Potrero Medical (United States)

Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.

While weightlifting, a 58-year-old man developed sudden-onset, tearing chest pain, rapidly followed by the inability to move his legs. His medical history included the repair of a traumatic descending aortic laceration 30 years earlier. Physical examination was notable for unequal blood pressures (240/97 mmHg in the left arm and 164/87 mmHg in the right), absent femoral pulses, mottled lower extremities, and loss of motor and sensory function below the T6 spinal level. Computed tomograms were obtained. One unexpectedly showed occlusion of the aorta distal to the left subclavian artery (Fig. 1). A chronic dissection was seen anterior to the thrombosed aorta at the level of the ligamentum arteriosum (Fig. 2). Distally, crescentic calcification was consistent with luminal displacement of intimal calcification secondary to an acute aortic dissection (Fig. 3). Otherwise, the proximal ascending aorta and distal aorta appeared to be free of disease. No collateral vessels bridged the occluded segment of the aorta, suggesting an absence of preexisting luminal obstruction. Despite emergent axillofemoral bypass, the patient's neurologic deficits persisted, and he remained paraplegic. Subsequent magnetic resonance imaging confirmed infarction of the spinal cord beginning at T6 (Fig. 4). Fig. 1. Computed tomographic angiogram (sagittal view) shows occlusion of the thoracic aorta. Thrombus occludes the proximal descending aorta distal to the left subclavian artery (arrow). The proximal ascending and distal descending aortic segments appear to ... Fig. 2. Computed tomographic angiogram (axial view) reveals diffuse calcification of the descending thoracic aorta above the main pulmonary artery. Anterior to the descending aorta at the level of the ligamentum arteriosum is a focal outpouching with a heavily ... Fig. 3. Computed tomographic angiogram (axial view of the descending thoracic aorta at the level of the pulmonary artery) reveals crescentic calcification at the distal end of the aortic occlusion, most consistent with intimal calcification that has been displaced ... Fig. 4. Magnetic resonance image (sagittal view) of the thoracolumbar spine reveals an abnormal T2 signal within the spinal cord beginning at T6, indicating infarction (arrow).

†This project, “From Maintenance to Abstinence in a Therapeutic Community,” was supported by NIDA Grant No. 1 RO1 DA03057.