Friday, July 12, 2024

Can Medical Marijuana Help Me With My Nausea?

In the sometimes hazy realm of medical marijuana research, the answer to “Can marijuana cure nausea?” is a rare, unambiguous “Yes.” But it’s a not quite a full-throated one.

For decades, anecdotal evidence of marijuana’s anti-nausea properties has been a major argument in the medical cannabis movement. In 1999, this position got a boost from the medical establishment, when the American Society of Clinical Oncology adopted guidelines for the use of antiemetics (medicines that keep you from barfing) that included a place for cannabis.

A new generation of antiemtics that target serotonin receptors and have been available for about twenty years take pride of place in the ASCO guidelines. However, for those patients who cannot tolerate these drugs or for whom they prove ineffective, there are a variety of “lower-therapeutic index” options. Among these options, the ASCO has ruled that cannabis is OK-ish. The guidelines cite evidence that cannabis is “significantly less” effective than metoclopramide, which is the best of the second-tier options. The preferred cannabinoid is synthetic THC, which is currently approved in the U.S. in two chemical forms, dronabinol and nabilone (which are marketed under the names Marinol and Cesamet, respectively).

<p< span=””>In 2015, the American Medical Association reexamined the antiemetic effect of marijuana as part of a comprehensive review> of the literature on medical cannabis. Its findings jibe with the ASCO’s earlier examination, but the AMA’s report is also clearer about the dearth of evidence on the topic. Only 28 studies were deemed robust enough for the AMA to consider, and of those 23 were at high risk of bias. The remaining 5 had an unclear risk of bias.

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Smoked marijuana is not endorsed by either the ASCO or the AMA, nor is it likely to be, because of dosage difficulty among other medical objections (such as the one about smoking not being good for you). Nevertheless, partisans of inhaled cannabis have some compelling counter arguments—perhaps the most compelling being “How can you be expected to swallow a pill and keep it down, when throwing things up is the condition you’re trying to treat?”



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