Managing AEs of Cannabis Use in Patients With Cancer

Patients with cancer using cannabis may experience adverse events that range from common and short lived to less common and dangerous, explained Marie Parish, PharmD, BCOP, a gastrointestinal oncology pharmacist with Mayo Clinic. However, products coformulated with cannabidiol (CBD) will dampen the psychoactive effects of tetrahydrocannabinol (THC), allowing patients to function better, she noted.

Transcript

What is important to know about the common and less common adverse events of cannabis in patients with cancer and how to manage them?

[With] some of the more common adverse effects, the nice thing about them is that they're usually short lived and pretty transient. You can see some dizziness, you can see some drowsiness, you can see the classical euphoria. Sometimes you can get some rebound anxiety if the THC dose is too high. Sometimes you could get a lingering headache if the THC dose is too high.

Then there's some of the lesser common ones that maybe are a little bit more dangerous—like the rebound media and depression, if you have chronic users who all of a sudden, abruptly stop using it. You can also see almost a cyclic vomiting syndrome in folks who also do that, they'll use it pretty chronically and then abruptly stop. I've seen folks go to the emergency room for that. So those are things I kind of watch out for.

For patients, what's interesting is, if you have products that are coformulated with CBD, it will kind of dampen those psychoactive effects of THC, but not take away the clinical benefit. If I have patients who are interested in maybe helping with pain or helping with sleep, but they don't want to feel high all the time, I recommend a product that’s coformulated with CBD and that will take away that stoned feeling and allow them to function day to day much better. I offer that as a means of mitigating some of the side effects that may be less desirable.

What do we consider chronic use of cannabis?

Daily use [of] normally a dose of over 5 milligrams or more. It's a little hard to quantify milligram doses when you're talking about inhaled products, but with the edible products, it's getting easier to quantify how much people are using. So that is, traditionally, what would be considered chronic use.