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Online search activity of cannabis use in cancer and the impact of legalization

We identified the most shared news stories on this topic on social media from July 2017 to July 2018 using Buzzsumo (Buzzsumo, Brighton, England). Buzzsumo is a social media analyzer that evaluates the engagement of news stories, which include likes, comments, and shares on social networks (i.e., Facebook, Twitter, Reddit, and Pinterest) [11-12]. We first performed an analysis using search terms (selected by author consensus) ‘cancer’ with either ‘cure,’ ‘therapy,’ or ‘treatment’, to find high-impact news stories (those with more than 10,000 engagements) on cancer treatments and to determine what proportion of these news stories discussed cannabis and alternative treatments as cancer treatments. We then used the same ‘cannabis cancer’ search terms from the Google Trends analysis. High-impact news stories were reviewed independently by the first and last authors. These news stories were classified as accurate news, false news or irrelevant news, based on social media studies on medical misinformation [11,13]. The classification was based on the quality of the scientific information and citation of credible sources; news stories claiming cannabis as a cancer cure were classified as false news. This classification was performed by the first and second authors, with the senior authors adjudicating discrepancies.

Results

Impact of medical and recreational cannabis legalization on online search activity

We compared search activity over time for cannabis and cancer versus standard cancer therapies using Google Trends’ relative search volume (RSV) tool and determined the impact of cannabis legalization. We classified news on social media about cannabis use in cancer as false, accurate, or irrelevant. We evaluated the cannabis-related social media activities of cancer organizations.

This study has several limitations. Social media and online search activity around cannabis do not represent the actual use of cannabis. Further, not all states had RSV data available due to periods with low search volume, limiting generalizability. Finally, we could not determine what proportion of the audience of social media news stories about cannabis as a cancer cure were actual patients.

APHCV receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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Newer antiemetics (e.g., 5-HT3 receptor antagonists) have not been directly compared with Cannabis or cannabinoids in cancer patients. However, the Cannabis-extract oromucosal spray, nabiximols, formulated with 1:1 THC:CBD was shown in a small pilot randomized, placebo-controlled, double-blinded clinical trial in Spain to treat chemotherapy-related N/V.[47][Level of evidence: 1iC]

The preferred citation for this PDQ summary is:

PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Cannabis and Cannabinoids. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389198]

Cannabis

In 1937, the U.S. Treasury Department introduced the Marihuana Tax Act. This Act imposed a levy of $1 per ounce for medicinal use of Cannabis and $100 per ounce for nonmedical use. Physicians in the United States were the principal opponents of the Act. The American Medical Association (AMA) opposed the Act because physicians were required to pay a special tax for prescribing Cannabis, use special order forms to procure it, and keep special records concerning its professional use. In addition, the AMA believed that objective evidence that Cannabis was harmful was lacking and that passage of the Act would impede further research into its medicinal worth.[6] In 1942, Cannabis was removed from the U.S. Pharmacopoeia because of persistent concerns about its potential to cause harm.[2,3] Recently, there has been renewed interest in Cannabis by the U.S. Pharmacopeia.[7]

Epidemiologic studies examining one association of Cannabis use with head and neck squamous cell carcinomas have also been inconsistent in their findings. A pooled analysis of nine case-control studies from the U.S./Latin American International Head and Neck Cancer Epidemiology (INHANCE) Consortium included information from 1,921 oropharyngeal cases, 356 tongue cases, and 7,639 controls. Compared with those who never smoked Cannabis, Cannabis smokers had an elevated risk of oropharyngeal cancers and a reduced risk of tongue cancer. These study results both reflect the inconsistent effects of cannabinoids on cancer incidence noted in previous studies and suggest that more work needs to be done to understand the potential role of human papillomavirus infection.[13] A systematic review and meta-analysis of nine case-control studies involving 13,931 participants also concluded that there was insufficient evidence to support or refute a positive or negative association between Cannabis smoking and the incidence of head and neck cancers.[14]

A randomized, placebo-controlled, crossover, pilot study of nabiximols in 16 patients with chemotherapy-induced neuropathic pain showed no significant difference between the treatment and placebo groups. A responder analysis, however, demonstrated that five patients reported a reduction in their pain of at least 2 points on an 11-point scale, suggesting that a larger follow-up study may be warranted.[69]

Understanding the mechanism of cannabinoid-induced analgesia has been increased through the study of cannabinoid receptors, endocannabinoids, and synthetic agonists and antagonists. Cannabinoids produce analgesia through supraspinal, spinal, and peripheral modes of action, acting on both ascending and descending pain pathways.[41] The CB1 receptor is found in both the central nervous system (CNS) and in peripheral nerve terminals. Similar to opioid receptors, increased levels of the CB1 receptor are found in regions of the brain that regulate nociceptive processing.[42] CB2 receptors, located predominantly in peripheral tissue, exist at very low levels in the CNS. With the development of receptor-specific antagonists, additional information about the roles of the receptors and endogenous cannabinoids in the modulation of pain has been obtained.[43,44]