Oncology Rounds

Medical marijuana: The oncology drug you’re not talking about, but should

By Deirdre Saulet and Kate Wister

Today, more than half of U.S. states have legalized medical marijuana and eight states—along with Washington, D.C.—allow for recreational use. But at the national-level, marijuana remains a Schedule 1 drug, severely limiting the research capabilities of scientists attempting to assess its health effects.

Many physicians are hesitant to discuss and/or recommend cannabis to their patients, not knowing how the legal landscape might change and not fully understanding its medical benefits and risks. Despite a paucity of research, more states continue to legalize medical marijuana and more cancer patients are using the drug to help manage their symptoms.

Q&A: What providers should know about the medical marijuana legal landscape

A recent study surveyed cancer patients in Seattle, Washington and found that 24% of respondents had used medical marijuana in the past year, and that these patients were more likely to use cannabis because of its legalization. The majority of patients reported using cannabis to help manage pain, chemotherapy-related symptoms such as nausea and vomiting, or neuropsychiatric problems. 90% of patients said that medical marijuana provided a moderate-to-major benefit as they went through cancer treatment.

Limited research, but promising benefits

Despite the perceived benefits of marijuana use by cancer patients, concrete evidence remains scarce. The National Academies of Sciences, Engineering, and Medicine recently published a report analyzing all literature on the health effects of medical marijuana to date, in an effort to synthesize some conclusive evidence about its positive and negative health effects. Although researchers concluded that we still have a long way to go to understanding the full scope of medical marijuana, the report did yield some interesting findings.

For cancer patients, some of the most promising findings include the benefit of marijuana to help manage pain and "conclusive evidence" that certain oral cannabinoids are effective at helping manage chemotherapy-induced nausea and vomiting. However, the risks associated with cannabis use are more ambiguous, highlighting a need for more research—especially studies that evaluate the risks and benefits of the multiple types of cannabis available on the market.

Without counsel from doctors, patients seek information elsewhere

Due to this lack of research, many physicians do not feel equipped to counsel patients on the use of medical marijuana, and patients are seeking advice elsewhere—mostly from friends, family, other cancer patients, and the internet. The study in Seattle found that 74% of patients would prefer to receive information from their cancer care team, but only 15% of respondents said they received information from their physician or nurse. Some states are taking steps to address this lack of preparedness, but for the most part, physicians are left with little to no guidance on how to advise their patients.

Since studies have found that the majority of cancer patients are not receiving guidance from their care team about medical marijuana, oncologists need to be more proactive about broaching the subject with their patients. Some steps physicians can take to support their patients include:

  • Brush up on the available literature on marijuana’s benefits and risks
  • Make sure patients are aware of the limited research
  • Determine if your state offers any education or certification program for physicians
  • Encourage patients using medical marijuana acquire it legally and through a reputable source
  • Reassure patients that they should feel comfortable telling you about medical marijuana usage, so that you get a holistic picture of their treatment
  • Review our blog post: What providers should know about the medical marijuana legal landscape

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