Medical Marijuana and Me

Medical Marijuana and Me

James Randolph Hillard, MD

Jan 04, 2016

In November 2008, Michigan voters voted to legalize medical marijuana by a margin of 63% to 37%. I opposed the measure because dronabinol, which is pure delta-9-THC in sesame oil, has been available for prescription as a Schedule II drug since 1986 and as a Schedule III drug since 1999. Why did we need smoked marijuana? Furthermore, I regarded the literature on medical marijuana as not particularly convincing.

Fast forward to January 2011. I started oxaliplatin, capecitabine, and trastuzumab therapy for my stomach cancer. I got really bad nausea and vomiting, at least grade 2, both immediate and delayed. My doctor prescribed ondansetron, prochlorperazine, aprepitant, dexamethasone, alprazolam, and dronabinol. He suggested that I try them and see what worked best. I tried them all. I ended up using aprepitant plus dexamethasone with every infusion. Initially I was reluctant to use ondansetron because of all the possible side effects listed, including such scary ones as temporary blindness. Eventually, I ended up popping ondansetron like candy, and it helped a lot without any side effects other than mild constipation. Prochlorperazine made me feel like a zombie, and alprazolam made me over-sedated and not that much less nauseated. Dronabinol 10 mg did make me a lot less nauseated but made me almost catatonic. The recreational term for this condition is apparently “couch lock.” Some people like it, but I didn’t. Lower doses did not help with my nausea. Also, on several occasions, I vomited up my antiemetics

Anyway, I made it through seven rounds of oxaliplatin and then continued oral capecitabine plus trastuzumab infusions. Next, I started whole abdominal 3-D conformational radiation (40 G fractionated over 25 days), because I had peritoneal metastases and over 20 positive lymph nodes. The first couple radiation treatments seemed like a piece of cake, but each one made me more nauseated. I think that I may have even reached Grade 3 N&V by the end of the first week.

Back in December, I had gotten a medical marijuana card, just in case, but I had not used it. The card was very easy to get. At that time, there were at least 18 medical marijuana dispensaries between Michigan State University, where I work, and the state capitol building two miles away. (Now down to two due to zoning changes.) I picked a dispensary at random and went in feeling nervous. As I often do when feeling nervous, I became talkative. Since I still had the connection in my mind of marijuana possession and going to prison, I asked the guys sitting on either side of me, “What are you in for?” One of them had some radiographs with him and responded that he had a “bum shoulder.” The one on the other side said, “Well, man, I have these really bad migraines.” Then one of them asked what was wrong with me. When I said stomach cancer, they both fidgeted and said they were sorry about that, and turned away and started flipping through magazines. A nice Haitian doctor met with me for about 5 minutes and filled out my paperwork. I mailed it in along with a check for $100, and in 3 weeks I could legally buy cannabis at any of the dispensaries.

After my fifth dose of radiation, I went into a dispensary and showed my card and a photo ID and was taken into a back room, where dozens of different strains of cannabis were on display in glass containers, along with several types of hashish and related concentrates, plus various “medibles,” including cookies, candies, and, of course, brownies. Everybody there was very friendly and gave me advice about which strains were most helpful for which symptoms.

So, after my next radiation treatment, when I started feeling nauseated, I took just 2 or 3 puffs of a sativa-dominant hybrid; within about 15 minutes, I was feeling a lot less nauseated and I was not feeling at all catatonic. Relaxed, sort of happy, sort of hungry, but not couch-locked. So, I started having a few puffs after each treatment.

Quite literally, I was smoking dope in order not to be stoned. I continued for a couple weeks after radiation was over, and then once in a while for another month or so, and then stopped using it a couple months before going back to work.

So, have I changed my opinion about medical marijuana? Yes. I realize that what I am sharing is “purely anecdotal.” There is still not a lot of high-grade evidence regarding the effectiveness of cannabis in most of the conditions for which it is being suggested; however, recent reviews have found reasonable evidence that it does help with nausea and maybe with pain (e.g. Kramer JL. CA Cancer J Clin. 2015;65:109-22.). Of course, a major reason that there is not better-quality data is that it has been so extremely difficult for anyone to do cannabis research in the last few decades, much less to get funding for it. I do believe that it is time to move cannabis from Schedule I to Schedule II.

Medical marijuana helped with my chemo/radiation therapy-induced nausea. Might I have discontinued radiation if I had not been able to use medical marijuana? Might I have relapsed and, well, died if I had discontinued my radiation? Might medical marijuana have saved my life? All purely hypothetical questions, of course.

Epilogue: In 2011, I wrote a paper about my experiences and submitted it to JAMA. It was rejected within 48 hours, which was a new personal best for me. I had never before had an article accepted or rejected in less than about 48 days. Thank you for letting me share with you here.

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Comments

Yu-Chun Donald Lie, PhD

Jan, 08 2016 3:48 PM

Very interesting and insightful sharing, Dr. Hillard ! I enjoy reading and learning from it.  Blessings, Don

Miriam Knoll, MD

Jan, 13 2016 11:53 AM

Thanks for sharing your experiences; this is a great article. You bring up an interesting point- I'm also not sure why doctors are so quick to dismiss good advice when the source is 'anectodal.' Especially in today's culture of precision medicine, I think your experience illustrated well how EVERYTHING about the human body is somewhat unique from person-to-person, not just the cancer. Medicines that work for one person may not work for others. It is only by sharing 'anectodal' evidence that people have the ammunition and fortitude to keep trying to find what will eventually help.

It's good to know that when 'everything failed' to help with nausea, there were actually more options. Wishing you good health and a speedy recovery!

Collin Thomas Zimmerman, MD

Jan, 20 2016 3:28 PM

Great to read your experience! A well worn mantra for me in oncology has been "you cant argue with results." 


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