how do you take cbd oil for cancer

Olivia Newton-John’s Stage 4 Cancer Cannabis Management

— The singer and actress updates fans on her battle, but can marijuana help?

by Michele R. Berman, MD, and Mark S. Boguski, MD, PhD August 22, 2019

Singer/actress Olivia Newton-John, 70, was recently seen on “60 Minutes Australia,” where she updated viewers on how she is doing with her stage 4 breast cancer.

The Grease star was originally diagnosed with breast cancer in 1992, after finding a small, painful lump. She underwent a partial mastectomy and breast reconstruction, followed by chemotherapy. She also used complementary treatments, such as herbal supplements, acupuncture, meditation, and visualization.

“I researched a lot and felt satisfied with my course of treatment. It was sort of an East meets West approach. I meditated every day, did yoga, and homeopathy, ate well — I boosted my inner strength as much as I could. When bad thoughts came in, I pushed them right out.”

In 2013, she was again diagnosed with breast cancer, this time after discovering a lump in her shoulder. She had kept this relapse quiet until recently.

In May 2017, Newton-John postponed some shows, saying that she was suffering with a “long-running issue with sciatica.” Turns out, this was not the cause of her back pain. Her publicity team posted a statement on Facebook, which said:

“The back pain that initially caused her to postpone the first half of her concert tour, has turned out to be breast cancer that has metastasized to the sacrum. In addition to natural wellness therapies, Olivia will complete a short course of photon [sic] radiation therapy and is confident she will be back later in the year, better than ever, to celebrate her shows.”

“‘I decided on my direction of therapies after consultation with my doctors and natural therapists and the medical team at my Olivia Newton-John Cancer Wellness and Research Centre [which she founded in 1995] in Melbourne, Australia,’ says Olivia Newton-John.”

In addition to hormone suppression therapy (via estrogen receptor blockade), Newton-John has continued to use complementary treatments including herbs, marijuana, and mindfulness/meditation therapy.

The tumor in her sacrum caused a sacral fracture, leaving her in severe pain, described as “months and months of excruciating, sleep-depriving, crying out loud pain.” Unable to walk, she “willed herself” to walk, progressing from a wheelchair, to a walker, cane, and finally to be able to walk unassisted.

Originally treated for pain with morphine, Newton-John was able to wean herself off the morphine by using marijuana, primarily cannabis oil. She claims it also is helping her with anxiety and sleep. Her husband, John Easterling, grows many of the herbs and marijuana in a greenhouse in the backyard of their California home. Olivia says: “I really believe the cannabis has made a huge difference. If I don’t take the drops, I can feel the pain, so I know it’s working.”

Newton-John refuses to focus on how much time she could have left, feeling that concentrating on a specific time could be a self-fulfilling prophecy. “So, for me, psychologically, it’s better not to have any idea of what they expect or what the last person that has what you have lived, so I don’t, I don’t tune in.”

Newton-John is organizing a auction of some of her memorabilia (including her famous Grease leather jacket and pants) to raise money for the Olivia Newton-John Cancer Wellness & Research Centre. Besides caring for cancer patients, the institute has been involved in about 200 clinical trials.

Is there a role for marijuana in the management of cancer patients?

Marijuana, also known as cannabis, has been used for medicinal purposes for at least 3,000 years. It was introduced into Western medicine in 1839 by W.B. O’Shaughnessy, who learned of its medicinal properties while working in India for the British East India Company. Its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects.

The cannabis plant produces resin containing psychoactive compounds called cannabinoids, in addition to other compounds found in plants, such as terpenes and flavonoids. In the U.S., it is a controlled substance and is classified as a Schedule I agent (a drug with a high potential for abuse, and no currently accepted medical use).

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. The main psychoactive cannabinoid in Cannabis is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the high of delta-9-THC.

There are two potential roles for cannabis in cancer management: as a primary treatment or as an adjuvant therapy aimed at ameliorating symptoms of cancer or the side effects of medical invention. Unfortunately, cannabis’ status as a Schedule I drug has severely limited scientific inquiry into the potential benefits (and side effects) of cannabis in regard to cancer, especially as a primary treatment.

There are a few studies done in mice, rats, and in vitro human cancer cell lines, that suggest that cannabinoids may have a protective effect against the development of certain types of tumors. Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.

No ongoing clinical trials of cannabis as a treatment for cancer in humans were identified in a PubMed search. The only published trial of any cannabinoid in patients with cancer is a small pilot study of intratumoral injection of delta-9-THC in patients with recurrent glioblastoma multiforme, which demonstrated no significant clinical benefit.

Although few relevant surveys of practice patterns exist, it appears that physicians caring for cancer patients in the U.S. who recommend medicinal cannabis do so predominantly for symptom management. The potential benefits of medicinal cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep.

Antiemetic effect

Dronabinol, a synthetically produced delta-9-THC, was approved in the U.S. in 1986 as an antiemetic to be used in cancer chemotherapy. Nabilone, a synthetic derivative of delta-9-THC, was first approved in Canada in 1982 and is now also available in the U.S. Numerous clinical trials and meta-analyses have shown that dronabinol and nabilone are effective in the treatment of nausea and vomiting induced by chemotherapy. Both dronabinol and nabilone have been approved by the FDA for the treatment of nausea/vomiting associated with cancer chemotherapy in patients who have failed to respond to conventional antiemetic therapy. The American Society of Clinical Oncology antiemetic guidelines updated in 2017 recommends that the FDA-approved cannabinoids, dronabinol, or nabilone be used to treat nausea/vomiting that is resistant to standard antiemetic therapies.

See also  cbd oil list of what used for

Appetite Stimulation

The studies that look at cannabinoid’s effect on appetite on patients with cancer or HIV have had mixed results. A few studies showed no significant improvement in appetite or weight gain. However, a smaller, placebo-controlled trial of dronabinol in cancer patients demonstrated improved and enhanced chemosensory perception in the cannabinoid group — food tasted better, appetite increased, and the proportion of calories consumed as protein was greater than in the placebo recipients.

Another clinical trial that involved 139 patients with HIV or AIDS and weight loss found that, compared with placebo, oral dronabinol was associated with a statistically significant increase in appetite after 4 to 6 weeks of treatment. Patients receiving dronabinol tended to have weight stabilization, whereas patients receiving placebo continued to lose weight.

Analgesia

Pain management improves a patient’s quality of life throughout all stages of cancer. Cancer pain results from inflammation, invasion of bone or other pain-sensitive structures, or nerve injury.

A 2017 review looked at five studies evaluating the efficacy of cannabis in patients with cancer. “Four out of the five studies found that cannabis was significantly associated with a decrease in cancer-associated pain,” the authors wrote. Limitations to the studies included the small number of patients in some studies, variation in route of administration, and a lack of dosing guidelines. Further research is needed into this potentially important adjuvant treatment.

Anxiety and Sleep

In a small pilot study of analgesia involving 10 patients with cancer pain, secondary measures showed that 15 mg and 20 mg doses of the cannabinoid delta-9-THC were associated with anxiolytic effects. Another small placebo-controlled study of dronabinol in cancer patients with altered chemosensory perception also noted increased quality of sleep and relaxation in THC-treated patients.

Patients often experience mood elevation after exposure to cannabis, depending on their previous experience. In a five-patient case series of inhaled cannabis that examined analgesic effects in chronic pain, it was reported that patients who self-administered cannabis had improved mood, improved sense of well-being, and less anxiety.

Seventy-four patients with newly diagnosed head and neck cancer self-described as current cannabis users were matched to 74 nonusers in a Canadian study investigating quality of life. Cannabis users had significantly lower scores in the anxiety/depression and pain/discomfort scale. Cannabis users were also less tired, had more appetite, and better general well-being

Cannabis’ status as a Schedule I drug has limited studies on the potential benefits of cannabis for cancer patients as well as others with chronic illness. Even with the increasing number of states that have legalized medicinal or recreational marijuana, researchers may shy away from this research because of federal restrictions and inability to get federal grants to pay for such research.

Do you think it’s time for the federal government to revisit marijuana’s status?

Clinical trials (all as adjuvant therapy): ClinicalTrials.gov

Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

Medical Cannabis

Cannabis refers to a family of plants from which marijuana and hemp are produced. These plants are grown around the world and have been used in herbal remedies for centuries.

In modern times, marijuana has generally been viewed as a recreational drug. But there is growing interest in its medical uses. The terms “medical marijuana,” “medical cannabis,” “medical hemp,” or “medical CBD” refer to the use of products made from the cannabis plant to treat certain health conditions.

Many people diagnosed with cancer report that cannabis products are effective for managing their symptoms and treatment side effects. There is some research supporting the use of medical cannabis for managing certain conditions, but federal laws in the United States make it difficult to study medical cannabis.

It’s important to know that cannabis is not a cure or treatment for cancer itself, even though there are many such claims online. You should not use medical cannabis instead of proven cancer treatments.

  • What are cannabinoids?
  • What conditions is medical cannabis used for?
  • Is medical cannabis legal?
  • What to expect when using medical cannabis
  • Side effects and safety of medical cannabis

What are cannabinoids?

Cannabis plants contain many chemicals known as cannabinoids. Cannabinoids cause certain effects when you consume them. They do this by interacting with your body’s endocannabinoid system, which actually produces its own cannabinoids called “endocannabinoids.” Scientists are still working to understand how the endocannabinoid system works, but it seems to play a role in many processes in your body.

The research done on cannabis so far suggests that most of its medical benefits are related to the effects of two main cannabinoids:

  • THC (delta-9-tetrahydrocannabinol), which causes the high associated with marijuana
  • CBD (cannabidiol), which does not cause a high

THC and CBD seem to offer different medical benefits. A good example of these differences can be seen when comparing the only cannabinoid medicines approved by the U.S. Food and Drug Administration (FDA): Marinol (chemical name: dronabinol) and other synthetic THC medicines are approved to treat nausea caused by chemotherapy. The CBD medicine Epidiolex is approved to treat seizure disorders in children.

Different forms of cannabis contain different amounts or combinations of cannabinoids. Marijuana contains enough THC to cause a high (more than 0.3%) and varying amounts of CBD. Hemp contains mostly CBD and only trace amounts of THC, which does not cause a high.

Cannabis products made from extracted oils can contain all or mostly THC or CBD, or different combinations. “Whole plant” marijuana products are often grouped by “strains” to describe their balance of THC and CBD. Whole plant or “full spectrum” products often contain other cannabinoids that can cause other effects.

The effects of cannabinoids also vary depending on how they are consumed. The most common ways to consume medical cannabis are:

  • eating “edibles” or taking capsules, oils, or tinctures by mouth, which can take one to a few hours to take effect and can last for up to 6 hours
  • inhaling cannabis smoke or vapor, which takes effect within minutes and fades over a few hours

What conditions is medical cannabis used for?

It’s extremely important to know that cannabis is not a cure or treatment for breast cancer, despite many claims. It’s dangerous to use cannabis instead of proven cancer therapies. It’s also important to talk to your doctor before using cannabis products to make sure it won’t interact or interfere with any of your medicines or treatments.

See also  cbd hemp oil spray for pain

People use cannabis products to manage cancer symptoms, treatment side effects, and other challenges along the cancer journey. The most common reasons people with breast cancer use cannabis are to manage:

  • pain (including joint and muscle aches, discomfort, and stiffness)
  • anxiety and stress
  • insomnia
  • nausea, vomiting, and loss of appetite caused by chemotherapy

Some studies support the use of cannabis for these conditions. Still, because marijuana is federally illegal in the United States, research on medical cannabis to manage cancer symptoms and treatment side effects is limited.

Patient surveys have provided important insights about how people use medical cannabis. About 42% of people diagnosed with breast cancer who completed our survey said they used medical cannabis products to manage breast cancer symptoms or treatment side effects. The people who used medical cannabis ranged in age, cancer stage, and treatment phase, and most (75%) found it to be “very” or “extremely” helpful.

But again, it’s important to talk to your doctor about using cannabis products, especially during cancer treatment, to make sure it’s a safe option for you. If you find that your doctor is not knowledgeable or experienced with cannabis, you may want to seek advice from an oncologist who participates in your state or country’s medical cannabis program.

“It’s important for people to know that anything they ingest that produces a change in their bodies is acting like a drug, and it has the potential for side effects, interactions with other drugs, as well as benefits,” said Virginia F. Borges, M.D., MMSc., professor of medicine and director of the Breast Cancer Research Program at the University of Colorado Cancer Center. “People have to be as diligent about researching medical marijuana as they would be with any other supplement or drug they were taking.”

Because marijuana has been legal for both medical and recreational use in Colorado for many years, Dr. Borges has cared for a number of breast cancer patients who use or have used medical cannabis to ease treatment side effects.

“I’ve mainly seen it used in conjunction with prescription drugs to control pain and other side effects in patients living with metastatic disease,” she said. “It’s rare that a person living with metastatic breast cancer would have only one side effect to manage. So, by adding in medical marijuana, it often allows me to cut back on the number of drugs I prescribe. With a high-quality source for medical marijuana and knowing how it affects an individual, using medical marijuana can put more control back in the hands of my patient.”

Is medical cannabis legal?

The legal status of cannabis for either recreational or medical use varies across the world and continues to change. It’s important to understand the laws in your state or country before you purchase or use cannabis.

Marijuana (the form of cannabis that contains more than 0.3% THC — enough to cause a high) is illegal nationwide under federal law in the United States. At the same time, most U.S. states have passed their own laws either legalizing the use of marijuana entirely or to treat certain medical conditions. But even in states where marijuana is legal, U.S. federal government employees and people who work for companies that receive federal grant funding cannot legally use marijuana under the Drug-Free Workplace Act.

Many other countries also allow the use of medical marijuana, including Australia, Canada, the United Kingdom, and many others in Europe and South America.

Marijuana laws vary from state to state in the U.S. Some states allow people with certain health conditions to get a medical marijuana card through their doctor, which allows them to buy cannabis products at an approved dispensary. Other states only allow the medical use of CBD to treat certain serious conditions. In states where marijuana is legal for recreational use, anyone of legal age can buy cannabis products from a dispensary, but some of these shops carry medical products that are only available to people with certain health conditions.

If marijuana is legal where you live, it’s important to know that quality control of these products can be uncertain. Most cannabis products, even those sold at medical dispensaries, are not regulated like other medicines. They may contain contaminants such as mold, heavy metals, and pesticides, and the labels may include incorrect information about types, doses, and ingredients. You can ask the dispensary for a “certificate of analysis” for the products you might buy, which tells you about ingredients, dose, and contaminants.

Medical cannabis is not approved by the FDA for use in people with cancer. But three synthetic THC medicines have been approved to treat nausea and vomiting caused by chemotherapy:

  • Cesamet (chemical name: nabilone)
  • Marinol (chemical name: dronabinol)
  • Syndros (chemical name: dronabinol in liquid form)

In Canada and some European countries, Sativex (chemical name: nabiximols), an oral spray containing equal amounts of THC and CBD, is approved for the treatment of certain types of pain related to cancer.

Epidiolex, a medicine with CBD extracted from marijuana, is FDA-approved for use in children with severe seizure disorders. It is not approved for people with cancer, but studies are ongoing.

What about CBD products?

CBD products can be made from marijuana or hemp (the form of cannabis that contains only trace amounts of THC and does not cause a high). In the U.S., CBD products have typically only been available at medical marijuana dispensaries.

However, the U.S. Congress passed a federal law called the 2018 Farm Bill. This law made it legal for companies to produce and sell CBD products made from hemp. Now, many more companies are selling CBD products. You’ve probably seen them everywhere from grocery stores and pharmacies to gas stations and online ads.

But just because CBD products made from hemp are sold everywhere, in all kinds of products, and their legal restrictions have been loosened, you shouldn’t assume they are safe, effective, or even legal where you live (some state laws still consider hemp CBD illegal).

Like all cannabis products, hemp CBD products are not regulated the same way medicines are. So it’s hard to know if they are made safely, contain contaminants, or are labeled accurately. It’s also illegal for companies to market any cannabis product as a cure, treatment, or dietary supplement. The FDA has warned many companies that have marketed CBD products in this way.

See also  best cbd oil for cysts at lower lumbar

Medical grade CBD products from a medical marijuana dispensary or an independent pharmacy are likely a safer and more effective option, because you can ask for a certificate of analysis that tells you about the ingredients, dose, and if there are contaminants such as mold, heavy metals, or pesticides.

What to expect when using medical cannabis

The ways cannabis can affect you depends on many factors and can be hard to predict. The effects of cannabis can vary from person to person.

Also, cannabis comes in a variety of strains, each with different potency and amounts or combinations of cannabinoids. Of note, products that contain THC may cause a high, while products with CBD only or trace amounts of THC will not.

The way you consume cannabis can also influence the effects. Cannabis products come in many different forms, including:

  • edibles, such as cookies, candy, mints, or brownies
  • gelcaps or pills
  • dried leaves or buds for smoking, vaporizing, or making tea
  • tinctures or sprays that are used under the tongue or along the gum line
  • oils for inhaling with a vape pen or vaporizer
  • oils for mixing into tea, honey, or food
  • creams and other products that are applied to the skin

Eating edibles or taking oils by mouth can take one to a few hours to take effect and can last up to about 6 hours. It can be difficult to know the dose in some edibles and how long the effects will last. Oils, sprays, and tinctures may give you more control over the dose you take.

Inhaling cannabis smoke or vapor takes effect within minutes and fades more rapidly. Inhaling can give you more control over the dose you take, when the effects will start, and how long they will last. But many oncologists prefer that their patients not smoke or vaporize cannabis products, especially during active cancer treatment that can affect the lungs or immune system. That’s one reason why it’s important to talk to your doctor before you start using cannabis.

Every person’s situation is unique. The best forms and doses of medical cannabis and the reasons for using it will vary from person to person.

Side effects and safety of medical cannabis

Information on cannabis side effects is limited because research on medical cannabis in people with cancer is limited. Side effects are also likely to vary depending on the dose you take and the amounts and combinations of THC and CBD in each product.

Reported side effects of marijuana, which has THC, include:

  • increased heart rate
  • low blood pressure
  • dizziness and falling
  • tiredness, fatigue, sleepiness
  • fainting
  • hallucinations
  • paranoia

CBD is usually well-tolerated, but reported side effects include:

  • drowsiness and fatigue
  • dry mouth
  • diarrhea
  • reduced appetite

It’s not well understood how cannabis products may interact with other medicines, including cancer therapies. That’s why it’s important to talk to your doctor about using medical cannabis both before and during treatment. Working together, you can come up with the best way to relieve your symptoms.

“The medicines and therapies you use can interact with each other. They may meet up and cause no effect, a beneficial effect, or a harmful effect,” said Marisa Weiss, M.D., founder and chief medical officer of Breastcancer.org and director of breast radiation oncology at Lankenau Medical Center. “For example, a helpful effect is when cannabis reduces nausea from chemotherapy. But a harmful effect can happen if cannabis interferes with the benefit of chemotherapy or increases the risk of lung damage during radiation and chemotherapy if cannabis is smoked or vaped.”

Important things to consider before using medical cannabis

If you decide that you’re interested in trying medical cannabis to treat your breast cancer symptoms or treatment side effects, here are some things to consider before you do:

  • Talk to your doctor: As with all vitamins, supplements, herbs, and over-the counter medicines, always tell your doctor if you are using any type of cannabis product to make sure it won’t interact or interfere with your cancer treatments.
  • Find a doctor in a medical marijuana program: If you live in a place where medical marijuana is legal, make an appointment with a doctor who participates in your state or country’s medical marijuana program. These are doctors who are trained and certified to qualify patients for medical cannabis and oversee their care. Some states also certify trained nurses, physician’s assistants, and pharmacists to qualify patients for medical cannabis.
  • Find a medical cannabis dispensary you are comfortable with: Most oncologists prefer that their patients get their medical cannabis products from a medical cannabis dispensary if they are available where you live. Medical dispensaries focus on medical patients rather than just recreational users. They should have knowledgeable staff members or a pharmacist who can answer your questions about their products.

When choosing products, it’s important to understand the different effects of THC and CBD. THC and CBD each offer different medical benefits. For example, CBD may be better at easing anxiety, while THC may be better at controlling nausea caused by chemotherapy.

THC and CBD are present in different levels in different strains of marijuana. Most medical cannabis products are made by extracting these cannabinoids from the cannabis plant and putting different amounts of them into the products. The label on the product usually shows the ratio of THC to CBD. Hemp products mostly contain CBD, but can have trace levels of THC and other cannabinoids which are unlikely to be listed on the label.

  • Is the cannabis in your products grown with any pesticides?
  • Are your products stored and handled properly to avoid spoilage and contamination?
  • Is there a “sell by” date on the packaging?
  • Are your products tested for fungus, bacteria, or pesticide levels? What are the results? (Ask for a certificate of analysis or “COA”).

Written by: Adam Leitenberger, editorial director

This content was developed with contributions from the following experts:

Donald I. Abrams, M.D., Zuckerberg San Francisco General Hospital; Osher Center for Integrative Medicine; University of California San Francisco

Virginia F. Borges, M.D., MMSc., professor of medicine and director of the Breast Cancer Research Program at the University of Colorado Cancer Center

Marisa Weiss, M.D., founder and chief medical officer of Breastcancer.org; director of breast radiation oncology at Lankenau Medical Center, Wynnewood, Pa.

This content made possible in part through generous support from Ananda Health.