FEATURE
Marijuana Legalization Laws in the U.S.
Cannabis prohibited
Has decriminalized
cannabis possession laws
that he served on the National Academies of Sci-
ences, Engineering, and Medicine committee that
issued a report on cannabis and cannabis-derived
products in January 2017. 11 “We outlined very
clearly the barriers to doing research with cannabis,”
he said, which include its schedule I classification;
inadequate financial support; and limited access to
the quantity, quality, and type of cannabis product
necessary to address specific research questions on
the health effects of cannabis use.
Both proponents of medical marijuana and
regulators are worried about the quality of cannabis
products and the potential for AEs with poor-quality
cannabis. For example, Dr. Abrams explained, con-
cerns about pulmonary aspergillosis may dampen
patient and clinician enthusiasm for medical can-
nabis. The pulmonary infection is triggered by direct
inhalation of fungal spores that can be present on
cannabis plants. Heating cannabis buds may not be
enough to sterilize them, potentially exposing those
with compromised immune systems to the fungus.
The age of the plant and the way it is stored during
shipment can contribute to the presence of mold. 12
For patients with acute myeloid leukemia who
are immunocompromised and smoke, rates of
acquiring aspergillosis infection may be 12 times
higher than those who don’t smoke. For those who
smoke marijuana, aspergillus infection rates can be
higher still. 13 The incidence may decrease in today’s
more-accepting legal environment; the way the
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Has legalized non-
psychoactive medical cannabis
Has legalized psychoactive
medical cannabis
plant is grown, stored, and transported has evolved
as medical dispensaries have taken hold. “Cannabis
gets infected with mold and fungus when people
used the ‘old-school’ methods of cannabis coming
in from Mexico on boats, being sprayed down and
hidden under tarps,” Dr. Abrams suggested.
Reefer Madness
The research is sparse for hematology patients, who
are either left out of studies or opt not to participate
in them.
A study out of the Sheba Medical Center in Tel
Aviv, where medical cannabis is legal, evaluated pat-
terns of use among patients with cancer at a single
institution. Of 17,000 cancer patients (excluding
those with hematologic malignancies), the vast
majority of cannabis users had metastatic disease,
and they found the agent useful for improving pain,
boosting general well-being, increasing appetite, and
controlling nausea. 15
Researchers at the Smilow Cancer Hospital at
Yale in New Haven, Connecticut, a state where
medical cannabis is legal, described their clinical
experience with the agent. Among 108 patients
with cancer who initiated medical marijuana under
the supervision of a palliative-care specialist, the
overwhelming majority had solid tumors, compared
with hematologic malignancies (91% vs. 9%). As
with the Israeli study, most of the patients who used
medical cannabis had late-stage disease and used the
Has both medical and
decriminalization laws
Cannabis legalized
agent to manage pain and cachexia. 16
Similarly, in a survey-based study of 926 cancer
patients at their institute in Washington, Dr. Pergam
and colleagues found that the largest group of
respondents had an underlying solid tumor malig-
nancy (66%), and the remaining one-third had a
hematologic malignancy. 17
The lack of representation in formal trials doesn’t
mean that patients with hematologic malignancies
are turning away from cannabis use. In Dr. Pergam’s
group, 24 percent of patients reported using cannabis
in the previous year, and 21 percent reported using
it in the past month – primarily to treat physical and
neuropsychiatric symptoms. Though active cannabis
users were less likely to be hematopoietic cell trans-
plant recipients in comparison with prior and never
users, the underlying type of cancer ultimately did
not influence rates of cannabis use.
Dr. Casarett noted anecdotally that the patients
with blood cancer that he treats are not averse to
cannabis use.
“I practice in a state in which medical canna-
bis is not legal, so I can’t make recommendations;
however, many of my patients with cancer and
other diagnoses use it,” he said. “In my experience,
patients with hematologic malignancies seem to
use medical cannabis more for anxiety, sleep, and
nausea, compared [with] patients with solid tumors,
for whom pain seems to be more prominent as an
indication.”
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