CannabinoidsCannabisLifestyleNipping Nausea with a little Bud

July 23, 2019by Sonal Thakar
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Nausea is the feeling of unease and discomfort with an urge to vomit. It is a common effect associated with chemotherapy, migraines, motion sickness, inflammatory gastrointestinal conditions, general anesthesia, food poisoning, stomach flu, and many other conditions. While cannabis may have the potential to treat several sources of nausea, the most well-studied is chemotherapy-induced nausea and vomiting. In fact, medical cannabis laws in the 1990’s were put in place to safeguard cancer patients looking for alternative therapeutics for symptom relief.

Chemotherapy-induced nausea and vomiting affects 60-80% of cancer patients undergoing treatment1. In addition, patients may experience anticipatory nausea when visiting their chemotherapy clinic (even before starting treatment). This type of nausea and vomiting is severe and peaks 6-24 hours after treatment. Traditional anti-nausea medications are effective when taken before beginning chemotherapy, but 34% of patients still suffer from nausea2.

Oncologists in the 1970’s found that “smoked” cannabis reduced chemotherapy-induced nausea and vomiting. Since 1985, synthetic cannabinoids have been approved to treat nausea and vomiting. Studies indicate that synthetic cannabinoids, phytocannabinoids, and potentially smoked cannabis reduce or eliminates nausea3-6. More recently, approved traditional medications, cannabis breeding methods to cultivate therapeutic strains, and isolation of phytocannabinoids from the cannabis plant have improved the treatment potential for nausea. More studies are needed, however, to compare traditional medications with cannabis-based treatments. Personal preference is also an important factor when determining therapeutic treatments. When surveyed, patients preferred cannabinoids to overcome chemotherapy-induced nausea and vomiting despite the side effects of feeling dizzy, drowsy, or high4. The two commonly prescribed synthetic cannabinoids are nabilone and dronabinol, which are variations of THC. They are prescribed when patients are not responding to the traditional drug cocktail. Like any traditional medications, synthetic cannabinoids work best when consumed prior to chemotherapy.

Motion sickness nausea is induced by your eyes sensing stillness while your inner ear, which is part of the vestibular system responsible for mediating balance and movement, is sensing movement (in a vehicle or otherwise). This mismatch causes the nausea. Cannabis is potentially able to provide symptom relief from chemotherapy, motion, or other types of nausea, by interacting with the endocannabinoid system receptors (CB1 and 5-hydroxytryptamine 3 (5-HT3) receptors) located on the dorsal vagal complex in the brain (which regulates the feeling of nausea and vomiting). A preliminary study exposed 21 participants to parabolic flight maneuvers, which simulates space travel weightlessness, and measured endocannabinoid levels before and after the flight. Individuals who felt motion sickness had lower endocannabinoid levels (anandamide and 2-arachidonoylglycerol) throughout the flight compared to others who had an increase in endocannabinoid levels7, and therefore no nausea. Animal models have shown THC, but not CBD, is effective in reducing nausea from motion sickness8,9, CBD treatment, however, has alleviated toxin-induced nausea in animal models9. While replication of these results is needed, especially in humans, the results suggest a promising correlation of the endocannabinoid system and nausea. More work needs to be done to elucidate the mechanism of action, effective dosing, and pharmacology for cannabinoid treatment for the range of causes of nausea.

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References

  1. Sommariva, S., Pongiglione, B. & Tarricone, R. Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: A systematic review. Crit Rev Oncol Hematol 99, 13-36 (2016).
  2. Kim, H.J. et al. Ramosetron Versus Ondansetron in Combination With Aprepitant and Dexamethasone for the Prevention of Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting: A Multicenter, Randomized Phase III Trial, KCSG PC10-21. Oncologist 20, 1440-7 (2015).
  3. Kramer, J.L. Medical marijuana for cancer. CA Cancer J Clin 65, 109-22 (2015).
  4. Tramer, M.R. et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 323, 16-21 (2001).
  5. Turgeman, I. & Bar-Sela, G. Cannabis for cancer – illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology. Expert Opin Investig Drugs 28, 285-296 (2019).
  6. NIH National Cancer Institute. Cannabis and Cannabinoids (PDQ®)–Health Professional Version. in Complementary & Alternative Medicine Vol. 2019 (2019).
  7. Chouker, A. et al. Motion sickness, stress and the endocannabinoid system. PLoS One 5, e10752 (2010).
  8. Cluny, N.L., Naylor, R.J., Whittle, B.A. & Javid, F.A. The effects of cannabidiol and tetrahydrocannabinol on motion-induced emesis in Suncus murinus. Basic Clin Pharmacol Toxicol 103, 150-6 (2008).
  9. Parker, L.A., Rock, E.M. & Limebeer, C.L. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol 163, 1411-22 (2011).

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