# Cannabis and cannabinoids for pain, appetite and cancer control

Source: https://onco.cc/technologies/cannabinoids-pain-appetite/  
OnCo record `cannabinoids-pain-appetite` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cannabis and cannabinoids are used by patients for pain, appetite and sleep. Three phase 3 trials of a THC:CBD mouth spray added to opioids did not beat placebo for cancer pain, dronabinol failed for appetite, and no human trial shows tumour control, so ASCO's 2024 guideline advises against them as cancer treatment outside a trial.

## Summary

Three randomised placebo-controlled phase 3 trials of nabiximols (THC:CBD oromucosal spray) added to optimised opioids for advanced cancer pain (Fallon et al. 2017; Lichtman et al. 2018) failed to meet their primary endpoints, and dronabinol did not improve appetite or weight in a randomised trial against megestrol acetate. Observational surveys report benefit for sleep and wellbeing but cannot separate expectation. Preclinical antitumour activity of cannabinoids in glioma and other models has not been followed by any positive human efficacy trial, and CBD oils sold online vary widely in content. The 2024 ASCO guideline recommends that clinicians should not recommend cannabis or cannabinoids to treat cancer except in a clinical trial, notes low-certainty evidence for pain and sleep, and flags interactions: CBD inhibits CYP2C19 and CYP3A4, and observational data suggest cannabis users may respond less well to checkpoint immunotherapy, an unconfirmed but concerning signal. Legal status and product quality vary by country.

## Fields

- Kind: Technology
- Status: phase-2
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:insufficient
- Principle: CB1 and CB2 receptor agonism modulates nociception, appetite and mood; in tumour models cannabinoids induce apoptosis and inhibit angiogenesis at concentrations not achieved in patients.
- Strengths: Widely used; open discussion improves safety; Some low-certainty evidence for sleep and neuropathic pain
- Limitations: Phase 3 pain trials negative; No human evidence of tumour control; CYP interactions and possible reduced immunotherapy response

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Medical_cannabis
- ASCO guideline: cannabis and cannabinoids in adults with cancer (JCO 2024): https://doi.org/10.1200/JCO.23.02596
- Nabiximols for opioid-treated cancer patients with poorly controlled chronic pain, randomised trial (J Pain Symptom Manage 2018): https://doi.org/10.1016/j.jpainsymman.2017.09.001
- Cannabis impacts tumour response rate to nivolumab (Oncologist 2019): https://doi.org/10.1634/theoncologist.2018-0383
- NCI PDQ: Cannabis and cannabinoids: https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq

## Connected records

- cancers: [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cancer pain management](https://onco.cc/technologies/pain-management/), [Cannabinoids for chemotherapy nausea (dronabinol, nabilone, medical cannabis)](https://onco.cc/technologies/cannabinoids-nausea/), [Dietary supplements during cancer treatment: interactions and harms](https://onco.cc/technologies/dietary-supplements-treatment-interactions/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/)
- drugs: [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- bottlenecks: [Misinformation and unproven therapies](https://onco.cc/bottlenecks/b-misinformation/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/)
- key papers: [Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline](https://onco.cc/key-papers/paper-braun-j-clin-oncol/), [Cannabis Impacts Tumor Response Rate to Nivolumab in Patients with Advanced Malignancies](https://onco.cc/key-papers/paper-taha-oncologist/), [Results of a Double-Blind, Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain](https://onco.cc/key-papers/paper-lichtman-j-pain-symptom-manage/)

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