Legal use of marijuana in Washington State (in management of prostate cancer)

Although the U.S. Food & Drug Administration had nothing to do with this decision, as of midnight last night it is legal to possess and use small amounts of marijuana in Washington State (without a prescription or a doctor’s recommendation) … including as a way to manage pain and other side effects of progressive prostate cancer if you happen to believe it is effective for that use.

As far as The “New” Prostate Cancer InfoLink is aware, there are absolutely no robust data to suggest that marijuana is therapeutically effective in the management of any stage of prostate cancer, its symptoms, or the associated side effects of treatment. In fact, in a PubMed search, we found only two articles (by Sarfaraz et al. and by Ramos and Bianco) that were specific to use of cannabinoids in prostate cancer. However, we also suspect that many men now in their 60s and early 70s in Washington State have prior experience of the use of marijuana from their younger days. For those who are interested, the full text of the article by Ramos and Bianco is available on line.

We do strongly advise any prostate cancer patient in Washington State who decides to exercise his legal right to use marijuana to inform his doctor that he is doing this (because marijuana use may affect the therapeutic value of other forms of treatment). We would also note that, although it is legal to possess and use small quantities of marijuana in Washington as of this morning, it may still be difficult to acquire it since it isn’t yet legal to grow it or to sell it!

15 Responses

  1. When I had prostate cancer, the medications I was given to shrink my prostate made me nauseous and difficult to sleep. I used marijuana in a vaporizer and it worked for me. The same was true for a friend who had myeloma and chemotherapy.

    I would like the sitemaster to provide cogent data that “marijuana use may affect the therapeutic value of other forms of treatment.”

  2. Dear Elucidated1:

    There are almost no sound and reliable data on the effects of taking marijuana in combination with prescription drugs. Indeed, much of the information that does exist is issued by organizations like the Australian National Cannabis Prevention and Information Centre, which could be said to have a biased point of view (click here for an example taken from, appropriately, the University of Washington).

    Having said that, the specific effects induced by marijuana use could easily affect the clinical value of some prescription drugs. It is good clinical practice to let one’s physician(s) know about all the drugs and supplements one is taking so that if you do have odd responses to treatment s/he has a full picture of the situation. The fact that there are no data that allow me to specifically state (for example) that using marijuana may lower your PSA level or decrease the effectiveness of a specific 5-alpha-reductase inhibitor does not decrease the possibility that “marijuana use may affect the therapeutic value of other forms of treatment.” Please note that I was extremely careful to use the term “may” — not “does” or “would” or “can.”

    Just because we cannot see a specific tree in the wood doesn’t mean it isn’t there. I quote from an academic review of the pharmacology of cannabis: “Cannabis affects almost every body system. It combines many of the properties of alcohol, tranquillizers, opiates and hallucinogens; it is anxiolytic, sedative, analgesic, psychedelic; it stimulates appetite and has many systemic effects. In addition, its acute toxicity is extremely low: no deaths directly due to acute cannabis use have ever been reported.”

  3. I agree with much of what you said. . .but when you write “we do strongly advise”. . .it kind of takes with wind out of your careful “could” and “may” argument. Aren’t biases amazing?

  4. Why? We “strongly advise” patients to tell their doctors about all the supplements and drugs they may be using (OTC drugs included)! What your doctor doesn’t know may kill you (as PC-SPES most certainly did in a number of well-documented cases of men with prostate cancer).

    I would point out that the effects of marijuana when used in combination with many types of antidepressant could well have very odd effects … since the effects of marijuana may be either additive to or contrary to the effects of specific types of antidepressant … and plenty of men with prostate cancer are taking antidepressants on a regular basis.

  5. There are data available that when chemotherapy is needed, that patients can suffer side effects that cannibinoids can help with. Such side effects are stress, overall mood, and loss of appetite, for example. A good friend of mine is a Harvard-trained oncologist and while he does not prescribe marijuana use, he does suggests it can be effective in improving QoL. He is also insistent that anybody that goes that route chooses a vaporizer or ingestion versus smoking the stuff.

  6. Caution is called for when using modal terms like “can.” That term is quite weak, meaning something close to “is logically possible,” which is not at all specific. I try to use modalities as precisely as I can, to express what I think or wish to say. Instead of “can,” in this context, I’d use, e.g., “seems to be able to,” or “has been known to” (which isn’t a modal phrase, but OK). There is a number of other modalities of different strength, like “might” versus “might well.”

    I am not sure about cannabis. All it does for me is to change my mood for the better, making me more mellow and just generally feeling at ease. I would legalise it everywhere for this reason alone. I never experienced pain relief, but others have.

  7. One major reason that there is no verifiable data on the medical effecacy of marijuana is no one will fund a study since anyone can grow it and big pharma will not make obscene profits on it. In fact, if any reasonable results were to come out positive on cannabis, it would certainly make a dent in our US obsession with “legal” medication.

    How many more times do we have to see “legal” and “approved” medications that big pharma make billions on … compromise patients so badly that people actually die and there are significant lawsuits won by the victims?

    But times are changing: Right now there are doctors in several states prescribing edible marijuana to patients. In Oregon, for example, there are patients in assisted care facilities who are being compromised by 8-10 different “legal” medications to their own demise. Dispensaries there make regular deliveries to those facilities and apparently it is working well with doctors able to take patients off other medications. And despite what you might think, Oregon has much stricter laws on medical marijuana than other states.

    I find it humorous that the sitemaster used the word “legal” more than once in his missive. That word is slowly becoming more dated and irrelevant in the marijuana dialogue, though.

    With Washington and Colorado legalizing marijuana, 20 states, including voters in Arizona of all places, approving medical marijuana, the handwriting is on the proverbial wall. Last week in a Quinnipiac University national poll, 51% of Americans now support the legalization of marijuana and those under 40 support it two to one.

  8. Actually, Elucidated1, the primary reason that there has been so little research into the appropriate medical uses of marijuana is that owning and using the product to do such research has been illegal, and the National Institutes of Health cannot fund any such research.

    You may not like “Big Pharma” but it is not “Big Pharma” that decides how to treat people. Any physician or patient is at complete liberty to not take or prescribe any pharmaceutical or biopharmaceutical product if they don’t this it’s worth it.

  9. Sitemaster:

    I think that’s not quite correct, at least in the Netherlands. First, the health minister Edith Schippers, following the advice of an insurer-government organisation, has simply forbidden at least one cancer medication — lapatinib — to be prescribed for certain indications. Doctors protested, but it did not help. This implies, if I understand you rightly, that your “at complete liberty” incorrectly describes the Dutch medical system, which by the way suffers from a form of near-privatisation in which the insurers are (IMHO) given too much leeway. I know nothing about other countries, as yet. Second, in common speech “Big Pharma” refers to the drug companies, not to physicians. So it is hard for me to understand your second paragraph.

  10. Dear George:

    I think you have missed my point entirely. The point that I am making is that just because a drug or treatment is available in a specific setting (e.g., the Dutch national health system) does NOT mean that a doctor has to prescribe it for a specific patient if the doctor thinks it is inappropriate, nor does a patient have to agree to take it if he or she doesn’t want to. This is utterly different from the situation you describe.

    In other words, just because “Big Pharma” develops and gets approval, legally, to market drug X in setting Y doesn’t mean that anyone absolutely has to use it. We ascribe vast amounts of the “blame” about drugs that don’t work well enough to “Big Pharma” and completely ignore the fact that doctors and patients play well defined roles in the decisons to use these products.

    “Big Pharma” has become the next social target after the tobacco companies, but the situations are distinctly different. It is not as though the drug companies have ever claimed that their products are benign or necessarily even particularly effective in many cases. Every drug comes with a detailed list of its effectiveness and adverse effects … Doctors and patients have a responsibility to themselves to understand these, just as anyone who smokes today has a responsibility to appreciate the risk of lung cancer and other adverse effects.

  11. Uh, big pharma is in it for the profits. That is number one. Just like oil companies. Biomed in San Diego is very lucrative and the two people I know in that business have made huge financial gains. One just retired in Kauai. In a capitalistic society, companies are allowed to make as much as they want. But when Americans and our health care system are compromised by the huge US drug manfacturers, among other things, and many people are going bankrupt, at what point in time do we call them out?

    My son was denied health insurance, in July, due to a seizure. His medication, hyperbole aside, is life saving, yet drug companies here charge $600 a month. So, do I just let him die? The exact same medication in Vancouver is $320. It’s time to renegotiate with big pharma, hospitals that over-test and over-admit as was on 60 Minutes last week. Obamacare changed health insurance administrative costs from 34% to 20%. Kaiser charges 8%. What are we missing?

  12. In my opinion, the majority of US doctors have no transparency. They have no menu of services or related costs and no report card of successes and failures … leaving the consumers to fend for themselves.

  13. BTW, Sitemaster, you said that the reason that marijuana has not been researched is that it is illegal. I submit that there are several stand alone drugs that are illegal in their pure form yet are used by doctors.

  14. Yes, I did miss the point entirely. I did not notice the import of your second “not.”

  15. It’s possible that the Sitemaster’s reference to “big pharma” and its supposed defects were motivated by the flurry of pros and cons aimed at Dr Ben Goldacre’s recent book Bad Pharma. I read an extract from it in The Guardian, but am unable to form any opinion about the subject. He is quite critical of the drug industry’s use of trials, and I hope that the book gives enough documentation to let the reader decide about these subjects. I think he does not discuss the requirement to note and discuss all known adverse effects of a drug one is thinking of taking. If so, then the book might well be one-sided. The Guardian piece was removed from the Net when the book was published, but is summarised and discussed, perhaps too positively, here (in an important blog largely devoted to political economy). I have the book and hope to read it soon.

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