I met Ms. Martin at Kendall Regional Medical Center. I was consulted on her case to help manage her pain after she was bitten by a dog. Upon questioning her about her past medical history, she informed me that she was in remission from her stage four lung cancer. I congratulated her and asked her what her treatment plan consisted of and she replied, “One gram of THC daily for the past 90 days as per the RSO (Rick Simpson) protocol.” Ms. Martin was fortunate enough to have friends and family steer her in the right direction. She learned how to make her own suppositories to facilitate consumption of cannabis into her body in such high doses. It saddened me that she had to go through this process in fear as if she was a criminal receiving her “medicine” in an illegal manner. I educated her about the current law and how she should come see me in the office to get registered with the Office of Compassionate Use and get an ID card from the Department of Health. I told her she can start using the Medical Marijuana Treatment Centers (MMTCs) as she qualifies and needs a maintenance regimen. Imagine her Oncologist’s reaction when seeing her for a follow-up visit reviewing her scans to see her lung tumor was gone. I asked her how she was feeling in the hospital without her cannabis. Her pain was not controlled, she seemed anxious to be discharged. Again, I was reminded that no formal policies pertaining to cannabis use in a hospital or skilled nursing facility in Florida have been written nor addressed.
Mr Alonso who was diagnosed with pancreatic cancer and within two weeks of his diagnosis, his son had flown in from California and he was already using RSO prior to our first visit. His son told me how he was dosing him more so in the evenings yet throughout the day to help develop tolerance to be able to use enough THC for apoptosis or programmed cell death. Again, I commended him for his willingness to be open minded to his son’s treatment plan. I wanted to make sure he understood I agree, from a physician’s perspective as the power of our words can change the patient’s mindset, comfort and enable healing. The research exists demonstrating the importance of the endocannabinoid system in immune function, pain management and appetite and the importance of Cannabidiol (CBD), one of the non-intoxicating cannabinoids used in maintaining homeostasis and balance in our nervous system.
I recently met another gentleman who was referred to me by a Cannabis Certified Physician. He has had cancer in the past but was currently in remission. If a patient had a diagnosis of cancer but does not actively have cancer are they are candidate? What if they are using Cannabis in hopes of their cancer not reoccurring. For example, decreasing inflammation in the colon with CBD could lead to a reduction in the risk of colon cancer. I wondered how many Physicians must be nervous to register patients because of the many questions they have with very limited guidance or education.
And then, with almost no warning, my best friend’s mother was diagnosed with renal cell carcinoma with metastasis to the lungs and I saw first-hand, from the perspective of the family how life changes. A 74-year Hispanic woman who exercised daily, took supplements and vitamins, was not taking even one pharmaceutical with no prior medical history was just given a diagnosis of cancer during COVID-19. Besides setting up appointments with specialists and verifying insurance information and reviewing costs of chemotherapy and CT scans, we put our heads together to focus on the natural alternatives that could help save her life like, glutathione (antioxidant), vitamin C, coQ10, probiotics, illuminating sugar and using cannabis. We started using a full spectrum CBD (25mg three time per day) for the first week until she was able to be approved for her cannabis card. Then we used a 5-1 CBD-THC ratio, for ex 25mg CBD given with 5mg THC to counter the intoxicating effects as CBD is a negative allosteric modulator and changes the shape of the CB1 receptor so THC has less psychoactive effects. This was in preparation for the pain she may feel in her low back from the kidney mass, the nausea and loss of appetite that soon followed from her daily chemo pill and the need to get restful sleep and avoid depression. When she started getting ulcers in her mouth, we used Sonia Martinez Marco Drugs compounding pharmacy for magic mouthwash and glutamine to heal and prevent further ulcers in her GI tract from the chemo. We discussed coffee enemas, diet changes, and visiting schedules due to our fear of her contracting Covid-19. My point is, it takes a village and we do not have enough answers to say if one option will work so we should be open to listening and learning and trying Eastern and Western options. I now see the struggle of using THC for the first time in a cannabis naïve patient, having days of dizziness or fatigue, finding the right ratio or even terpene profile for night vs daytime. Once the cannabis medication regimen is optimized, the fear of not being able to buy the same consistent formula or cultivar becomes worrisome.
More than anything, I am grateful for my patients who have taught me over the years and my experience recommending cannabis for so many patients and conditions as I am now in their shoes and empathetic to their fears and challenges. With confidence, I tell me best friend, trust me, Cannabis, even if it does not save her life will provide quality of life. The three times per day THC dose will help her become more tolerant to the intoxicating effects so we can avoid opioids, increase her appetite, help her sleep well and have a more positive mood. There is definitely a place for cannabis in end of life care however education is paramount.
The National Institute on Drug Abuse (NIDA) published that “Recent animal studies have shown that marijuana can kill certain cancer cells and reduce the size of others.” A 1996 study discovered cannabinoids can block cell growth, prevent the development of the blood vessels tumors need to grow. Studies suggest CBD may kill cancer cells without harming normal cells. A study done recently in St George’s University in London proved how effective cannabinoids can be in decreasing metastasis of aggressive tumors. The study found that the cannabinoids weakened the cancer cells making them more susceptible to radiation treatment. Another study in Molecular Cancer Therapies states “dramatic reductions” in fatal variations of brain cancer with specific cannabinoids were used in conjunction with radiation therapy. In 2011, the American Association for Cancer Research demonstrated CBD kills cells associated with Breast Cancer reducing the growth and spread of tumors with no effect on normal cells. Current research is underway evaluating glioblastoma multiform with a THC/CBD spray.
As medical professionals and patients search for natural alternatives to synthetic and toxic pharmaceuticals more has been discovered about terpenes in Cannabis. Alpha terpineol has been proven to be an anticancer agent besides being an antioxidant, antibiotic, antidepressant and anti-inflammatory. This was discovered by Dr. Saadia Bashir Hassan in Sweden in June 2010 published in Anticancer Research. The results show that alpha terpineol inhibits the growth of tumor cells by inhibiting the NF-KB pathway. An additional study in 2014 found alpha terpineol induces apoptosis (programmed cell death) in patients with liver cancer and suppresses tumor growth. In Science Direct in June 2015 found alpha terpineol kills cancer cells and inhibit tumor growth. Now we just need the FDA and DEA to read the science and support cannabis research. In addition, these terpenes would be present in whole flower or full spectrum cannabis.
Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines at the Spine and Wellness Centers of America