Medical Cannabis for treatment of Nausea
The marijuana plant cannabis is known to have therapeutic effects, including the relief of nausea…
Despite the increasing prevalence and acceptance of medical cannabis use amongst the general public, the evidence required by physicians to use cannabis as a treatment is generally lacking. Research on the health effects of cannabis and cannabinoids has been limited worldwide, leaving patients, health care professionals, and policy-makers without the evidence they need to make sound decisions regarding the use of cannabis and cannabinoids.
Case studies report that many of the symptoms and complications of Nausea can be alleviated by medical cannabis use…
40 YEARS OF CASE STUDIES…
Case Study American Cancer Society, USA first published in 1982 - Cannabis and cancer chemotherapy
Cannabis was found to be efficacious in reducing nausea and vomiting associated with cancer chemotherapy across a wide range of chemotherapeutic regimes and tumour types. Administered one hour before chemotherapy, then every four hours for a total of four doses.
Case Study University of New Mexico, USA May 2021 – Cannabis offers immediate relief from symptoms of nausea, but product use matters
Researchers at The University of New Mexico examined the effects of consuming cannabis on nausea symptoms from five minutes to one-hour post-cannabis consumption and showed that using Cannabis results in an average symptom improvement of nearly 40%.
Case Study National Library of Medicine, British Pharmacological Society, August 2011-Current– Regulation of nausea and vomiting by cannabinoids
Abstract: Considerable evidence demonstrates that manipulation of the endocannabinoid system regulates nausea and vomiting in humans and other animals. Recently, evidence from experiments suggests that cannabinoids may be especially useful in treating the more difficult to control symptoms of nausea and anticipatory nausea in chemotherapy patients, which are less well controlled by the currently available conventional pharmaceutical agents. Preclinical research indicates that cannabinoids, including CBD, may be effective clinically for treating both nausea and vomiting produced by chemotherapy or other therapeutic treatments.
Introduction: A major advance in the control of acute emesis (nausea, retching and vomiting) in chemotherapy was the finding that blockade of one type of receptor could suppress the acute emetic response. In clinical trials with humans, treatment often combines with the corticosteroid dexamethasone during the first chemotherapy treatment reduce the incidence of acute vomiting by approximately 70%.
More recently, receptor antagonists have been developed that not only decrease acute vomiting, but also decrease delayed vomiting induced by chemotherapy, which is the symptom reported to be the most distressing to patients undergoing treatment.
Anti-emetic effects of cannabinoids in human clinical trials: The cannabis plant has been used for several centuries for multiple therapeutic applications including the attenuation of nausea and vomiting. Ineffective treatment of chemotherapy-induced nausea and vomiting prompted oncologists to investigate the anti-emetic properties of cannabinoids in the late 1970s and early 1980s. The first cannabinoid agonist, nabilone, which is a synthetic analogue of THC was specifically licensed for the suppression of nausea and vomiting produced by chemotherapy.
Conclusions: Since the discovery of the mechanism of action of cannabinoids, our understanding of the role of the endocannabinoid system in the control of nausea and vomiting has greatly increased. Although chemotherapy-induced vomiting is well controlled in most patients by conventionally available drugs, nausea (acute, delayed, and anticipatory) continues to be a challenge. Nausea is often reported as more distressing than vomiting because it is a continuous sensation. Indeed, this distressing symptom of chemotherapy treatment (even when vomiting is pharmacologically controlled) can become so severe that as many as 20% of patients discontinue the treatment (Jordan et al., 2005). Both preclinical and human clinical research suggests that cannabinoid compounds may have promise in treating nausea in chemotherapy patients.
Summary: All reported clinical trials for the effectiveness of cannabinoid compounds on chemotherapy-induced nausea and vomiting have involved oral use of cannabinoids, which may be less effective than sublingual or inhaled cannabinoids, given the need to titrate the dose. Recently, a combination of THC and the non-psychoactive plant CBD was made available. To date, the effectiveness of this compound in reducing nausea and vomiting has not been evaluated. Although many cannabis users claim that smoking is a more effective emetic than oral CBD, no controlled studies have yet been published that evaluate this possibility.
Guidance for the use of medicinal cannabis for the prevention or management of nausea and vomiting in Australia, Australian Government Department of Health – December 2017
A set of guidance documents has been made available to assist doctors and their patients who choose to prescribe medicinal cannabis in Australia under current access schemes. These have been developed based on reviews of available evidence for the use of medicinal cannabis in five different settings. Included is an overview addressing the evidence base for medicinal cannabis therapy generally as well as specific documents relating to medicinal cannabis in the treatment of chemotherapy-induced nausea and vomiting (CINV). The document reflects the evidence supporting the use of medicinal cannabis in nausea and vomiting and the recommendations of the Nausea and Vomiting Working Group.
Review Method: The Australian Government Department of Health commissioned a team from the University of New South Wales, University of Sydney, and University of Queensland under the coordination of the National Drug and Alcohol Council (NDARC) to review the available evidence for the use of medicinal cannabis in five settings: palliative care, epilepsy, chemotherapy-induced nausea and vomiting (CINZ), multiple sclerosis (MS) and chronic pain.
The researchers conducted a review of previously published reviews from multiple databases and is an evidence-based minimum set of items for reporting on randomised controlled trials (RCTs). These guidelines have been developed because of concern for low quality trials and aim to improve the quality of medical research, remove bias and improve transparency and accurate reporting of findings.
Management of nausea and vomiting results
Nausea and vomiting may occur in distinct clinical settings of varying aetiology, with either acute or chronic duration symptoms, including:
· Chemotherapy-induced nausea and vomiting (CINV)
· Radiotherapy-induced nausea and vomiting (RINZ)
· Cancer-associated nausea and vomiting
· Chronic disease-associated nausea and vomiting
· Palliative care
· Post-operative nausea and vomiting (PONV)
· Nausea and vomiting arising from long-term concomitant medication administration
There are reports that several medicinal cannabis products have relieved the symptoms of CINV when compared to placebo…
· The scope of this document is broad given the limited evidence available and does not encompass all clinical conditions where nausea and vomiting may occur.
· There are limitations in how the clinical evidence was obtained and reviewed.
· Dose-response information for efficacy is lacking, for starting does. This is particularly relevant when applying data obtained from younger adults to the elderly.
· There is an absence of information regarding drug-drug interactions, for medicines of any class, arising from medicinal cannabis administration.
· There are no long-term animal or human data on which to model or predict toxicity. This is most relevant for use in pregnant women, children and young adults.
National Drug and Alcohol Research Centre (NDARC) Review
· The complete control of nausea and vomiting (absence of nausea and vomiting without the use of rescue medication) in the acute phase (within 24 hours of treatment with chemotherapy) and in the delayed phase (after 24 hours of treatment with chemotherapy) of nausea and vomiting.
· Complete control of vomiting (absence of episodes of vomiting without use of rescue medication) in the acute and delayed phases of nausea and vomiting.
· Complete control of nausea (absence of episodes of nausea without use of rescue medication) in the acute and delayed phases of nausea and vomiting.
· Subjective experience of appetite (using self-reported scoring system such as visual analogue scale).
· Subjective experience of nausea (also using self-reported scoring system such as visual analogue scale, for number, duration, and severity of episode).
· Study withdrawal due to any reason
· Cross-over studies only: participant preference for one or other of the interventions (cannabis or control).
· Adverse effects, including ‘feeling high’, sedation, euphoria, dizziness, heightened sense of anxiety or agitation, depression, hallucinations, paranoia, hypotension, focal dystonia, extrapyramidal effects, and oculogyric crisis.
At iCannabis we are a group that specialises in educating and helping Australian patients gain access to Cannabis for Medical purposes, through education and real-life experiences with the healing powers of this plant. If you wish to be connected to a medical cannabis doctor please complete our 'Qualifying Tool' on the website.