INDIA’S ON A ROLL?
management of cancer is of interest because of its effect on an individual’s mood, pain, and its hallucinating effects. Several reports have suggested that cannabis may be an effective treatment for the nausea, vomiting and lack of appetite that cancer patients experience.
In patients with advanced cancer, it may help them sleep, elevate their mood, improve appetite and give relief from pain. Cannabis has also shown some effects as an anti-tumour drug in cancers such as breast, prostate, certain brain tumours, skin, colon, pancreatic cancer and lymphoma, in laboratory samples.
There is no evidence to suggest its benefit in any clinical trial done on patients. When cannabis was compared to a placebo for pain relief, predictably it was more effective. We do not have any study which compares cannabis or its products to any standard painkiller such as morphine. Studies of cannabis as a drug which would improve appetite in cancer patients, or reduce nausea and vomiting, have also not showed any benefits. The American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) guidelines do not recommend cannabinoids as first-line therapies for treatment of cancer-induced nausea and vomiting.
We have seen parents smoke with babies in their arms and at their bedside. Will they be responsible with marijuana if it is legalised in India? I doubt it. Cannabis, in fact, could be linked to a number of serious health hazards. Cannabis smoke contains many carcinogens, and could itself lead to development of cancer. Since a large number of cannabis smokers also smoke tobacco, it is difficult to determine with any accuracy the impact of cannabis in causing various cancers.
Moreover, cannabis has a strong potential for causing addiction. It has many side effects — shortterm memory loss, impaired attention, impaired coordination and even psychosis. People who use cannabis for a long time may be hampering their learning capacity, memory, suffering loss of IQ, and may develop other drug and alcohol addiction.
Recently, a young IT engineer, who was getting his mother treated for cancer of the large intestine, asked my opinion on a drug he had found online. I was shocked to learn that it was a bottle of cannabis oil, which is not legally available in India. He was keen to get it for his mother to fight the cancer. There are some who ask me about allowing patients to smoke marijuana in the hope that it will control the pain or effect a cure.
Cannabis as a domesticated plant has a cultural history spanning thousands of years, many continents, and has many uses — recreational, medicinal, and even for ceremonial purposes in Hindu festivals such as Shivratri and Holi.
The medical fraternity was rather late in identifying the effects of cannabis on the body. The first cannabinoid receptors were identified in the brain in 1988. For any drug to reach from laboratory to patients, it must go through a rigorous process of testing in tissues, animal models, then phase I, II and III trials. In these studies, scientists test safety, and effective dosage of the drug for a certain condition. In the last three decades, very patchy medical research has been done to test the benefits of cannabis for various illnesses mainly because the use of cannabis is illegal and it was thus difficult to get regulatory approvals for medical research.
We already have a number of good drugs available for control of cancers, pain, and other treatment-related side effects. The current problem is that these drugs are either inaccessible to the common man or are too expensive.
Rather than trying to make cannabis legal — which will have very little impact on quality of life or cure rate of cancer — the government should focus on making standard effective drugs available to not just people who are living in the cities, but also in smaller towns and villages. (Dr Prasad Raj Dandekar is head of radiation oncology at the Sir H N Reliance Foundation Hospital, Mumbai) DECCAN CHRONICLE SUNDAY | 3 SEPTEMBER 2017 | HYDERABAD