Trevor Gordon was working as an investment analyst and trader when he received his cancer diagnosis on his wife’s birthday in 2016. The 32-year-old was diagnosed with urachal adenocarcinoma, a rare and aggressive form of cancer with a poor prognosis and no reliably effective treatment. Doctors had found a tumor in his abdomen, about 10 cm in diameter, and three small nodules in his lungs.
The Toronto resident used medical cannabis to offset nausea and pain throughout an intense chemotherapy regimen. After having surgery midway through 2017 to remove the tumor, doctors prescribed opiates to manage the pain. But Gordon’s body developed a dependence to the medication, so he suggested tapering off the opioids and trying cannabis.
“My doctors didn’t seem to take cannabis as a viable, legitimate option,” he said. “Every time I go and talk to them about pain, [opiates] are the only thing they turn to. They know that cannabis is a very helpful medication, but they don’t incorporate it into the care that they’re giving. Physician education is lacking and poses a barrier to better outcomes for patients.”
That could be changing. Health Canada has granted approval to researchers at Tetra Bio-Pharma, a firm bringing cannabinoid-based treatments to market, to carry out a phase three trial to evaluate the effectiveness of smoked cannabis for pain management and quality of life improvement in advanced-stage cancer patients. This is the first time smoked cannabis is being studied in a phase three trial, which is the last stage of clinical research before a treatment option can be approved for medical use. The main site for the study will be Santé Cannabis, a medical cannabis clinic in Montreal, with a number of other sites across the country.
“We’re investigating the most common route of administration of cannabis which has endured over thousands of years,” said Erin Prosk, director of Santé Cannabis. “Smoked or inhaled cannabis is an effective way to treat acute symptoms, for patients to receive rapid relief when they really need it.”
They seek to enrol 946 patients with incurable cancer and cancer-related pain which has not responded to opioid treatment into a four-week randomized, double-blind, placebo-controlled trial. The experimental group will smoke one 280-milligram pellet of dried cannabis containing nine per cent THC and two per cent CBD three times a day. For the control group, cannabis will have no THC and 0.6 per cent CBD.
“The difference is that with inhalation, we’re tapping into this almost immediate effect – the peak effect is within five minutes and it really allows patients to titrate their dose to what they really need in that moment,” Prosk said. “So for the advanced cancer population, they’re suffering from a multitude of symptoms: pain, sometimes nausea, low appetite, fatigue. It’s the instant relief that comes from cannabis as an inhaled substance that is really most helpful for that population.”
The research team is currently awaiting to see whether their protocol will also be approved by the FDA, which would allow them to enlist sites in the United States for participation in the trial.
For Trevor Gordon, medical cannabis was not a cure. But it played an important role in managing pain – particularly when he needed relief quickly.
“If you take a pill, you have to wait 40 minutes for it to go through your digestive system,” he said. “Even if you take a fast-acting pill, you’re still talking 20 to 25 minutes. If you smoke cannabis, you’re already feeling so much better within four to five minutes and it’s so easy to get that relief. It gives you an immediate relief. I think it’s a really helpful breakthrough medication.”
Trevor Gordon poses with his dog at the Canadians for Fair Access to Medical Marijuana rally in Toronto in January, 2017. Photo by Kate Robertson