Cannabis in palliative care: current challenges and practical recommendations

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Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM.

The therapeutic potential of cannabis and cannabinoids

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Cannabis-based medications exert their effects mainly through the activation of cannabinoid receptors (CB1 and CB2). More than 100 controlled clinical trials of cannabinoids or whole-plant preparations for various indications have been conducted since 1975. The findings of these trials have led to the approval of cannabis-based medicines (dronabinol, nabilone, and a cannabis extract [THC:CBD=1:1]) in several countries. In Germany, a cannabis extract was approved in 2011 for the treatment of moderate to severe refractory spasticity in multiple sclerosis.

Medical cannabis for the treatment of chronic pain and other disorders: misconceptions and facts

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Recently, many countries have enacted new cannabis policies, including decriminalization of cannabis possession as well as legalization of medical and recreational cannabis. In this context, patients and their physicians have had an increasing number of conversations about the risks and benefits of cannabis. While cannabis and cannabinoids continue to be evaluated as pharmacotherapy for medical conditions, the best evidence currently exists for the following medical conditions: chronic pain, neuropathic pain, and spasticity resulting from multiple sclerosis.

Cannabinoids in late-onset Alzheimer’s disease

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Given the lack of effective treatments for late-onset Alzheimer’s disease (LOAD) and the substantial burden on patients, families, health care systems, and economies, finding an effective therapy is one of the highest medical priorities. Several in vitro and in vivo studies have demonstrated that cannabinoids can reduce oxidative stress, neuro-inflammation, and the formation of amyloid plaques and neurofibrillary tangles, the key hallmarks of LOAD.

The Antitumor Activity of Plant-Derived Non-Psychoactive Cannabinoids

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As a therapeutic agent, most people are familiar with the palliative effects of the primary psychoactive constituent of Cannabis sativa (CS), Δ(9)-tetrahydrocannabinol (THC), a molecule active at both the cannabinoid 1 (CB1) and cannabinoid 2 (CB2) receptor subtypes. Through the activation primarily of CB1 receptors in the central nervous system, THC can reduce nausea, emesis and pain in cancer patients undergoing chemotherapy. During the last decade, however, several studies have now shown that CB1 and CB2 receptor agonists can act as direct anti-tumor agents in a variety of aggressive cancers.

Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy

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The purpose of the study was to better understand why patients with history of head and neck cancer (HNC) treated with radiotherapy are using medical marijuana (MM). MM provided benefit in altered sense, weight maintenance, depression, pain, appetite, dysphagia, xerostomia, muscle spasm, and sticky saliva. HNC patients report MM use to help with long-term side effects of radiotherapy.

Safety and Efficacy of Medical Cannabis Oil for Behavioral and Psychological Symptoms of Dementia: An-Open Label, Add-On, Pilot Study

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Tetrahydrocannabinol (THC) is a potential treatment for Alzheimer’s disease (AD). To measure efficacy and safety of medical cannabis oil (MCO) containing THC as an add-on to pharmacotherapy, in relieving behavioral and psychological symptoms of dementia (BPSD). Adding MCO to AD patients’ pharmacotherapy is safe and a promising treatment option.

Cannabis in cancer care

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Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Delta-9-tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy-induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer-related pain, possibly synergistic with opioid analgesics.

Pain in Extrapyramidal Neurodegenerative Diseases

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Pain is one of the most common non-motor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications. The most beneficial analgesics were non-steroidal anti-inflammatory drugs and medical cannabis.

Cannabis for cancer – illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology.

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A flowering plant of variegated ingredients and psychoactive qualities, Cannabis has long been used for medicinal and recreational purposes. Regulatory approvals have been gained across a broad range of palliative and therapeutic indications, and in some cases, included in standard treatment guidelines. The use of Cannabis and cannabinoid-based-medicines in oncology is summarized in this article. Sufficient evidence supports use of Cannabis for palliative indications in oncology, however, patients should be carefully selected, guided and followed.