Much attention has been paid to the unearthing of the
2500-year-old mummy known as the “Siberian Ice Maiden.”
Discovered in 1993, her subterranean burial chamber
included a pouch of cannabis among other archeologic
findings1. Magnetic resonance imaging revealed that the
princess had a primary tumour in the right breast, with
axial adenopathy and metastatic disease. It is hypothesized
that the cannabis was used to manage her pain and
perhaps other symptoms, or even possibly as a treatment
for her malignant disease.
Widely used as medicine during the ensuing millennia,
cannabis disappeared from the pharmaceutical armamentarium
in the 1940s as its prohibition took hold. Today, we
are in the midst of what appears to be something of a medicinal
cannabis renaissance, with patients across the globe
gaining increased access to this potent botanical medicine.
In a 2014 WebMD poll, 82% of oncologists indicated their
belief that patients should have access to cannabis, ranking
highest among medical subspecialists in their support2.
Regrettably, most oncologists trained during the era of
cannabis prohibition and have no knowledge of how to use
the plant as medicine. In these days of targeted therapies
and nanotechnology, the modern oncologist might feel
somewhat ill at ease recommending a herbal intervention,
notwithstanding the number of potent cytotoxic chemotherapeutic
agents derived from plants.
An even more vexing concern to the oncologist is the
lack of data on which to base treatment recommendations.
Given the nature of the drugs that they prescribe, oncologists
are used to seeing strong evidence of a favourable
risk–benefit ratio before recommending a therapeutic
intervention. Usually, oncology drugs have proceeded
through preclinical studies, followed by the traditional
phase i, ii, and iii analyses, before we feel comfortable
adding them to our toolbox. Such data about the clinical
effectiveness of medicinal cannabis are all but lacking.
In the United States, cannabis is classified as a
Schedule I agent with a high potential for abuse and no
accepted medical use. The study of cannabis requires a
special Schedule I license from the U.S. Drug Enforcement