Opioids and Cancer - Friend or Foe?

The effect of opioids on cancer progression, metastases, and recurrence is increasingly being questioned by researchers and clinicians, and serves as an important reminder of the urgent need for more research into safe and effective non-opioid alternatives.

In a review published in the journal, Current Opinion in Supportive and Palliative Care, investigators examined the evidence for the action of opioids on the processes involved in cancer progression. In other words - they’re trying to figure out if taking opioids to treat cancer pain could actually cause the disease to progress faster.

The analysis showed there is sufficient in vitro and animal model work to make a plausible case for a detrimental effect of opioids on cancer progression and advised: “In the light of the uncertainty of opioid effect on cancer, any decision making should be tempered by knowing that stress and pain undoubtedly contribute to cancer progression.”

Given the high rates of pain prevalence amongst cancer patients, the importance of identifying non-opioid alternatives cannot be overstated. While more research is undoubtedly needed, the role of cannabinoids in treating cancer-related pain is promising and urgently warrants further investigation.

Cannabinoids are already a well-known and evidence-based treatment option for chemotherapy induced nausea and vomiting. While treating this symptom, I’ve seen several patients also experience reductions in their cancer-related pain and anxiety, which has allowed us to reduce their opioid and anti-anxiety medications in some cases. In many cases, cannabinoid therapy has also helped reduce or eliminate other intolerable side-effects caused by these powerful medications, including constipation, insomnia and lack of appetite.

Full article available here.

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Why women with breast cancer are turning to cannabis (it's not nausea).

Using cannabinoids to ease the symptoms of chemotherapy-induced nausea and vomiting is considered one of the medical applications most strongly supported by the research. But cancer encompasses an entire range of diseases, with treatments – and side-effects - that vary as well.

In the first ever study conducted to evaluate the underlying reasons women with breast cancer use cannabis, the results revealed that pain was the number one reason, followed by anxiety, insomnia, nausea and anorexia.

With more than half the women diagnosed with breast cancer being over the age of 50, treatment can exacerbate pre-existing medical conditions associated with older age (ie. arthritis, neuropathy). With many patients suffering an average of 3 symptoms, cannabis can help reduce polypharmacy as it is a multimodal medication and can manage many of these symptoms simultaneously.

Read the full article here.

Cannabis versus Cancer: Scientific American

Scientific American reports: "Countless scientific studies have shown that medical cannabis offers palliative care benefits, including appetite stimulation, pain relief and more. But early research indicates that cannabinoids can do so much more. Data is showing that medical marijuana has antitumor effects and may one day be used as a cancer treatment, not just as a drug to ease symptoms of the disease." Full article. 

New Jersey Governor, Phil Murphy expands medical marijuana program: NBC

A renaissance is coming to New Jersey’s long embattled medical marijuana program. 

Democratic Gov. Phil Murphy announced a long list of reforms this morning, including lowering fees for patients and caregivers, adding five approved medical conditions and proposing legislation to increase monthly product limit for patients.

Patients receiving hospice care would be eligible for an unlimited supply of cannabis. Effective immediately, patients suffering from anxiety, migraines, Tourette’s syndrome, chronic pain related to musculoskeletal disorders, and chronic visceral pain will be eligible for the medical cannabis program.

Murphy added that he would like to eventually see opioid addiction added to the growing list of approved conditions. He called cannabis “an offensive weapon” to the growing crisis.

Full article 

Medical cannabis safer for elderly with chronic pain than opioids: European Pharmaceutical Review

Medical cannabis therapy can significantly reduce chronic pain in patients age 65 and older without adverse effects, according to researchers at Ben-Gurion University of the Negev (BGU) and the Cannabis Clinical Research Institute at Soroka University Medical Center.

The new study found that cannabis therapy is safe and efficacious for elderly patients who are seeking to address cancer symptoms, Parkinson’s disease, post-traumatic stress disorder, ulcerative colitis, Crohn’s disease, multiple sclerosis, and other medical issues.

“While older patients represent a large and growing population of medical cannabis users, few studies have addressed how it affects this particular group, which also suffers from dementia, frequent falls, mobility problems, and hearing and visual impairments,” says Victor Novack, a Professor of Medicinein the BGU Faculty of Health Sciences (FOHS), and head of the Soroka Cannabis Clinical Research Institute. 

“After monitoring patients 65 and older for six months, we found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported.” Read full article here and review research here.

Five most common uses for medical cannabis in 65+ demographic: Strainprint

Seniors are among one of the largest existing and growing demographics of medical cannabis users, evidenced by international trends as well as supported by the data collected from the Strainprint app, a mobile application that helps medical cannabis users track their intake and learn which strains and dosages work best for them. Strainprint also provides doctors and clinics with observational data to improve industry treatment knowledge. Based on their current data, here are the top five conditions for which people aged 65 and over are using medical cannabis. Full article.

NBA players ready to lift ban on medical marijuana use: San Francisco Chronicle

The San Francisco Chronicle reports that National Basketball Players Association (NPBA) Executive Director Michele Roberts has voiced her support for lifting the league’s ban on marijuana in the near future.

“My own view is that there are substantial signs that support its efficacy and the value that it has for us, especially pain management,” Roberts told SB Nation.” We’re in talks with the league to see where we can go with it.” Full article.

Sarnia doctor partners with Trillium Villa to assess benefits of medical marijuana in nursing homes: Lambton Shield

Dr. Blake Pearson partners with Trillium Villa on a new, trailblazing collaboration to determine whether medicinal marijuana can improve quality of life for residents of Sarnia's long-term care community who are living with conditions such as chronic pain, movement disorders and anxiety. Read here.

Medical marijuana therapy program to help seniors: Blackburn News Canada

Dr. Blake Pearson says, “In my clinic daily, I see the benefits of THC and CBD, and in a continuing care facility we see patients suffering from chronic pain, sleep disorders, and dementia-related anxiety. I think it’s a natural fit to try it out and hopefully reduce some of the polypharmacy going on in those types of settings." Full article.

Research: Pharmacological management of chronic neuropathic pain, Canadian Pain Society

The Canadian Pain Society has advanced cannabinoid therapy from a fourth-line (2007) to the third-line (2014) recommendation, citing the following evidence:

• Since 2006, seven high quality studies investigated cannabinoid therapy in neuropathic pain, and all but one of these studies had positive results.
• Mucosal spray of 50/50 mixture of THC/CBD provided significant pain relief for patients with multiple sclerosis.
• One trial found that nabilone was effective for pain relief in patients with painful diabetic neuropathy, with improved sleep and overall quality of life. 
• There is increasing evidence of the benefits of cannabinoid therapy in managing neuropathic pain: overall NNT of 3.4.