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17 cannapatientcare.com october/november 2021 | cannabis patient care patient focus A study in the Journal of Psychoactive Drugs found that, in comparison to pharmaceutical drugs, medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost. Due to the medical use of cannabis, 42% stopped taking a pharmaceutical drug and 38% used less of a pharmaceutical drug (3). Cannabis can stimulate appetite, help with sleep and nau- sea, and reduce pain. But even as advocates and cancer pa- tients like DiMonda offered more and more evidence of its benefits, mainstream medicine has taken a hands off ap- proach to cannabis for the treatment of cancer. Legalization of medical use of cannabis is still spreading (4), and it is hoped that movement will have some effect on at least keeping conversations about cannabis for cancer going. While legalization of medical cannabis continues, Brambi- la believes legalization of recreational consumption is actual- ly having a chilling effect. "The legalization movement started with trying to get people access to cannabis as a medicine," he said. "We've lost a lot of that with (recreational) legaliza- tion now. There needs to be more information out there to take cannabis as a serious medicine." Working in California had its advantages because people there were more open to discussing medical cannabis. Now working in Connecticut, DiMonda sees that there is a sort of California-cool coming to the East Coast. "I think that sort of openness is finding its way here," she said. "People are becom- ing a lot more aware and they are also more interested. You are finding shops that are popping up a lot more here. I think that legalization will change a lot of this so that people can start discussing it openly. Now, there is still the risk of arrest." Education is the key, Brambila said. "The stigma and the conservative views around cannabis are really fueled by mis- information, and just no understanding of the medical aspect of the endocannabinoid system," he said (5). "Through build- ing that awareness, we really hope that it also affects the leg- islative process. We should destigmatize it so people don't feel ashamed of using it. People don't feel ashamed of walk- ing into a dispensary or seeking advice for taking medicinal cannabis. That's the part where we want to change things." Mainstream Medicine Sees Results But Remains Conflicted Bambila said that they wanted to figure out the dynamic be- tween the standardized care and how cannabis would enhance that. "We found that it works great together. One is not better than the other. We don't advocate for only cannabis use. We take the integrative medicine perspective. Every compound has a therapeutic relevancy as long as it's used correctly," he said. The prognosis for DiMonda's type of cancer is that she is going to be in treatment for the rest of her life. "We've real- ly, I guess, turned the page on that because of the outcome that she's had," Brambila said. "That's really what we want to advocate in terms of research is that cannabis can actually be a solution, maybe a doorway into people not having to deal with a chronic disease like metastatic cancer in their lives." Mainstream medicine continues to be conflicted about can- nabis. DiMonda's oncologist, a researcher working at Memori- al Sloan Cancer Clinic, which is one of the top cancer clinics in the country, was happy that the cannabis treatment was having an effect. But she still did not buy in to using it, DiMonda said. "My oncologist was not really changed at all by the results," she said. "She thinks the results were wonderful. However, she will stick to her treatment protocol. What we found is that most of the time doctors are so regimented in the treatment that (can- nabis) doesn't really expand their world. Some people hear the story (of our use) and they absolutely love the story. But as far as changing people's minds, it's been very difficult." Brambila said working with such a highly regarded oncologist was a "very interesting dynamic for us," because this particular oncologist specializes in triple negative breast cancer, identify- ing targets within the cancer cells to develop therapies. Triple negative breast cancer is a type of breast cancer that tests neg- ative for estrogen receptors, progesterone receptors, and ex- cess HER2 protein (6)—a protein that plays a role in the regula- tion of cell growth and differentiation. This kind of cancer does not respond to hormonal therapy medicines. "We explained the science (of cannabis) to her," he said. "I think because of her research background, it's very dif- ficult for a true researcher to just look at a single event and say 'OK, well, there's some potential here.' They really look at the re- sults in numbers and want to see statistics. What she explained to Nicole is that her outcome is really within the one percent of her patient population, which means her outcome is really rare." Oncologists are waiting for better data. The Journal of the American Medical Association reported that cannabis in oncology may have potential for use to treat nausea and pain, and work as an antitumor agent. "However, much of the data are based on an- imal data, small trials, or are outdated," the report concluded (7). Continued Research JAIME BRAMBILA AND Nicole DiMonda are thrilled to an- nounce their continued research efforts on how cannabi- noids can play a role in cancer treatment. Their latest en- deavors include pre-clinical trials as well as a research project with the University of Connecticut focused on iden- tifying the specific chemotypes in their cannabis strains that are producing anticancer effects. They are currently seeking funding opportunities to support these research initiatives. For more information please contact them at funding@ gracehw.com or visit their website gracehw.com.