Conundrum:

a) an intricate and difficult problem; b) a question or problem having only a conjectural answer.
 
It seems like every time I turn to write about medical cannabis I am confronted with a conundrum. This time I am facing what to say about a couple of scientific articles that I just read. One describes research carried out by Wilfred Ngwa, et. al, where they are using  “nanoparticle drones” to precisely target lung cancer cells and remotely activate them with radiation to emit “micrometer range missile-like electrons” to destroy tumor cells. Wow! And can you guess what therapeutic medicine they are also loading into these nanoparticle drones? That's right: cannabinoids! Double wow!

In addition, Ngwa and friends are showing that the cannabinoids work synergistically with radiotherapy to enhance damage to these lung cancer cells (as was shown with brain glioma cancer by Katherine Scott, et. al).  Here is where 1+1=3. And as Ngwa points out, “For lung cancer, the use of nanoparticle drones may provide an excellent strategy for highly targeted delivery of cannabinoid payloads to tumor cells to boost damage to the tumor cells and inhibit growth while minimizing the side effects"; in other words, without getting you stoned out of your mind.

And to top this all off, Ngwa is showing that these cannabinoid-loaded nanoparticle drones are more effective against lung cancer by administering them through inhalation rather than intravenously. Wowee-zowee! Sci-fi here we come.

Then, after reading this mind-blowing research on cancer and cannabinoids, I was drawn to an article by Ilana Braun, et. al, in the Journal of Clinical Oncology titled, “Medical Oncologists’ Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study.” Sounds promising, doesn’t it? Medical oncologists are discussing therapeutic use of cannabis for cancer; certainly they will be discussing these cancer-destroying aspects of cannabis that Ngwa, Scott and others are revealing. Unfortunately, the majority of physicians only said that they believed cannabis to be effective for appetite loss and/or cachexia, anxiety and pain.

The survey also revealed that most discussions on the use of cannabis for cancer were initiated by patients or their families, not the oncologists themselves. And, most revealing on the current state of affairs, only 30% of the oncologists surveyed felt sufficiently informed to make ANY recommendations regarding medical cannabis. A sad state of affairs, indeed.

So here is my conundrum: I always recommend patients to follow the advice and direction of their care-providing physician; do not replace standard treatments with cannabis, but rather see if your physician is amenable to adding cannabis to the standard treatment regime, based on the latest research and insights that are taking place around the world. Adding cannabis will probably do no harm, and may actually increase the effectiveness of the standard treatment. When dealing with difficult-to-treat cancers or cancers notorious for metastasizing, why not add cannabis to the mix? When an unpleasant death is staring you in the face and the clock is ticking, you'll probably be willing to try anything. Yet your doctor is (probably justifiably) worried about malpractice liability and his/her ignorance of the issues.

As the ladies in Sri Lanka say with a flip of their wrists, “What to do?”

Peace,
Dr. B.