There is much about CBD that is still unknown. It has largely gone unstudied because, until 2018, it was considered a schedule I drug by the U.S. Drug Enforcement Administration (DEA). A schedule I drug is a drug that has been declared illegal by the DEA because of safety concerns over its potential for abuse and because there is no accepted medical use for it. Then, in September 2018, the DEA updated CBD’s status to become a schedule V drug. Schedule V drugs have a lower potential for abuse and are deemed to have some medical use.
Studies to answer this question are underway. Some scientists are studying whether CBD could relieve some of the side effects of cancer and its treatment, such as pain, insomnia, anxiety, or nausea. Other scientists are studying whether CBD could potentially slow or stop the growth of cancer.
What is CBD?
Cannabidiol, also known as CBD, is one of many chemicals found in the cannabis plant. It has been touted in some online forums as an alternative treatment, and even a cure, for many illnesses, including cancer. And, some people with cancer say that CBD has helped them as a complementary therapy in managing their symptoms and side effects from standard cancer treatment.
CBD comes from cannabis plants called hemp that are specifically grown with high levels of CBD and low levels of THC. Cannabis plants grown with high levels of THC are usually called marijuana. CBD comes from oil that is extracted from the cannabis plant. That oil can then be ingested as a liquid, a capsule, a gummy, or inhaled through vaping. It can also be added as an ingredient in such products as lotions and skin patches.
Yet there’s very little research around CBD and its use in treating people with cancer. Here’s what to know about what CBD is and what science currently shows about whether it’s safe and effective for people with cancer to use.
Six patients were included in the statistical analysis of the EORTC QLQ-C30. Among these 6, five completed the study and received cannabis capsules for a period of 6 months and 1 patient took the cannabis treatment for a period of 4.5 months. The results showed no significant difference in the overall QoL score before and after the cannabis treatment. However, in the appetite loss subscale of the questionnaire, it was found that patients reported significantly fewer complaints about appetite loss after receiving the cannabis treatment (P = .05). Figure 2 demonstrates the scores of this subscale among the 6 patients who completed the cannabis treatment.
The most common oral administration of cannabinoids is through eating edibles, mainly cookies, chocolate bars, and lozenges. Since absorption is attenuated when cannabinoids are ingested orally, 14 edibles usually contain high dosages of cannabinoids (50-300 mg). The high dosage may cause undesirable side effects, mainly dizziness, anxiety, and dissociation. These side effects may cause patients to withdraw from the therapeutic process. The oral administration route has the longest therapeutic window (4-8 hours) 14 and lacks the undesirable effects of smoking. The unmet need for an oral formulation with higher bioavailability and a lower peak of psychoactive effect led us to use a new oral capsule standardized with a longer therapeutic window and lower Cmax. 13,14 In Israel, cannabis pills are given under the regulations of the Ministry of Health to advanced cancer patients with various symptoms to improve their QoL. 15,16
EORTC QLQ-C30 appetitive loss subscale among the 6 patients who completed the cannabis treatment (EORTC QLQ-C30, European Organization of Research and Treatment of Cancer Quality of Life Questionnaires).
Body Weight Evolution
Twenty-four patients signed the consent form and entered the study. Median age of the entire group of patients was 66 years, and 62.5% were male. Those patients had 12 different malignancies; the most prevalent types were pancreas and colon carcinoma (4 patients each) and lung and prostate carcinoma (3 patients each). Chemotherapy was administered to 21 (87.5%) patients, 3 together with radiation. Only 2 patients received immunotherapy and 1 received radiation alone. Median weight was 65.5 kg, and median ECOG performance status was 1.
The rest of the 13 patients were given a reduced dosage of 5 mg capsules. Of these 13 patients, 10 received one 5 mg capsule daily for periods ranging from 2 weeks to 6 months. Only 3 patients received 5 mg twice a day. Among these 3, one received 1 capsule of 5 mg daily for 5 days and then dosage was increased to 2 capsules daily for 9 days. This patient dropped out after 2 weeks due to severe chemotherapy-related side effects. The second patient received 1 capsule of 5 mg for 2 months and 2 capsules daily until study completion, and the third patient received one 5 mg capsule daily for 1 month and 2 capsules daily until study completion. Tachycardia was not reported as an adverse event during this study.
This study has several limitations. One is the number of patients who dropped out before study completion. This may be explained by the level of disease progression in a number of patients. Most patients suffered from various types of advanced cancer and received heavy oncological treatments at the time of the study. These conditions may have caused difficulties for these patients to take the cannabis capsules and to stay in the study until its completion. Another limitation is the lack of data collected throughout the study. This limitation may be explained mainly by the patients’ physical condition that may have influenced their compliance regarding completing the questionnaires and returning them on time.
Several formulations of cannabis with different pharmacokinetic and pharmacodynamics are available in the market. Pulmonary assimilation of inhaled THC (tetrahydrocannabinol) causes a maximum plasma concentration within minutes; psychotropic effects start within seconds to a few minutes, reach a maximum after 15 to 30 minutes, and taper off within 2 to 3 hours. Following oral ingestion, absorption is slow and erratic, resulting in maximal plasma concentrations usually after 60 to 120 minutes. In several studies, maximal plasma concentrations were observed as late as 4 hours, and even 6 hours in some cases. 13 Several subjects showed more than 1 plasma peak. In case of oral administration, psychotropic effects set in with a delay of 30 to 90 minutes, reach their maximum after 2 to 3 hours, and last for about 4 to 12 hours, depending on dose and specific effect. 13 Another common route of administration is sublingual. Pure cannabinoids are extracted from the raw plant, dissolved in different oils, and administered with a dropper. The therapeutic window of sublingual oil administration is 2 to 4 hours with a rapid onset due to quick absorption through the oral cavity.