44% of Oncologists Had Recommended Illegal Marijuana to Cancer Patients for Nausea | Research

The takeaway

A 1990 survey of over 1,000 American oncologists found that 44% had recommended illegal marijuana to chemotherapy patients, 48% would prescribe it if legal, and a majority considered it should be available by prescription.

Read this if you want to understand how medical professionals viewed cannabis for cancer treatment before legalization.

44% of oncologists had recommended illegal marijuana to cancer patients

What the researchers found

In 1990, researchers surveyed a random sample of 2,430 members of the American Society of Clinical Oncology about their experiences and attitudes toward medical marijuana. The 43% response rate yielded 1,035 completed surveys.

The results revealed a striking gap between medical practice and drug policy. More than 44% of responding oncologists reported having recommended illegal marijuana use to at least one chemotherapy patient for nausea control. Nearly half (48%) said they would prescribe marijuana if it were legal.

Oncologists who expressed an opinion rated smoked marijuana as somewhat more effective than the legally available oral dronabinol (Marinol) and roughly as safe. A majority (54%) believed marijuana should be available by prescription.

The researchers noted that oncologists' experience with medical marijuana was more extensive, and their opinions more favorable, than regulatory authorities appeared to have believed.

Why it matters

This survey provided the first large-scale evidence that practicing cancer doctors were already widely recommending an illegal drug to their patients, revealing a disconnect between drug policy and clinical reality that would fuel the medical marijuana movement throughout the 1990s.

The numbers in context

2,430 surveys mailed. 1,035 responses (43% rate). 44% had recommended marijuana to patients. 48% would prescribe if legal. 54% favored prescription availability. Smoked marijuana rated more effective than oral dronabinol.

How the study worked

Random-sample anonymous survey mailed to approximately one-third of U.S.-based American Society of Clinical Oncology members (N=2,430). Response rate: 43% (1,035 responses). Measured attitudes, experiences, and opinions regarding antiemetic use of marijuana.

What this study cannot tell us

The 43% response rate means non-respondents may have held different views. Anonymous surveys may elicit more candid responses about illegal recommendations but cannot be verified. Oncologists' subjective comparisons of smoked marijuana versus dronabinol may reflect bias rather than controlled observation.

How to read the evidence

A random-sample survey of a relevant medical specialty, published in a top oncology journal. Good methodology but subject to response bias.

When this study was published

Published in 1991, before any U.S. state had legalized medical marijuana. The medical cannabis landscape has changed dramatically since.

The bigger picture

Published in the Journal of Clinical Oncology, this survey had significant policy impact. It directly addressed the legal question of whether marijuana had "currently accepted medical use," providing evidence that a large proportion of the relevant medical specialty considered it therapeutic. California's Proposition 215 legalizing medical marijuana followed six years later.

Questions still open

Has the proportion of oncologists recommending cannabis changed with legalization? How do modern antiemetics compare to both smoked cannabis and oral THC? Would the results differ if the survey were repeated with current oncologists?

Common questions

Did oncologists think marijuana worked for nausea?

Yes. A majority rated smoked marijuana as somewhat more effective than the legal oral THC (dronabinol) for controlling chemotherapy-induced nausea.

Were doctors actually recommending an illegal drug?

Yes. More than 44% reported having recommended illegal marijuana to at least one cancer patient for nausea control.

Read the original research

Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 9(7), 1314-9

View on PubMed ↗

Citation

Doblin, R E; Kleiman, M A. (1991). Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes.. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 9(7), 1314-9.