Antiemetic Effect of Delta-9-Tetrahydrocannabinol in Patients Receiving Cancer Chemotherapy

Abstract

Anecdotal accounts suggested that smoking marihuana decreases the nausea and vomiting associated with cancer chemotherapeutic agents. Oral delta-9-tetrahydrocannabinol was compared with placebo in a controlled, randomized, “double-blind” experiment. All patients were receiving chemotherapeutic drugs known to cause nausea and vomiting of central origin. Each patient was to serve as his own control to determine whether tetrahydrocannabinol had an antiemetic effect. Twenty-two patients entered the study, 20 of whom were evaluable. For all patients an antiemetic effect was observed in 14 of 20 tetrahydrocannabinol courses and in none of 22 placebo courses. For patients completing the study, response occurred in 12 of 15 courses of tetrahydrocannabinol and in none of 14 courses of placebo (P<0.001). No patient vomited while experiencing a subjective “high.” Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducing vomiting caused by chemotherapeutic agents.

Nausea and vomiting of central origin occur after the administration of a variety of cancer chemotherapeutic agents and frequently constitute the major morbidity associated with such treatment. Control with classic antiemetics is incomplete and variable.

Anecdotal accounts from patients suggested that smoking marihuana before receiving intravenous anti-tumor drugs resulted in diminution of nausea and vomiting, and, in contradistinction to the usual post-therapeutic anorexia, some were able to take food shortly after therapy. Effects of marihuana on nausea and vomiting in human beings deserve to be reported. It has been demonstrated that oral delta-9-tetrahydrocannabinol (THC) causes the same physiologic effects as smoking marihuana (Isbell, Gorodetzky and colleagues, 1967; Perez-Reyes, Lipton, Timmons and colleagues, 1973).

The purpose of this study was to determine the effects of orally administered THC on nausea and vomiting in patients receiving cancer chemotherapy.

NOTE: This work was supported in part by a Cancer Center Support Grant Comprehensive (2PO2CA06516-12). It is here reprinted with permission from The New England Journal of Medicine, October 16, 1975, 293, 16, 795–797. We are indebted to Drs. Lester Grinspoon and Yvonne Bishop for assistance in this investigation.