Cachexia – Medical Marijuana Research Overview
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Overview of Cachexia
Cachexia, or “wasting syndrome,” refers to the marked weight loss in patients diagnosed with a serious illness, like cancer, HIV/AIDS, congestive heart failure, rheumatoid arthritis, tuberculosis, chronic obstructive pulmonary disease, cystic fibrosis and Crohn’s disease. With cachexia, normal nutritional support isn’t effective at reversing the loss in mass. The syndrome is a serious one, as patients with cachexia generally respond poorly to treatments like chemotherapy and therefore have a shorter survival time.
According to Cancer Cachexia Hub, cachexia is a complex syndrome that can be caused by a combination of factors, including ones that are disease-related like digestive problems, treatment-related like the nausea and vomiting, and patient-related like distress and depression.
In early stages of cachexia, patients will notice just slight losses in appetite and body weight. Anorexia, while not a cause of cachexia, is commonly an associated with patients with cachexia.
Over time, as the condition gets worse, the patient consumes even less food and experiences greater weight loss. Severe stages are marked with obvious muscle wasting. Because of mass loss, those with cachexia also experience an overall poor quality of life due to weakness, fatigue, respiratory complications and a general disinterest in participating in social activities.
Cachexia is commonly associated with the final stages of cancer because of body’s immune system response. The interaction between the cancer cells and with the immune system’s pro-inflammatory cytokines (protein molecules that signal cells to produce an inflammatory reaction) lead to cachexia. This interaction can accelerate the loss of skeletal muscle.
Findings: Effects of Cannabis on Cachexia
Common treatment methods for cachexia include hypercaloric or intravenous feeding and the administration of appetite-stimulating medications like growth hormones, testosterone and progesterones. Medical marijuana has also proven to be effective at boosting appetite. Marijuana contains the cannabinoid tetrahydrocannabinol, or THC, which influences the neural networks to convince the brain that it’s hungry.
Tetrahydrocannabinol (THC) has shown to significantly stimulate appetite in patients that have cachexia related to cancer (Nelson, Walsh, Deeter & Sheehan, 1994) (Jatoi, et al., 2002) (Nauck & Klaschik, 2004). In addition, medical marijuana has demonstrated effective at increasing appetite and stabilizing body weight in AIDS-cachexia patients (Beal, et al., 1995). Many clinical studies looking at THC’s ability to stimulate appetite also saw its ability to increase in body weight in HIV-positive and cancer patients (Gorter, 1999).
Evidence also suggests that cannabis may help cachexia patients increase their energy and physical activity levels, which in turn could lower the risk of atrophy and improve mood. A 2015 study found that adult women with severe anorexia nervosa treated with cannabis medication saw a modest increase in physical activity (Andries, Gram & Stoving, 2015).
In addition, medical marijuana may potentially help lower the risk of cachexia developing. Because of its anti-nausea effects, patients may be more inclined to eat regularly and because of a lack of vomiting, are more able to absorb nutrients and calories (Woodridge, et al., 2005).
States That Have Approved Medical Marijuana for Cachexia
Currently, 23 states have approved medical marijuana specifically for the treatment of cachexia. These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont and Washington. In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
There are other states that don’t specifically list cachexia as an approved condition for medical marijuana, but that allow cannabis use for related conditions like cancer and HIV/AIDS. These states include: Florida (cancer, Crohn’s disease, HIV/AIDS), Georgia (cancer, Crohn’s), Massachusetts (cancer, HIV/AIDS, Crohn’s disease), New Jersey (cancer, Crohn’s disease, HIV/AIDS), New York (cancer, HIV/AIDS), Ohio (cancer, HIV/AIDS), and Pennsylvania (cancer, HIV/AIDS).
Research on Cannabis’ effect on Cachexia
- Tetrahydrocannabinol in cannabis was effective at stimulating appetite in patients experiencing cancer-associated anorexia.
A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia.(http://www.ncbi.nlm.nih.gov/pubmed/8035251)
- Drug with THC found to be most effective at palliating anorexia associated with cancer.
Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study.
- A review article on the evidence supporting that THC is effective at increasing appetite.
Mechanism of action of cannabinoids: how it may lead to treatment of cachexia, emesis, and pain. (http://www.ncbi.nlm.nih.gov/pubmed/15357514)
Abrams, DI., Jay, CA., Shade, SB., Vizoso, H., Reda, H., Press, S., Kelly, ME., Rowbotham, MC. and Petersen, KL. (2007, February). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-21.
Andries, A., Gram, B. and Stoving, RK. (2015, March). Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial. Eating and Weight Disorders, 20(1), 13-21.
Beal, JE., Olson, R., Laubenstein, L., Morales, JO., Bellman, P., Yangco, B., Lefkowitz, L, Plasse, TF. and Shephard, KV. (1995, February). Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and System Management, 10(2), 89-97.
Cachexia (n.d.). Patient. Retrieved from http://patient.info/doctor/cachexia.
Gorter, RW. (1999, October). Cancer cachexia and cannabinoids. Foreschende Komplementarmedizin, 3, 21-2.
Jatoi, A., Windschitl, HE., Loprinzi, CL., Sloan, JA., Dakhil, SR., Mailliard, JA., Pundaleeka, S., Kardinal, CG., Fitch, TR., Krook, JE., Novotny, PJ. and Christensen, B. (2002). Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. Journal of Clinical Oncology, 20(2), 567-73.
Martin, BR., Wiley, JL. (2004). Mechanism of action of cannabinoids: how it may lead to treatment of cachexia, emesis, and pain. The Journal of Supportive Oncology, 2(4), 305-14.
Nauck, F., Klaschik,E. (2004, June). Cannabinoids in the treatment of the cachexia-anorexia syndrome in palliative care patients. Schmerz, 18(3), 197-202.
Nelson, K., Walsh, D., Deeter, P. and Sheehan, F. (1994). A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. Journal of Palliative Care, 10(1), 14-8.
What causes Cancer Cachexia? (n.d.). Cancer Cachexia Hub. Retrieved from http://www.cancercachexia.com/what-causes-cancer-cachexia.
Woodridge, E., Barton, S., Samuel, J., Osario, J., Dougherty, A. and Holdcroft, A. (2005, April 20). Cannabis use in HIV for pain and other medical symptoms. Journal of Pain and Symptom Management, 29(4), 358-67.
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