Cbd oil for severe pain cancer

A selective review of medical cannabis in cancer pain management

Insufficient management of cancer-associated chronic and neuropathic pain adversely affects patient quality of life. Patients who do not respond well to opioid analgesics, or have severe side effects from the use of traditional analgesics are in need of alternative therapeutic op-tions. Anecdotal evidence suggests that medical cannabis has potential to effectively manage pain in this patient population. This review presents a selection of representative clinical studies, from small pilot studies conducted in 1975, to double-blind placebo-controlled trials conducted in 2014 that evaluated the efficacy of cannabinoid-based therapies containing tetrahydrocannabinol (THC) and cannabidiol (CBD) for reducing cancer-associated pain. A review of literature published on Medline between 1975 and 2017 identified five clinical studies that evaluated the effect of THC or CBD on controlling cancer pain, which have been reviewed and summarised. Five studies that evaluated THC oil capsules, THC:CBD oromucosal spray (nabiximols), or THC oromucosal sprays found some evidence of cancer pain reduction associated with these therapies. A variety of doses ranging from 2.7-43.2 mg/day THC and 0-40 mg/day CBD were administered. Higher doses of THC were correlated with increased pain relief in some studies. One study found that significant pain relief was achieved in doses as low as 2.7-10.8 mg THC in combination with 2.5-10.0 mg CBD, but there was conflicting evidence on whether higher doses provide superior pain relief. Some reported side effects include drowsiness, hypotension, mental clouding, and nausea and vomiting. There is evidence suggesting that medical cannabis reduces chronic or neu-ropathic pain in advanced cancer patients. However, the results of many studies lacked statistical power, in some cases due to limited number of study subjects. Therefore, there is a need for the conduct of further double-blind, placebo-controlled clinical trials with large sample sizes in order to establish the optimal dosage and efficacy of different cannabis-based therapies.

Keywords: Medical cannabis; cancer; pain.

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Cannabis, CBD oil and cancer

Cannabis is a plant and a class B drug. It affects people differently. It can make you feel relaxed and chilled but it can also make you feel sick, affect your memory and make you feel lethargic. CBD oil is a chemical found in cannabis.

Summary:

  • Cannabis has been used for centuries recreationally and as a medicine.
  • It is illegal to possess or supply cannabis as it is a class B drug.
  • Research is looking at the substances in cannabis to see if it might help treat cancer.
  • There are anti sickness medicines that contain man-made substances of cannabis.

What are cannabis and cannabinoids?

Cannabis is a plant. It is known by many names including marijuana, weed, hemp, grass, pot, dope, ganja and hash.

The plant produces a resin that contains a number of substances or chemicals. These are called cannabinoids. Cannabinoids can have medicinal effects on the body.
The main cannabinoids are:

  • Delta-9-tetrahydrocannabinol (THC)
  • Cannabidiol (CBD)

THC is a psychoactive substance that can create a ‘high’ feeling. It can affect how your brain works, changing your mood and how you feel.

CBD is a cannabinoid that may relieve pain, lower inflammation and decrease anxiety without the psychoactive ‘high’ effect of THC.

Different types of cannabis have differing amounts of these and other chemicals in them. This means they can have different effects on the body.

Cannabis is a class B drug in the UK. This means that it is illegal to have it, sell it or buy it.

CBD oil, cannabis oil and hemp oil

There are different types of oil made from parts of the cannabis plant. Some are sold legally in health food stores as a food supplement. Other types of oil are illegal.

CBD oil comes from the flowers of the cannabis plant and does not contain the psychoactive substance THC. It can be sold in the UK as a food supplement but not as a medicine. There is no evidence to support its use as a medicine.

Cannabis oil comes from the flowers, leaves and stalks of the cannabis plant. Cannabis oil often contains high levels of the psychoactive ingredient THC. Cannabis oil is illegal in the UK.

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Hemp oil comes from the seeds of a type of cannabis plant that doesn’t contain the main psychoactive ingredient THC. Hemp seed oil is used for various purposes including as a protein supplement for food, a wood varnish and an ingredient in soaps.

Why people with cancer use it

Cannabis has been used medicinally and recreationally for hundreds of years.

There has been a lot of interest into whether cannabinoids might be useful as a cancer treatment. The scientific research done so far has been laboratory research, with mixed results, so we do not know if cannabinoids can treat cancer in people.

Results have shown that different cannabinoids can:

  • cause cell death
  • block cell growth
  • stop the development of blood vessels – needed for tumours to grow
  • reduce inflammation
  • reduce the ability of cancers to spread

Scientists also discovered that cannabinoids can:

  • sometimes encourage cancer cells to grow
  • cause damage to blood vessels

Cannabinoids have helped with sickness and pain in some people.

Medical cannabis

This means a cannabis based product used to relieve symptoms.

Some cannabis based products are available on prescription as medicinal cannabis. The following medicines are sometimes prescribed to help relieve symptoms.

Nabilone (Cesamet)

Nabilone is a drug developed from cannabis. It is licensed for treating severe sickness from chemotherapy that is not controlled by other anti sickness drugs. It is a capsule that you swallow whole.

Sativex (Nabiximols)

Sativex is a cannabis-based medicine. It is licensed in the UK for people with Multiple Sclerosis muscle spasticity that hasn’t improved with other treatments. Sativex is a liquid that you spray into your mouth.

Researchers are looking into Sativex as a treatment for cancer related symptoms and for certain types of cancer.

How you have it

Cannabis products can be smoked, vaporized, ingested (eating or drinking), absorbed through the skin (in a patch) or as a cream or spray.

CBD oil comes as a liquid or in capsules.

Side effects

Prescription drugs such as Nabilone can cause side effects. This can include:

  • increased heart rate
  • blood pressure problems
  • drowsiness
  • mood changes
  • memory problems

Cannabis that contains high levels of THC can cause panic attacks, hallucinations and paranoia.

There are also many cannabis based products available online without a prescription. The quality of these products can vary. It is impossible to know what substances they might contain. They could potentially be harmful to your health and may be illegal.

Research into cannabinoids and cancer

We need more research to know if cannabis or the chemicals in it can treat cancer.

Clinical trials need to be done in large numbers where some patients have the drug and some don’t. Then you can compare how well the treatment works.

Many of the studies done so far have been small and in the laboratory. There have been a few studies involving people with cancer.

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Sativex and temozolomide for a brain tumour (glioblastoma) that has come back

In 2021, scientists reported the final results of a phase 1 study to treat people with recurrent glioblastoma (a type of brain tumour that has come back). The study looked at Sativex in combination with the chemotherapy drug temozolomide.

Researchers found that adding Sativex caused side effects, which included, vomiting, dizziness, fatigue, nausea and headache but patients found the side effects manageable.

They also observed that 83 out of 100 people (83%) were alive after one year using Sativex, compared to 44 out of 100 people (44%) taking the placebo.

However, this phase 1 study only involved 27 patients, which was too small to learn about any potential benefits of Sativex. The study wanted to find out if Sativex and temozolomide was safe to take by patients.

Researchers have now started a larger phase 2 trial called ARISTOCRAT, to find out if this treatment is effective and who might benefit from it. Speak to your specialist if you want to take part in a clinical trial.

Sativex and cancer pain

There are trials looking at whether Sativex can help with cancer pain that has not responded to other painkillers.

The results of one trial showed that Sativex did not improve pain levels. You can read the results of the trial on our clinical trials website.

Cancer and nausea and vomiting

A cannabis based medicine, Nabilone, is a treatment for nausea and vomiting.

A Cochrane review in 2015 looked at all the research available looking into cannabis based medicine as a treatment for nausea and sickness in people having chemotherapy for cancer. It reported that many of the studies were too small or not well run to be able to say how well these medicines work. They say that they may be useful if all other medicines are not working.

Other research

A drug called dexanabinol which is a man made form of a chemical similar to that found in cannabis has been trialled in a phase 1 trial. This is an early trial that tries to work out whether or not the drug works in humans, what the correct dose is and what the side effects might be. The results are not available yet. You can read about the trial on our clinical trials database.

Word of caution

Cannabis is a class B drug and illegal in the UK.

There are internet scams where people offer to sell cannabis preparations to people with cancer. There is no knowing what the ingredients are in these products and they could harm your health.
Some of these scammers trick cancer patients into buying ‘cannabis oil’ which they then never receive.

You could talk with your cancer specialist about the possibility of joining a clinical trial. Trials can give access to new drugs in a safe and monitored environment.

More information

The science blog on our website has more information about cannabis and cancer.