Nausea and vomiting are common symptoms associated with general illness and cancer treatment. Although studies have been fairly limited, there is some evidence to support the treatment of these symptoms with medical cannabis. The mixture of CBD and THC has been reported to increase feelings of well-being and prevent the vomiting response. Cannabinoids may also be used for the stimulation of appetite following chemotherapy.
Nausea is the feeling of stomach upset and is sometimes followed by vomiting. These symptoms may be caused by a range of factors and might not be considered serious. However, chemotherapy-induced nausea and vomiting (CINV) affect up to 80% of cancer patients during the course of treatment. They remain two of the most debilitating side effects associated with chemotherapy and may be categorised as acute, delayed, anticipatory, breakthrough or refractory.
Antihistamines and anticholinergics are commonly prescribed for the alleviation of nausea and vomiting. Traditional home treatments such as the avoidance of strongly-flavoured foods and regular intake of cold liquids may be considered sufficient in some instances. Nausea and vomiting associated with migraine and headaches often respond positively to dopamine antagonists, such as metoclopramide, prochlorperazine, and chlorpromazine. Although not currently available as a standard treatment, Nabiolone has also been indicated for nausea and vomiting.
The antiemetic effects of the endocannabinoid system appear to be produced by a multi-step process in which CB1 ligands act as retrograde synaptic messengers. Consistent with this, CB1 receptor antagonists have been shown to induce vomiting in animals, while THC – a partial agonist of CB1 receptors – exhibits anti-emetic effects.
Nabilone (synthetic THC) is licensed in the UK for CINV in adults. It is also approved by the Food and Drug Administration (FDA) in the US for CINV in cancer patients who fail to respond adequately to conventional antiemetic treatments.
Nabilone is typically given 1-2mg b.d, with the first dosage administered 1-3 hours before the start of chemotherapy. The maximum recommended daily dosage is 6mg.
Most of the original studies supporting the use of nabilone in CINV were conducted in the 1970s and 1980s, leading to FDA approval in 1985. For example, a double-blind, randomised, crossover trial published in 1981 found that nabilone was superior to prochlorperazine in reducing nausea and vomiting associated with chemotherapy.
Yes. Cannabis-based medicinal products (CBMPs) have been legal since the 1st of November 2018, when they moved from a Schedule 1 product to a Schedule 2 product. This reflects their potential for medical use.
Cannabis-based medicinal products, also known as CBMPs, can be prescribed by private consultants, when appropriate, within their specialty area when there is unmet clinical need.
In the UK cannabis medicines are accessed primarily via private clinics. However, any specialist physician can prescribe cannabis medicines. GROW® is here to provide education and support to any specialists looking to prescribe or just to find out more.
There are 3 licensed medicines which contain cannabinoids – Epidiolex for some forms of epilepsy, Sativex for multiple sclerosis (MS), and Nabilone for chemotherapy-induced nausea and vomiting (CINV). However, only a handful of prescriptions have been issued in the NHS to date.
Most cannabis-based medicinal products (CBMPs) are instead unlicensed, and they must be written on a private prescription, typically issued by private clinics specialising in medical cannabis treatment.
Cannabis medicines come in multiple forms; flowers, often referred to as herbal cannabis (to be vaporised, rather than smoked), oils (taken under the tongue) and capsules. Cannabis medicines come in high-THC, high-CBD and balanced varieties.
Smoking medical cannabis is illegal. Medical cannabis can instead be taken in different forms depending on the desired speed of onset and duration of action, which is discussed between the patient and their doctor.
It’s important to find a clinic that works for you. Most importantly you need to find a Doctor that specialises in your condition. For example, patients with pain will need to see pain specialist, while those with a mental health condition must see a psychiatrist.
It’s important for patients to know they can use any pharmacy that supplies the appropriate medicines in the UK.
Some clinics have a preferred pharmacy but will be able to send prescriptions to others if needed. If patients have any questions about available medicines, they can contact IPS Pharma.
To speed up the process, patients should bring a copy of their medical records. These are then forwarded to the clinic in advance of the first consultation.
No. Cannabis-based medicinal products (CBMPs) are only prescribed by GMC-registered specialist doctors. As they are medicinal, CBMPs are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA); which ensures the safety, quality, and effectiveness of medicines in the UK.
Over-the-counter (OTC) CBD products can be purchased without a prescription in pharmacies, health food shops, or online. These may come in forms such as oil tinctures, capsules, or vapes. They are not medicinal products as they are regulated by the Food Standards Agency (FSA) as a food supplement, with a 0.3% limit on THC.
Patients are free to seek a second opinion from another clinic. Patients should ensure the clinic has communicated their reasons for deciding not to prescribe. It may be that they feel you should try other medicines before trying cannabis medicines, or that they need to see more information about your medical history before they are happy to prescribe.
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