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Two prescription cannabinoids are available, dronabinol (Marinol) (a synthetic Δ9-THC) and nabilone (Cesamet) (a Δ9-THC congener), which are FDA-approved for the treatment of chemotherapy-induced nausea and vomiting. These medications have shown efficacy in the management of pain and distress. In contrast to smoked marijuana, they feature oral administration, chemical purity, precise dosages, and a slower onset but sustained duration of action. They may be less likely than smoked marijuana to induce anxiety, panic, and negative mood states, but they have otherwise similar side-effect profiles.

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As marijuana use becomes legal in some states, the dominant public opinion is that marijuana is a harmless source of mood alteration. Although the harms associated with marijuana use have not been well studied, enough information is available to cause concern.

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Medical Marijuana: Where is the evidence? – Science …

There are other questions to consider in Marilyn's case. Could marijuana's cognitive side effects, particularly its effects on memory, promote or exacerbate chemotherapy-induced cognitive dysfunction? If Marilyn's pulmonary disease includes lymphangitic spread, could smoking cause hypoxemia? What effects will marijuana's potential immunologic hazards (e.g., chemical constituents, pyrolized gases, viable fungal spores, or pesticide residues) have on her health during periods of immunocompromise? How will marijuana, alone or in combination with other medications associated with potential cognitive and psychomotor impairment, affect her ability to safely operate a motor vehicle? What are the possible effects of marijuana on tumor progression? The putative cannabinoid receptor GPR55 (G-protein–coupled receptor 55) is expressed in human breast cancers, with higher levels of expression correlated with more aggressive phenotypes. The marijuana constituent Δ9-THC has been shown in some studies to act as a GPR55 agonist, raising the possibility that it can promote cancer-cell proliferation.

Marijuana Is Replacing Over-The-Counter Medicine, A …

Smoked marijuana is a nonmedical, nonspecific, and potentially hazardous method of drug delivery. The cannabis plant contains hundreds of pharmacologically active compounds, most of which have not been well characterized. Each dispensed quantity of marijuana is of uncertain provenance and of variable and uncertain potency and may contain unknown contaminants.

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Gary M. Reisfield, M.D., Robert L. DuPont, M.D.

From the University of Florida College of Medicine, Gainesville (G.M.R.); the Institute for Behavior and Health, Rockville, MD (R.L.D.); and Georgetown University School of Medicine, Washington, DC (R.L.D.).

N Engl J Med 2013; 368:866-868 DOI: 10.1056/NEJMclde1300970

Assure Marilyn — and follow through on the assurance — that throughout her illness she will be accompanied, cared for, and helped to live as well and as long as possible. Reassure her that meticulous attention will be paid to symptom relief. Discuss the patient-specific potential risks and benefits of smoked marijuana and of the administration of pharmaceutical cannabinoids. There is little scientific basis for recommending that she smoke marijuana for symptom control. As Bernard Lown remarked, “Caring without science is well-intentioned kindness, but not medicine.”

Components of the marijuana plant may have medicinal properties

Cannabinoids, however, should be used only as lower-tier therapies for chemotherapy-induced nausea and vomiting, since other medications, such as 5-hydroxytryptamine3-receptor antagonists, dexamethasone, and aprepitant, have superior efficacy and fewer side effects.