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State of the science: cannabis and cannabinoids in palliative medicine—the potential
  1. Priodarshi Roychoudhury1,
  2. Astha Koolwal Kapoor2,
  3. Declan Walsh3,
  4. Henry Cortes1 and
  5. Hance Clarke1,4,5
  1. 1 Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
  2. 2 Department of Oncoanesthesia, AIIMS, New Delhi, Delhi, India
  3. 3 Department of Supportive Care and Survivorship, Atrium Health, Charlotte, North Carolina, USA
  4. 4 Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Centre for Cannabinoid Therapeutics, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Professor Hance Clarke, Anesthesia and Pain Medicine, University Health Network, Toronto, ON M5G 2C4, Canada; hance.clarke{at}uhn.ca

Abstract

Cannabinoids are chemicals derived naturally from the cannabis plant or are synthetically manufactured. They interact directly with cannabinoid receptors or share chemical similarity with endocannabinoids (or both). Within palliative medicine, cannabinoid receptors (CB1 and CB2) may modulate some cancer symptoms: appetite, chemotherapy-induced nausea and vomiting, and mood, pain and sleep disorders. Opioid and cannabinoid receptors have overlapping neuroanatomical receptor distribution, particularly at the dorsal horn, dorsal striatum and locus coeruleus. They have a favourable safety profile compared with opioids, and cannabis-based medicines help chronic pain. While cannabidiol (CBD) has anti-inflammatory properties, tetrahydrocannabinol (THC) is the psychoactive substance for issues such as mood and sleep. Nabiximols (Sativex), a CBD:THC combination, is Food and Drug Administration approved for some multiple sclerosis symptoms and epilepsy. There has been a swift societal evolution in attitudes about use of cannabis and cannabinoid medicines for chronic pain. In the USA, 33 states have now legalised prescription-based medical cannabis for several medical conditions; Canada has had legislation since 2001 authorising medical use. The European Union (EU) recently declared all EU citizens must have access to medical cannabis over the next 4 years. The integration into medicine and routine clinical use of cannabis is fraught with information gaps, regulatory issues and scarcity of research. Each patient should have a comprehensive assessment and risk–benefit discussion before any cannabis-based intervention to avoid possible complications such as hallucinations, psychosis and potential cardiac harm.

  • pain
  • supportive care
  • anorexia
  • terminal care
  • cancer
  • end of life care

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Footnotes

  • Twitter @drhaclarke

  • Contributors All authors have contributed to the writing and revision of the current manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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