Cannabis Sativa Flowers

Medical Marijuana for Pancreatitis

Update September 2015

While there is still a troubling lack of scientific studies on the effectiveness of medical marijuana for CP, anecdotal feedback among the pancreatitis patient community suggests that some people have found it helpful in coping with pain, nauseau, or sleep problems, as well as lessening the stress and anxiety associated with chronic pain.  Others do not find such relief or simply do not like the psychotropic effects of marijuana.  Also anecdotally, pancreatitis specialists seem more open to patients experimenting with marijuana, likely figuring that the risks are much less than prescription opiates.

The National Cancer Institute recently issued a report on cannabis and cannabinoids meant for health professionals.  (Cannabinoids are the active ingredients in marijuana, which can be isolated and administered in pill, liquid or other forms.)  The ultimate conclusion was that “At present, there is insufficient evidence to recommend inhaling Cannabis as a treatment for cancer-related symptoms or cancer treatment–related side effects.”  However, the report did include some points relevant to our inquiry (largely from animal or small-scale human studies):

  • Cannabinoids may protect against certain tumors:  “Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death.”
  • A mouse study suggested that cannabinoids may protect against inflammation in the colon.
  • Smoking marijuana may help with pain:  “Two randomized controlled trials of inhaled Cannabis in patients with peripheral neuropathy or neuropathic pain of various [causes] found that pain was reduced in patients who received inhaled Cannabis, compared with those who received placebo.”
  • There is conflicting evidence about whether marijuana helps with nausea and vomiting — one study showed no effect and the other helped 25% of patients.
  •  In very small studies (one had five people), “patients administered THC had improved mood, improved sense of well-being, and less anxiety,” as well as improved sleep.
  • Marijuana won’t kill you.  In sharp contrast to opiates often prescribed for pain, “lethal overdoses from Cannabis and cannabinoids do not occur.”
  • Some consider marijuana addictive, but “their addictive potential is considerably lower than that of other prescribed agents or substances of abuse.”

These findings certainly suggest that the medical profession should give marijuana very serious consideration for treating pancreatitis — especially since there is virtually no risk of overdose and a relatively low risk of addiction…much less than pain medications of choice like oxycodone.

With more states legalizing marijuana for medical or recreational use, and with bipartisan bills pending in Congress to decriminalize marijuana on the federal level, hopefully scientific studies are on the way.  Certainly CP patients living in medical marijuana states might want to address the issue with their doctor.  (You can find a table of state medical marijuana laws here.)

Below is the original article from 2013:

One of the biggest challenges with pancreatitis is pain management.  Those who suffer from chronic pancreatitis are often prescribed strong pain medications such as hydrocodone and oxycodone.  Prescription painkillers are highly addictive and are responsible for over 15,000 deaths a year, amounting to a “public health epidemic” according to the Centers for Disease Control.  Concerns about overuse of painkillers are mounting, and the FDA and states are considering restrictions on their availability.   (CNN:  FDA Advisory Panel Votes to Tighten Restrictions on Hydrocodone)

Cannabis Sativa Flowers

Cannabis Sativa Flowers (source: Wikipedia)

Medical marijuana is obviously gaining in acceptability and availability around the U.S. While some disagree over the long-term health effects, by any measure marijuana is much less dangerous than prescription painkillers.  Recently, there have also been reports that cannabinoids (the principal active ingredients in marijuana) can not only help with pain management, but may be able to help with other symptoms (such as spasticity with multiple sclerosis) or even have the potential to stop tumor progression in certain cancers. (See an article by Dr. Sanjay Gupta supporting use of medical marijuana — “Why I Changed My Mind on Weed.”)

Whether medical marijuana can help people with pancreatitis is therefore of serious interest.  Unfortunately, few studies have been done and it is difficult to find a strong (informed) opinion either for or against.

There are, however, some studies that bear on the subject.  First, it seems that excessive marijuana use can cause acute pancreatitis.  Reports are rare but doctors seem confident in the cause.  

Second, there are some studies (mostly with mice) suggesting that certain cannabinoids can reduce inflammation in the pancreas:

Perhaps most relevant to those of us with chronic pancreatitis, a 2008 German study of isolated cells of patients with chronic pancreatitis found that introduction of cannabinoids can reduce inflammation and prevent fibrosis, or scarring According to the authors, the results suggested that “(re-)activation of the (endo-) cannabinoid system in chronic pancreatitis may be beneficial for suppressing disease progress” (parentheses are theirs).    Find it here:  Cannabinoids reduce markers of inflammation and fibrosis in pancreatic stellate cells

And just to confuse matters, one study found that cannabinoids make acute pancreatitis worse in the early stage and can help at later stages:  Dual, time-dependent deleterious and protective effect of anandamide on the course of cerulein-induced acute pancreatitis.

Clearly more research is needed.  If there is a better route than reliance on addictive, potentially deadly prescription painkillers, pancreatitis patients need to know it.

At least one politician endorses medical marijuana for pancreatitis…as an alibi:  Former House Minority Leader says marijuana is recognized as a treatment for his pancreas pain.

Update August 2013:

A report by the Controlled Substances and Tobacco Directorate at Health Canada found that studies on cannabinoids’ effect on pancreatitis were conflicting:

There are only a handful of reports on the effects of cannabinoids in experimental animal models of acute or chronic pancreatitis, and the findings from these reports are conflicting. Thus, the use of cannabinoids in the treatment of acute or chronic pancreatitis remains unclear.

The report concluded that “These contradictory findings may be due to differences in experimental methods, differences in timing of drug administration, differences in the types of agonists and antagonists that were used, differences in the route of administration, and differences in animal species.”

Time for a rigorous, controlled human study in a state where medical marijuana is legal (California?).

 

Withaferin A Shows Early Promise to Treat Pancreatitis

A recent study has demonstrated promising results for Withaferin A (“WA”), a plant-based compound traditionally used in Indian herbal medicine, in treating pancreatitis.

Researchers from Virginia Commonwealth University, the University of Virginia and the Baylor Institute induced pancreatitis in mice and then studied the effect of WA on progression of the disease.  They found that WA reduced the severity of pancreatitis, both when administered preventatively and as a treatment.  WA acted to suppress the proinflammatory genes activated by pancreatitis and decrease pancreatic cell death.  The results were apparently confirmed in tests with human tissue.

WA is a steroidal lactone derived from Indian Winter Cherry or ashwagandha, a plant traditionally used in Aruyvedic medicine.  It has been studied for possible treatment of prostate prostate cancer, lymphoma and diabetes, among other conditions, but does not appear to be utilized currently as an FDA-approved treatment.

While preliminary, the study seems to merit additional research.  An abstract of the article, published in July’s Journal of Gastroenterology, can be accessed here.

Another Promising Test for Early Stage Pancreatic Cancer

Recently, we wrote about a very encouraging test for pancreatic cancer that initially showed 100% accuracy.  It is a blood test , so relatively non-invasive — though the test must be custom designed to detect the “telomeres” that signal emerging cancer.

Now, a new study has been announced that uses a urine test to detect early pancreatic cancer.  This test detects four different varieties of “MicroRNAs,” which are involved in a variety of cell regulation processes and, when they show up in unpredictable forms or amounts, signal the presence of cancer.  The test was conducted at several hospitals in England.

The test showed high sensitivity (accurate detection of positive results) and specificity (accurate detection of negative results) — over 80% for both. While not as high as the blood test announced recently, these tests must go through lengthy, rigorous study, so the more candidates, the better.

Now we should hope that both tests navigate regulatory hurdles quickly and successfully.

Early Test for Pancreatic Cancer Hopefully On the Way

Pancreatic cancer is one of the most deadly forms of cancer, with a five-year survival rate of only six percent.  The low survival rate is because, in 80% of the cases, it has already spread to other organs when first detected.

Early detection means better treatment options and a much better chance of survival.  The problem is that PanCan has been very hard to detect early.  According to the Pancreatic Cancer Action Network, “[t]here is currently no standard diagnostic tool or established early detection method for pancreatic cancer,” but such a test is “urgently needed.”

Pancreatic cancer is a particular concern for people battling chronic pancreatitis since about five percent of CP patients will contract pancreatic cancer — a much higher risk than faced by the general population.

Fortunately, life-saving help may be on the way.  This summer, researchers led by a team at MD Anderson Cancer Center announced that they have developed a blood test that detected pancreatic cancer with “absolute specificity and sensitivity.” Put simply, this means 100% accuracy.  The test detests “exosomes” — tiny particles released by cancer cells — that are present when a patient has pancreatic cancer, but not when the patient has chronic pancreatitis.  The exosomes apparently have value beyond detection, providing doctors with helpful information on the stage and precise mutations of the cancer — opening up the possibility of customized therapies.

By OpenStax College [CC BY 3.0]

Moreover, because detection involved a blood test, it is much less invasive than the usual diagnostic tools used for PanCan, such as CT scans and endoscopic ultrasounds…but with greater accuracy.

The researchers caution that larger studies are required to validate the findings, but note that 100% accuracy is extremely encouraging (and not something often found in such tests).

It is high time that doctors had effective tools to detect and fight this lethal disease.  We should all hope — and demand — that the test be made commercially available as soon as possible.

 

Potential Treatment for Pancreatic Cancer Converts Cancer Cells Back to Healthy Ones

Statins Hold Promise to Treat Pancreatitis

Pancreatitis is an extremely debilitating condition.  In its acute form, it often requires hospitalization and lengthy recovery; it can also be fatal.  Chronic pancreatitis is progressive, causing severe chronic pain, nausea, fatigue, and a host of other issues, significantly impacting quality of life.  And so far there has been no medication to treat the disease — leaving patients and their doctors with few good options other than risky and invasive surgery.

Recent research has raised hope that a common class of medicines used to treat cholesterol, statins, may be effective to treat pancreatitis.  A study published this month in Gut (a leading gastroenterology journal) suggests that simvastatin, a popular statin sold under the brand name “Zocor,”  was associated with a reduced risk of acute pancreatitis.  The same result held true for atorvastatin, which is sold under the brand “Lipitor”.  (You can find an abstract of the study here.)

statinsAnother study published in 2011 in the journal Laboratory Investigation involving rats (and not humans) found that a different statin, prevastatin, reduces the progression of inflammation, fibrosis and loss of exocrine function in chronic pancreatitis.  The study’s authors conclude that “These results support the clinical use of pravastatin for patients with chronic pancreatitis.” You can find an abstract of the study here and a the full text here.

Together these studies certainly raise the possibility that statins may reduce the risk or severity of pancreatitis, or possibly both.  There has not yet been a clinical trial testing these hypotheses — the Gut study published this month was a “retrospective cohort study,” meaning that it examined past data from a patient population rather than testing a possible intervention prospectively on current patients.  I have heard through the grapevine that at least one top hospital is seeking funding for such a trial; hopefully they will be successful soon.

However, while statins are not approved to treat or prevent pancreatitis, doctors are still able to prescribe them for that purpose.  This is called an “off-label use,” and it is both legal and common (you can read a WebMD article on the practice here).   Moreover, since statins are among the most prescribed drugs in the U.S., they are widely accepted and their side effects fairly well understood…making it a relatively low-risk experiment.   (The most common side effects are muscle pains, though statins can also put strain on your liver — see the Mayo Clinic’s primer on statins here.)

This is a very exciting possibility for those of us suffering from pancreatitis, with few good options on the horizon.  (For information on Sun-101, another drug in development that could be used for chronic pancreatitis, visit this post.)  At this point we have grounds for cautious optimism…well worth a discussion with your doctor.

Favorable Long Term Outcomes with Total Pancreatectomy and Islet Transplantation

One of the top surgical options for those suffering from chronic pancreatitis is removal of the pancreas, with transplantation of the pancreas’s islet cells to the liver.  (The surgery is called total pancreatectomy with islet autotransplantation, commonly abbreviated TP/IAT.)

When successful, this removes the source of pain and toxicity — the exocrine function of the pancreas, or its production of enzymes — while allowing the liver to perform the endocrine function of the liver (the production of insulin).  Patients must take enzymes for food disgestion, but if sufficient healthy islet cells are left and the transplantation succeeds, patients would not become diabetic and require insulin.

Many patients report that the surgery is a lifesaver, greatly reducing their pain and allowing them to live a normal life again. Recently we posted a video that discusses outcomes 6 and 12 months after surgery, finding a significant increase in physical and mental health ratings and improvement in quality of life.

In October, a study will be published in the Annals of Surgery examining patient outcomes five years after TP/IAT surgery for 112 patients.  There were no deaths at the time of surgery and the survival rate after five years was almost 95%.   There were continued improvements in reported quality of life during the period, and at five years 73% were “narcotic independent.”  Only 27% ended up insulin independent at the end of the period.

Bear in mind that the procedure is relatively new, and is constantly evolving.  For example, the surgery has just started being performed laparoscopically, which should be expected to improve outcomes. It is fair to assume that the more recent procedures are even more favorable statistically than ones performed ten years ago.  On the other hand, there is no truly longitudinal data that indicate how patients fare without a pancreas decades after the procedure, something patients are very keen to understand.

You can find an abstract of the article here.

The Bionic Pancreas for Diabetes…and Hopefully A Good Step for Chronic Pancreatitis

Big news in the world of diabetes was announced this week:  Researchers at Mass General Hospital and Boston University invented a “bionic pancreas” that can help diabetes patients regulate their blood sugar.  The device includes a sensor implanted under the skin and two pumps, all controlled by an iPhone app.  The sensor measures blood sugar every five minutes.  When it detects that blood sugar is too high, the app signals one pump to deliver fast-acting insulin to the bloodstream; if blood sugar is too low, it signals the other pump to provide glucagon that will raise it.

bionic pancreasCurrently, patients can use insulin pumps that deliver an amount of insulin based on their blood sugar and what they eat, which they program into the pump.  The addition of the sensor takes this to another level…though users still enter some data about what they are eating into the app (such as whether they are eating breakfast, lunch or dinner, and whether they are eating more or less than usual), which then drives an algorithm to determine how much medicine should be needed.

The device showed some promising results in a five-day human trial involving 20 adults and 32 teenagers with type 1 diabetes.   For example, when using the bionic pancreas, all of the adults had mean glucose levels at the therapeutic target compared with 9 out of the 20 when using the insulin pump.  (See a New England Journal of Medicine article discussing methods and results in detail.)

One implication for those suffering with chronic pancreatitis is that it can help deal with diabetes following a pancreatic resection, or removal of the pancreas.  More and more patients opt to undergo this serious procedure when quality of life suffers due to CP.  The state of the art procedure includes transplantation of insulin-producing cells to the liver with the goal of avoiding diabetes, but it is a significant risk.  (You can see a video discussing the results of the TP/IP procedure in this post.)  It is good to know that those patients will likely have additional tools available to them to deal with that risk.

The greater hope is that it is a step in the direction of a true bionic pancreas — an implantable device that performs the critical functions of the pancreas and can supplement or replace the defective organ that causes so many of us pain and suffering.  That step will likely require stem cells, perhaps in combination with 3D printing of tissue — both of which are the subject of research now.  (See a recent post on growing insulin-producing cells.)  Those developments cannot come soon enough…but are likely -10 years away.  In the meantime, hopefully incremental solutions like this will continue to emerge.

For more information on the bionic pancreas, see the researchers’ website at http://www.artificialpancreas.org/ or see a recent Time Magazine piece on the development here.