A federal government agency has published a wide-ranging series of scientific reports on marijuana and cancer as part of an effort to better understand “core questions” around patients’ relationship with cannabis—including sourcing, cost, behavioral patterns, patient–provider communications and reasons for use.
One study looks specifically at patients who use medical marijuana as an alternative to opioids to treat their cancer-related pain.
Published in a special issue of the Journal of the National Cancer Institute Monographs, the package of 14 articles details the results of broad, federally funded surveys of cancer patients from a dozen agency-designated cancer centers across the country—including in areas where marijuana is legal for adult use, permitted only for medical purposes or still outlawed.
An introduction by National Cancer Institute (NCI) officials describes the project as an “initial effort to address major knowledge gaps such as understanding how cancer patients access and use cannabis, assessing the perceived risks and benefits with its use, and examining whether cancer patients discuss cannabis use with their healthcare providers during treatment.”
The individual reports cover an array of issues covered in the patient surveys, the officials explained, highlighting “key topics related to cannabis use such as sourcing of cannabis, associated cost, behavioral factors associated with cannabis use (such as smoking, drinking or using other substances), patient-provider communication on cannabis use during treatment, ethnic variations in patterns, sources and reasons for cannabis use as well as methodologic concerns related to survey data analysis.”
A main finding of one study led by NCI researchers, for example, is that patients’ “reported use of cannabis since diagnosis varied only slightly by legal status.” Of those surveyed between September 2021 and August 2032, 34.3 percent of patients who resided in states where marijuana was legal for adults over 21 reported using the substance, compared to 31.5 percent in medical-only states and 24.7 percent in states where cannabis was illegal.
In all, just under one-third (32.9 percent) of patients reported using cannabis, with respondents reporting that they used marijuana primarily to treat cancer—and treatment-related symptoms such as difficulty sleeping, pain and mood changes. The most common perceived benefits “were for pain, sleep, stress and anxiety, and treatment side effects,” the report stated.
Only one in eight health-care professionals surveyed “felt knowledgeable about the topic of cannabis.”
Authors wrote that the “large geographically diverse survey demonstrates that patients are using cannabis regardless of its legality in their state of residence.”
“In general,” they observed, “cancer patients perceived that the benefits of using cannabis outweighed the risks.”
Another analysis, conducted with data from 2021 to 2022, found that about one in six patients (17 percent) were “actively using cannabis at the time of survey completion,” while about 26 percent reported having used the substance since their cancer diagnosis.
While authors of that report noted that perspectives “about cannabis use and education varied widely among health-care professionals” surveyed, 72 percent said cannabis was safe and 57 percent said marijuana was beneficial for patients.
About four in 10 (39 percent) health-care professionals “felt comfortable providing guidance to patients about cannabis use,” the paper found, but only one in eight (13 percent) “felt knowledgeable about the topic of cannabis.”
Among patients in that study, the most common modes of consumption were gummies (33 percent) and smoking (30 percent), while the most common reasons for use were related to insomnia (46 percent), pain (41 percent) and mood (39 percent).”
Black patients were less likely to manage pain with opioids compared to white patients, “and more likely to report that cannabis was more effective.”
Another study looked at marijuana use among patients with cancer in different stages, finding that “survivors diagnosed with cancer at advanced stages were more likely to consider using cannabis than those diagnosed at non-advanced stages.”
Specifically, the odds of a patient considering cannabis use were 63 percent higher “among cancer survivors diagnosed at stages III/IV than among those diagnosed at stages I/II,” that research found.
Researchers who looked at patient costs associated with marijuana use during cancer found that the median out-of-pocket cost for cannabis was $80 per month. Men and people 45 and older, meanwhile, tended to spend more than $100 a month or more on marijuana.
“Of the 166 patients who stopped using cannabis early or used less than preferred, 28 percent attributed it to cost and 26 percent to lack of insurance coverage,” that report found.
Authors concluded using marijuana during cancer treatment “may contribute to significant out-of-pocket costs, with men and younger patients more likely to pay higher costs.”
Another study in the special issue, looking at cannabis and prescription opioids among cancer patients, observed the use of marijuana “for cancer symptom management and as an opioid alternative,” noting some demographic differences.
Compared with white patients, “Black patients were less likely to use opioids for pain … and more likely to report that cannabis was more effective than opioids.”
“Clinical guidelines surrounding cannabis use for patients with cancer have not caught up with what patients are actually doing.”
More broadly, 43.4 percent of participants reported using marijuana instead of opioids to manage pain. Of those, 398 (79.6 percent white, 70.4 percent Black, 80 percent Hispanic or other race) said the reason was because “cannabis is safer”; while 366 (74.3 percent white, 53.7 percent Black, 76.4 percent Hispanic or other race) (72.3%) said the reason was because “cannabis is less addictive”; and 360 (71.8 percent white, 63 percent Black, 74.5 percent Hispanic or other race) said the reason was because “cannabis has fewer side effects.”
“Clinical guidelines surrounding cannabis use for patients with cancer have not caught up with what patients are actually doing,” lead author Rebecca Ashare, a University of Buffalo psychology professor, stated in a September 4 press release.
The press release described how in some health care systems, patients with opioid prescriptions are screened for other drugs, and patients who test positive for cannabis can have their opioid prescriptions revoked.
“At the time of this study, my thoughts about next steps would have been about educating patients on what to do, but that ship has sailed and patients are already using cannabis,” Ashare continued.
“Now I believe we need to be educating providers about how to talk to patients about cannabis, opioids, co-use and substitution.”
Earlier in 2024, separate research on the possible therapeutic value of lesser-known compounds in cannabis says that a number of minor cannabinoids may have anticancer effects on blood cancer that warrant further study.
That research, published in the journal BioFactors, looked at minor cannabinoids and multiple myeloma (MM), testing responses in cell models to the cannabinoids CBG, CBC, CBN and CBDV as well as studying CBN in a mouse model.
“Together, our results suggest that CBG, CBC, CBN and CBDV can be promising anticancer agents for MM,” authors wrote, “due to their cytotoxic effect on MM cell lines and, for CBN, in in vivo xenograft mouse model of MM.”
In some cases, different types of cancer cells affecting the same part of the body appear to respond differently to various cannabis extracts.
While cannabis is widely used to treat certain symptoms of cancer and some side-effects of cancer treatment, there’s long been interest in the possible effects of cannabinoids on cancer itself. As the new study notes, most research on that front has looked at cannabinoids like THC and CBD.
And, as a 2019 literature review found, the majority of the studies have also been based on in vitro experiments, meaning they did not involve human subjects but rather isolated cancer cells from humans, while some of the research used mice. Consistent with the latest findings, that study found cannabis showed potential in slowing the growth of cancer cells and even killing cancer cells in certain cases.
A separate study found that in some cases, different types of cancer cells affecting the same part of the body appeared to respond differently to various cannabis extracts.
A scientific review of CBD earlier in 2024 also touched on “the diverse anticancer properties of cannabinoids” that the authors said present “promising opportunities for future therapeutic interventions in cancer treatment.”
Research published in late 2023 found that marijuana use was associated with improved cognition and reduced pain among cancer patients and people receiving chemotherapy
While cannabis produces intoxicating effects, and that initial “high” can temporarily impair cognition, patients who used marijuana products from state-licensed dispensaries over two weeks actually started reporting clearer thinking, the study from the University of Colorado found.
Also in late 2023, the National Institutes of Health awarded researchers $3.2 million to study the effects of using cannabis while receiving immunotherapy for cancer treatment, as well as whether access to marijuana helps reduce health disparities.
Federal courts are also considering two separate lawsuits on legal access to therapeutic psilocybin among cancer patients in end-of-life care.
Image (cropped) via Oregon State
This story was originally published by Marijuana Moment, which tracks the politics and policy of cannabis and drugs. Follow Marijuana Moment on Twitter and Facebook, and sign up for its newsletter.