Cannabis
(Marijuana seeds) medical usage
Chemotherapy-Induced Nausea and Vomiting
The use of effective chemotherapeutic drugs
has produced cures in some malignancies and retarded the growth of others,
but nausea and vomiting are frequent side effects of these drugs. Nausea
ranks behind only hair loss as a concern of patients on chemotherapy,
and many patients experience it as the worst side effect of chemotherapy.
The side effects can be so devastating that patients abandon therapy or
suffer diminished quality of life. As a result, the development of effective
strategies to control the emesis induced by many chemotherapeutic agents
is a major goal in the supportive care of patients with malignancies.
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The mechanism by which chemotherapy induces
vomiting is not compl
etely
understood. Studies suggest that emesis is caused by stimulation of receptors
in the central nervous system or the gastrointestinal tract. This stimulation
appears to be caused by the drug itself, a metabolite of the drug, or
a neurotransmitter.
,
In contrast with an emetic like apomorphine, there is a delay between
the administration of chemotherapy and the onset of emesis. This delay
depends on the chemotherapeutic agent; emesis can begin anywhere from
a few minutes after the administration of an agent like mustine to an
hour for cisplatin.
The most desirable effect of an antiemetic
is to control emesis completely, which is currently the primary standard
in testing new antiemetic agents (R. Gralla, IOM workshop). Patients recall
the number of emetic episodes accurately, even if their antiemetics are
sedating or affect memory;
thus, the desired end point of complete control is also a highly reliable
method of evaluation. The degree of nausea can be estimated through the
use of established visual analogue scales.
,
Another consideration in using antiemetic
drugs is that the frequency of emesis varies from one chemotherapeutic
agent to another. For example, cisplatin causes vomiting in more than
99% of patients who are not taking an antiemetic (with about 10 vomiting
episodes per dose), whereas methotrexate causes emesis in less than 10%
of patients.
,
,
Among chemotherapeutic agents, cisplatin is the most consistent emetic
known and has become the benchmark for judging antiemetic efficacy. Antiemetics
that are effective with cisplatin are at least as effective with other
chemotherapeutic agents. Controlling for the influence of prior chemotherapy
and balancing predisposing factors such as, sex, age, and prior heavy
alcohol use among study groups are vital for reliability. Reliable randomization
of patients and blinding techniques (easier when there are no psychoactive
effects) are also necessary to evaluate the control of vomiting and nausea.
Migraine Headaches
There is clearly a need for improved migraine
medications. Sumatriptan (Imitrex) is the best available medication
for migraine headaches, but it fails to abolish migraine symptoms in
about 30% of migraine patients.
,
Marijuana has been proposed numerous times as a treatment for migraine
headaches, but there are almost no clinical data on the use of marijuana
or cannabinoids for migraine. Our search of the literature since 1975
yielded only one scientific publication on the subject. It presents
three cases of cessation of daily marijuana smoking followed by migraine
attacks--not convincing evidence that marijuana relieves migraine headaches.
The same result could have been found if migraine headaches were a consequence
of marijuana withdrawal. While there is no evidence that marijuana withdrawal
is followed by migraines, when analyzing the strength of reports such
as these it is important to consider all logical possibilities. Various
people have claimed that marijuana relieves their migraine headaches,
but at this stage there are no conclusive clinical data or published
surveys about the effect of cannabinoids on migraine.
However, a possible link between cannabinoids
and migraine is suggested by the abundance of cannabinoid receptors
in the periaqueductal gray (PAG) region of the brain. The PAG region
is part of the neural system that suppresses pain and is thought to
be involved in the generation of migraine headaches.
The link or lack thereof between cannabinoids and migraine might be
elucidated by examining the effects of cannabinoids on the PAG region.
Recent results indicating that both cannabinoid receptor subtypes are
involved in controlling peripheral pain
suggest that the link is possible. Further research is warranted.
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