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Choosing a Product, Route of Administration, Initial Dosage, Titration, Monitoring and Management of Adverse Effects

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Cannabis and Cannabinoid-Based Medicines in Cancer Care

Abstract

Authorizing and monitoring Cannabinoid-Based Medicines in advanced cancer and palliative care is not as difficult as it seems. Clinicians with a basic knowledge of the endocannabinoid system and cannabinoid pharmacology can surmise the appropriate settings where it can be introduced and, within a structured goal-setting environment, can safely initiate and monitor the use of Cannabinoid-Based Medicines, even in advanced cancer patients. Starting with a trial of approved pharmaceutical cannabinoids is recommended before attempting natural cannabis products. Cannabis comes in two main product types: dried flowers meant for inhalation and extracts meant for inhalation, oral ingestion, and other applications. The former is primarily inhaled through combustion or vaporization, while the latter is usually further transformed into other products, including edibles, oils, capsules, topical salves, suppositories, etc. Most patients will benefit from oral or oromucosal administration for baseline administration, while inhaled cannabis is reserved for breakthrough or episodic symptoms in specific clinical settings.

The main active ingredients of cannabis are THC and CBD, which have their own indications, contraindications, drug interactions, and titration regimens. The three main types of cannabis product formulations include THC dominant, CBD dominant, and products with mixed THC/CBD ratios. Cannabinoid-Based Medicines is an individualized treatment, and slow titration is key in order to reduce adverse effects, particularly in frail or cannabis-naive patients. Risks of cannabis use disorder must always be kept in mind if long-term survival is expected.

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Acknowledgments

This chapter was inspired in great part by The Prescriber Guidebook (© Santé Cannabis), which was developed by the team of healthcare professionals and research personnel at Santé Cannabis, Quebec’s premier medical cannabis clinic and research organization. The Prescriber Guidebook is one part of a comprehensive training and support program offered by Santé Cannabis. If you are interested in more in-depth medical cannabis training, please register to the Santé Cannabis Prescriber Training Portal: formation.santecannabis.ca.

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Schecter, D., Cyr, C. (2022). Choosing a Product, Route of Administration, Initial Dosage, Titration, Monitoring and Management of Adverse Effects. In: Cannabis and Cannabinoid-Based Medicines in Cancer Care. Springer, Cham. https://doi.org/10.1007/978-3-030-89918-9_7

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