Cannabis and cannabinoids for pain, appetite and cancer control
Many people with cancer use cannabis for pain, appetite and sleep. Randomised trials of a cannabis mouth spray added to opioids did not beat placebo for cancer pain, appetite trials were negative, and there is no evidence that cannabis or CBD oil shrinks tumours in people. The 2024 ASCO guideline recommends against using it to treat cancer outside a trial.
Overview
Three randomised placebo-controlled phase 3 trials of nabiximols (THC:CBD oromucosal spray) added to optimised opioids for advanced cancer pain (Fallon et al. 2017; Lichtman et al. 2018) failed to meet their primary endpoints, and dronabinol did not improve appetite or weight in a randomised trial against megestrol acetate. Observational surveys report benefit for sleep and wellbeing but cannot separate expectation. Preclinical antitumour activity of cannabinoids in glioma and other models has not been followed by any positive human efficacy trial, and CBD oils sold online vary widely in content. The 2024 ASCO guideline recommends that clinicians should not recommend cannabis or cannabinoids to treat cancer except in a clinical trial, notes low-certainty evidence for pain and sleep, and flags interactions: CBD inhibits CYP2C19 and CYP3A4, and observational data suggest cannabis users may respond less well to checkpoint immunotherapy, an unconfirmed but concerning signal. Legal status and product quality vary by country.
How it works
CB1 and CB2 receptor agonism modulates nociception, appetite and mood; in tumour models cannabinoids induce apoptosis and inhibit angiogenesis at concentrations not achieved in patients.
- Widely used; open discussion improves safety
- Some low-certainty evidence for sleep and neuropathic pain
- Phase 3 pain trials negative
- No human evidence of tumour control
- CYP interactions and possible reduced immunotherapy response
Latest papers
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