Chemotherapy-induced nausea and vomiting (CINV)

Chemotherapy-induced nausea and vomiting (CINV) is a common and debilitating side effect of cancer treatment. Many cancer patients undergo chemotherapy and experience severe nausea and vomiting, which can cause weight loss, malnutrition, dehydration, and a poor quality of life. Traditional antiemetic drugs have limited efficacy and are associated with numerous side effects, including sedation, dizziness, and extrapyramidal symptoms. Medical cannabis has been proposed as an alternative treatment option for CINV due to its antiemetic properties.

Research has shown that the cannabinoids present in cannabis, such as THC and CBD, can alleviate nausea and vomiting associated with chemotherapy. THC, in particular, has been found to be effective in reducing acute and delayed CINV. In a randomized, double-blind, placebo-controlled trial involving 214 cancer patients undergoing chemotherapy, oral THC was found to be more effective than placebo in reducing the frequency and severity of nausea and vomiting. THC was also found to be superior to prochlorperazine, a commonly used antiemetic drug, in reducing CINV.

CBD has also been studied for its antiemetic effects. Unlike THC, CBD does not produce psychoactive effects and has a good safety profile. In a double-blind, placebo-controlled study involving 16 cancer patients, CBD was found to be effective in reducing nausea and vomiting induced by chemotherapy. Another study involving 22 cancer patients found that a combination of THC and CBD was more effective than THC alone in reducing CINV.

The mechanism by which cannabinoids alleviate CINV is not entirely clear, but it is believed to involve the activation of cannabinoid receptors in the brain and gut. The endocannabinoid system, which is involved in the regulation of appetite, pain, and mood, is also thought to play a role in the antiemetic effects of cannabinoids. THC and CBD are believed to modulate the release of neurotransmitters involved in nausea and vomiting, such as serotonin and dopamine.

In addition to its antiemetic properties, cannabis may also have other therapeutic benefits for cancer patients. Preclinical studies have shown that cannabinoids can inhibit the growth of cancer cells and induce cancer cell death. Cannabinoids have also been shown to have analgesic and anti-inflammatory effects, which may be beneficial for cancer patients experiencing pain and inflammation.

Despite the promising results of preclinical and clinical studies, the use of medical cannabis for CINV is still controversial. Some healthcare providers are hesitant to recommend cannabis due to its psychoactive effects and the lack of standardized dosing and administration methods. Moreover, the legality of medical cannabis varies across different countries and states, which may limit access for cancer patients.

In conclusion, medical cannabis has shown promise as an alternative treatment option for chemotherapy-induced nausea and vomiting. THC and CBD, the two most studied cannabinoids, have been found to be effective in reducing acute and delayed CINV. The mechanism of action of cannabinoids in alleviating CINV involves the activation of cannabinoid receptors in the brain and gut, as well as modulation of neurotransmitter release. Cannabis may also have other therapeutic benefits for cancer patients, such as inhibiting the growth of cancer cells and reducing pain and inflammation. However, the use of medical cannabis for CINV is still controversial and more research is needed to establish its safety and efficacy as a treatment option.