize medical marijuana. (See Question 3).

  2. What are cannabinoids?

    Cannabinoids, also known as phytocannabinoids, are chemicals in Cannabis that cause drug-like effects in the body, including the central nervous system and the immune system. Over 100 cannabinoids have been found in Cannabis. The main psychoactive cannabinoid in Cannabis is delta-9-THC. Another active cannabinoid is cannabidiol (CBD).

    Cannabinoids may help treat the side effects of cancer and cancer treatment.

  3. If Cannabis is illegal, how do some cancer patients in the United States use it?

    Although federal law prohibits the use of Cannabis, the map below shows the states and territories that have legalized Cannabis for medical purposes. Some other states have legalized only one ingredient in Cannabis, such as cannabidiol (CBD), and these states are not included in the map. Medical marijuana laws vary from state to state.

    ENLARGEA map showing the U.S. states and territories that have approved the medical use of Cannabis.
    A map showing the U.S. states and territories that have approved the medical use of Cannabis.

     

  4. How is Cannabis given or taken?

    Cannabis may be taken by mouth (in baked products or as an herbal tea) or may be inhaled. When taken by mouth, the main psychoactive ingredient in Cannabis (delta-9-THC) is processed by the liver and changed into a different psychoactive chemical (11-OH-THC).

    When Cannabis is smoked and inhaled, cannabinoids quickly enter the bloodstream. The psychoactive chemical (11-OH-THC) is made in smaller amounts than when taken by mouth.

    A growing number of clinical trials are studying a medicine made from an extract of Cannabis that contains specific amounts of cannabinoids. This medicine is sprayed under the tongue.

  5. Have any laboratory or animal studies been done using Cannabis or cannabinoids?

    In laboratory studies, tumor cells are used to test a substance to find out if it is likely to have any anticancer effects. In animal studies, tests are done to see if a drug, procedure, or treatment is safe and effective in animals. Laboratory and animal studies are done before a substance is tested in people.

    Laboratory and animal studies have tested the effects of cannabinoids in laboratory experiments. See the Laboratory/Animal/Preclinical Studies section of the health professional version of Cannabis and Cannabinoids for information on laboratory and animal studies done using cannabinoids.

  6. Have any studies of Cannabis or cannabinoids been done in people?

    No ongoing studies of Cannabis as a treatment for cancer in people have been found in the CAM on PubMed database maintained by the National Institutes of Health.

    Small studies have been done, but the results have not been reported or suggest a need for larger studies.

    Cannabis and cannabinoids have been studied as ways to manage side effects of cancer and cancer therapies.

    Nausea and vomiting

    Cannabis and cannabinoids have been studied in the treatment of nausea and vomiting caused by cancer or cancer treatment:

    • Delta-9-THC taken by mouth: Two cannabinoid drugs, dronabinol and nabilone, approved by the U.S. Food and Drug Administration (FDA), are given to treat nausea and vomiting caused by chemotherapy in patients who have not responded to standard antiemetic therapy. Clinical trials have shown that both dronabinol and nabilone work as well as or better than other drugs to relieve nausea and vomiting.
    • Oral spray with delta-9-THC and CBD: Nabiximols, a Cannabis extract given as a mouth spray, was shown in a small randomized, placebo-controlled, double-blinded clinical trial in Spain to treat nausea and vomiting caused by chemotherapy.
    • Inhaled Cannabis: Ten small trials have studied inhaled Cannabis for the treatment of nausea and vomiting caused by chemotherapy.

    Newer drugs given for nausea caused by chemotherapy have not been directly compared with Cannabis or cannabinoids in cancer patients.

    There is growing interest in treating children for symptoms such as nausea with Cannabis and cannabinoids, but studies are limited. The American Academy of PediatricsExit Disclaimer has not endorsed Cannabis and cannabinoid use because of concerns about its effect on brain development.

    Stimulating appetite

    The ability of cannabinoids to increase appetite has been studied:

    • Delta-9-THC taken by mouth: A clinical trial compared delta-9-THC (dronabinol) and a standard drug (megestrol, an appetite stimulant) in patients with advanced cancer and loss of appetite. Results showed that delta-9-THC did not help increase appetite or weight gain in advanced cancer patients compared with megestrol.
    • Inhaled Cannabis: There are no published studies of the effect of inhaled Cannabis on cancer patients with loss of appetite.

    Pain relief

    Cannabis and cannabinoids have been studied in the treatment of pain:

    • Vaporized Cannabis with opioids: In a study of 21 patients with chronic pain, vaporized Cannabis given with morphine relieved pain better than morphine alone, while vaporized Cannabis given with oxycodone did not give greater pain relief. Further studies are needed.
    • Inhaled Cannabis: Randomized controlled trials of inhaled Cannabis in patients with peripheral neuropathy or other nerve pain found pain was reduced in patients who received inhaled Cannabis compared with those who received placebo.
    • Cannabis plant extract: A study of Cannabis extract that was sprayed under the tongue found it helped patients with advanced cancer whose pain was not relieved by strong opioids alone. In another study, patients who were given lower doses of cannabinoid spray showed better pain control and less sleep loss than patients who received a placebo. Control of cancer-related pain in some patients was better without the need for higher doses of Cannabis extract spray or higher doses of their other pain medicines. Adverse events were related to high doses of cannabinoid spray.
    • Delta-9-THC taken by mouth: Two small clinical trials of oral delta-9-THC showed that it relieved cancer pain. In the first study, patients had good pain relief, less nausea and vomiting, and better appetite. A second study showed that delta-9-THC could relieve pain as well as codeine. An observational study of nabilone also showed that it relieved cancer pain along with nausea, anxiety, and distress when compared with no treatment. Neither dronabinol nor nabilone is approved by the FDA for pain relief.

    Anxiety

    Cannabis and cannabinoids have been studied in the treatment of anxiety.

    • Inhaled Cannabis: A small case series found that patients who inhaled Cannabis had improved mood, improved sense of well-being, and less anxiety. In another study, 74 patients newly diagnosed with head and neck cancer who were Cannabis users were matched to 74 nonusers. The Cannabis users had markedly lower anxiety or depression and less pain or discomfort than the nonusers. The Cannabis users were also less tired, had more appetite, and reported greater feelings of well-being.
  7. Have any side effects or risks been reported from Cannabis and cannabinoids?

    Side effects of cannabinoids can include:

    Both Cannabis and cannabinoids may be addictive. Symptoms of withdrawal from cannabinoids include:

    • Being easily annoyed or angered.
    • Trouble sleeping.
    • Unable to stay still.
    • Hot flashes.
    • Nausea and cramping (rare).

    These symptoms are mild compared with symptoms of withdrawal from opiates and usually go away after a few days.

 

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