Exploring the polarization of cannabis in our society
24 states allow recreational cannabis and 38 states allow medical cannabis (as of the time of this writing). If you live in one of these states, chances are you’ve had discussions with your patients regarding recreational use and medical use. Your response likely depended on which camp you fall into: Cannabis is a panacea and will cure any disease, or cannabis is the devil’s grass and will cause the downfall of society. The reality is somewhere in the middle.
To understand the complexities of cannabis and the cause of societal polarization, we need to explore the history and legalization of cannabis. The roots of cannabis cultivation can be traced back to the Central Asia mountains over 12,000 years ago. The seeds then went on a journey of global expansion, with records for medical cannabis use appearing in BCE in China, Egypt, and Greece, and later in the Roman Empire.
By the 19th century, cannabis for medical use was widespread in Europe. Medical cannabis worked its way onto the pharmacy shelves during the 19th and early 20th centuries and was described in the United States Pharmacopoeia for the first time in 1850. The complex interplay of Mexican immigration, racism, and the war on drugs spurred cannabis criminalization and stigma in our U.S. society.
In 1964, the structure of THC, the main psychoactive, was discovered in Israel by Mechoulam and Gaoni. This enabled the discovery of the endocannabinoid system and opened the floodgates for numerous advancements in the field. The endocannabinoid system (ECS) is key to understanding the cannabis debate in modern society.
Cannabis has over 400 chemicals, 100 of which have been identified as cannabinoids. CBD and THC are the most studied cannabinoids and interact uniquely with the ECS. The ECS is a complex and widespread brain signaling system that plays a role in affective and cognitive functions, and psychotic disorders, and might be the target for various therapeutic compounds. Directly and indirectly, both natural endocannabinoids and plant-based phytocannabinoids change and influence many psychological systems influenced by ECS.
Because of the clinical applications of cannabis and the non-psychoactive nature of most phytocannabinoids except THC, there is great therapeutic potential for cannabis and cannabinoids. The discovery of ECS has cast new light on the powerful potential of several phytocannabinoids, particularly CBD, in various pathological conditions, including inflammation, cancer, addiction, and epilepsy.
These scientific advancements have brought medical cannabis into the limelight. However, more than a century of carefully cultivated government policy and deeply entrenched social stigma created a roadblock for medical cannabis.
Harnessing the therapeutic potential of cannabis: medical applications and case study
We can destigmatize the medicinal use of cannabis and unleash the potential of medical cannabis across a variety of medical conditions. This can be accomplished through education at the government, patient, and medical community levels. There is an unmet need for cannabis education at medical schools and throughout medical education training. We cannot do this without pumping money into research and learning more about the science of cannabis. We need to explore today’s most pressing questions:
- Should recreational and medical cannabis be marketed as candy?
- Should THC have limits?
- What are the long-term effects of medical use?
- Who should use cannabis?
- What are the risks of cannabis during pregnancy?
- At what age is cannabis safe, and at what stage of development is it harmful?
- What is the right dose?
Products are hitting shelves faster than the research, and consumers and clinicians alike need to know the facts about cannabis, such as CBD sold in retail stores is unregulated and usually contains very low doses.
Now, let’s dive into the weeds of the known and potential medical benefits of cannabis use:
Pain: Improvements in neuropathic pain, fibromyalgia pain, and cancer pain. Pain is #1 reason cannabis is prescribed.
Cachexia: Increasing appetite and weight gain in HIV and cancer.
Nausea and Vomiting: Relieves chemo-therapy-induced nausea and vomiting.
Multiple Sclerosis Spasticity: Improvements in central pain and reduction in spasticity.
Epilepsy: Significantly reduces the frequency of convulsive seizures, and drop seizures in pediatric and adult patients. Improvements in refractory epilepsy
Opioid Addiction: Potential to alleviate opioid withdrawal symptoms.
Dystonia: Potential to alleviate dystonia-like symptoms and dystonia progression.
Glaucoma: THC may reduce intraocular pressure. CDB has opposite effects, and more research is needed.
Alzheimer’s Disease: Potential to protect against excitotoxicity, oxidative stress, and inflammation and improve Alzheimer’s Disease symptoms.
Anxiety and Depression: A patient-reported study of medical cannabis users showed 50% use for anxiety and about 35% use for depression. Research is limited but growing.
Sleep: Low doses of cannabis and THC may decrease sleep-onset latency and increase slow-wave sleep and total sleep time
Other Potential Benefits: While research remains limited, cannabis may have potential anti-tumor effects, and helpful effects for Inflammatory Bowel Disease, Heart Failure, Hepatitis C, Ischemia/reperfusion injury, Huntington’s disease, Metabolic Syndrome, Obesity, Diabetes, Parkinson’s Disease, and PTSD.
Improvements in restorative sleep might be the answer behind the wide range of potential medical benefits of cannabis.
Epilepsy Case Study:
A PBS Newshour sheds light on the potentially life-changing impact of medical cannabis for epilepsy. Lenny and Amy Lopez adopted a 5-year-old son, Isaias, who has epilepsy Dravet’s syndrome.
In the beginning, he would have hundreds of seizures per day. He couldn’t play or eat. More severe seizures would leave him “shut off”. His parents saw the CNN documentary “Weed” and heard the story of a family in Colorado using a high CBD strain of cannabis to treat their daughter’s Dravet’s epilepsy.
When their regular doctor was unwilling to consider medical cannabis, they found Dr. Elizabeth Thiele, director of the pediatric epilepsy program at Massachusetts General Hospital. Dr. Thiele shared in their frustration and saw firsthand that most children didn’t respond to existing therapies. She saw the promising potential of cannabis oil.
After they administered daily doses of cannabis oil (mostly CBD), Isaias’ seizures reduced in intensity and frequency by about 80%. Unlike conventional seizure medications which made him non-responsive or caused him to act out, cannabis oil was effective and well-tolerated, significantly changing Isaias’ life.
The Takeaway
As this multi-billion dollar industry experiences explosive growth, smart clinicians know they need the latest research and practical strategies on cannabinoid research and application.
BRAINWeek 2024 hosts not one but two sessions dedicated to cannabis and cannabinoids: “Higher Education: A Review of Cannabis and Cannabinoids” and “The Elephant in the Room: Discussing the Role of the Endocannabinoid System on Wellness and Disease.”
We hope you’ll join us for BRAINWeek on May 9-11, 2024 in Scottsdale, AZ!
