Written by Gabriele Dennert and the CAM-Cancer Consortium.
Updated November 13, 2009

Cannabinoids

Abstract and key points

  • Cannabinoids are components isolated from Cannabis sativa and Cannabis indica plants (hemp).
  • The antiemetic efficacy of cannabis in chemotherapy-induced nausea/vomiting has been established in a systematic review.
  • The use of cannabinoids for anorexia-cachexia-syndrome in advanced cancer is not supported by the evidence from randomised controlled trials.
  • Several randomised controlled trials indicate a mild analgesic effect of cannabinoids in cancer patients.
  • Dose-limitating central nervous and cardiovascular adverse effects have frequently been observed in clinical studies.

Cannabinoids are components isolated from Cannabis sativa and Cannabis indica plants (hemp). This summary deals with cannabinoid products for medical use. Medical cannabinoids are claimed to alleviate nausea and vomiting in chemo-/radiotherapy and in palliative care. They are also recommended for the treatment of anorexia and cachexia in patients with advanced cancer and for the control of chronic tumour pain. The pharmacokinetics of cannabinoids have been intensively investigated and cannabinoid effects in humans have been linked to their agonist activity at two cannabinoid receptors.

The antiemetic efficacy of cannabinoids in chemotherapy-induced nausea/vomiting has been established in a systematic review. If cannabinoids can offer improvements over modern antiemetic medication, especially serotonin antagonists, in preventing acute or delayed chemotherapy induced nausea and vomiting is still unclear. Only anecdotal evidence is available to support the use of medical cannabinoids against radiotherapy-related nausea and nausea in palliative care patients.

The use of cannabinoids for anorexia-cachexia-syndrome in advanced cancer is not supported by the evidence from randomised controlled trials.
Several randomised controlled trials also indicate a mild analgesic effect of cannabinoids in cancer patients. Insufficient evidence is available to support the introduction of cannabinoids into widespread clinical use as analgesics.

The main limitation of cannabinoids is seen in the high frequency of serious adverse effects on the central nervous system and the cardiovascular system. Known absolute and relative contraindications and pharmacological interactions should be carefully considered. Medical cannabinoids are subject to country-specific prohibitory legislation.

Considering the availability of well-investigated and established medications for chemotherapy-induced nausea and chronic pain, a first-line use of medical cannabinoids is not recommended. Medical cannabinoids might be beneficial in individual cases as adjuncts to other antiemetic or analgesic medication when standard treatment fails in symptom control. Potential hazards and toxicities should be considered.

Citation Gabriele Dennert, CAM-Cancer Consortium. Cannabinoids [online document]. http://www.cam-cancer.org/CAM-Summaries/Biologically-Based-Practices/Cannabinoids. November 13, 2009.

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The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.