Cannabis Is “An Effective Treatment” For Cancer Patients, Israeli Study Concludes

[Editor's note: This post is excerpted from this week's forthcoming NORML weekly media advisory. To have NORML's news alerts and legislative advisories delivered straight to your in-box, sign up here.]

Some two-thirds of Israeli cancer patients authorized to use cannabis report long-term, symptomatic improvement from the plant, according to clinical data presented in late January at a conference of the Israeli Oncologists Union and reported this week in several international media outlets.

Investigators at the Sheba Medical Center in Tel Aviv, in conjunction with the Israeli Cancer Association, assessed the efficacy of cannabis therapy over the course of one year in 264 patients with cancer. Israeli media reported the findings:

“Some 61 percent of the respondents reported a significant improvement in their quality of life as a result of the medical marijuana, while 56 percent noted an improvement in their ability to manage pain. In general, 67 percent were in favor of the treatment, while 65 percent said they would recommend it to other patients.”

The study concluded that cannabis is an “effective” treatment for certain symptoms of the disease cancer and recommended, “The treatment should be offered to the patients in earlier stages of cancer.”

In the trial, the most common types of cancer for which medical marijuana was authorized was lung cancer (21 percent ), breast cancer (12 percent ) and pancreatic cancer (10 percent ).

The study focused primarily on the use of cannabis to relieve various symptoms of cancer or cancer treatment, such as pain and nausea, but did not evaluate whether marijuana therapy could potentially suppress the proliferation of the disease. In preclinical trials, various cannabinoids – including THC and CBD (cannabidiol) – have been shown to selectively target and eliminate malignant cells and cancerous tumors.

To date, some 6,000 Israelis possess government authorization to use cannabis therapeutically. Patients authorized by the federal program may either cultivate cannabis at home or they may obtain marijuana from one of the nation’s 12 licensed cannabis farms.

Last summer, the Israeli Health Ministry formally acknowledged the therapeutic utility of cannabis and announced newly amended guidelines to more effectively govern the state-sponsored production and distribution of medical marijuana. The Ministry estimates that as many as 40,000 patients will eventually have access to medicinal cannabis once the Israeli program is fully implemented.

NORML’s literature review of the anti-cancer properties of cannabis and cannabinoids is available here.

Wider Use Of Cannabis Therapy Could Reduce Prescription Pain Drug Deaths

[Editor's note: This post is excerpted from this week's forthcoming NORML weekly media advisory. To have NORML's news alerts and legislative advisories delivered straight to your in-box, sign up here.]

Physicians who prescribe opioid drugs to patients with neuropathy (nerve pain) ought to consider recommending cannabis as an alternative therapy, according to a peer-reviewed paper published online this week in the Harm Reduction Journal.

“There is sufficient evidence of safety and efficacy for the use of (cannabis/cannabinoids) in the treatment of nerve pain relative to opioids,” the commentary states. “In states where medicinal cannabis is legal, physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. … Prescribing cannabis in place of opioids for neuropathic pain may reduce the morbidity and mortality rates associated with prescription pain medications and may be an effective harm reduction strategy.”

The author notes that between the years 1999 and 2006, “approximately 65,000 people died from opioid analgesic overdose.” By contrast, he writes “[N]o one has ever died from an overdose of cannabis.”

In clinical trials, inhaled cannabis has been consistently shown to reduce neuropathic pain of diverse causes in subjects unresponsive to standard pain therapies.

In November, clinical investigators at the University of California, San Francisco reported that vaporized cannabis augments the analgesic effects of opiates in subjects prescribed morphine or oxycodone. Authors of the study surmised that cannabis-specific interventions “may allow for opioid treatment at lower doses with fewer [patient] side effects.”

Neuropathy affects between five percent and 10 percent of the US population. The condition is often unresponsive to conventional analgesic medications such as opiates and non-steroidal anti-inflammatory drugs.

Full text of the paper, “Prescribing cannabis for harm reduction” is available online here.

Pot For Pain: The Verdict Is In

[Editor's note: This post is excerpted from this week's forthcoming NORML weekly media advisory. To have NORML's media advisories and legislative updates delivered straight to your in-box, sign up for 'NORML News' here.]

Cannabis inhalation and the administration of cannabinoids are both associated with “significant analgesic effects” in the treatment of chronic non-cancer pain, according to a systemic review of randomized controlled trials to be published in the British Journal of Clinical Pharmacology.

Investigators from the University of Toronto, Hospital for Sick Children, conducted a literature review regarding the efficacy of cannabinoids in the treatment of chronic pain, including neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Eighteen randomized controlled trials published between 2003 and 2010 involving a total of 766 participants met inclusion criteria. Four of the trials assessed inhaled cannabis, while other studies assessed the analgesic properties of either plant-derived cannabinoids or synthetic cannabinoids.

“Overall the quality of trials was excellent,” authors wrote. “Fifteen of the eighteen trials that met inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared to placebo, several reported significant improvements in sleep. There were no serious adverse effects.”

Researchers noted that all four trials involving inhaled cannabis “found a positive effect with no serious adverse side effects.” They added: “Of special importance is the fact that two of the trials examining smoked cannabis demonstrated a significant analgesic effect in HIV neuropathy, a type of pain that has been notoriously resistant to other treatments normally used for neuropathic pain. In the trial examining cannabis based medicines in rheumatoid arthritis a significant reduction in disease activity was also noted, this is consistent with pre-clinical work demonstrating that cannabinoids are anti-inflammatory.”

Investigators concluded, “[C]annabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain. Given the prevalence of chronic pain, its impact on function and the paucity of effective therapeutic interventions, additional treatment options are urgently needed. More large-scale trials of longer duration reporting on pain and level of function are required.”

NORML has additional information on the analgesic properties of cannabinoids in its handbook, Emerging Clinical Applications for Cannabis and Cannabinoids, here.

Inhaled Marijuana ‘Clearly Has Medical Value’ For Hard to Treat Chronic Pain Conditions

[Editor's note: This post is excerpted from this week's forthcoming NORML weekly media advisory. To have NORML's media advisories delivered straight to your in-box, sign up for NORML's free e-zine here.]

Inhaled cannabis reduces pain and improves sleep compared to placebo, and is well tolerated by patients with chronic neuropathy, according to clinical trial data published this week in the Journal of the Canadian Medical Association (CMAJ).

Investigators at McGill University in Montreal assessed the efficacy of inhaled cannabis on pain intensity in 23 subjects with chronic post-traumatic or post-surgical neuropathic pain in a randomized, double-blind, placebo-controlled crossover trial. Participants in the study received a single inhalation of 25 mg of 9.4 percent herbal cannabis or placebo three times daily. All of the volunteers in the study suffered from refractory pain for which conventional therapies had proven ineffective.

Researchers reported: “[H]erbal cannabis … significantly reduced average pain scores compared with … cannabis placebo in adult participants. … We found significant improvement in measures of sleep quality and anxiety. … Our results support the claim that smoked cannabis reduces pain, improves mood, and helps sleep.”

Speaking to Web MD online, the study’s lead researcher Mark Ware said: “We’ve shown again that cannabis is an analgesic. Clearly it has medical value.”

In February, investigators from the California Center for Medicinal Cannabis Research summarized the results of four separate FDA ‘gold standard’ designed clinical trials demonstrating that inhaled marijuana was safe and effective for the treatment of neuropathy.

An estimated one to two percent of the population suffers from some form of neuropathic pain, which typically goes untreated by standard analgesics.

Listen to NORML Executive Director Allen St. Pierre and NORML Advisory Board member Lester Grinspoon discuss this trial, and other subjects related to the medical use of cannabis, on NPR’s The Diane Rehm show here.

Pain Clinics Test Patients for Marijuana Use

By Dale Gieringer, Director, CA NORML

Like many medical marijuana users, Kristin Redeen needed additional prescription medications for her severe chronic pain. For seven years she had been treated at a private pain clinic in the Central Valley, where a doctor maintained her on Percocet, a semi-synthetic opioid. One day Kristin was unexpectedly asked to submit a urine sample.  

“They already knew about my medical marijuana use,” says Kristin, who contacted California NORML. “I didn’t think I was doing anything wrong.”

When the test  came back, Kristin was informed that the clinic would no longer renew her prescription because she had tested positive for an illegal controlled substance. Her doctor at the clinic cited legal concerns, claiming –falsely– that DEA regulations forbid giving prescription narcotics to users of marijuana or other illegal drugs.

Kristin was cut off from her Percocet and began suffering seizures. She finally found a physician who was willing to prescribe her another opioid, Vicodin, but only at low doses insufficient to relieve her constant pain.

Kristin is one of a growing number of medical marijuana patients discriminated against by pain clinics. “I must have heard of 25 cases this year,” says Doug Hiatt, an attorney in Washington state. “It’s Jim Crow medicine.”

NORML has received a surge of complaints within the last six months.  Many medical marijuana users report that they can’t find a clinic willing to take them on.  Others, like Kristin, have been abandoned by clinics that suddenly adopted aggressive drug-screening policies.

Clinics say they are legally compelled to drug-test chronic pain patients so as to avoid liability for overdoses and diversion of prescription drugs, particularly opioids such as oxycontin –which have nothing to do with cannabis.

Chronic pain patients have good reason to object to being denied medical access to cannabis. Chronic pain is the leading indication for medical cannabis use, accounting for 90% of the patients in Oregon’s medical marijuana program.   More than 60 studies have shown cannabinoids to be effective in pain relief, according to a compilation by the International Association of Cannabis Medicine which includes four controlled studies of smoked marijuana by California’s Center for Medicinal Cannabis Research. (more…)