State of the science: cannabis and cannabinoids in palliative medicine—the potential

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.

https://restorativemedicine.org/journal/cbd-physiological-modulator-cancer/

“…19,20,24 The European Union (EU) recently proclaimed that all EU citizens must be granted access to medical cannabis within the next 4 years. 25 CBD is the second most common phytocannabinoid in cannabis and the most common in the hemp plant. The CBD molecule is shown with a tetrahydro-biphenyl skeleton formed by the monoterpene, p-cymene (Figure 1).…”

Current status of Complementary and Alternative Medicine Interventions in the Management of Pancreatic Cancer – An Overview

“…Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are well-known, naturally occurring compounds of cannabis. Their beneficial properties are widely used in treating cancer pain, nausea and vomiting, mood and sleep disorders, and appetite stimulation [ 95 , 100 ].…”

“…Compound Kushen injection (CKi), a Chinese patent drug, is widely used as adjuvant therapy in the cancer treatment, especially neoplasms of the digestive system. Matrine and oxymatrine are believed to be the compounds of CKI that have anti-cancer properties [94]; the former inhibits proliferation, arrests the cell cycle, and induces apoptosis in PC in vitro [95]. In a meta-analysis from 2022 [87••] it has been emphasized that Cki combined with CT may improve OS and QoL as well as relieving CT-related thrombocytopenia, CTrelated GI adverse effects, and pain when compared to CT alone [87 Huachansu injection (HCSi) is a water-soluble preparation extracted from the toad's skin and parotid venom glands (Bufo bufo gargarizans Cantor) containing Chansu [46].…”

“…Pain relief [84] Xiang-Sha-Liu-jun-zi-tang Prevents dyspeptic symptoms [76] TCM injections Brucea javanica oil emulsion injection Inhibits angiogenesis, cell proliferation and invasion, induces apoptosis and autophagy [88] Compound Kushen injection Inhibits proliferation, arrests the cell cycle, induces apoptosis [95] Huachansu injection Inhibits PC metastasis Reduces adverse effects as adjuvant therapy [96] [93…”