By 1994, Oncologists Ranked Marijuana Ninth for Nausea and Most Would Not Prescribe It Even If Legal | Research

The takeaway

A survey of 141 oncologists found they ranked marijuana ninth among antiemetics for mild nausea, believed it worked in about 50% of patients, and most said they would not prescribe it more even if legal restrictions were lifted.

Read this if you want to understand how oncologists' views on cannabis for nausea shifted as newer antiemetics became available.

Only 6% of oncologists would prescribe marijuana more frequently if legal barriers were removed

What the researchers found

Researchers surveyed two groups of practicing oncologists about their antiemetic preferences, receiving completed surveys from 141 physicians (78% response rate). The results revealed a notably cooled enthusiasm compared to earlier surveys.

Marijuana (in any form) ranked ninth for mild-to-moderate nausea and sixth for severe chemotherapy-induced symptoms. Most oncologists (65%) had prescribed marijuana or oral THC ten times or fewer in their careers. Only 3.5% had prescribed it more than 100 times.

Oncologists who had prescribed marijuana estimated it effectively relieved nausea in about 50% of patients, with unpleasant side effects in about 25%. Only 6% said they would prescribe it "much more frequently" if legal barriers were removed.

This was a marked shift from an earlier survey where 44% of oncologists had recommended illegal marijuana. By 1994, with better antiemetics emerging, cannabis had moved down the preference list.

Why it matters

This survey showed that as better antiemetics became available, oncologists' interest in marijuana declined substantially. It provided evidence that cannabis was useful but not uniquely effective, a finding relevant to medical marijuana policy debates.

The numbers in context

141 respondents (78% response rate). Marijuana ranked 9th for mild nausea, 6th for severe. 65% prescribed it 10 times or fewer. 3.5% prescribed it 100+ times. Estimated 50% efficacy, 25% adverse effects. Only 6% would prescribe more if legal.

How the study worked

Mailed questionnaire survey to two groups: a systematic sample from ASCO membership (N=120) and all adult oncologists in metropolitan Washington, D.C. (N=60). 78% response rate (141 respondents). Conducted before ondansetron approval.

What this study cannot tell us

Conducted just before ondansetron approval, so respondents had limited experience with the newer antiemetics. Response rates, while good, may still introduce selection bias. Oncologists' estimates of efficacy and side effects are subjective.

How to read the evidence

A survey with a high response rate (78%) of practicing oncologists. Captures professional opinion but not clinical trial evidence.

When this study was published

Published in 1994, before ondansetron and other modern antiemetics became standard. The antiemetic landscape has changed dramatically.

The bigger picture

This study captured the moment when cannabinoid antiemetics were being overtaken by newer drug classes, particularly serotonin antagonists like ondansetron. The finding that only 6% would prescribe more marijuana if legal challenged the narrative that legal barriers were the primary obstacle to medical cannabis use.

Questions still open

Has oncologist opinion on cannabis antiemetics changed with the broader availability of medical marijuana? How does marijuana compare to modern serotonin antagonist antiemetics? Is there a role for cannabinoids as adjunct antiemetics?

Common questions

Did oncologists think marijuana was effective for nausea?

Those who had prescribed it estimated about 50% efficacy, but ranked it ninth among available antiemetics for mild nausea, suggesting better alternatives existed.

Would they prescribe more if it were legal?

No. Only 6% said they would prescribe it much more frequently without legal restrictions, suggesting the barriers were clinical (limited efficacy, side effects) not just legal.

Read the original research

Marijuana as an antiemetic drug: how useful is it today? Opinions from clinical oncologists.

Journal of addictive diseases, 13(1), 53-65

View on PubMed ↗

Citation

Schwartz, R H; Beveridge, R A. (1994). Marijuana as an antiemetic drug: how useful is it today? Opinions from clinical oncologists.. Journal of addictive diseases, 13(1), 53-65.