CBD oil and cancer: 9 things to know
BY Cynthia DeMarco
CBD oil (cannabidiol) is everywhere these days. Once available only at novelty or vitamin shops, it’s now also at your local grocery store, pharmacy or even yoga studio.
It comes in many forms: oils that are dropped under the tongue, roll-ons that are applied to the skin and even solutions for vaping. Some producers extract CBD oil and add it into foods to create edible products.
But what is CBD oil exactly, and how does it affect cancer patients? Can it really treat — or even cure — cancer or relieve its symptoms? To separate fact from fiction, we spoke with our Kimberson Tanco, M.D. Here’s what he wants cancer patients to know.
What is CBD oil, and how does it differ from marijuana and hemp?
Marijuana and hemp are both varieties of the cannabis sativa plant. Both contain cannabidiol (CBD) and tetrahydrocannabinol (THC) — the two most-common, known active ingredients.
The main difference is that hemp has far less THC than a typical marijuana plant. And unlike THC, CBD is not a psychoactive agent, so there’s less possibility that it will cause the same mental confusion, drowsiness or hallucinations that often come with THC.
Is there any truth to the claims that CBD oil can cure cancer?
Right now, no. There is no evidence that CBD oil can cure cancer.
What, if anything, can CBD oil do to alleviate the symptoms of cancer or the side effects of cancer treatment?
It’s hard to say if CBD oil can alleviate cancer symptoms or cancer treatment side effects, because the studies are pretty mixed and even fewer are standardized.
There have been reports that cannabinoids like THC and CBD may be helpful for nausea and vomiting and anorexia, as well as neuropathy, anxiety, depression and insomnia. Synthetic cannabinoids like dronabinol have been approved for use with chemotherapy-induced nausea and vomiting, but have not been shown to be superior to conventional anti-nausea medications.
Have any CBD-oil derived products been approved by the U.S. Food and Drug Administration (FDA) to treat cancer, its symptoms, or the side effects caused by its treatment?
Have any products using CBD-oil been approved by the FDA to treat anything?
Yes. Epidiolex. It was originally approved in 2018 for the treatment of two conditions, both related to epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. But aside from Epidiolex, no CBD product has been approved by the FDA for any other medical purpose.
What are the dangers of using CBD oil?
Quality, cleanliness and regulation are the biggest concerns.
All drugs and dietary supplements are regulated by the FDA. But as long as CBD oil is not marketed as a medicine or a dietary supplement, producers can get around that policy. So right now, CBD oil is very unregulated. That means it’s hard to know how much CBD or THC is really in any given product. Certain hemp CBD products have been found to contain significantly less CBD or more THC than advertised.
In terms of purity, THC and CBD are both extracted from hemp and marijuana using essentially similar processes. But trace amounts of THC could still end up in CBD oil. And if the THC is at a high enough concentration, it could produce the psychoactive effects that THC is known for.
Second, if a lab produces both CBD and THC products, there can be cross-contamination — whether it’s through extraction, handling or packaging.
Third, the plant itself may have higher levels of THC than expected. This could be due to its environment, prolonged flowering periods or cross-contamination and pollination between male and female plants, resulting in offspring with higher THC content. This especially affects hemp plants, which should have less than 0.3% THC levels.
Finally, there have been some reports of people getting infections after using CBD and cannabis products. This is especially concerning for immunocompromised patients, who are already susceptible to bacterial and fungal infections.
Studies on a certain CBD manufacturer showed its products were contaminated with a chemical known as 5F-ADB, which mimics THC. 5F-ADB is classified by the U.S. Drug Enforcement Administration as illegal, potentially addictive and with no accepted medical use.
Other sorts of substances have been found in CBD products, too, such as dextromethorphan, which is an ingredient in cough medicines. Heavy metals like lead and arsenic, pesticides and mold have also been found in CBD products.
Does CBD oil have any side effects?
CBD oil can adversely affect liver function. In fact, this is on the warning label for Epidiolex.
And in lab studies, CBD has been shown to inhibit certain enzymes responsible for the metabolism of drugs, such as CYP2D6 and CYP3A4. This can affect how drugs work and affect our bodies, either by reducing their efficiency or making them more dangerous. This includes chemotherapy and other medications.
This is very important for cancer patients to understand, as many people think CBD oil is not a medicine. They think of it more as a vitamin or a supplement, so they might not let their doctors know they’re using it. Patients might not realize it can be potentially harmful. So, it’s very important to tell your doctor if you’re using CBD oil.
Is CBD oil even legal?
CBD has a very complex legal status right now.
At the national level, any product of marijuana — including CBD — is still technically illegal when used medically. Although the 2018 Farm Bill legalized the production of hemp nationally, that’s only permitted if it’s not marketed for medical use or as a dietary supplement. CBD products intended for medical use should undergo an FDA review process.
State laws vary. In Texas, the Compassionate Use Act allows for the use of medical marijuana for certain conditions. Originally only for intractable epilepsy, the law was expanded this year to include cancer and certain neurodegenerative conditions, such as Parkinson’s and multiple sclerosis.
But the application of this law is pretty jumbled right now. So, while it may be legal to use CBD in a state like Colorado or Alaska, if an employer follows federal regulations, the standardization and quality of a CBD product matters. Because if there’s even a small percentage of THC in that product, then a drug test might come back positive. And this could result in legal issues for the user.
What’s the most important thing cancer patients should know about CBD oil?
There’s still a lot to learn. So always let your health care team know if you are using CBD oil. That way, we can make sure nothing interacts adversely with your cancer treatments or other medications.
Also, avoid products with health-related claims on their labels. The only product approved by the FDA for its medical value is Epidiolex.
Wondering whether you should use CBD oil to cope with cancer treatment and its side effects? We spoke with Kimberson Tanco, M.D., to separate fact from fiction.
Olivia Newton-John’s Stage 4 Cancer Cannabis Management
— The singer and actress updates fans on her battle, but can marijuana help?
by Michele R. Berman, MD, and Mark S. Boguski, MD, PhD August 22, 2019
Singer/actress Olivia Newton-John, 70, was recently seen on “60 Minutes Australia,” where she updated viewers on how she is doing with her stage 4 breast cancer.
The Grease star was originally diagnosed with breast cancer in 1992, after finding a small, painful lump. She underwent a partial mastectomy and breast reconstruction, followed by chemotherapy. She also used complementary treatments, such as herbal supplements, acupuncture, meditation, and visualization.
“I researched a lot and felt satisfied with my course of treatment. It was sort of an East meets West approach. I meditated every day, did yoga, and homeopathy, ate well — I boosted my inner strength as much as I could. When bad thoughts came in, I pushed them right out.”
In 2013, she was again diagnosed with breast cancer, this time after discovering a lump in her shoulder. She had kept this relapse quiet until recently.
In May 2017, Newton-John postponed some shows, saying that she was suffering with a “long-running issue with sciatica.” Turns out, this was not the cause of her back pain. Her publicity team posted a statement on Facebook, which said:
“The back pain that initially caused her to postpone the first half of her concert tour, has turned out to be breast cancer that has metastasized to the sacrum. In addition to natural wellness therapies, Olivia will complete a short course of photon [sic] radiation therapy and is confident she will be back later in the year, better than ever, to celebrate her shows.”
“‘I decided on my direction of therapies after consultation with my doctors and natural therapists and the medical team at my Olivia Newton-John Cancer Wellness and Research Centre [which she founded in 1995] in Melbourne, Australia,’ says Olivia Newton-John.”
In addition to hormone suppression therapy (via estrogen receptor blockade), Newton-John has continued to use complementary treatments including herbs, marijuana, and mindfulness/meditation therapy.
The tumor in her sacrum caused a sacral fracture, leaving her in severe pain, described as “months and months of excruciating, sleep-depriving, crying out loud pain.” Unable to walk, she “willed herself” to walk, progressing from a wheelchair, to a walker, cane, and finally to be able to walk unassisted.
Originally treated for pain with morphine, Newton-John was able to wean herself off the morphine by using marijuana, primarily cannabis oil. She claims it also is helping her with anxiety and sleep. Her husband, John Easterling, grows many of the herbs and marijuana in a greenhouse in the backyard of their California home. Olivia says: “I really believe the cannabis has made a huge difference. If I don’t take the drops, I can feel the pain, so I know it’s working.”
Newton-John refuses to focus on how much time she could have left, feeling that concentrating on a specific time could be a self-fulfilling prophecy. “So, for me, psychologically, it’s better not to have any idea of what they expect or what the last person that has what you have lived, so I don’t, I don’t tune in.”
Newton-John is organizing a auction of some of her memorabilia (including her famous Grease leather jacket and pants) to raise money for the Olivia Newton-John Cancer Wellness & Research Centre. Besides caring for cancer patients, the institute has been involved in about 200 clinical trials.
Is there a role for marijuana in the management of cancer patients?
Marijuana, also known as cannabis, has been used for medicinal purposes for at least 3,000 years. It was introduced into Western medicine in 1839 by W.B. O’Shaughnessy, who learned of its medicinal properties while working in India for the British East India Company. Its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects.
The cannabis plant produces resin containing psychoactive compounds called cannabinoids, in addition to other compounds found in plants, such as terpenes and flavonoids. In the U.S., it is a controlled substance and is classified as a Schedule I agent (a drug with a high potential for abuse, and no currently accepted medical use).
Cannabinoids, also known as phytocannabinoids, are chemicals in cannabis that cause drug-like effects in the body, including the central nervous system and the immune system. The main psychoactive cannabinoid in Cannabis is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the high of delta-9-THC.
There are two potential roles for cannabis in cancer management: as a primary treatment or as an adjuvant therapy aimed at ameliorating symptoms of cancer or the side effects of medical invention. Unfortunately, cannabis’ status as a Schedule I drug has severely limited scientific inquiry into the potential benefits (and side effects) of cannabis in regard to cancer, especially as a primary treatment.
There are a few studies done in mice, rats, and in vitro human cancer cell lines, that suggest that cannabinoids may have a protective effect against the development of certain types of tumors. Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.
No ongoing clinical trials of cannabis as a treatment for cancer in humans were identified in a PubMed search. The only published trial of any cannabinoid in patients with cancer is a small pilot study of intratumoral injection of delta-9-THC in patients with recurrent glioblastoma multiforme, which demonstrated no significant clinical benefit.
Although few relevant surveys of practice patterns exist, it appears that physicians caring for cancer patients in the U.S. who recommend medicinal cannabis do so predominantly for symptom management. The potential benefits of medicinal cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep.
Dronabinol, a synthetically produced delta-9-THC, was approved in the U.S. in 1986 as an antiemetic to be used in cancer chemotherapy. Nabilone, a synthetic derivative of delta-9-THC, was first approved in Canada in 1982 and is now also available in the U.S. Numerous clinical trials and meta-analyses have shown that dronabinol and nabilone are effective in the treatment of nausea and vomiting induced by chemotherapy. Both dronabinol and nabilone have been approved by the FDA for the treatment of nausea/vomiting associated with cancer chemotherapy in patients who have failed to respond to conventional antiemetic therapy. The American Society of Clinical Oncology antiemetic guidelines updated in 2017 recommends that the FDA-approved cannabinoids, dronabinol, or nabilone be used to treat nausea/vomiting that is resistant to standard antiemetic therapies.
The studies that look at cannabinoid’s effect on appetite on patients with cancer or HIV have had mixed results. A few studies showed no significant improvement in appetite or weight gain. However, a smaller, placebo-controlled trial of dronabinol in cancer patients demonstrated improved and enhanced chemosensory perception in the cannabinoid group — food tasted better, appetite increased, and the proportion of calories consumed as protein was greater than in the placebo recipients.
Another clinical trial that involved 139 patients with HIV or AIDS and weight loss found that, compared with placebo, oral dronabinol was associated with a statistically significant increase in appetite after 4 to 6 weeks of treatment. Patients receiving dronabinol tended to have weight stabilization, whereas patients receiving placebo continued to lose weight.
Pain management improves a patient’s quality of life throughout all stages of cancer. Cancer pain results from inflammation, invasion of bone or other pain-sensitive structures, or nerve injury.
A 2017 review looked at five studies evaluating the efficacy of cannabis in patients with cancer. “Four out of the five studies found that cannabis was significantly associated with a decrease in cancer-associated pain,” the authors wrote. Limitations to the studies included the small number of patients in some studies, variation in route of administration, and a lack of dosing guidelines. Further research is needed into this potentially important adjuvant treatment.
Anxiety and Sleep
In a small pilot study of analgesia involving 10 patients with cancer pain, secondary measures showed that 15 mg and 20 mg doses of the cannabinoid delta-9-THC were associated with anxiolytic effects. Another small placebo-controlled study of dronabinol in cancer patients with altered chemosensory perception also noted increased quality of sleep and relaxation in THC-treated patients.
Patients often experience mood elevation after exposure to cannabis, depending on their previous experience. In a five-patient case series of inhaled cannabis that examined analgesic effects in chronic pain, it was reported that patients who self-administered cannabis had improved mood, improved sense of well-being, and less anxiety.
Seventy-four patients with newly diagnosed head and neck cancer self-described as current cannabis users were matched to 74 nonusers in a Canadian study investigating quality of life. Cannabis users had significantly lower scores in the anxiety/depression and pain/discomfort scale. Cannabis users were also less tired, had more appetite, and better general well-being
Cannabis’ status as a Schedule I drug has limited studies on the potential benefits of cannabis for cancer patients as well as others with chronic illness. Even with the increasing number of states that have legalized medicinal or recreational marijuana, researchers may shy away from this research because of federal restrictions and inability to get federal grants to pay for such research.
Do you think it’s time for the federal government to revisit marijuana’s status?
Clinical trials (all as adjuvant therapy): ClinicalTrials.gov
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.
The singer and actress updates fans on her battle, but can marijuana help?