CONICET | Buscador de Institutos y Recursos Humanos

2017-18 the palliative care unit of the Angel H. Roffo Oncological Institute has accompanied patients using medical cannabis for pain control and other symptoms. A brief report case is presented in which a patient has reduced opioid dosage for pain control, without anti cancer treatment.Clinical Case: In June 2017 a 76 year old woman came into our unit for pain control. She has a left breast infiltrating Carcinoma, Stage III a, hormonal receptors negative and HER(-) with 17 years evolution. She was admitted in the Observational Protocol ?Cannabis and Health? created by the La Plata National University, toxicology department of the Biochemical Faculty & our institute. She had at admission multiple bone, dermic, liver, supra and infra diaphragmatic adenopathies, and pulmonary metastases. She had received various schedules of treatment, but the illness progressed during 2017. She was on 8/10 pain intensity localized in vertebrae regions between D8 to L4, somatic and neuropathic characterizations, received radiotherapy a year ago and now was medicated with weak opiods without optimal response. Her medication was Codeine 30 mg tid, Paracetamol 500 mg tid, Pregabaline 75 mg tid, Ibuprofen 400 mg tid, Dexametasone 4 mg qd. She decided by her own to be medicated with Cannabis Oil to improve her treatment of pain, anorexia and asthenia, which had worsen. The patient was observed during a year. We detected that her Oral Morphine Equivalent Daily Dose (DEMO) decreased 97% in the first 14 days of Cannabis treatment. Her quality of life improved in spite of illness progression.Method: The used Cannabis oil samples were extracted with ethanol and, after a clean-up process, the cannabinoid profile was analyzed by HPLC-UV/DAD using analytical standards to identify and quantify (Cerilliant).Results: A drastic reduction of DEMO was observed after 14 days of initiated treatment using 0,5 ml of sublingual Cannabis (THC= 12,92 mg)(CBD= 4,11mg), discontinuing Pregabalin & Paracetamol, keeping only Ibuprofen 400 mg bid. During that year, due to illness development, DEMO increased up to 6 mg, pregabalin up to 100 mg qd, Ibuprofen 600 mg bid and Cannabis 1 ml qd. (THC= 25,85 mg)(CBD= 8,23 mg) While an increase of Codeine was needed, it was lesser than ¼ of the initial DEMO. The patient kept on receiving sublingual Cannabis until 3 days before death. No adverse effects were reported.Discussion: During 2017-18 we checked on 33 patients who received Cannabis oils or smoked Cannabis for symptom control. The majority was on concomitant oncological treatment. This woman was not affected by this variable.Conclusion: Evidence of the co analgesic role of Cannabis in pain control was clearly observed in this case. It was of interest that there was no need to include morphine into the schedule, and the other pharmacological parameters were kept reasonably stable. We observed in the majority of patients who received Cannabis Oil referred subjective betterment of pain. These patients were on anti cancer treatment so they were not evaluable