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.

     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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