Safety and Efficacy Evaluation of the 1st Legalized Pharmaceutical Grade Medical Cannabis for Palliative Cancer in Thailand

Abstract

Background : Cancer patients often present with chronic pain, loss of appetite and insomnia. As the physiologic and metabolic derangement caused by abnormal metabolites or direct tumor invasion. It can be a challenge to ensure good quality of life at the end of life and a peaceful death. The discovery of endocannabinoids system (ECS) and their physiologic roles in past several decades especially the cancer treatment potential has spotlighted to the public and medical interest. The first legally medical cannabis amnesty bill had been proposed in Thailand and the Government Pharmaceutical Organization (GPO) launched the pharmaceutical grade of medical cannabis. However, there was no evidence of safety and standard effective dose for the cancer patients.

Objective : To study the safety and efficacy of the first legalized medical cannabis used in Thailand.

Method : The study was an experimental study. Fourteen of stage IV cancer patients were recruited and gradually titrated with balance THC and CBD 1 to 4 mg/daysublingually as in-patient at National Cancer Institute. All patients were followed up for three months.

Results : One of fourteen patients (7%) had transient hallucinations on the 3rd day of treatment and symptoms disappeared after discontinuing medical cannabis. Seven of 14 cases (50%) who complained of moderate to severe pain had improved pain score, and four of these cases had no opioids throughout the course. All 12 patients (100%) with insomnia had sleep improvement, and ten of twelve patients (83.33%) had better appetites.

Conclusions : Small dose of medical cannabis uses had no serious side effect and trended to benefit palliative care. The larger randomized control trial should be further investigated to elucidate this hypothesis.