BMJ 2001;323:16 [Full] ( 7 July ) Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review Martin R Tramèr, staff anaesthetist a, Dawn Carroll, senior research nurse b, Fiona A Campbell, consultant in anaesthetics and pain management c, D John M Reynolds, consultant clinical pharmacologist d, R Andrew Moore, consultant biochemist b, Henry J McQuay, professor of pain relief b.  a Division d'Anesthésiologie, Département Anesthésiologie, Pharmacologie Clinique et Soins Intensif de Chirurgie, Hôpitaux Universitaires, CH-1211 Genève 14, Switzerland, b Pain Research, Nuffield Department of Anaesthetics, Churchill, Oxford Radcliffe Hospital, Oxford OX3 7LJ, c Pain Management Centre, Undercroft, South Block, Queen's Medical Centre, Nottingham NG7 2UH, d Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE Correspondence to: M R Tramèr, martin.tramer@hcuge.ch Objective: To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy. Design: Systematic review. Data sources: Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000. Studies: 30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours. Results: Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3.  Some potentially beneficial side effects occurred more often with cannabinoids: "high" 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7.  Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7.  Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11. Conclusions: In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use. What is already known on this topic Requests have been made for legalisation of cannabis (marijuana) for medical use. Long term smoking of cannabis can have physical and neuropsychiatric adverse effects. Cannabis may be useful in the control of chemotherapy related sickness. What this study adds: Oral nabilone and dronabinol and intramuscular levonantradol are superior to conventional antiemetics (such as prochlorperazine or metoclopramide) in chemotherapy. Side effects are common with cannabinoids, and although some may be potentially beneficial (euphoria, "high," sedation), others are harmful (dysphoria, depression, hallucinations). Many patients have a strong preference for cannabinoids. Op/ED Boston Globe, May 2, 2006 Marijuana and chemotherapy Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.