Medical Marijuana: An Oncologist's Perspective

Nevada legalized medical marijuana in 2000. First, physicians determine whether patients have a qualifying medical condition such as cancer, AIDS, or glaucoma. The Nevada Department of Health and Human Services then verifies an applicant is in compliance with the law and, if so, issues a registration card authorizing medical marijuana use. Click here to read a commentary on medical marijuana by Nevada oncologist Anthony V. Nguyen, MD.

A small number of patients with cancer I treat report medical marijuana alleviates symptoms of cachexia, anorexia, and severe nausea. I suspect its use and benefit are likely underreported due to fear of legal consequence and the stigma attached to marijuana. In Nevada, a state registry program within the Nevada Department of Health and Human Services, Nevada State Health Division, allows patients diagnosed with a chronic or debilitating medical condition, including cancer, to obtain a registry identification card authorizing medical marijuana use.

Overall, marijuana is not a routine drug I recommend up front for severe nausea, cachexia, or anorexia. In my practice, patients benefiting from medical marijuana usually arrive already possessing the drug and simply notify me of their use. Typically, I do not ask whether they have a state registry card or where they obtained the marijuana. I simply request that they update me on any drugs or herbal supplements they are taking, so that I may determine any harmful drug interactions with their current treatment plan. Oral intake of cannabis may have a high first-pass effect in the liver, creating the potential for pharmacokinetic interaction with others drugs.

I approach medical marijuana with the same open-mindedness with which I approach all integrative oncology. I believe that medical marijuana has helped alleviate symptoms of cachexia and anorexia in some of the patients with cancer I treat. The main reason I have not adopted a routine practice in completing applications for medical marijuana is my lack of training in its use. Medical marijuana use is not typically taught to oncology students. I also believe oncologists have not adopted routine medical marijuana recommendations because of a general unfamiliarity with varying state legislation governing its use. An additional hindrance is a paucity of clinical trial data; the majority of medical marijuana evidence is anecdotal.

See our companion feature article: "Medical Marijuana: Smoke and Mirrors?"