{"id":5568,"date":"2017-10-20T17:16:10","date_gmt":"2017-10-20T21:16:10","guid":{"rendered":"http:\/\/lcpllutzlivetotell.org\/?p=5568"},"modified":"2019-08-08T12:57:38","modified_gmt":"2019-08-08T16:57:38","slug":"cannabis-cannabinoids-pdq-health-professional-version","status":"publish","type":"post","link":"https:\/\/www.lutzlivetotell.org\/?p=5568","title":{"rendered":"Cannabis and Cannabinoids (PDQ\u00ae)\u2013Health Professional Version"},"content":{"rendered":"<div class=\"row collapse previous-next-links show-for-large-up\">\n<section id=\"_1\" class=\"show\">\n<h2>Overview<\/h2>\n<div id=\"_section_1\" class=\"pdq-sections\">\n<p id=\"_2\" tabindex=\"-1\">This\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cancer<\/a>\u00a0information summary provides an overview of the use of\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>and its components as a treatment for people with cancer-related\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptoms<\/a>\u00a0caused by the disease itself or its treatment.<\/p>\n<p id=\"_17\" tabindex=\"-1\">This summary contains the following key information:<\/p>\n<div class=\"pdq-content-list\">\n<ul id=\"_18\">\n<li><em>Cannabis<\/em>\u00a0has been used for medicinal purposes for thousands of years.<\/li>\n<li>By federal law, the possession of\u00a0<em>Cannabis<\/em>\u00a0is illegal in the United States, except within approved research settings; however, a growing number of states, territories, and the District of Columbia have enacted laws to legalize its medical use.<\/li>\n<li>The U.S. Food and Drug Administration has not approved\u00a0<em>Cannabis<\/em>\u00a0as a treatment for cancer or any other medical condition.<\/li>\n<li><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=643008&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Chemical<\/a>\u00a0components of\u00a0<em>Cannabis<\/em>, called\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoids<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=43976&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">activate<\/a>\u00a0specific\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44958&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">receptors<\/a>throughout the body to produce\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=463167&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pharmacologic<\/a>\u00a0effects, particularly in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46481&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">central nervous system<\/a>\u00a0and the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46356&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">immune system<\/a>.<\/li>\n<li>Commercially available cannabinoids, such as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45240&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">dronabinol<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716290&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nabilone<\/a>, are approved drugs for the treatment of cancer-related\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46580&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">side effects<\/a>.<\/li>\n<li>Cannabinoids may have benefits in the treatment of cancer-related side effects.<\/li>\n<\/ul>\n<\/div>\n<p id=\"_79\" tabindex=\"-1\">Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the\u00a0<a title=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\" href=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\">NCI Dictionary of Cancer Terms<\/a>, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window.<\/p>\n<p id=\"_80\" tabindex=\"-1\">Reference citations in some\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44271&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">PDQ<\/a>\u00a0cancer information summaries may include links to external websites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the websites, or of any treatment or product, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board or the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44266&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">National Cancer Institute<\/a>.<\/p>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_3\" class=\"show\">\n<h2>General Information<\/h2>\n<div id=\"_section_3\" class=\"pdq-sections\">\n<p id=\"_4\" tabindex=\"-1\"><em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>, also known as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=285927&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">marijuana<\/a>, originated in Central Asia but is grown worldwide today. In the United States, it is a controlled substance and is classified as a Schedule I agent (a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">drug<\/a>\u00a0with a high potential for abuse, and no currently accepted medical use). The\u00a0<em>Cannabis<\/em>\u00a0plant produces a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=642508&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">resin<\/a>\u00a0containing psychoactive\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=422394&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">compounds<\/a>\u00a0called\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoids<\/a>, in addition to other compounds found in plants, such as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=463097&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">terpenes<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=330168&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">flavonoids<\/a>. The highest\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=683342&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">concentration<\/a>\u00a0of cannabinoids is found in the female flowers of the plant.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_2.1\">1<\/a>]\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Clinical trials<\/a>\u00a0conducted on medicinal\u00a0<em>Cannabis<\/em>\u00a0are limited. The\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454785&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">U.S. Food and Drug Administration<\/a>\u00a0(FDA) has not approved the use of\u00a0<em>Cannabis<\/em>\u00a0as a treatment for any medical\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=651193&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">condition<\/a>. To conduct\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44168&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">clinical<\/a>\u00a0drug research with\u00a0<em>Cannabis<\/em>\u00a0in the United States, researchers must file an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=762975&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Investigational New Drug<\/a>\u00a0(IND) application with the FDA, obtain a Schedule I license from the U.S. Drug Enforcement Administration, and obtain approval from the National Institute on Drug Abuse.<\/p>\n<p id=\"_19\" tabindex=\"-1\">The potential benefits of medicinal\u00a0<em>Cannabis<\/em>\u00a0for people living with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cancer<\/a>\u00a0include\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46084&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antiemetic<\/a>\u00a0effects,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">appetite<\/a>\u00a0stimulation, pain relief, and improved sleep.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_2.2\">2<\/a>] Although few relevant surveys of practice patterns exist, it appears that\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390246&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">physicians<\/a>\u00a0caring for cancer patients in the United States who recommend medicinal\u00a0<em>Cannabis<\/em>\u00a0do so predominantly for\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=269453&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptom management<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_2.3\">3<\/a>] A growing number of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46245&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pediatric<\/a>\u00a0patients are seeking symptom relief with\u00a0<em>Cannabis<\/em>\u00a0or cannabinoid treatment, although studies are limited.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_2.4\">4<\/a>] The\u00a0<a title=\"https:\/\/www.aap.org\/\" href=\"https:\/\/www.aap.org\/\">American Academy of Pediatrics<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>\u00a0has not endorsed\u00a0<em>Cannabis<\/em>\u00a0and cannabinoid use because of concerns about brain development.<\/p>\n<p id=\"_20\" tabindex=\"-1\">Cannabinoids are a group of terpenophenolic compounds found in\u00a0<em>Cannabis<\/em>\u00a0species (e.g.,\u00a0<em>Cannabis sativa\u00a0<\/em>L.). This summary will review the role of\u00a0<em>Cannabis<\/em>\u00a0and the cannabinoids in the treatment of people with cancer and disease-related or treatment-related\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46580&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">side effects<\/a>.<\/p>\n<h6>References<\/h6>\n<ol>\n<li id=\"section_2.1\">Adams IB, Martin BR: Cannabis: pharmacology and toxicology in animals and humans. Addiction 91 (11): 1585-614, 1996.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_2.2\">Abrams DI: Integrating cannabis into clinical cancer care. Curr Oncol 23 (2): S8-S14, 2016.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=27022315&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=27022315&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_2.3\">Doblin RE, Kleiman MA: Marijuana as antiemetic medicine: a survey of oncologists&#8217; experiences and attitudes. J Clin Oncol 9 (7): 1314-9, 1991.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=2045870&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=2045870&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_2.4\">Sallan SE, Cronin C, Zelen M, et al.: Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine. N Engl J Med 302 (3): 135-8, 1980.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=6985702&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=6985702&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_5\" class=\"show\">\n<h2>History<\/h2>\n<div id=\"_section_5\" class=\"pdq-sections\">\n<p id=\"_6\" tabindex=\"-1\"><em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>use for medicinal purposes dates back at least 3,000 years.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.1\">1<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.5\">5<\/a>] It was introduced into\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454743&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Western medicine<\/a>\u00a0in 1839 by W.B. O\u2019Shaughnessy, a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44306&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">surgeon<\/a>\u00a0who learned of its medicinal properties while working in India for the British East India Company. Its use was promoted for reported\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45590&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analgesic<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=450118&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">sedative<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44187&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anti-inflammatory<\/a>, antispasmodic, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46083&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anticonvulsant<\/a>\u00a0effects.<\/p>\n<p id=\"_21\" tabindex=\"-1\">In 1937, the U.S. Treasury Department introduced the Marihuana Tax Act. This Act imposed a levy of $1 per\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=330174&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">ounce<\/a>\u00a0for medicinal use of\u00a0<em>Cannabis<\/em>\u00a0and $100 per ounce for nonmedical use.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390246&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Physicians<\/a>\u00a0in the United States were the principal opponents of the Act. The American Medical Association (AMA) opposed the Act because physicians were required to pay a special tax for\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44711&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prescribing<\/a>\u00a0<em>Cannabis<\/em>, use special order forms to procure it, and keep special records concerning its professional use. In addition, the AMA believed that objective evidence that\u00a0<em>Cannabis<\/em>\u00a0was harmful was lacking and that passage of the Act would impede further research into its medicinal worth.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.6\">6<\/a>] In 1942,\u00a0<em>Cannabis<\/em>\u00a0was removed from the U.S.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=285980&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Pharmacopoeia<\/a>\u00a0because of persistent concerns about its potential to cause harm.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.2\">2<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.3\">3<\/a>]<\/p>\n<p id=\"_22\" tabindex=\"-1\">In 1951, Congress passed the Boggs Act, which for the first time included\u00a0<em>Cannabis<\/em>\u00a0with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44691&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">narcotic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">drugs<\/a>. In 1970, with the passage of the Controlled Substances Act,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=285927&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">marijuana<\/a>\u00a0was classified by Congress as a Schedule I drug. Drugs in Schedule I are distinguished as having no currently accepted medicinal use in the United States. Other Schedule I substances include\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=641798&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">heroin<\/a>, LSD, mescaline, and methaqualone.<\/p>\n<p id=\"_23\" tabindex=\"-1\">Despite its designation as having no medicinal use,\u00a0<em>Cannabis<\/em>\u00a0was distributed by the U.S. government to patients on a case-by-case basis under the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46526&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Compassionate Use<\/a><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=762975&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Investigational New Drug<\/a>\u00a0program established in 1978. Distribution of\u00a0<em>Cannabis<\/em>\u00a0through this program was closed to new patients in 1992.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.1\">1<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.4\">4<\/a>] Although federal law prohibits the use of\u00a0<em>Cannabis<\/em>,\u00a0<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#link\/_250\">Figure 1<\/a>\u00a0below shows the states and territories that have legalized\u00a0<em>Cannabis<\/em>\u00a0use for medical purposes. Additional states have legalized only one ingredient in\u00a0<em>Cannabis<\/em>, such as cannabidiol (CBD), and are not included in the map. Some medical marijuana laws are broader than others, and there is state-to-state variation in the types of medical conditions for which treatment is allowed.<\/p>\n<figure id=\"figure_250\" class=\"image-center\"><a class=\"article-image-enlarge\" href=\"https:\/\/www.cancer.gov\/images\/cdr\/live\/CDR774100.jpg\" target=\"_blank\" rel=\"noopener noreferrer\">ENLARGE<\/a><img decoding=\"async\" id=\"_250\" title=\"A map showing the U.S. states and territories that have approved  the medical use of Cannabis.\" src=\"https:\/\/www.cancer.gov\/images\/cdr\/live\/CDR774100-750.jpg\" alt=\"A map showing the U.S. states and territories that have approved  the medical use of Cannabis.\" \/><figcaption class=\"caption-container\">Figure 1.\u00a0<em>Cannabis<\/em>\u00a0map.<\/figcaption><\/figure>\n<p id=\"_24\" tabindex=\"-1\">The main psychoactive constituent of\u00a0<em>Cannabis<\/em>\u00a0was identified as delta-9-tetrahydrocannabinol (THC). In 1986, an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373084&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">isomer<\/a>\u00a0of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">synthetic<\/a>\u00a0delta-9-THC in sesame oil was licensed and approved for the treatment of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chemotherapy<\/a>\u00a0-associated\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390302&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nausea<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390324&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">vomiting<\/a>\u00a0under the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44672&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">generic<\/a>\u00a0name\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45240&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">dronabinol<\/a>.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Clinical trials<\/a>\u00a0determined that dronabinol was as effective as or better than other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46084&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antiemetic<\/a>\u00a0agents available at the time.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.7\">7<\/a>] Dronabinol was also studied for its ability to stimulate weight gain in patients with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">AIDS<\/a>\u00a0in the late 1980s. Thus, the indications were expanded to include treatment of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44103&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anorexia<\/a>associated with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44366&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">human immunodeficiency virus<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45364&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">infection<\/a>\u00a0in 1992. Clinical trial results showed no statistically\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390271&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">significant<\/a>\u00a0weight gain, although patients reported an improvement in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">appetite<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.8\">8<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.9\">9<\/a>] Another important\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoid<\/a>\u00a0found in\u00a0<em>Cannabis<\/em>\u00a0is CBD.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.10\">10<\/a>] This is a nonpsychoactive cannabinoid, which is an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44919&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analog<\/a>\u00a0of THC.<\/p>\n<p id=\"_25\" tabindex=\"-1\">In recent decades, the neurobiology of cannabinoids has been analyzed.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.11\">11<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.14\">14<\/a>] The first cannabinoid\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44958&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">receptor<\/a>, CB1, was identified in the brain in 1988. A second cannabinoid receptor, CB2, was identified in 1993. The highest expression of CB2 receptors is located on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44953&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">B lymphocytes<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44062&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">natural killer cells<\/a>, suggesting a possible role in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=468803&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">immunity<\/a>.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44026&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Endogenous<\/a>cannabinoids (endocannabinoids) have been identified and appear to have a role in pain modulation, control of movement, feeding behavior, mood, bone growth,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44042&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inflammation<\/a>, neuroprotection, and memory.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.15\">15<\/a>]<\/p>\n<p id=\"_202\" tabindex=\"-1\">Nabiximols (Sativex), a\u00a0<em>Cannabis<\/em>\u00a0extract with a 1:1 ratio of THC:CBD, is approved in Canada (under the Notice of Compliance with Conditions) for symptomatic relief of pain in advanced cancer and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44135&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">multiple sclerosis<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_3.16\">16<\/a>] Canada, New Zealand, and some countries in Europe also approve nabiximols for spasticity of multiple sclerosis, a common symptom that may include muscle stiffness, reduced mobility, and pain, and for which existing therapy is unsatisfactory.<\/p>\n<h6>References<\/h6>\n<ol>\n<li id=\"section_3.1\">Abel EL: Marihuana, The First Twelve Thousand Years. New York: Plenum Press, 1980.\u00a0<a title=\"http:\/\/www.druglibrary.org\/Schaffer\/hemp\/history\/first12000\/abel.htm\" href=\"http:\/\/www.druglibrary.org\/Schaffer\/hemp\/history\/first12000\/abel.htm\">Also available online<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>. Last accessed October 18, 2017.<\/li>\n<li id=\"section_3.2\">Joy JE, Watson SJ, Benson JA, eds.: Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academy Press, 1999.\u00a0<a title=\"https:\/\/www.nap.edu\/read\/6376\/chapter\/1\" href=\"https:\/\/www.nap.edu\/read\/6376\/chapter\/1\">Also available online<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>. Last accessed October 18, 2017.<\/li>\n<li id=\"section_3.3\">Mack A, Joy J: Marijuana As Medicine? The Science Beyond the Controversy. Washington, DC: National Academy Press, 2001.\u00a0<a title=\"https:\/\/www.nap.edu\/read\/9586\/chapter\/1\" href=\"https:\/\/www.nap.edu\/read\/9586\/chapter\/1\">Also available online<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>. Last accessed October 18, 2017.<\/li>\n<li id=\"section_3.4\">Booth M: Cannabis: A History. New York, NY: St Martin&#8217;s Press, 2003.<\/li>\n<li id=\"section_3.5\">Russo EB, Jiang HE, Li X, et al.: Phytochemical and genetic analyses of ancient cannabis from Central Asia. J Exp Bot 59 (15): 4171-82, 2008.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19036842&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19036842&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.6\">Schaffer Library of Drug Policy: The Marihuana Tax Act of 1937: Taxation of Marihuana. Washington, DC: House of Representatives, Committee on Ways and Means, 1937.\u00a0<a title=\"http:\/\/www.druglibrary.org\/schaffer\/hemp\/taxact\/woodward.htm\" href=\"http:\/\/www.druglibrary.org\/schaffer\/hemp\/taxact\/woodward.htm\">Available online<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>. Last accessed October 18, 2017.<\/li>\n<li id=\"section_3.7\">Sallan SE, Zinberg NE, Frei E 3rd: Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. N Engl J Med 293 (16): 795-7, 1975.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1099449&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1099449&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.8\">Gorter R, Seefried M, Volberding P: Dronabinol effects on weight in patients with HIV infection. AIDS 6 (1): 127, 1992.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1311935&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1311935&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.9\">Beal JE, Olson R, Laubenstein L, et al.: Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage 10 (2): 89-97, 1995.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7730690&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7730690&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.10\">Adams R, Hunt M, Clark JH: Structure of cannabidiol: a product isolated from the marihuana extract of Minnesota wild hemp. J Am Chem Soc 62 (1): 196-200, 1940.\u00a0<a title=\"http:\/\/pubs.acs.org\/doi\/abs\/10.1021\/ja01858a058\" href=\"http:\/\/pubs.acs.org\/doi\/abs\/10.1021\/ja01858a058\">Also available online<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>. Last accessed October 18, 2017.<\/li>\n<li id=\"section_3.11\">Devane WA, Dysarz FA 3rd, Johnson MR, et al.: Determination and characterization of a cannabinoid receptor in rat brain. Mol Pharmacol 34 (5): 605-13, 1988.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=2848184&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=2848184&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.12\">Devane WA, Hanus L, Breuer A, et al.: Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 258 (5090): 1946-9, 1992.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1470919&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1470919&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.13\">Pertwee RG, Howlett AC, Abood ME, et al.: International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid receptors and their ligands: beyond CB\u2081 and CB\u2082. Pharmacol Rev 62 (4): 588-631, 2010.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=21079038&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=21079038&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.14\">Felder CC, Glass M: Cannabinoid receptors and their endogenous agonists. Annu Rev Pharmacol Toxicol 38: 179-200, 1998.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9597153&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9597153&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.15\">Pacher P, B\u00e1tkai S, Kunos G: The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 58 (3): 389-462, 2006.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16968947&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16968947&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_3.16\">Howard P, Twycross R, Shuster J, et al.: Cannabinoids. J Pain Symptom Manage 46 (1): 142-9, 2013.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23707385&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23707385&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_7\" class=\"show\">\n<h2>Laboratory\/Animal\/Preclinical Studies<\/h2>\n<div id=\"_section_7\" class=\"pdq-sections\">\n<p id=\"_8\" tabindex=\"-1\"><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabinoids<\/a>\u00a0are a group of 21-carbon\u2013containing terpenophenolic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=422394&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">compounds<\/a>\u00a0produced uniquely by\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>species (e.g.,\u00a0<em>Cannabis sativa<\/em>\u00a0L.).[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.1\">1<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.2\">2<\/a>] These plant-derived compounds may be referred to as phytocannabinoids. Although delta-9-tetrahydrocannabinol (THC) is the primary psychoactive ingredient, other known compounds with biologic activity are cannabinol, cannabidiol (CBD), cannabichromene, cannabigerol, tetrahydrocannabivarin, and delta-8-THC. CBD, in particular, is thought to have\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390271&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">significant<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45590&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analgesic<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44187&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anti-inflammatory<\/a>, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44645&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anxiolytic<\/a>\u00a0activity without the psychoactive effect (high) of delta-9-THC.<\/p>\n<section id=\"_26\">\n<h3 id=\"_26_toc\">Antitumor Effects<\/h3>\n<p id=\"_27\" tabindex=\"-1\">One study in mice and rats suggested that cannabinoids may have a protective effect against the development of certain types of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tumors<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.3\">3<\/a>] During this 2-year study, groups of mice and rats were given various\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44664&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">doses<\/a>\u00a0of THC by\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=729771&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">gavage<\/a>. A dose-related decrease in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46145&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">incidence<\/a>\u00a0of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45709&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hepatic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46217&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">adenoma<\/a>\u00a0tumors and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46363&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hepatocellular carcinoma<\/a>\u00a0(HCC) was observed in the mice. Decreased incidences of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46079&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">benign tumors<\/a>\u00a0(<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45844&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">polyps<\/a>\u00a0and adenomas) in other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257523&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">organs<\/a>(<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=415575&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mammary gland<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46645&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">uterus<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46229&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pituitary<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=367406&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">testis<\/a>, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46254&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pancreas<\/a>) were also noted in the rats. In another study, delta-9-THC, delta-8-THC, and cannabinol were found to inhibit the growth of Lewis\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270740&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lung<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46216&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">adenocarcinoma<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cells<\/a>\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45733&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">in vitro<\/a>\u00a0<\/em>and\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46352&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">in vivo<\/a>\u00a0<\/em>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.4\">4<\/a>] In addition, other tumors have been shown to be sensitive to cannabinoid-induced growth inhibition.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.5\">5<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.8\">8<\/a>]<\/p>\n<p id=\"_28\" tabindex=\"-1\">Cannabinoids may cause\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446109&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antitumor<\/a>\u00a0effects by various mechanisms, including\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45736&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">induction<\/a>\u00a0of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cell<\/a>\u00a0death, inhibition of cell growth, and inhibition of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tumor<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46529&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">angiogenesis<\/a>\u00a0invasion and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46710&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">metastasis<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.9\">9<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.12\">12<\/a>] Two reviews summarize the molecular mechanisms of action of cannabinoids as antitumor agents.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.13\">13<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.14\">14<\/a>] Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death. For example, these compounds have been shown to induce\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46524&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">apoptosis<\/a>\u00a0in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45700&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">glioma<\/a>\u00a0cells in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476357&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">culture<\/a>\u00a0and induce\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46039&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">regression<\/a>\u00a0of glioma tumors in mice and rats, while they protect normal glial cells of astroglial and oligodendroglial lineages from apoptosis mediated by the CB1\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44958&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">receptor<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.9\">9<\/a>]<\/p>\n<p id=\"_143\" tabindex=\"-1\">The effects of delta-9-THC and a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">synthetic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46054&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">agonist<\/a>\u00a0of the CB2 receptor were investigated in HCC.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.15\">15<\/a>] Both agents reduced the viability of HCC cells\u00a0<em>in vitro<\/em>\u00a0and demonstrated antitumor effects in HCC\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45914&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">subcutaneous<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44095&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">xenografts<\/a>\u00a0in nude mice. The investigations documented that the anti-HCC effects are mediated by way of the CB2 receptor. Similar to findings in glioma cells, the cannabinoids were shown to trigger cell death through stimulation of an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=763770&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">endoplasmic reticulum<\/a>\u00a0stress pathway that activates\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=561319&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">autophagy<\/a>\u00a0and promotes apoptosis. Other investigations have confirmed that CB1 and CB2 receptors may be potential targets in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45323&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">non-small cell lung<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45963&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">carcinoma<\/a>\u00a0[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.16\">16<\/a>] and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444971&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">breast cancer<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.17\">17<\/a>]<\/p>\n<p id=\"_152\" tabindex=\"-1\">An\u00a0<em>in vitro<\/em>\u00a0study of the effect of CBD on programmed cell death in breast cancer\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44016&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cell lines<\/a>found that CBD induced programmed cell death, independent of the CB1, CB2, or vanilloid receptors. CBD inhibited the survival of both\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45270&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">estrogen receptor\u2013positive<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45272&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">estrogen receptor\u2013negative<\/a>\u00a0breast cancer cell lines, inducing apoptosis in a concentration-dependent manner while having little effect on nontumorigenic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44560&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mammary<\/a>\u00a0cells.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.18\">18<\/a>] Other studies have also shown the antitumor effect of cannabinoids (i.e., CBD and THC) in preclinical models of breast cancer.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.19\">19<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.20\">20<\/a>]<\/p>\n<p id=\"_154\" tabindex=\"-1\">CBD has also been demonstrated to exert a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45487&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chemopreventive<\/a>\u00a0effect in a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=561606&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mouse model<\/a>\u00a0of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44237&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">colon cancer<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.21\">21<\/a>] In this\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44758&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">experimental<\/a>\u00a0system,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=367457&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">azoxymethane<\/a>\u00a0increased\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45846&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">premalignant<\/a>\u00a0and malignant\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46324&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lesions<\/a>\u00a0in the mouse colon. Animals treated with azoxymethane and CBD concurrently were protected from developing premalignant and malignant lesions. In\u00a0<em>in vitro<\/em>\u00a0experiments involving\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444983&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">colorectal cancer<\/a>\u00a0cell lines, the investigators found that CBD protected\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45671&amp;version=healthprofessional&amp;language=English&amp;dictionary=genetic\" type=\"GlossaryTermRefs\">DNA<\/a>\u00a0from oxidative damage, increased endocannabinoid levels, and reduced\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46479&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cell proliferation<\/a>. In a subsequent study, the investigators found that the antiproliferative effect of CBD was counteracted by selective CB1 but not CB2 receptor\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=350250&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antagonists<\/a>, suggesting an involvement of CB1 receptors.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.22\">22<\/a>]<\/p>\n<p id=\"_155\" tabindex=\"-1\">Another investigation into the antitumor effects of CBD examined the role of intercellular adhesion molecule-1 (ICAM-1).[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.12\">12<\/a>] ICAM-1 expression has been reported to be negatively correlated with cancer\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46710&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">metastasis.<\/a>\u00a0In\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=445043&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lung cancer<\/a>\u00a0cell lines, CBD upregulated ICAM-1, leading to decreased cancer cell invasiveness.<\/p>\n<p id=\"_29\" tabindex=\"-1\">In an\u00a0<em>in vivo<\/em>\u00a0model using severe combined immunodeficient mice, subcutaneous tumors were generated by inoculating the animals with cells from human non-small cell lung carcinoma cell lines.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.23\">23<\/a>] Tumor growth was inhibited by 60% in THC-treated mice compared with vehicle-treated control mice. Tumor specimens revealed that THC had\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44186&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antiangiogenic<\/a>\u00a0and antiproliferative effects. However, research with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44835&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">immunocompetent<\/a>murine tumor models has demonstrated\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45727&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">immunosuppression<\/a>\u00a0and enhanced tumor growth in mice treated with THC.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.24\">24<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.25\">25<\/a>]<\/p>\n<p id=\"_30\" tabindex=\"-1\">In addition, both plant-derived and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44026&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">endogenous<\/a>\u00a0cannabinoids have been studied for anti-<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373080&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inflammatory<\/a>\u00a0effects. A mouse study demonstrated that endogenous cannabinoid system signaling is likely to provide intrinsic protection against colonic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44042&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inflammation<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.26\">26<\/a>] As a result, a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44209&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hypothesis<\/a>\u00a0that phytocannabinoids and endocannabinoids may be useful in the risk reduction and treatment of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444983&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">colorectal cancer<\/a>\u00a0has been developed.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.27\">27<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.30\">30<\/a>]<\/p>\n<p id=\"_188\" tabindex=\"-1\">CBD may also enhance uptake of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44020&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cytotoxic<\/a>\u00a0drugs into malignant cells. Activation of the transient receptor potential vanilloid type 2 (TRPV2) has been shown to inhibit proliferation of human\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">glioblastoma multiforme<\/a>\u00a0cells and overcome resistance to the chemotherapy agent carmustine.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.31\">31<\/a>] One study showed that coadministration of THC and CBD over single-agent usage had greater antiproliferative activity in an\u00a0<em>in vitro<\/em>\u00a0study with multiple human glioblastoma multiforme cell lines.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.32\">32<\/a>] In an\u00a0<em>in vitro<\/em>\u00a0model, CBD increased TRPV2 activation and increased uptake of cytotoxic drugs, leading to apoptosis of glioma cells without affecting normal human\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=269436&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">astrocytes<\/a>. This suggests that coadministration of CBD with cytotoxic agents may increase drug uptake and potentiate cell death in human glioma cells. Also, CBD together with THC may enhance the antitumor activity of classic chemotherapeutic drugs such as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45387&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">temozolomide<\/a>\u00a0in some mouse models of cancer.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.13\">13<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.33\">33<\/a>]<\/p>\n<\/section>\n<section id=\"_227\">\n<h3 id=\"_227_toc\">Antiemetic Effects<\/h3>\n<p id=\"_228\" tabindex=\"-1\">Preclinical research suggests that emetic circuitry is tonically controlled by endocannabinoids. The antiemetic action of cannabinoids is believed to be mediated via interaction with the 5-hydroxytryptamine 3 (5-HT3) receptor. CB1 receptors and 5-HT3 receptors are colocalized on gamma-aminobutyric acid (GABA)-ergic neurons, where they have opposite effects on GABA release.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.34\">34<\/a>] There also may be direct inhibition of 5-HT3 gated ion currents through non\u2013CB1 receptor pathways. CB1 receptor antagonists have been shown to elicit\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=256560&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">emesis<\/a>\u00a0in the least shrew that is reversed by cannabinoid agonists.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.35\">35<\/a>] The involvement of CB1 receptor in emesis prevention has been shown by the ability of CB1 antagonists to reverse the effects of THC and other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">synthetic<\/a>\u00a0cannabinoid CB1 agonists in suppressing vomiting caused by\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45230&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cisplatin<\/a>\u00a0in the house musk shrew and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476347&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lithium<\/a>chloride in the least shrew. In the latter model, CBD was also shown to be efficacious.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.36\">36<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.37\">37<\/a>]<\/p>\n<\/section>\n<section id=\"_32\">\n<h3 id=\"_32_toc\">Appetite Stimulation<\/h3>\n<p id=\"_33\" tabindex=\"-1\">Many\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454774&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">animal studies<\/a>\u00a0have previously demonstrated that delta-9-THC and other cannabinoids have a stimulatory effect on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">appetite<\/a>\u00a0and increase food intake. It is believed that the endogenous cannabinoid system may serve as a regulator of feeding behavior. The endogenous cannabinoid anandamide potently enhances appetite in mice.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.38\">38<\/a>] Moreover, CB1\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44958&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">receptors<\/a>\u00a0in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46359&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hypothalamus<\/a>\u00a0may be involved in the motivational or reward aspects of eating.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.39\">39<\/a>]<\/p>\n<\/section>\n<section id=\"_34\">\n<h3 id=\"_34_toc\">Analgesia<\/h3>\n<p id=\"_35\" tabindex=\"-1\">Understanding the mechanism of cannabinoid-induced\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=449929&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analgesia<\/a>\u00a0has been increased through the study of cannabinoid receptors, endocannabinoids, and synthetic agonists and antagonists. Cannabinoids produce analgesia through supraspinal, spinal, and peripheral modes of action, acting on both ascending and descending pain pathways.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.40\">40<\/a>] The CB1 receptor is found in both the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46481&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">central nervous system<\/a>\u00a0(CNS) and in peripheral\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373935&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nerve<\/a>terminals. Similar to\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45054&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">opioid<\/a>\u00a0receptors, increased levels of the CB1 receptor are found in regions of the brain that regulate nociceptive processing.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.41\">41<\/a>] CB2 receptors, located predominantly in peripheral\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tissue<\/a>, exist at very low levels in the CNS. With the development of receptor-specific antagonists, additional information about the roles of the receptors and endogenous cannabinoids in the modulation of pain has been obtained.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.42\">42<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.43\">43<\/a>]<\/p>\n<p id=\"_36\" tabindex=\"-1\">Cannabinoids may also contribute to pain modulation through an anti-inflammatory mechanism; a CB2 effect with cannabinoids acting on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44845&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mast cell<\/a>\u00a0receptors to attenuate the release of inflammatory agents, such as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=657848&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">histamine<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=335511&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">serotonin<\/a>, and on keratinocytes to enhance the release of analgesic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45054&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">opioids<\/a>\u00a0has been described.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.44\">44<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.46\">46<\/a>] One study reported that the efficacy of synthetic CB1- and CB2-receptor agonists were comparable with the efficacy of morphine in a murine model of tumor pain.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.47\">47<\/a>]<\/p>\n<p id=\"_229\" tabindex=\"-1\">Cannabinoids have been shown to prevent chemotherapy-induced neuropathy in animal models exposed to\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45258&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">paclitaxel<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45435&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">vincristine<\/a>, or cisplatin.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.48\">48<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.50\">50<\/a>]<\/p>\n<\/section>\n<section id=\"_230\">\n<h3 id=\"_230_toc\">Anxiety and Sleep<\/h3>\n<p id=\"_231\" tabindex=\"-1\">The endocannabinoid system is believed to be centrally involved in the regulation of mood and the extinction of aversive memories. Animal studies have shown CBD to have anxiolytic properties. It was shown in rats that these anxiolytic properties are mediated through unknown mechanisms.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.51\">51<\/a>] Anxiolytic effects of CBD have been shown in several animal models.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.52\">52<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.53\">53<\/a>]<\/p>\n<p id=\"_232\" tabindex=\"-1\">The endocannabinoid system has also been shown to play a key role in the modulation of the sleep-waking cycle in rats.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.54\">54<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_4.55\">55<\/a>]<\/p>\n<\/section>\n<h6>References<\/h6>\n<ol>\n<li id=\"section_4.1\">Adams IB, Martin BR: Cannabis: pharmacology and toxicology in animals and humans. Addiction 91 (11): 1585-614, 1996.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.2\">Grotenhermen F, Russo E, eds.: Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. Binghamton, NY: The Haworth Press, 2002.<\/li>\n<li id=\"section_4.3\">National Toxicology Program: NTP toxicology and carcinogenesis studies of 1-trans-delta(9)-tetrahydrocannabinol (CAS No. 1972-08-3) in F344 rats and B6C3F1 mice (gavage studies). Natl Toxicol Program Tech Rep Ser 446 (): 1-317, 1996.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12594529&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12594529&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.4\">Bifulco M, Laezza C, Pisanti S, et al.: Cannabinoids and cancer: pros and cons of an antitumour strategy. Br J Pharmacol 148 (2): 123-35, 2006.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16501583&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16501583&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.5\">S\u00e1nchez C, de Ceballos ML, Gomez del Pulgar T, et al.: Inhibition of glioma growth in vivo by selective activation of the CB(2) cannabinoid receptor. Cancer Res 61 (15): 5784-9, 2001.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=11479216&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=11479216&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.6\">McKallip RJ, Lombard C, Fisher M, et al.: Targeting CB2 cannabinoid receptors as a novel therapy to treat malignant lymphoblastic disease. Blood 100 (2): 627-34, 2002.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12091357&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12091357&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.7\">Casanova ML, Bl\u00e1zquez C, Mart\u00ednez-Palacio J, et al.: Inhibition of skin tumor growth and angiogenesis in vivo by activation of cannabinoid receptors. J Clin Invest 111 (1): 43-50, 2003.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12511587&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12511587&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.8\">Bl\u00e1zquez C, Gonz\u00e1lez-Feria L, Alvarez L, et al.: Cannabinoids inhibit the vascular endothelial growth factor pathway in gliomas. Cancer Res 64 (16): 5617-23, 2004.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=15313899&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=15313899&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.9\">Guzm\u00e1n M: Cannabinoids: potential anticancer agents. Nat Rev Cancer 3 (10): 745-55, 2003.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=14570037&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=14570037&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.10\">Bl\u00e1zquez C, Casanova ML, Planas A, et al.: Inhibition of tumor angiogenesis by cannabinoids. FASEB J 17 (3): 529-31, 2003.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12514108&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12514108&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.11\">Vaccani A, Massi P, Colombo A, et al.: Cannabidiol inhibits human glioma cell migration through a cannabinoid receptor-independent mechanism. Br J Pharmacol 144 (8): 1032-6, 2005.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=15700028&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=15700028&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.12\">Ramer R, Bublitz K, Freimuth N, et al.: Cannabidiol inhibits lung cancer cell invasion and metastasis via intercellular adhesion molecule-1. FASEB J 26 (4): 1535-48, 2012.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22198381&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22198381&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.13\">Velasco G, S\u00e1nchez C, Guzm\u00e1n M: Towards the use of cannabinoids as antitumour agents. Nat Rev Cancer 12 (6): 436-44, 2012.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22555283&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22555283&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.14\">Cridge BJ, Rosengren RJ: Critical appraisal of the potential use of cannabinoids in cancer management. Cancer Manag Res 5: 301-13, 2013.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=24039449&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=24039449&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.15\">Vara D, Salazar M, Olea-Herrero N, et al.: Anti-tumoral action of cannabinoids on hepatocellular carcinoma: role of AMPK-dependent activation of autophagy. Cell Death Differ 18 (7): 1099-111, 2011.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=21475304&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=21475304&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.16\">Preet A, Qamri Z, Nasser MW, et al.: Cannabinoid receptors, CB1 and CB2, as novel targets for inhibition of non-small cell lung cancer growth and metastasis. 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Psychopharmacology (Berl) 100 (4): 558-9, 1990.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1969666&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1969666&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.54\">M\u00e9ndez-D\u00edaz M, Caynas-Rojas S, Arteaga Santacruz V, et al.: Entopeduncular nucleus endocannabinoid system modulates sleep-waking cycle and mood in rats. Pharmacol Biochem Behav 107: 29-35, 2013.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23584096&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23584096&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_4.55\">Pava MJ, den Hartog CR, Blanco-Centurion C, et al.: Endocannabinoid modulation of cortical up-states and NREM sleep. PLoS One 9 (2): e88672, 2014.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=24520411&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=24520411&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_9\" class=\"show\">\n<h2>Human\/Clinical Studies<\/h2>\n<div id=\"_section_9\" class=\"pdq-sections\">\n<section id=\"_37\">\n<h3 id=\"_37_toc\"><em>Cannabis<\/em>\u00a0Pharmacology<\/h3>\n<p id=\"_38\" tabindex=\"-1\">When oral\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>is\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44100&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">ingested<\/a>, there is a low (6%\u201320%) and variable\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44068&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">oral<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44225&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">bioavailability<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.1\">1<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.2\">2<\/a>] Peak\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45839&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">plasma<\/a>\u00a0concentrations of delta-9-tetrahydrocannabinol (THC) occur after 1 to 6 hours and remain elevated with a terminal half-life of 20 to 30 hours. Taken by mouth, delta-9-THC is initially metabolized in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46312&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">liver<\/a>\u00a0to 11-OH-THC, a potent psychoactive\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462687&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">metabolite<\/a>.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44600&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Inhaled<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoids<\/a>\u00a0are rapidly absorbed into the bloodstream with a peak\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=683342&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">concentration<\/a>\u00a0in 2 to 10 minutes, declining rapidly for a period of 30 minutes and with less generation of the psychoactive 11-OH metabolite.<\/p>\n<p id=\"_39\" tabindex=\"-1\">Cannabinoids are known to interact with the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45709&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hepatic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390266&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cytochrome P450 enzyme system<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.3\">3<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.4\">4<\/a>] In one study, 24\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cancer<\/a>\u00a0patients were treated with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46682&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">intravenous<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45391&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">irinotecan<\/a>\u00a0(600\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44213&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mg<\/a>, n = 12) or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45382&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">docetaxel<\/a>\u00a0(180 mg, n = 12), followed 3 weeks later by the same\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">drugs<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=635464&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">concomitant<\/a>\u00a0with medicinal\u00a0<em>Cannabis<\/em>\u00a0taken in the form of an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=463714&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">herbal<\/a>\u00a0tea for 15 consecutive days, starting 12 days before the second treatment.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.4\">4<\/a>] The\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=478733&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">administration<\/a>\u00a0of\u00a0<em>Cannabis<\/em>\u00a0did not significantly influence exposure to and clearance of irinotecan or docetaxel, although the herbal tea route of administration may not reproduce the effects of inhalation or oral\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44100&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">ingestion<\/a>\u00a0of fat-<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467861&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">soluble<\/a>\u00a0cannabinoids.<\/p>\n<\/section>\n<section id=\"_105\">\n<h3 id=\"_105_toc\">Cancer Risk<\/h3>\n<p id=\"_106\" tabindex=\"-1\">A number of studies have yielded conflicting evidence regarding the risks of various cancers associated with\u00a0<em>Cannabis<\/em>\u00a0use.<\/p>\n<p id=\"_112\" tabindex=\"-1\">A pooled analysis of three case-cohort studies of men in northwestern Africa (430 cases and 778\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44149&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">controls<\/a>) showed a significantly increased risk of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=445043&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lung cancer<\/a>\u00a0among\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=439432&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tobacco<\/a>smokers who also inhaled\u00a0<em>Cannabis<\/em>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.5\">5<\/a>]<\/p>\n<p id=\"_113\" tabindex=\"-1\">A large,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=286525&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">retrospective cohort study<\/a>\u00a0of 64,855 men aged 15 to 49 years from the United States found that\u00a0<em>Cannabis<\/em>\u00a0use was not associated with tobacco-related cancers and a number of other common\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45771&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">malignancies<\/a>. However, the study did find that, among nonsmokers of tobacco, ever having used\u00a0<em>Cannabis<\/em>\u00a0was associated with an increased risk of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=445079&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prostate cancer<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.6\">6<\/a>]<\/p>\n<p id=\"_114\" tabindex=\"-1\">A population-based\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348989&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">case-control study<\/a>\u00a0of 611 lung cancer patients revealed that\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45641&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chronic<\/a>low\u00a0<em>Cannabis<\/em>\u00a0exposure was not associated with an increased risk of lung cancer or other upper\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44811&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">aerodigestive tract<\/a>\u00a0cancers and found no positive associations with any cancer type (<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44068&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">oral<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46061&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pharyngeal<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46317&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">laryngeal<\/a>, lung, or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46408&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">esophagus<\/a>) when adjusting for several confounders, including cigarette smoking.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.7\">7<\/a>]<\/p>\n<p id=\"_116\" tabindex=\"-1\">A systematic review\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=430407&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">assessing<\/a>\u00a019 studies that evaluated\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45846&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">premalignant<\/a>\u00a0or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45772&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">malignant<\/a>\u00a0lung\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46324&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">lesions<\/a>\u00a0in persons 18 years or older who inhaled\u00a0<em>Cannabis<\/em>\u00a0concluded that\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=286105&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">observational studies<\/a>\u00a0failed to demonstrate\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44167&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">statistically significant<\/a>\u00a0associations between\u00a0<em>Cannabis<\/em>inhalation and lung cancer after adjusting for tobacco use.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.8\">8<\/a>]<\/p>\n<p id=\"_201\" tabindex=\"-1\"><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257225&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Epidemiologic<\/a>\u00a0studies examining one association of\u00a0<em>Cannabis<\/em>\u00a0use with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=597171&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">head and neck squamous cell carcinomas<\/a>\u00a0have also been inconsistent in their findings. A pooled analysis of nine case-control studies from the U.S.\/Latin American International Head and Neck Cancer Epidemiology (INHANCE) Consortium included information from 1,921\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46024&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">oropharyngeal<\/a>\u00a0cases, 356 tongue cases, and 7,639 controls. Compared with those who never smoked\u00a0<em>Cannabis<\/em>,\u00a0<em>Cannabis<\/em>\u00a0smokers had an elevated risk of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446523&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">oropharyngeal cancers<\/a>and a reduced risk of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tongue cancer<\/a>. These study results both reflect the inconsistent effects of cannabinoids on cancer\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46145&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">incidence<\/a>\u00a0noted in previous studies and suggest that more work needs to be done to understand the potential role of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45714&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">human papillomavirus<\/a><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45364&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">infection<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.9\">9<\/a>]<\/p>\n<p id=\"_177\" tabindex=\"-1\">With a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44209&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hypothesis<\/a>\u00a0that chronic marijuana use produces\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44922&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">adverse effects<\/a>\u00a0on the human\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=468796&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">endocrine<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46564&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">reproductive systems<\/a>, the association between\u00a0<em>Cannabis<\/em>\u00a0use and incidence of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=695185&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">testicular germ cell tumors<\/a>\u00a0(TGCTs) has been examined.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.10\">10<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.12\">12<\/a>] Three population-based case-control studies reported an association between\u00a0<em>Cannabis<\/em>\u00a0use and elevated risk of TGCTs, especially\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46255&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nonseminoma<\/a>\u00a0or mixed-<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44171&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">histology<\/a>\u00a0tumors.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.10\">10<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.12\">12<\/a>] However, the sample sizes in these studies were inadequate to address\u00a0<em>Cannabis<\/em>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44664&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">dose<\/a>\u00a0by addressing associations with respect to recency, frequency, and duration of use. These early reports of\u00a0<em>Cannabis<\/em>\u00a0use and TGCTs established the need for larger, well-powered,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44079&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prospective studies<\/a>, especially studies evaluating the role of endocannabinoid signaling and cannabinoid receptors in TGCTs.<\/p>\n<p id=\"_226\" tabindex=\"-1\">An analysis of 84,170 participants in the California Men\u2019s Health Study was performed to investigate the association between\u00a0<em>Cannabis<\/em>\u00a0use and the incidence of bladder cancer. During 16 years of follow-up, 89\u00a0<em>Cannabis<\/em>\u00a0users (0.3%) developed\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444968&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">bladder cancer<\/a>\u00a0compared with 190 (0.4%) of the men who did not report\u00a0<em>Cannabis<\/em>\u00a0use (<em>P<\/em>\u00a0&lt; .001). After adjusting for age, race, ethnicity, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=455136&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">body mass index<\/a>,\u00a0<em>Cannabis<\/em>\u00a0use was associated with a 45% reduction in bladder cancer incidence (hazard ratio, 0.55; 95% confidence interval, 0.33\u20131.00).[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.13\">13<\/a>]<\/p>\n<p id=\"_115\" tabindex=\"-1\">A comprehensive Health Canada monograph on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=285927&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">marijuana<\/a>\u00a0concluded that while there are many cellular and molecular studies that provide strong evidence that inhaled marijuana is carcinogenic, the epidemiologic evidence of a link between marijuana use and cancer is still\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=556498&amp;version=healthprofessional&amp;language=English&amp;dictionary=genetic\" type=\"GlossaryTermRefs\">inconclusive<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.14\">14<\/a>]<\/p>\n<\/section>\n<section id=\"_73\">\n<h3 id=\"_73_toc\">Cancer Treatment<\/h3>\n<p id=\"_74\" tabindex=\"-1\">Clinical data in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46245&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pediatric<\/a>\u00a0use is limited to a few\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44007&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">case reports<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.15\">15<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.16\">16<\/a>] No\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">clinical trials<\/a>\u00a0of\u00a0<em>Cannabis<\/em>\u00a0as 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 single, small study of intratumoral injection of delta-9-THC in patients with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45862&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">recurrent<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">glioblastoma multiforme<\/a>, which demonstrated no significant clinical benefit.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.17\">17<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.18\">18<\/a>] In a trial (<a title=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02255292\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02255292\">NCT02255292<\/a>) conducted in Israel, oral cannabidiol (CBD) was investigated as a single\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44176&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">salvage<\/a>\u00a0agent for recurrent\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45301&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">solid tumors<\/a>. The study was projected to be completed in 2015; however, no results have been published. A small exploratory\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45831&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">phase II<\/a>\u00a0study (<a href=\"https:\/\/www.cancer.gov\/clinicaltrials\/NCT01812603\">GWCA1208 Part A [NCT01812603]<\/a>) was completed in the United Kingdom that used nabiximols, a 1:1 ratio of THC:CBD in a\u00a0<em>Cannabis<\/em>-based medicinal extract oromucosal spray, in conjunction with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45387&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">temozolomide<\/a>\u00a0in treating patients with recurrent glioblastoma multiforme. Another Israeli group postulated that the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44187&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anti-inflammatory<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44041&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">immunosuppressive<\/a>\u00a0effects of cannabidiol might make it a valuable adjunct in the treatment of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45585&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">acute<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45703&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">graft-versus-host disease<\/a>\u00a0(GVHD) in patients who have undergone\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44920&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">allogeneic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=693540&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hematopoietic stem cell<\/a><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46631&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">transplantation<\/a>. The authors investigated CBD 300 mg\/d in addition to standard GVHD\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46538&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prophylaxis<\/a>\u00a0in 48 adult patients who had undergone transplantation predominantly for\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45145&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">acute leukemia<\/a>\u00a0or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45266&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">myelodysplastic syndrome<\/a>\u00a0(<a title=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01385124\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01385124\">NCT01385124<\/a>\u00a0and\u00a0<a title=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01596075\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01596075\">NCT01596075<\/a>).[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.19\">19<\/a>] The combination of CBD with standard GVHD prophylaxis was found to be safe. Compared with 101 historical controls treated with standard prophylaxis, patients who received CBD appeared to have a lower\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46145&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">incidence<\/a>\u00a0of grade II to grade IV GVHD, suggesting that a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45858&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">randomized<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44014&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">controlled trial<\/a>\u00a0(RCT) is warranted.<\/p>\n<\/section>\n<section id=\"_40\">\n<h3 id=\"_40_toc\">Antiemetic Effect<\/h3>\n<section id=\"_81\">\n<h4 id=\"_81_toc\">Cannabinoids<\/h4>\n<p id=\"_41\" tabindex=\"-1\">Despite advances in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=463167&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pharmacologic<\/a>\u00a0and nonpharmacologic management,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390302&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nausea<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390324&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">vomiting<\/a>\u00a0(N\/V) remain distressing\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46580&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">side effects<\/a>\u00a0for cancer patients and their families.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45240&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Dronabinol<\/a>, a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">synthetically<\/a>\u00a0produced delta-9-THC, was approved in the United States in 1986 as an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46084&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antiemetic<\/a>\u00a0to be used in cancer\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chemotherapy<\/a>.\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716290&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Nabilone<\/a>, a synthetic derivative of delta-9-THC, was first approved in Canada in 1982 and is now also available in the United States.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.20\">20<\/a>] Both dronabinol and nabilone have been approved by the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454785&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">U.S. Food and Drug Administration<\/a>\u00a0for the treatment of N\/V associated with cancer chemotherapy in patients who have failed to\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44085&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">respond<\/a>\u00a0to conventional antiemetic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44737&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">therapy<\/a>. Numerous\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44168&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">clinical<\/a>\u00a0trials and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=691484&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">meta-analyses<\/a>\u00a0have shown that dronabinol and nabilone are effective in the treatment of N\/V induced by chemotherapy.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.21\">21<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.24\">24<\/a>] The\u00a0<a title=\"http:\/\/williams.medicine.wisc.edu\/antiemesis.pdf\" href=\"http:\/\/williams.medicine.wisc.edu\/antiemesis.pdf\">National Comprehensive Cancer Network Guidelines<\/a><a class=\"icon-exit-notification\" title=\"Exit Disclaimer\" href=\"https:\/\/www.cancer.gov\/policies\/linking\"><span class=\"hidden\">Exit Disclaimer<\/span><\/a>\u00a0recommend cannabinoids as breakthrough treatment for chemotherapy-related N\/V.<\/p>\n<p id=\"_42\" tabindex=\"-1\">One systematic review studied 30 randomized comparisons of delta-9-THC preparations with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46688&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">placebo<\/a>\u00a0or other antiemetics from which data on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=346517&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">efficacy<\/a>\u00a0and harm were available.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.25\">25<\/a>] Oral nabilone, oral dronabinol, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44048&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">intramuscular<\/a>\u00a0levonantradol (a synthetic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44919&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analog<\/a>\u00a0of dronabinol) were tested. Inhaled\u00a0<em>Cannabis<\/em>\u00a0trials were not included. Among all 1,366 patients included in the review, cannabinoids were found to be more effective than the conventional antiemetics\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45232&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prochlorperazine<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45225&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">metoclopramide<\/a>, chlorpromazine,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467870&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">thiethylperazine<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476306&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">haloperidol<\/a>, domperidone, and alizapride. Cannabinoids, however, were not more effective for patients receiving very low or very high\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454776&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">emetogenic<\/a>\u00a0chemotherapy. Side effects included a feeling of being high,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=468801&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">euphoria<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=450118&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">sedation<\/a>\u00a0or drowsiness, dizziness, dysphoria or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=430479&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">depression<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476341&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hallucinations<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=468802&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">paranoia<\/a>, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44039&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hypotension<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.25\">25<\/a>]<\/p>\n<p id=\"_43\" tabindex=\"-1\">Another analysis of 15\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44015&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">controlled studies<\/a>\u00a0compared nabilone with placebo or available antiemetic drugs.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.26\">26<\/a>] Among 600 cancer patients, nabilone was found to be superior to prochlorperazine, domperidone, and alizapride, with nabilone favored for continuous use.<\/p>\n<p id=\"_261\" tabindex=\"-1\">A Cochrane meta-analysis of 23 randomized RCTs reviewed studies conducted between 1975 and 1991 that investigated dronabinol or nabilone, either as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=754011&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">monotherapy<\/a>\u00a0or as an\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467826&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">adjunct<\/a>\u00a0to the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44198&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">conventional<\/a>\u00a0dopamine\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=350250&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antagonists<\/a>\u00a0that were the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44930&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">standard<\/a>\u00a0antiemetics at that time.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.27\">27<\/a>] The chemotherapy regimens involved drugs with low, moderate, or high\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467221&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">emetic<\/a>\u00a0potential. The meta-analysis graded the quality of evidence as low for most outcomes. The review concluded that individuals were more likely to report complete absence of N\/V when they received cannabinoids compared with placebo, although they were more likely to withdraw from the study because of an adverse event. Individuals reported a higher preference for cannabinoids than placebo or prochlorperazine. There was no difference in the antiemetic effect of cannabinoids when compared with prochlorperazine. The authors concluded that\u00a0<em>Cannabis<\/em>-based medications may be useful for treating\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=350245&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">refractory<\/a>\u00a0chemotherapy-induced N\/V; however, they cautioned that their assessment may change with the availability of newer antiemetic regimens.<\/p>\n<p id=\"_269\" tabindex=\"-1\">At least 50% of patients who receive moderately emetogenic chemotherapy may experience delayed chemotherapy-induced N\/V. Although selective neurokinin 1 antagonists that inhibit substance P have been approved for delayed N\/V, a study was conducted before their availability to assess dronabinol,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=616146&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">ondansetron<\/a>, or their combination in preventing delayed-onset chemotherapy-induced N\/V.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.28\">28<\/a>] Ondansetron, a serotonin 5-hydroxytryptamine 3\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467824&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">(5-HT3) receptor antagonist<\/a>, is one of the mainstay agents in the current antiemetic armamentarium. In this trial, the primary objective was to assess the response 2 to 5 days after moderately to severely emetogenic chemotherapy. Sixty-one patients were analyzed for efficacy. The total response\u2013a composite endpoint\u2013including nausea intensity, vomiting\/retching, and use of rescue medications, was similar with dronabinol (54%), ondansetron (58%), and combination therapy (47%) when compared with placebo (20%). Nausea absence was greater in the active treatment groups (dronabinol 71%, ondansetron 64%, combination therapy 53%) when compared with placebo (15%;\u00a0<em>P<\/em>\u00a0&lt; .05 vs. placebo for all). Occurrence rates for nausea intensity and vomiting\/retching episodes were the lowest in patients treated with dronabinol, suggesting that dronabinol compares favorably with ondansetron in this situation where a substance P inhibitor would currently be the drug of choice.<\/p>\n<p id=\"_107\" tabindex=\"-1\">(Refer to the\u00a0<em><a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/side-effects\/nausea\/nausea-hp-pdq#link\/_457\">Cannabis<\/a><\/em>\u00a0section in the PDQ summary on\u00a0<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/side-effects\/nausea\/nausea-hp-pdq\">Treatment-Related Nausea and Vomiting<\/a>\u00a0for more information.)<\/p>\n<\/section>\n<section id=\"_82\">\n<h4 id=\"_82_toc\"><em>Cannabis<\/em><\/h4>\n<p id=\"_44\" tabindex=\"-1\">Ten trials have evaluated the efficacy of inhaled\u00a0<em>Cannabis<\/em>\u00a0in chemotherapy-induced N\/V.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.29\">29<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.32\">32<\/a>] In two of the studies, inhaled\u00a0<em>Cannabis<\/em>\u00a0was made available only after dronabinol failure. In the first trial, no antiemetic effect was achieved with marijuana in patients receiving\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45253&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cyclophosphamide<\/a>\u00a0or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45140&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">doxorubicin<\/a>,[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.29\">29<\/a>] but in the second trial, a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44167&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">statistically significant<\/a>\u00a0superior antiemetic effect of inhaled\u00a0<em>Cannabis<\/em>\u00a0versus placebo was found among patients receiving high-dose\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45393&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">methotrexate<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.30\">30<\/a>] The third trial was a randomized,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45673&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">double-blind<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44840&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">placebo-controlled<\/a>, crossover trial involving 20 adults in which both inhaled marijuana and oral THC were evaluated. One-quarter of the patients reported a favorable antiemetic response to the cannabinoid\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44737&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">therapies<\/a>. This latter study was reported in abstract form in 1984. A full report, detailing the methods and outcomes apparently has not been published, which limits a thorough interpretation of the significance of these findings.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.31\">31<\/a>]<\/p>\n<p id=\"_255\" tabindex=\"-1\">Newer antiemetics (e.g., 5-HT3 receptor antagonists) have not been directly compared with\u00a0<em>Cannabis<\/em>\u00a0or cannabinoids in cancer patients. However, the\u00a0<em>Cannabis<\/em>-extract oromucosal spray, nabiximols, formulated with 1:1 THC:CBD was shown in a small\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45838&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pilot<\/a>\u00a0randomized, placebo-controlled, double-blinded clinical trial in Spain to treat chemotherapy-related N\/V.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.33\">33<\/a>][<a href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=335121&amp;version=HealthProfessional&amp;language=English\">Level of evidence: 1iC<\/a>]<\/p>\n<\/section>\n<\/section>\n<section id=\"_45\">\n<h3 id=\"_45_toc\">Appetite Stimulation<\/h3>\n<p id=\"_46\" tabindex=\"-1\"><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44103&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Anorexia<\/a>, early satiety, weight loss, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44108&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cachexia<\/a>\u00a0are problems experienced by cancer patients. Such patients are faced not only with the disfigurement associated with wasting but also with an inability to engage in the social interaction of meals.<\/p>\n<section id=\"_83\">\n<h4 id=\"_83_toc\">Cannabinoids<\/h4>\n<p id=\"_48\" tabindex=\"-1\">Three controlled trials demonstrated that oral THC has variable effects on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454699&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">appetite<\/a>stimulation and weight loss in patients with advanced malignancies and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44366&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">human immunodeficiency virus<\/a>\u00a0(HIV) infection.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.26\">26<\/a>] One study evaluated the efficacy of dronabinol alone or with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46617&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">megestrol<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=655020&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">acetate<\/a>\u00a0compared with that of megestrol acetate alone for managing cancer-associated anorexia.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.34\">34<\/a>] In this randomized, double-blind study of 469 adults with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=478743&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">advanced cancer<\/a>\u00a0and weight loss, patients received 2.5 mg of oral THC twice daily, 800 mg of oral megestrol daily, or both. Appetite increased by 75% in the megestrol group and weight increased by 11%, compared with a 49% increase in appetite and a 3% increase in weight in the oral THC group after 8 to 11 weeks of treatment. These two differences were statistically\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390271&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">significant<\/a>. Furthermore, the combined therapy did not offer additional benefits beyond those provided by megestrol acetate alone. The authors concluded that dronabinol did little to promote appetite or weight gain in advanced cancer patients compared with megestrol acetate. However, a smaller, placebo-controlled trial of dronabinol in cancer patients demonstrated improved and enhanced chemosensory perception in the cannabinoid group\u2014food tasted better, appetite increased, and the proportion of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44651&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">calories<\/a>\u00a0consumed as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46092&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">protein<\/a>\u00a0was greater than in the placebo recipients.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.35\">35<\/a>]<\/p>\n<p id=\"_175\" tabindex=\"-1\">In a randomized clinical trial, researchers compared the safety and effectiveness of orally administered\u00a0<em>Cannabis<\/em>\u00a0extract (2.5 mg THC and 1 mg CBD), THC (2.5 mg), or placebo for the treatment of cancer-related anorexia-cachexia in 243 patients with advanced cancer who received treatment twice daily for 6 weeks. Results demonstrated that although these agents were well tolerated by these patients, no differences were observed in patient appetite or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45417&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">quality of life<\/a>\u00a0among the three groups at this dose level and duration of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454757&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">intervention<\/a>.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.36\">36<\/a>]<\/p>\n<p id=\"_49\" tabindex=\"-1\">Another clinical trial that involved 139 patients with HIV or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45950&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">AIDS<\/a>\u00a0and 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.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.37\">37<\/a>]<\/p>\n<\/section>\n<section id=\"_84\">\n<h4 id=\"_84_toc\"><em>Cannabis<\/em><\/h4>\n<p id=\"_78\" tabindex=\"-1\">In trials conducted in the 1980s that involved\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=561403&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">healthy control<\/a>\u00a0subjects, inhaling\u00a0<em>Cannabis<\/em>led to an increase in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44109&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">caloric intake<\/a>, mainly in the form of between-meal snacks, with increased intakes of fatty and sweet foods.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.38\">38<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.39\">39<\/a>]<\/p>\n<p id=\"_237\" tabindex=\"-1\">No published studies have explored the effect of inhaled\u00a0<em>Cannabis<\/em>\u00a0on appetite in cancer patients.<\/p>\n<\/section>\n<\/section>\n<section id=\"_51\">\n<h3 id=\"_51_toc\">Analgesia<\/h3>\n<section id=\"_85\">\n<h4 id=\"_85_toc\">Cannabinoids<\/h4>\n<p id=\"_52\" tabindex=\"-1\">Pain management improves a patient\u2019s quality of life throughout all\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45885&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">stages<\/a>\u00a0of cancer. Through the study of cannabinoid\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44958&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">receptors<\/a>, endocannabinoids, and synthetic agonists and antagonists, the mechanisms of cannabinoid-induced\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=449929&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analgesia<\/a>\u00a0have been analyzed.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.40\">40<\/a>][<a href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=335121&amp;version=HealthProfessional&amp;language=English\">Level of evidence:1iC<\/a>] The CB1 receptor is found in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46481&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">central nervous system<\/a>\u00a0(CNS) and in peripheral\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373935&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nerve<\/a>\u00a0terminals.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.41\">41<\/a>] CB2 receptors are located mainly in peripheral\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tissue<\/a>and are expressed in only low amounts in the CNS. Whereas only CB1 agonists exert\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45590&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analgesic<\/a>\u00a0activity in the CNS, both CB1 and CB2 agonists have analgesic activity in peripheral tissue.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.42\">42<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.43\">43<\/a>]<\/p>\n<p id=\"_53\" tabindex=\"-1\">Cancer pain results from\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44042&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inflammation<\/a>, invasion of bone or other pain-sensitive structures, or nerve injury. When cancer pain is severe and persistent, it is often resistant to treatment with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45054&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">opioids<\/a>.<\/p>\n<p id=\"_54\" tabindex=\"-1\">Two studies examined the effects of oral delta-9-THC on cancer pain. The first, a double-blind, placebo-<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44015&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">controlled study<\/a>\u00a0involving ten patients, measured both pain intensity and pain relief.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.44\">44<\/a>] It was reported that 15 mg and 20 mg doses of the cannabinoid delta-9-THC were associated with substantial analgesic effects, with antiemetic effects and appetite stimulation.<\/p>\n<p id=\"_55\" tabindex=\"-1\">In a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44671&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">follow-up<\/a>, single-dose study involving 36 patients, it was reported that 10 mg doses of delta-9-THC produced analgesic effects during a 7-hour\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45981&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">observation<\/a>\u00a0period that were comparable to 60 mg doses of codeine, and 20 mg doses of delta-9-THC induced effects equivalent to 120 mg doses of codeine.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.45\">45<\/a>] Higher doses of THC were found to be more\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=450118&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">sedative<\/a>\u00a0than codeine.<\/p>\n<p id=\"_56\" tabindex=\"-1\">Another study examined the effects of a plant\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=407760&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">extract<\/a>\u00a0with controlled cannabinoid content in an oromucosal spray. In a multicenter, double-blind, placebo-controlled study, the THC:CBD nabiximols extract and THC extract alone were compared in the analgesic management of patients with advanced cancer and with moderate-to-severe cancer-related pain. Patients were assigned to one of three treatment groups: THC:CBD extract, THC extract, or placebo. The researchers concluded that the THC:CBD extract was efficacious for pain relief in advanced cancer patients whose pain was not fully relieved by strong opioids.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.46\">46<\/a>] In a randomized, placebo-controlled, graded-dose trial, opioid-treated cancer patients with poorly controlled\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44654&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chronic pain<\/a>\u00a0demonstrated significantly better control of pain and sleep disruption with THC:CBD oromucosal spray at lower doses (1\u20134 and 6\u201310 sprays\/day), compared with placebo. Adverse events were dose related, with only the high-dose group (11\u201316 sprays\/day) comparing unfavorably with the placebo arm. These studies provide promising evidence of an\u00a0<em>adjuvant analgesic<\/em>\u00a0effect of THC:CBD in this opioid-refractory patient population and may provide an opportunity to address this significant clinical challenge.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.47\">47<\/a>] An open-label extension study of 43 patients who had participated in the randomized trial found that some patients continued to obtain relief of their cancer-related pain with long-term use of the THC:CBD oromucosal spray without increasing their dose of the spray or the dose of their other analgesics.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.48\">48<\/a>]<\/p>\n<p id=\"_194\" tabindex=\"-1\">A randomized, placebo-controlled, crossover pilot study of nabiximols in 16 patients with chemotherapy-induced neuropathic pain showed no significant difference between the treatment and placebo groups. A responder analysis, however, demonstrated that five patients reported a reduction in their pain of at least 2 points on an 11-point scale, suggesting that a larger follow-up study may be warranted.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.49\">49<\/a>]<\/p>\n<p id=\"_57\" tabindex=\"-1\">An\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=286105&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">observational study<\/a>\u00a0assessed the effectiveness of nabilone in advanced cancer patients who were experiencing pain and other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptoms<\/a>\u00a0(anorexia, depression, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=430405&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anxiety<\/a>). The researchers reported that patients who used nabilone experienced improved management of pain, nausea, anxiety, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454701&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">distress<\/a>\u00a0when compared with untreated patients. Nabilone was also associated with a decreased use of opioids,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44481&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nonsteroidal anti-inflammatory drugs<\/a>, tricyclic\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44105&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antidepressants<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45039&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">gabapentin<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45262&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">dexamethasone<\/a>, metoclopramide, and ondansetron.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.50\">50<\/a>]<\/p>\n<\/section>\n<section id=\"_86\">\n<h4 id=\"_86_toc\"><em>Cannabis<\/em><\/h4>\n<p id=\"_157\" tabindex=\"-1\"><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454774&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Animal studies<\/a>\u00a0have suggested a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=330184&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">synergistic<\/a>\u00a0analgesic effect when cannabinoids are combined with opioids. The results from one pharmacokinetic interaction study have been reported. In this study, 21 patients with chronic pain were administered vaporized\u00a0<em>Cannabis<\/em>along with sustained-release\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45400&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">morphine<\/a>\u00a0or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454764&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">oxycodone<\/a>\u00a0for 5 days.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.51\">51<\/a>] The patients who received vaporized\u00a0<em>Cannabis<\/em>\u00a0and sustained-release morphine had a statistically significant decrease in their\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=285973&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">mean<\/a>\u00a0pain score over the 5-day period; those who received vaporized\u00a0<em>Cannabis<\/em>\u00a0and oxycodone did not. These findings should be verified by further studies before recommendations favoring such an approach are warranted in general clinical practice.<\/p>\n<p id=\"_192\" tabindex=\"-1\">Neuropathic pain is a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptom<\/a>\u00a0cancer patients may experience, especially if treated with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45841&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">platinum-based<\/a>\u00a0chemotherapy or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46138&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">taxanes<\/a>. Two RCTs of inhaled\u00a0<em>Cannabis<\/em>\u00a0in patients with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44705&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">peripheral neuropathy<\/a>\u00a0or neuropathic pain of various etiologies found that pain was reduced in patients who received inhaled\u00a0<em>Cannabis<\/em>, compared with those who received placebo.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.52\">52<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.53\">53<\/a>] Two additional trials of inhaled\u00a0<em>Cannabis<\/em>\u00a0have also demonstrated the benefit of\u00a0<em>Cannabis<\/em>\u00a0over placebo in HIV-associated neuropathic pain.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.54\">54<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.55\">55<\/a>]<\/p>\n<\/section>\n<\/section>\n<section id=\"_60\">\n<h3 id=\"_60_toc\">Anxiety and Sleep<\/h3>\n<section id=\"_240\">\n<h4 id=\"_240_toc\">Cannabinoids<\/h4>\n<p id=\"_241\" tabindex=\"-1\">In a small pilot study of analgesia involving ten patients with cancer pain, secondary measures showed that 15 mg and 20 mg doses of the cannabinoid delta-9-THC were associated with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44645&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">anxiolytic<\/a>\u00a0effects.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.44\">44<\/a>][<a href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=335121&amp;version=HealthProfessional&amp;language=English\">Level of evidence: 1iC<\/a>]<\/p>\n<p id=\"_243\" tabindex=\"-1\">A small placebo-controlled study of dronabinol in cancer patients with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44643&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">altered<\/a>chemosensory perception also noted increased quality of sleep and relaxation in THC-treated patients.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.35\">35<\/a>][<a href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=335121&amp;version=HealthProfessional&amp;language=English\">Level of evidence: 1iC<\/a>]<\/p>\n<\/section>\n<section id=\"_87\">\n<h4 id=\"_87_toc\"><em>Cannabis<\/em><\/h4>\n<p id=\"_61\" tabindex=\"-1\">Patients often experience mood elevation after exposure to\u00a0<em>Cannabis<\/em>, depending on their previous experience. In a five-patient\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44006&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">case series<\/a>\u00a0of inhaled\u00a0<em>Cannabis<\/em>\u00a0that examined analgesic effects in chronic pain, it was reported that patients who self-administered\u00a0<em>Cannabis<\/em>\u00a0had improved mood, improved sense of well-being, and less anxiety.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.56\">56<\/a>]<\/p>\n<p id=\"_62\" tabindex=\"-1\">Another common effect of\u00a0<em>Cannabis<\/em>\u00a0is sleepiness. A 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.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.35\">35<\/a>]<\/p>\n<\/section>\n<\/section>\n<section id=\"_256\">\n<h3 id=\"_256_toc\">Clinical Studies of\u00a0<em>Cannabis<\/em>\u00a0and Cannabinoids<\/h3>\n<div><\/div>\n<figure class=\"table\"><figcaption id=\"_245_cap\">Table 1. Clinical Studies of\u00a0<em>Cannabis<\/em><span class=\"sup\">a<\/span><\/figcaption><a class=\"article-image-enlarge no-resize\" href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#\">ENLARGE<\/a><\/p>\n<div class=\"has-scroll scrollable\">\n<div>\n<table id=\"_245\" class=\"table-default expandable-container\" aria-labelledby=\"_245_cap\">\n<colgroup>\n<col width=\"14.07%\" \/>\n<col width=\"12.56%\" \/>\n<col width=\"15.95%\" \/>\n<col width=\"14.19%\" \/>\n<col width=\"14.32%\" \/>\n<col width=\"14.07%\" \/>\n<col width=\"14.82%\" \/><\/colgroup>\n<thead>\n<tr>\n<th>Reference Citation<\/th>\n<th>Type of Study<\/th>\n<th>Condition Treated<\/th>\n<th>No. of Patients: Enrolled; Treated; Control<span class=\"sup\">b<\/span><\/th>\n<th>Strongest Benefit Reported<span class=\"sup\">c<\/span><\/th>\n<th><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44011&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Concurrent Therapy<\/a>Used (Yes\/No\/ Unknown)<span class=\"sup\">d<\/span><\/th>\n<th>Level of Evidence Score<span class=\"sup\">e<\/span><\/th>\n<\/tr>\n<\/thead>\n<tfoot class=\"pdq-footer\">\n<tr>\n<td colspan=\"7\">CINV = chemotherapy-induced nausea and vomiting; HIV = human immunodeficiency virus; RCT = randomized controlled trial; N\/V = nausea and vomiting.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">a<\/span>Refer to text and the\u00a0<a title=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\" href=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\">NCI Dictionary of Cancer Terms<\/a>\u00a0for additional information and definition of terms.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">b<\/span>Number of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially recruited\/considered by the researchers who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">c<\/span>Strongest evidence reported that the treatment under study has activity or otherwise improves the well-being of cancer patients.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">d<\/span>Concurrent therapy for symptoms treated (not cancer).<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">e<\/span>For information about\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446533&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">levels of evidence<\/a>\u00a0analysis and an explanation of the level of evidence scores, refer to\u00a0<a href=\"https:\/\/www.cancer.gov\/publications\/pdq\/levels-evidence\/cam\">Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies<\/a>.<\/td>\n<\/tr>\n<\/tfoot>\n<tbody>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.29\">29<\/a>]<\/td>\n<td>RCT<\/td>\n<td>CINV<\/td>\n<td>8; 8; None<\/td>\n<td>None<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.30\">30<\/a>]<\/td>\n<td>RCT<\/td>\n<td>CINV<\/td>\n<td>15; 15; None<\/td>\n<td>Decreased N\/V<\/td>\n<td>Unknown<\/td>\n<td>1iiC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.33\">33<\/a>]<\/td>\n<td>Pilot RCT<\/td>\n<td>CINV<\/td>\n<td>16; 7; 9<\/td>\n<td>Decreased\/delayed N\/V<\/td>\n<td>5-HT3 receptor antagonists<\/td>\n<td>1iC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/figure>\n<div><\/div>\n<figure class=\"table\"><figcaption id=\"_246_cap\">Table 2. Clinical Studies of Cannabinoids<span class=\"sup\">a<\/span><\/figcaption><a class=\"article-image-enlarge no-resize\" href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#\">ENLARGE<\/a><\/p>\n<div class=\"has-scroll scrollable\">\n<div>\n<table id=\"_246\" class=\"table-default expandable-container\" aria-labelledby=\"_246_cap\">\n<colgroup>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/>\n<col width=\"14.28%\" \/><\/colgroup>\n<thead>\n<tr>\n<th>Reference Citation<\/th>\n<th>Type of Study<\/th>\n<th>Condition Treated<\/th>\n<th>No. of Patients: Enrolled; Treated; Control<span class=\"sup\">b<\/span><\/th>\n<th>Strongest Benefit Reported<span class=\"sup\">c<\/span><\/th>\n<th>Concurrent Therapy Used (Yes\/No\/ Unknown)<span class=\"sup\">d<\/span><\/th>\n<th>Level of Evidence Score<span class=\"sup\">e<\/span><\/th>\n<\/tr>\n<\/thead>\n<tfoot class=\"pdq-footer\">\n<tr>\n<td colspan=\"7\">No. = number; QoL =\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45417&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">quality of life<\/a>; RCT = randomized controlled trial; THC = delta-9-tetrahydrocannabinol.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">a<\/span>Refer to text and the\u00a0<a title=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\" href=\"https:\/\/www.cancer.gov\/publications\/dictionaries\/cancer-terms\/\">NCI Dictionary of Cancer Terms<\/a>\u00a0for additional information and definition of terms.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">b<\/span>Number of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially recruited\/considered by the researchers who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">c<\/span>Strongest evidence reported that the treatment under study has activity or otherwise improves the well-being of cancer patients.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">d<\/span>Concurrent therapy for symptoms treated (not cancer).<\/td>\n<\/tr>\n<tr>\n<td colspan=\"7\"><span class=\"sup\">e<\/span>For information about levels of evidence analysis and an explanation of the level of evidence scores, refer to\u00a0<a href=\"https:\/\/www.cancer.gov\/publications\/pdq\/levels-evidence\/cam\">Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies<\/a>.<\/td>\n<\/tr>\n<\/tfoot>\n<tbody>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.34\">34<\/a>]<\/td>\n<td>RCT<\/td>\n<td>Cancer-associated anorexia<\/td>\n<td>469; dronabinol 152, megestrol acetate 159, or both 158; none<\/td>\n<td>Megestrol acetate provided superior anorexia\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467854&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">palliation<\/a>among advanced cancer patients compared with dronabinol alone<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.35\">35<\/a>]<\/td>\n<td>Pilot RCT<\/td>\n<td>Appetite<\/td>\n<td>21; 11; 10<\/td>\n<td>THC, compared with placebo, improved and enhanced chemosensory perception<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.36\">36<\/a>]<\/td>\n<td>RCT<\/td>\n<td>Cancer-related anorexia-cachexia syndrome<\/td>\n<td>243;\u00a0<em>Cannabis<\/em>extract 95, THC 100; 48<\/td>\n<td>No differences in patients\u2019 appetite or QoL were found<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.37\">37<\/a>]<\/td>\n<td>RCT<\/td>\n<td>Appetite<\/td>\n<td>139; 72; 67<\/td>\n<td>Increase in appetite<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.40\">40<\/a>]<\/td>\n<td>Survey of RCTs<\/td>\n<td>Pain<\/td>\n<td><\/td>\n<td>Decreased pain<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.44\">44<\/a>]<\/td>\n<td>RCT<\/td>\n<td>Pain<\/td>\n<td>10; none; none<\/td>\n<td>Pain relief<\/td>\n<td>Unknown<\/td>\n<td>1iC<\/td>\n<\/tr>\n<tr>\n<td>[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_5.50\">50<\/a>]<\/td>\n<td>Observational study<\/td>\n<td>Pain<\/td>\n<td>112; 47; 65<\/td>\n<td>Decreased pain<\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/figure>\n<\/section>\n<section id=\"_TrialSearch_9_sid_5\">\n<h3 id=\"_TrialSearch_9_sid_5_toc\">Current Clinical Trials<\/h3>\n<p id=\"_TrialSearch_9_22\" tabindex=\"-1\">Use our\u00a0<a title=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/clinical-trials\/advanced-search\" href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/clinical-trials\/advanced-search\">advanced clinical trial search<\/a>\u00a0to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria.\u00a0<a title=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/clinical-trials\/\" href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/clinical-trials\/\">General information<\/a>\u00a0about clinical trials is also available.<\/p>\n<\/section>\n<h6>References<\/h6>\n<ol>\n<li id=\"section_5.1\">Adams IB, Martin BR: Cannabis: pharmacology and toxicology in animals and humans. Addiction 91 (11): 1585-614, 1996.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.2\">Agurell S, Halldin M, Lindgren JE, et al.: Pharmacokinetics and metabolism of delta 1-tetrahydrocannabinol and other cannabinoids with emphasis on man. Pharmacol Rev 38 (1): 21-43, 1986.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=3012605&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=3012605&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.3\">Yamamoto I, Watanabe K, Narimatsu S, et al.: Recent advances in the metabolism of cannabinoids. Int J Biochem Cell Biol 27 (8): 741-6, 1995.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7584607&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7584607&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.4\">Engels FK, de Jong FA, Sparreboom A, et al.: Medicinal cannabis does not influence the clinical pharmacokinetics of irinotecan and docetaxel. Oncologist 12 (3): 291-300, 2007.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17405893&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17405893&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.5\">Berthiller J, Straif K, Boniol M, et al.: Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb. J Thorac Oncol 3 (12): 1398-403, 2008.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19057263&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19057263&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.6\">Sidney S, Quesenberry CP Jr, Friedman GD, et al.: Marijuana use and cancer incidence (California, United States). Cancer Causes Control 8 (5): 722-8, 1997.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9328194&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9328194&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.7\">Hashibe M, Morgenstern H, Cui Y, et al.: Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 15 (10): 1829-34, 2006.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17035389&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17035389&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.8\">Mehra R, Moore BA, Crothers K, et al.: The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med 166 (13): 1359-67, 2006.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16832000&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=16832000&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.9\">Marks MA, Chaturvedi AK, Kelsey K, et al.: Association of marijuana smoking with oropharyngeal and oral tongue cancers: pooled analysis from the INHANCE consortium. 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J Pain 13 (5): 438-49, 2012.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22483680&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22483680&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.48\">Johnson JR, Lossignol D, Burnell-Nugent M, et al.: An open-label extension study to investigate the long-term safety and tolerability of THC\/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage 46 (2): 207-18, 2013.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23141881&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23141881&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.49\">Lynch ME, Cesar-Rittenberg P, Hohmann AG: A double-blind, placebo-controlled, crossover pilot trial with extension using an oral mucosal cannabinoid extract for treatment of chemotherapy-induced neuropathic pain. J Pain Symptom Manage 47 (1): 166-73, 2014.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23742737&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23742737&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.50\">Maida V, Ennis M, Irani S, et al.: Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring. J Support Oncol 6 (3): 119-24, 2008.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18402303&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18402303&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.51\">Abrams DI, Couey P, Shade SB, et al.: Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther 90 (6): 844-51, 2011.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22048225&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22048225&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.52\">Wilsey B, Marcotte T, Deutsch R, et al.: Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain 14 (2): 136-48, 2013.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23237736&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=23237736&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.53\">Wilsey B, Marcotte T, Tsodikov A, et al.: A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain 9 (6): 506-21, 2008.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18403272&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18403272&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.54\">Abrams DI, Jay CA, Shade SB, et al.: Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68 (7): 515-21, 2007.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17296917&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17296917&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.55\">Ellis RJ, Toperoff W, Vaida F, et al.: Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34 (3): 672-80, 2009.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18688212&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=18688212&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_5.56\">Noyes R Jr, Baram DA: Cannabis analgesia. Compr Psychiatry 15 (6): 531-5, 1974 Nov-Dec.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=4426188&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=4426188&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_11\" class=\"show\">\n<h2>Adverse Effects<\/h2>\n<div id=\"_section_11\" class=\"pdq-sections\">\n<section id=\"_88\">\n<h3 id=\"_88_toc\"><em>Cannabis<\/em>\u00a0and Cannabinoids<\/h3>\n<p id=\"_12\" tabindex=\"-1\">Because\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoid<\/a>\u00a0receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration, lethal overdoses from\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>and cannabinoids do not occur.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_6.1\">1<\/a>&#8211;<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_6.4\">4<\/a>] However, cannabinoid receptors are present in other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tissues<\/a>\u00a0throughout the body, not just in the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46481&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">central nervous system<\/a>, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44922&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">adverse effects<\/a>\u00a0include\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=415551&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tachycardia<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44039&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hypotension<\/a>,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44197&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">conjunctival<\/a>\u00a0injection, bronchodilation, muscle relaxation, and decreased\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45692&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">gastrointestinal<\/a>\u00a0motility.<\/p>\n<p id=\"_75\" tabindex=\"-1\">Although cannabinoids are considered by some to be addictive drugs, their addictive potential is considerably lower than that of other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44711&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prescribed<\/a>\u00a0agents or substances of abuse.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_6.2\">2<\/a>,<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_6.4\">4<\/a>] The brain develops a tolerance to cannabinoids.<\/p>\n<p id=\"_76\" tabindex=\"-1\">Withdrawal\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptoms<\/a>\u00a0such as irritability,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44043&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">insomnia<\/a>\u00a0with sleep\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=462676&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">electroencephalogram<\/a>disturbance, restlessness,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=256567&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">hot flashes<\/a>, and, rarely,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390302&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nausea<\/a>\u00a0and cramping have been observed. However, these symptoms appear to be mild compared with withdrawal symptoms associated with opiates or\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=694849&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">benzodiazepines<\/a>, and the symptoms usually dissipate after a few days.<\/p>\n<p id=\"_77\" tabindex=\"-1\">Unlike other commonly used drugs, cannabinoids are stored in adipose tissue and excreted at a low rate (half-life 1\u20133 days), so even abrupt cessation of cannabinoid intake is not associated with rapid declines in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45839&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">plasma<\/a>\u00a0concentrations that would precipitate severe or abrupt withdrawal symptoms or drug cravings.<\/p>\n<p id=\"_156\" tabindex=\"-1\">Since\u00a0<em>Cannabis<\/em>\u00a0smoke contains many of the same components as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=439432&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tobacco<\/a>\u00a0smoke, there are valid concerns about the adverse\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45852&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">pulmonary<\/a>\u00a0effects of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44600&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inhaled<\/a>\u00a0<em>Cannabis<\/em>. A longitudinal study in a noncancer population evaluated repeated measurements of pulmonary function over 20 years in 5,115 men and women whose smoking histories were known.[<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#cit\/section_6.5\">5<\/a>] While tobacco exposure was associated with decreased pulmonary function, the investigators concluded that occasional and low-cumulative\u00a0<em>Cannabis<\/em>\u00a0use was not associated with adverse effects on pulmonary function (forced expiratory volume in the first second of expiration [FEV1] and forced vital capacity [FVC]).<\/p>\n<\/section>\n<h6>References<\/h6>\n<ol>\n<li id=\"section_6.1\">Adams IB, Martin BR: Cannabis: pharmacology and toxicology in animals and humans. Addiction 91 (11): 1585-614, 1996.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8972919&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_6.2\">Grotenhermen F, Russo E, eds.: Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. Binghamton, NY: The Haworth Press, 2002.<\/li>\n<li id=\"section_6.3\">Sutton IR, Daeninck P: Cannabinoids in the management of intractable chemotherapy-induced nausea and vomiting and cancer-related pain. J Support Oncol 4 (10): 531-5, 2006 Nov-Dec.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17136871&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=17136871&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_6.4\">Guzm\u00e1n M: Cannabinoids: potential anticancer agents. Nat Rev Cancer 3 (10): 745-55, 2003.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=14570037&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=14570037&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<li id=\"section_6.5\">Pletcher MJ, Vittinghoff E, Kalhan R, et al.: Association between marijuana exposure and pulmonary function over 20 years. JAMA 307 (2): 173-81, 2012.\u00a0<a title=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22235088&amp;dopt=Abstract\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=22235088&amp;dopt=Abstract\">[PUBMED Abstract]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_13\" class=\"show\">\n<h2>Summary of the Evidence for Cannabis and Cannabinoids<\/h2>\n<div id=\"_section_13\" class=\"pdq-sections\">\n<p id=\"_14\" tabindex=\"-1\">To assist readers in evaluating the results of human studies of integrative, alternative, and complementary therapies for people with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cancer<\/a>, the strength of the evidence (i.e., the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446533&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">levels of evidence<\/a>) associated with each type of treatment is provided whenever possible. To qualify for a level of evidence\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390238&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">analysis<\/a>, a study must:<\/p>\n<div class=\"pdq-content-list\">\n<ul id=\"_70\">\n<li>Be published in a\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=537399&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">peer-reviewed scientific journal<\/a>.<\/li>\n<li>Report on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=43985&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">therapeutic<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=467853&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">outcome<\/a>\u00a0or outcomes, such as\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">tumor<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44085&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">response<\/a>, improvement in survival, or measured improvement in\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45417&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">quality of life<\/a>.<\/li>\n<li>Describe\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44168&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">clinical<\/a>\u00a0findings in sufficient detail for a meaningful evaluation to be made.<\/li>\n<\/ul>\n<\/div>\n<p id=\"_92\" tabindex=\"-1\">Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e.,\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=346519&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">endpoints<\/a>) measured. The resulting two scores are then combined to produce an overall score. An overall level of evidence score cannot be assigned to\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716077&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cannabinoids<\/a>because there has been insufficient clinical research to date. For an explanation of possible scores and additional information about levels of evidence analysis of CAM treatments for people with cancer, refer to\u00a0<a href=\"https:\/\/www.cancer.gov\/publications\/pdq\/levels-evidence\/cam\">Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies<\/a>.<\/p>\n<div class=\"pdq-content-list\">\n<p class=\"pdq-list-title\">Cannabinoids<\/p>\n<ul id=\"_90\" class=\"pdq-address-block\">\n<li>Several\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44014&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">controlled clinical trials<\/a>\u00a0have been performed, and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=691484&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">meta-analyses<\/a>\u00a0of these support a beneficial effect of cannabinoids (<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45240&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">dronabinol<\/a>\u00a0and nabilone) on\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">chemotherapy<\/a>\u00a0-induced\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390302&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">nausea<\/a>\u00a0and\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=390324&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">vomiting<\/a>\u00a0(N\/V) compared with\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46688&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">placebo<\/a>. Both dronabinol and nabilone are approved by the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=454785&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">U.S. Food and Drug Administration<\/a>\u00a0for the\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=439419&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">prevention<\/a>\u00a0or treatment of chemotherapy-induced N\/V in cancer patients but not for other\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=269453&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptom management<\/a>.<\/li>\n<\/ul>\n<\/div>\n<div class=\"pdq-content-list\">\n<p class=\"pdq-list-title\">Cannabis<\/p>\n<ul id=\"_91\">\n<li>There have been ten clinical trials on the use of\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44600&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">inhaled<\/a>\u00a0<em><a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=716285&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">Cannabis<\/a>\u00a0<\/em>in cancer patients that can be divided into two groups. In one group, four small studies assessed\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46084&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">antiemetic<\/a>activity but each explored a different patient population and chemotherapy\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45864&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">regimen<\/a>. One study demonstrated no effect, the second study showed a positive effect versus placebo, the report of the third study did not provide enough information to characterize the overall outcome as positive or neutral. Consequently, there are insufficient data to provide an overall level of evidence\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=430407&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">assessment<\/a>\u00a0for the use of\u00a0<em>Cannabis<\/em>\u00a0for chemotherapy-induced N\/V. Apparently, there are no published controlled clinical trials on the use of inhaled\u00a0<em>Cannabis<\/em>\u00a0for other cancer-related or cancer treatment\u2013related\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">symptoms<\/a>.<\/li>\n<li>An increasing number of trials are evaluating the oromucosal\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=478733&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">administration<\/a>\u00a0of\u00a0<em>Cannabis<\/em>\u00a0plant\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=407760&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">extract<\/a>\u00a0with fixed concentrations of cannabinoid components, with national drug regulatory agencies in Canada and in some European countries that issue approval for cancer pain.<\/li>\n<li>At present, there is insufficient evidence to recommend inhaling\u00a0<em>Cannabis<\/em>\u00a0as a treatment for cancer-related symptoms or cancer treatment\u2013related symptoms or cancer treatment-related\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46580&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">side effects<\/a>; however, additional research is needed.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_15\" class=\"show\">\n<h2>Changes to This Summary (10\/20\/2017)<\/h2>\n<div id=\"_section_15\" class=\"pdq-sections\">\n<p id=\"_16\" tabindex=\"-1\">The\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44271&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">PDQ<\/a>\u00a0<a class=\"definition\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=healthprofessional&amp;language=English&amp;dictionary=Cancer.gov\" type=\"GlossaryTermRefs\">cancer<\/a>\u00a0information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.<\/p>\n<p id=\"_267\" tabindex=\"-1\"><strong><a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#link\/_9\">Human\/Clinical Studies<\/a><\/strong><\/p>\n<p id=\"_272\" tabindex=\"-1\">Added\u00a0<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#link\/_269\">text<\/a>\u00a0to include the following information on moderately emetogenic chemotherapy: at least 50% of patients who receive moderately emetogenic chemotherapy may experience delayed chemotherapy-induced nausea and vomiting; although selective neurokinin 1 antagonists that inhibit substance P have been approved for delayed nausea and vomiting, a study was conducted before their availability to assess dronabinol, ondansetron, or their combination in preventing delayed-onset chemotherapy-induced nausea and vomiting (cited Meiri et al. as reference 28). Also added that occurrence rates for nausea intensity and vomiting\/retching episodes were the lowest in patients treated with dronabinol, suggesting that dronabinol compares favorably with ondansetron in this situation where a substance P inhibitor would currently be the drug of choice.<\/p>\n<p id=\"_disclaimerHP_3\" tabindex=\"-1\">This summary is written and maintained by the\u00a0<a title=\"http:\/\/www.cancer.gov\/publications\/pdq\/editorial-boards\/cam\" href=\"http:\/\/www.cancer.gov\/publications\/pdq\/editorial-boards\/cam\">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board<\/a>, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the\u00a0<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq#link\/_AboutThis_1\">About This PDQ Summary<\/a>\u00a0and\u00a0<a title=\"http:\/\/www.cancer.gov\/publications\/pdq\" href=\"http:\/\/www.cancer.gov\/publications\/pdq\">PDQ\u00ae &#8211; NCI&#8217;s Comprehensive Cancer Database<\/a>\u00a0pages.<\/p>\n<\/div>\n<div class=\"row collapse previous-next-links show-for-large-up\"><\/div>\n<\/section>\n<section id=\"_AboutThis_1\" class=\"show\">\n<h2>About This PDQ Summary<\/h2>\n<div id=\"_section_AboutThis_1\" class=\"pdq-sections\">\n<section id=\"_AboutThis_2\">\n<h3 id=\"_AboutThis_2_toc\">Purpose of This Summary<\/h3>\n<p id=\"_AboutThis_3\" tabindex=\"-1\">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of Cannabis and cannabinoids in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.<\/p>\n<\/section>\n<section id=\"_AboutThis_4\">\n<h3 id=\"_AboutThis_4_toc\">Reviewers and Updates<\/h3>\n<p id=\"_AboutThis_5\" tabindex=\"-1\">This summary is reviewed regularly and updated as necessary by the\u00a0<a title=\"http:\/\/www.cancer.gov\/publications\/pdq\/editorial-boards\/cam\" href=\"http:\/\/www.cancer.gov\/publications\/pdq\/editorial-boards\/cam\">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board<\/a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).<\/p>\n<p id=\"_AboutThis_22\" tabindex=\"-1\">Board members review recently published articles each month to determine whether an article should:<\/p>\n<div class=\"pdq-content-list\">\n<ul id=\"_AboutThis_6\">\n<li>be discussed at a meeting,<\/li>\n<li>be cited with text, or<\/li>\n<li>replace or update an existing article that is already cited.<\/li>\n<\/ul>\n<\/div>\n<p id=\"_AboutThis_7\" tabindex=\"-1\">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.<\/p>\n<p id=\"\" tabindex=\"-1\">The lead reviewers for Cannabis and Cannabinoids are:<\/p>\n<div class=\"pdq-content-list\">\n<ul id=\"\">\n<li>Donald I. Abrams, MD (UCSF Osher Center for Integrative Medicine)<\/li>\n<li>Nagi B. Kumar, PhD, RD, FADA (Fellow of the American Dietetic Association)<\/li>\n<li>Jing Li, PhD (Food and Drug Administration)<\/li>\n<li>Jeffrey D. White, MD (National Cancer Institute)<\/li>\n<\/ul>\n<\/div>\n<p id=\"_AboutThis_9\" tabindex=\"-1\">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website&#8217;s\u00a0<a title=\"https:\/\/www.cancer.gov\/contact\/email-us\" href=\"https:\/\/www.cancer.gov\/contact\/email-us\">Email Us<\/a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.<\/p>\n<\/section>\n<section id=\"_AboutThis_10\">\n<h3 id=\"_AboutThis_10_toc\">Levels of Evidence<\/h3>\n<p id=\"_AboutThis_11\" tabindex=\"-1\">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Integrative, Alternative, and Complementary Therapies Editorial Board uses a\u00a0<a href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq\">formal evidence ranking system<\/a>\u00a0in developing its level-of-evidence designations.<\/p>\n<\/section>\n<section id=\"_AboutThis_12\">\n<h3 id=\"_AboutThis_12_toc\">Permission to Use This Summary<\/h3>\n<p id=\"_AboutThis_13\" tabindex=\"-1\">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as \u201cNCI\u2019s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].\u201d<\/p>\n<p id=\"_AboutThis_14\" tabindex=\"-1\">The preferred citation for this PDQ summary is:<\/p>\n<p id=\"_AboutThis_15\" tabindex=\"-1\">PDQ\u00ae Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Cannabis and Cannabinoids. Bethesda, MD: National Cancer Institute. Updated &lt;MM\/DD\/YYYY&gt;. Available at:\u00a0<a title=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq\" href=\"https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq\">https:\/\/www.cancer.gov\/about-cancer\/treatment\/cam\/hp\/cannabis-pdq<\/a>. Accessed &lt;MM\/DD\/YYYY&gt;. [PMID: 26389198]<\/p>\n<p id=\"_AboutThis_16\" tabindex=\"-1\">Images in this summary are used with permission of the author(s), artist, and\/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in\u00a0<a title=\"https:\/\/visualsonline.cancer.gov\/\" href=\"https:\/\/visualsonline.cancer.gov\/\">Visuals Online<\/a>, a collection of over 2,000 scientific images.<\/p>\n<\/section>\n<section id=\"_AboutThis_17\">\n<h3 id=\"_AboutThis_17_toc\">Disclaimer<\/h3>\n<p id=\"_AboutThis_19\" tabindex=\"-1\">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the\u00a0<a title=\"https:\/\/www.cancer.gov\/about-cancer\/managing-care\" href=\"https:\/\/www.cancer.gov\/about-cancer\/managing-care\">Managing Cancer Care<\/a>\u00a0page.<\/p>\n<\/section>\n<\/div>\n<\/section>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Overview This\u00a0cancer\u00a0information summary provides an overview of the use of\u00a0Cannabis\u00a0and its components as a treatment for people with cancer-related\u00a0symptoms\u00a0caused by the disease itself or its treatment. This summary contains the following key information: Cannabis\u00a0has been used for medicinal purposes for thousands of years. By federal law, the possession of\u00a0Cannabis\u00a0is illegal &hellip;<\/p>\n","protected":false},"author":1,"featured_media":5566,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[617],"tags":[],"class_list":["post-5568","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cannabis"],"_links":{"self":[{"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/posts\/5568","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5568"}],"version-history":[{"count":0,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/posts\/5568\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=\/wp\/v2\/media\/5566"}],"wp:attachment":[{"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5568"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5568"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lutzlivetotell.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5568"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}