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18 cannabis patient care | vol. 2 no. 3 cannapatientcare.com patient focus Cannabis Complications But there is even more to consider when faced with mainstream medicine pushback on cannabis for cancer. "Generally speaking, doctors are still completely backwards in terms of how they approach this, whether or not they would support it," DiMonda explained. "And in many cases, it also cre- ates a really big problem because we know that CBD and THC can interfere with certain medications. What's happening now is you have people who are taking it, but they're not telling their doctor because their doctor is either not on board or doesn't know anything about cannabis. That becomes a big risk." For example, for people who are getting immunotherapy done for certain types of cancer, CBD does interfere and can effectively neutralize the immunotherapy treatment they are receiving. Here's why: The reason patients with autoimmune condi- tions could benefit from cannabis has to do with its ability to "down-regulate" or suppress the immune system. This sup- pression of the immune system is a contradictory goal to im- munotherapy. Although cannabis may continue to offer bene- fits during cancer treatment, studies show it can significantly decrease overall survival and time to tumor progression when combined with immunotherapy (8). Brambila said the way that he and his wife look at this is that everybody using cannabis for medicine are all in one big clinical research trial. "Most of the information that gets to doctors really comes from the bottom up, not from the top down," he said. "Patients will share their good experiences with their doctors. And that's how you get some sort of per- spective change. But that's why we need education." What About Cannabis for Veterans? The U.S. Department of Veterans Affairs (VA) have been circling around the issue of allowing medical cannabis to be used. While the VA cannot deny veterans benefits due to medical marijuana use, VA providers cannot recommend or prescribe cannabis since the Drug Enforcement Administration still classifies it as a Sched- ule I drug (9). "I think veterans are petrified because if their use gets back to the military, there are consequences," DiMonda said. Doctors working with veterans, many of whom are suffering from PTSD, just "throw a cocktail of pills" at the problem. "It's like Skittles," DiMonda said. "It's 'OK, here's a blue pill. Here's a yellow pill. Here's a white one. This is all going to make you feel better.' But we know what it's doing—it's slowly killing them." Brambila said that sort of multiple drug treatment is de- signed to make the veteran patient numb. "They're meant to desensitize them from their humanity, really, because they don't feel anything," he said. Glimmers of Hope Some of the cannabis-as-medicine education is coming from other countries, because these cases of cannabis use are not simply anec- dotal stories changing the minds of doctors, but carefully charted results of actual procedures and processes that include cannabis. Take Israel, for example, where cannabis is offered to all cancer patients. "It's part of the protocol now," DiMonda said. "That is such a huge deal because simply having that to rely upon makes the experience with chemo and your relationship with cancer completely change for the better." In 2012, some two-thirds of Israeli cancer patients author- ized to use cannabis report long-term, symptomatic improve- ment from the plant, according to clinical data presented at a conference of the Israeli Oncologists Union (10). Investigators at the Sheba Medical Center in Tel Aviv, in conjunction with the Israeli Cancer Association, assessed the efficacy of cannabis therapy over the course of one year in 264 patients with cancer. Their findings showed that 61% of the re- spondents reported a significant improvement in their quali- ty of life as a result of medical marijuana, while 56% noted an improvement in their ability to manage pain. In general, 67% were in favor of the treatment, while 65% said they would rec- ommend it to other patients. The study concluded that cannabis is an effective treatment for certain symptoms of cancer, and recommended that the treat- ment should be offered to patients in earlier stages of cancer. There is also legislation being passed in Chile and Argenti- na, Brambila said, as a result of grassroots movements there. "That really gave way to taking into consideration the medical aspect of cannabis in those countries," he said. "They haven't waned from that." Nicole DiMonda and Jaime Brambila enjoying a beautiful day.