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Thirty US states have issued medical cannabis laws, and all but one of them contain cancer in the list of permitted conditions. Such laws give cancer patients across the country access to a substance that is still illegal under federal law.
Anecdotal reports suggest marijuana is helpful in addressing symptoms of chemotherapy, such as pain and nausea. But it is unlikely that curious patients get clear instructions from their doctors, whether they should try marijuana, which form could work best, and how much they could take. A recent survey of 237 oncologists across the country found that while about 80 percent of people talk about marijuana with their patients, less than 30 percent feel that they have sufficient knowledge to advise them on their medical use.
Despite their shaky knowledge about the drug, nearly half of all oncologists recommend their patients medicinal cannabis, according to the study, which was published on Thursday in the Journal of Clinical Oncology. But more than half of those who suggest it do not consider themselves competent, Dr. Ilana Braun, a cancer psychiatrist at the Dana-Farber Cancer Institute in Boston, Massachusetts, and the lead author of the study. 19659010] "Unfortunately, the evidence base for the effectiveness of medical marijuana in oncology is still young at this time," says Braun. "Therefore, oncologists often borrow from clinical trials for other diseases or extrapolate from evidence of pharmaceutical grade cannabinoids."
The survey surveyed only medical marijuana, defined as non-pharmaceutical cannabis products recommended by providers for therapeutic use. It contained no pharmaceutical grade cannabinoids, such as A synthetic analog of tetrahydrocannabinol, or THC approved by the FDA for the treatment and prevention of chemotherapy-induced nausea and vomiting.
The study found most talk about medicine marijuana was initiated by the patient. That's not surprising at all, says dr. Jerry Mitchell, a medical oncologist at the Zangmeister Cancer Center in Columbus, Ohio, who was not affiliated with the study. He says he is interviewed by patients on medical marijuana several times a week.
"This is a product that's known," says Mitchell. "It's a product that cancer patients believe will help them, and they'll ask their doctors what they should do, and they should be advocates for their own health." The Medical Advisory Committee on Medicine – Cannabis says he can not be the one to who initiated these talks because there is currently no legal way to get the drug in Ohio. Although Ohio passed a law to create a medical cannabis program in 2016, pharmacies will not open until September of this year.
Oncologists' ignorance of medical marijuana alone leaves many cancer patients wondering which cannabis products – and what dosages – work best to combat the debilitating symptoms that often accompany chemotherapy.
Larry Lenkart, 60, was diagnosed with pancreatic cancer stage 4 in September last year. He experiences severe pain, stomach cramps and nausea that persist for up to 10 days after each chemotherapy. He had 11 laps so far.
"Chemo feels like the worst flu you've ever had – just continuously and continuously," says Lenkart, who lives in Springfield, Illinois.
His oncologist agreed to confirm that he had an admission requirement for his country's medical cannabis pilot program, but offered no additional guidance on what to do once he received his medical cannabis card.
So Lenkart searched online for information and received advice from friends and coworkers in the pharmacy. After four months of trial and error, he says he's still trying to figure out what works: food, oils, vapes, or marijuana buds.
"You have to play around properly with dosing," says Lenkart.
In the end, says Lenkart, marijuana helps with its symptoms of nausea, pain and mental drowsiness. "It makes an unbearable situation bearable," he says.
In the absence of rigorous evidence, such anecdotes may interfere with medical practice.
Mitchell says there is a lack of high quality evidence to support the use of medicine for cannabis for cancer-related diseases, and this may explain why many providers feel ill-equipped to guide patients in this matter. Randomized controlled trials simply do not exist.
But, says Mitchell, he suggests that many oncologists recommend recommending medicinal cannabis after pointing out the available evidence – including anecdotal evidence – against what's known about the alternatives.
For example, on chronic pain management: "They have opioids that clearly have problems," says Mitchell. "They have non-steroidals that can work, but sometimes are not effective for severe cancer pain, well, that's all we have in our toolbox, and if that's the case, then you have to go back and say, & # 39; Well, maybe I'm okay with anecdotal evidence. "
In fact, Braun and her colleagues found that about two thirds of oncologists find medical marijuana in combination with a standard treatment useful for symptoms such as pain, loss of appetite, and unwanted weight loss.
They also found oncologists in states with medical marijuana laws felt more familiar with medical marijuana compared to peers in states where they are prohibited by law. But in both cases, they also recommended their patients medical marijuana.
Suppliers in Western countries discussed and recommended medical marijuana rather than the South. Working in an outpatient setting and having a higher exercise volume was also a variable that led a vendor to recommend medical marijuana.
Brown says she does not know why these discrepancies exist, but she wants to deepen these questions in follow-up research.
It also plans to conduct clinical trials to investigate the use of medical marijuana for cancer-related symptoms.
In preparation for these studies, Braun says that she has potential to address the challenges associated with research on a Level 1 drug that is being considered along with heroin and LSD, having no medical use and high levels of abuse.
"I'm going to install an alarm safe behind closed doors" to store the controlled substance, she says. "It's complicated."
Brown says she is "firmly convinced that federal restrictions should be relaxed to promote the potential positive qualities of medical marijuana, not just its risks."
Without randomized controlled trials, it is difficult for oncologists to know the trade-offs they make when recommending medical marijuana over treatments that are "standard of care".
"And that's a big problem," says Mitchell. "That's a big knowledge gap."
This story was produced in collaboration with Side Effects Public Media a public health collaboration.
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