Frankly, marijuana doctors don’t always have the best reputation. Before the days of recreational cannabis, getting a medical marijuana recommendation from a strip-mall “420 doc” was often the only way to legally access the sweet leaf (in states that allowed it).
Now, as public acceptance of the plant grows through the expansion of medical and adult-use cannabis programs across America, a wider range of medical professionals are taking marijuana seriously as a treatment for epilepsy, brain damage, chronic pain, and a number of other ailments. More so, the science behind marijuana as medicine is evolving rapidly, with research institutions and Big Pharma making large investments in learning more about the medicinal power of pot. Forget about picking some Bubba Kush to help you sleep — now doctors are breaking down cannabis into its chemical components to find new medications and therapies personalized for individual patients.
Dr. Allan Frankel is one of these pioneers. As the founder of GreenBridge Medical in Santa Monica, California, Dr. Frankel is on the cutting edge of cannabis medicine, developing treatment plans for his patients that entail measured doses of particular cannabinoids targeted towards specific maladies. In doing so, Dr. Frankel aims to give patients an experience closer to that of a traditional doctor’s visit, but without the numerous side effects of conventional pharmaceuticals and procedures.
In his latest column for MERRY JANE, Dr. Frankel shares his experience and expertise in using cannabinoids to treat cancer: directly combating the disease itself, as well as treating the debilitating side effects of conventional cancer therapies in his patients.
Dr. Allan Frankel of GreenBridge Medical
Over the years, I have written many articles about cannabis cancer therapies. There is growing evidence that medical cannabis is effective in helping patients manage certain types of cancers at various stages, in conjunction with and as an alternative to traditional medical treatments. Medical cannabis is also effective in managing the side effects of cancer therapies and the symptoms of the disease.
Unfortunately, most people wait too long after diagnosis to begin cannabis therapies. They begin looking for alternative therapy when conventional treatments haven’t worked, and the disease is already advanced, sometimes with a terminal diagnosis.
When first diagnosed with cancer, I highly recommend that individuals consult a major cancer center for diagnosis confirmation, staging assessment, and recommendation of treatment protocols. Following assessment and treatment recommendations, medical cannabis should be considered as a complementary therapy.
My first concern is that a patient has the best medical care. Whatever the type of cancer or its stage of development, I recommend that any use of medical cannabis be undertaken with advice of a medical doctor experienced in cannabis treatments for cancer. If there is solid evidence regarding chemotherapy, radiation, or immunotherapy for treating a particular type of cancer — and you believe the risks are worth the potential gain — then using a combination of chemotherapy and cannabis should be seriously considered. Just because I am a medical cannabis specialist does not mean that I believe all standard therapies are of no value. However, there are situations where a patient’s response rate to chemotherapy is very low and the risks high. In such a scenario, I would skip the chemotherapy and look to cannabis as well as other complementary treatments.
I always tell my patients to consider any therapy that seems safe and has some rationale for its use. Keep an open mind.
About 20% of the patients I see are seeking help with cancer. They may experience pain, appetite loss, anxiety, depression, and insomnia, along with other symptoms of the disease and treatment side effects. The cannabis formulations I recommend can be very effective dealing with these issues as well as treating the cancer itself.
When I discuss the patient’s treatment at the time of their initial visit, I review several major areas:
- Treatment of the cancer itself, or “anti-proliferative” therapy.
- Treatment to prevent serious long-term side effects of chemotherapy, such as severe neuropathy and osteoporosis.
- Treatment of chemotherapy side effects, such as nausea.
- Treatment of cancer-related symptoms, such as pain or mood disorders. Anxiety and depression are also very common.
So, the overall therapy includes direct anti-cancer therapies, but must include the other areas as well. All four areas of treatment are critical for every patient and must be reviewed at every visit.
Speaking about “visits,” I must emphasize the plural. While an initial examination and treatment plan is critical, close follow-up with personal messaging, phone calls, and in-person visits is part and parcel of any good medical therapy. Without this close monitoring and ongoing review of scans and lab reports, proper care for the patient is compromised.
DIRECTLY TREATING CANCER WITH CANNABIS
I have always been impressed with the number of cannabinoids and terpene molecules that have anti-tumor effects. In reviewing the various methods by which cannabis kills cancer cells, it is remarkable how many of the mechanisms by which cannabinoids combat cancer are very similar to how chemotherapy functions to suppress the disease, but without the debilitating side effects.
Our endocannabinoid system, in particular anandamide, our “internal THC”, is a powerful mechanism in killing cancer. When we intake plant-based cannabinoids (or phytocannabinoids), our internal cannabinoids (or endocannabinoids) are activated, and our internal screening mechanism is now on high alert for any cancer cells.
Cannabinoids decrease blood flow to cancer cells, thereby killing many of them. Various chemotherapy drugs work in a very similar manner.
There are cannabinoid receptors on most cancer cells, and both our endocannabinoids as well as ingested phytocannabinoids attach to these receptors, with the effect of causing either cell death or “apoptosis,” meaning cell suicide.
Cannabis also increases our immune system’s responsiveness by activating our T-cells, which have direct and indirect effects on cancer cell growth.
Another powerful mechanism demonstrated in breast cancer cells and others as a result of cannabis-based treatments is making the cells “sticky” — this means that the cancer cells are less likely to metastasize or spread to other areas of the body.
PREVENTING LONG-TERM TOXICITY FROM CANCER THERAPIES
There are many short-term and long-term toxicities for patients that can result from chemotherapy. The short-term toxicities, such as nausea, will be discussed in the next section, but there are also some very serious long-term complications of chemotherapy where cannabis can be a very helpful treatment.
Two of the most significant long-term side effects of chemotherapy are osteoporosis (a weakening of bone strength) and neuropathy (pain, weakness, or numbness caused by nerve damage). Neuropathic pain can be very severe and last a lifetime; it’s often referred to as “suicide pain” due to its intensity. Steroids are often used in combination with chemotherapy to treat inflammation caused by cancer, or to directly to suppress tumors in combination with radiation therapy or chemo. However it’s the use of such steroids for cancer patients that also yields the painful side effects of brittle bones and nerve pain.
Often by using CBD (cannabidiol) at the time of chemotherapy administration instead of steroids, neuropathy and osteoporosis can be prevented or lessened. There are animal studies demonstrating this effect as well as a lot of anecdotal evidence. As doctors such as myself commonly use CBD in the treatment of the cancer, I’ve noted along with others that neuropathy seems uncommon in these patients, also indicating the potential prevention of neuropathy by using CBD in conjunction with anti-cancer treatments.
By decreasing the incidence of neuropathy with CBD, it is then possible to administer full courses of chemotherapy to the patient, instead of being forced to discontinue care due to the worsening neuropathy, enhancing a patient’s overall chances at beating their disease.
TREATMENT OF SHORT-TERM SIDE EFFECTS OF CHEMOTHERAPY
Those of us who’ve grappled with cancer personally or in our friends or family are aware that chemotherapy is very difficult to tolerate. Nausea and vomiting are usually the most severe side effects, and often are severe enough to warrant hospitalization for a day or more. Cannabis has many anti-nausea effects — in fact, all of the major cannabinoids have anti-nausea properties. CBD helps with nausea associated with anxiety, and clearly, having to deal with cancer and chemotherapy generates a lot of anxiety!
THC has been used as an anti-nausea medication for many years. In 1972, prior to President Nixon’s crackdown on cannabis, it was available for glaucoma studies. I remember stopping by the cancer wards at times when I was on call late at night, to see if any patients were experiencing unceasing vomiting. The nurses were eager to have any intern or resident grab a joint and wheel a patient outside to give them some relief; none of this would have happened if THC were not effective when everything else failed. Even today, with so many improved pharmaceutical medications for nausea, often it takes some cannabis to end the discomfort.
The “acid” or “precursor” molecules CBD-A and THC-A are also excellent anti-nausea molecules. These molecules also have significant anti-cancer effects which I will discuss below.
TREATMENT OF CANCER-RELATED SYMPTOMS
It is easy to understand how and why a patient with cancer would be afraid; troubled with anxiety, depression, pain and other symptoms that complicate the course of the illness, while leading to much despair in the patient as well as their family.
Working with cannabis for over 12 years has certainly taught me many ways of using cannabis in the treatment of pain and mood disorders. CBD helps with pain and anxiety. THC will often elevate their mood and help with pain. Combinations of CBD and THC are often superior to either alone. Usually these are administered under a patient’s tongue as it works more rapidly, avoiding a cancer patient’s typically inflamed gastrointestinal tract.
Keep your eyes open for THC-V. This is another ancient cannabinoid that is now working its way into the formularies of dispensaries. They’re currently derived from very rare strains, but as with CBD, in another year or two they will likely be readily available. THC-V offers a lot of promise with mood, osteoporosis, and pain — particularly neuropathic pain.
The reader must be wondering, so what type of cannabis should patients use? I wish we knew as much as we think we do. There are many who believe high dose THC to be the best answer. This has been promoted by Rick Simpson and many others. No doubt, there are many patients who do very well with this type of dosing. However, ingesting a gram of THC oil daily, for many, is extremely difficult, if not impossible.
Personally, I don’t believe a dose of a plant medicine should be so high that it makes a person ill.
If you follow studies using doses of CBD with THC in the 30 milligram range of each, there is definitely early clinical trial information demonstrating this to be a reasonable dose for treating various serious brain tumors.
I believe that any cannabis regimen for cancer treatment is better than not using any cannabis. Over time, standardized cannabis regimens will be development and there will be different protocols for different cancers. I know we would like to believe we know what is best for everyone, but we are just not yet there.
So, what do I do when a cancer patient asks me how to treat their ailment? In general, I suggest doses of around 120 milligrams, evenly divided by CBD, THC, CBD-A and THC-A.
I believe cannabis will play a major role in the treatment of cancer, and I can’t wait to see what happens next!
Disclaimer: This column is not intended to be a substitute for personalized medical advice, diagnosis, or treatment from a certified professional. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical ailment or treatment and before undertaking a new health care regimen.