Medical Marijuana and Mesothelioma

Although the sale and use of marijuana as a recreational substance is a federal offense in the U.S., as of Jan. 1, 2018, it is approved in nine states and the District of Columbia for recreational use and in 29 states for medicinal purposes — particularly for treating pain associated with cancer and for nausea and loss of appetite associated with chemotherapy treatment.

One mesothelioma survivor, Andy Ashcraft, used cannabis oil for years with encouraging success. His wife and caregiver thoroughly researched how to dose and administer cannabis oil to cancer patients before Andy began taking it.

Another survivor, Pete K., used edible medical marijuana to lessen the side effects of chemotherapy.

California resident and mesothelioma survivor Jim Huff uses CBD oil and THC oil to control his cancer and promote sleep.

Benefits and Side Effects of Medical Marijuana

Patients with mesothelioma cope with symptoms of the disease and side effects of cancer treatment such as chest pain and chemotherapy-induced nausea. Several clinical trials have found marijuana is effective in managing symptoms associated with cancer.

In these trials, marijuana was found effective for:

• Pain relief
• Nausea relief
• Improved appetite
• Improved sleep quality
• Anxiety relief

Despite its benefits, marijuana may also have side effects, including:

• Rapid heartbeat
• Low blood pressure
• Muscle relaxation
• Bloodshot eyes
• Slowed food digestion
• Dizziness
• Paranoia

Patients report side effects are generally mild and vary depending on the strain of marijuana and how much is consumed.

Scientific studies are also presenting evidence that marijuana possesses anti-tumor activity in certain types of cancer, including lung cancer.

Recent Scientific Research

Most of the scientific research on marijuana in cancer care happens outside of the U.S. because marijuana remains illegal at the federal level. Growing support for legalization of medical marijuana may promote cancer research in the future, but current research is stagnant in the U.S.

Global research efforts have increased in recent years because of a growing interest in the potential role of medical marijuana in cancer care. The research extends beyond the well-known THC chemical to include other compounds, such as CBD, collectively known as cannabinoids. The research has looked at marijuana not only as a means to control cancer symptoms and treatment side effects, but also as an anticancer therapy.

No less than 10 different malignant tumors thus far appear to be sensitive to cannabinoid-induced growth inhibition. Experimental systems to date have been in vivo murine subjects (rodent species) or in vitro experiments (test tube).

The regression of malignant cells and anticancer activity may be a consequence of initiating apoptosis (programmable cell death) and also decreasing the cancer cells’ ability to erode and invade into adjacent tissue. It appears that certain cancer cells actually have cannabinoid receptors, but the precise function remains largely unknown

• A 2014 study reported certain cannabinoid compounds in medical marijuana can kill a variety of cancer cells and block them from spreading. Researchers cited studies showing cannabinoids having anticancer effects in the following cancers: Lung, breast, prostate, skin, pancreatic, brain, bone, oral, thyroid and lymphoma.

• A 2016 study found THC and other cannabinoids can kill cancer cells and inhibit angiogenesis, the process through which tumors grow new blood vessels that allow cancer cells to spread. The study also noted research in animals that showed cannabinoids enhanced the effect of cancer drugs designed to stop tumor growth and spreading.

• Another 2016 study found THC and CBD inhibited the growth of neuroblastoma in test tube studies and mice studies. Of the two cannabinoids, CBD was more active against this cancer that affects adrenal glands and occurs most commonly in children under 5 years old.

It is important to note some laboratory research indicates cannabinoids may promote tumor growth in certain cancers. For example, one test tube study found THC promoted the growth of lung cancer and glioblastoma, a type of brain cancer.

Another test tube study found THC enhanced the growth and spreading of breast cancer. One study in mice with lung cancer found THC accelerated tumor growth by inhibiting parts of the immune system that control cancer.

Further research in humans is required to fully understand how the chemicals in marijuana affect different types of cancer.

Edible Medical Marijuana

Patients with mesothelioma or lung cancer usually have weakened lungs and experience trouble breathing. For these patients, consuming edible marijuana is preferable to smoking it to avoid any aggravation of lung tissues.

When marijuana is inhaled, the effects are felt almost immediately. When eaten, the medicine takes longer to take effect because of the digestive process. The effect can take from 20 minutes to two or more hours to be fully felt, but the average time is around 90 minutes.

Many patients find the psychoactive effects of edible marijuana are milder and the body relief is stronger. This is sometimes more effective for cancer patients who seek relief from physical symptoms. The effects may also last longer.

Edible medical marijuana comes in a variety of types. The most popular and most recognizable forms of edible marijuana are baked goods. Items such as brownies and cookies are made with cannabis-infused butter. Hash oil or hash-infused butter tends to have a higher concentration of medicine, so less medicine can be used, making the flavor milder. This type of medicine can also be made into chocolates.

For patients who are watching calories, fat or sugar, there are alternatives to heavy baked goods.

Tinctures are placed under the tongue for a short amount of time and then swallowed. According to some patients, the effect of this medicine is less sedating than edibles made with cannabis butter, and the medicine is absorbed more quickly.

Cannabis capsules usually contain a mix of cannabis and other oils, or other oils infused with cannabis. Patients take these like they would any other pill.

Other edibles include hard candies, cold drinks and teas. It is important to follow dosing instructions carefully and not overeat marijuana edibles. Patients are recommended to start with a very small dose to gauge the effects.

For patients who don’t prefer edibles, topical marijuana products are becoming more widely available and are primarily used to reduce body pain and inflammation in the area they are applied. Some states that haven’t enacted medical marijuana laws allow the sale of non-psychoactive cannabinoid products such as CBD topical creams.

Synthetic THC

Since marijuana is not readily available to many patients, drug companies have developed synthetic versions of tetrahydrocannabinol (THC), the active ingredient in marijuana. A synthetic form of THC called Marinol (dronabinol) was approved by the U.S. Food and Drug Administration (FDA) as an appetite stimulant and for nausea.

Cesamet (nabilone) is another drug that contains a synthetic cannabinoid similar to THC that was approved to treat nausea and vomiting caused by chemotherapy.

Patients who have tried synthetic and natural versions of marijuana often say marijuana in its natural form is more effective for symptom relief than the synthetic variety. Marinol and Cesamet can also have serious side effects that aren’t a risk with natural THC, including seizures, irregular heartbeat, vision changes, headaches and severe or persistent dizziness.

Regulation and Legalization of Medical Marijuana

Regulations on marijuana began in the early 1900s. Various pieces of legislation affected the regulation and criminalization of marijuana such as the Harrison Narcotics Act, the Marihuana Tax Act of 1937, the Boggs Act and the Narcotics Control Act.

In 1970, the Controlled Substances Act classified marijuana as a Schedule I substance having “no accepted medical use.”

The country’s attitude toward medical marijuana began to shift again in the late 1970s. In 1978, the National Institute on Drug Abuse (NIDA) supplied seven patients with marijuana after their physicians applied for the Expanded Access (Compassionate Use) program.

In 1991, 53 percent of oncologists agreed that marijuana should be available by prescription and 66 percent confirmed it helped cancer patients treat the side effects of chemotherapy.

The New England Journal of Medicine published an editorial calling for the rescheduling of marijuana in 1997, and in 2008 the American College of Physicians stated that it supported non-smoked THC. The organization also called for exemption from criminal prosecution for patients.

After California legalized the drug in 1996, other states followed. Presently, 29 states and the District of Columbia have legalized medical marijuana.

Recreational marijuana became legal to purchase in Colorado and Washington in 2014. Since then, the District of Columbia and six other states, including Alaska, California, Nevada, Oregon, Maine, Nevada, and Massachusetts have enacted recreational laws.

States That Have Legalized Medical Marijuana

State	Possession limit
Alaska	1 oz usable; 6 plants (3 mature, 3 immature)
Arizona	2.5 oz usable; 0-12 plants
Arkansas	3 oz usable per 14-day period
California	8 oz usable; 6 mature or 12 immature plants
Colorado	2 oz usable; 6 plants (3 mature, 3 immature)
Connecticut	2.5 oz usable
District of Columbia	2 oz useable; 6 plants (3 mature, 3 immature)
Delaware	6 oz usable
Florida	Amount to be determined
Hawaii	4 oz usable; 7 plants (3 mature, 4 immature)
Illinois	2.5 oz of usable cannabis during a 14-day period
Maine	2.5 oz usable; 6 plants
Maryland	30-day supply; no more than 120 grams (approximately 4 oz)
Massachusetts	60-day supply (10 oz)
Michigan	2.5 oz usable; 12 plants
Minnesota	30-day supply of non-smokable marijuana
Montana	1 oz usable; 4 plants (mature); 12 seedlings
Nevada	2.5 oz usable; 12 plants
New Hampshire	2 oz of usable cannabis during a 10-day period
New Jersey	2 oz usable
New Mexico	6 oz usable; 16 plants (4 mature, 12 immature)
New York	30-day supply of non-smokable marijuana
North Dakota	3 oz per 14-day period
Ohio	Maximum of a 90-day supply; amount to be determined
Oregon (only state to accept out-of-state applications)	24 oz usable; 24 plants (6 mature, 18 immature)
Pennsylvania	30-day supply
Rhode Island	2.5 oz usable; 12 plants
Vermont	2 oz usable; 9 plants (2 mature, 7 immature)
Washington	3 oz usable; 15 plants
West Virginia	30-day supply

At a federal level, marijuana remains illegal. Under former President Barak Obama’s administration, the U.S. Department of Justice (DOJ) stated it would let the states enforce their laws and would not intervene unless one of eight standards was violated, including keeping marijuana away from children, drug cartels and federal property. However, under President Donald Trump’s administration, the DOJ is reviewing that stance.

Talk with Your Oncologist

If you live in a state that offers medical marijuana, ask your oncologist how it might benefit or interfere with your treatment plan. People assume it couldn’t hurt to take a natural substance, but cannabis products contain antioxidants that may protect cancer cells from the wanted effects of chemotherapy and radiation therapy.

This means certain types of medical marijuana might have the potential to block your anticancer treatments from working properly. Your oncologist is your best resource for guidance on this matter.

While research shows medical marijuana can help cancer patients cope with pain, nausea, lack of appetite and insomnia, it is best to discuss how you want to use marijuana with your doctor to make sure you take the right product, at the right time, without interfering with your treatment plan.