Comprehensive Guide to Medical Cannabis: Understanding the Basics of Medical Marijuana

In this comprehensive article, we delve deep into the world of medical marijuana, providing you with all the essential information you need to know.

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Cannabis harbors a multitude of crucial molecules, with THC and CBD among them, displaying promise in both scientific investigations and anecdotal evidence. Explore the intricate workings of medical marijuana, its addictive potential, and any associated side effects for a comprehensive understanding.

What Is Medical Marijuana?

Medical marijuana and recreational marijuana share the same underlying product but serve distinct purposes. Cannabis flowers encompass notable quantities of substances like THC and CBD, which researchers are diligently investigating in laboratory settings.

When employed for their intended applications, several of these molecules exhibit encouraging preliminary results in studies involving cells, animals, and a limited number of human trials.

While anecdotal reports suggest that certain individuals may derive significant benefits from using medical marijuana, it is important to note that smoking cannabis is not a panacea for preventing and curing diseases.

Patients who rely on medical marijuana employ various methods of consumption, such as vaporizing raw flowers and extracts, ingesting edibles, or utilizing sublingual oils. These diverse approaches allow for personalized administration based on individual preferences and needs.

• Gaps in the Research

The limited availability of data poses a significant challenge to the credibility of anecdotal reports that portray medical marijuana as a miraculous remedy. Despite scientists extensively studying cannabis for over a century, our understanding of the plant and its medicinal properties has been impeded by decades of prohibition.

Presently, the Drug Enforcement Agency (DEA) in the United States classifies cannabis as a schedule I drug[1], placing it in the same category as LSD, heroin, and peyote. According to this classification, substances in schedule I have no recognized medical use and a high potential for abuse. This classification contradicts the current reality of cannabis being prescribed for medical purposes in 36 states across the country. Additionally, while certain member countries have legalized cannabis for specific conditions, its use is technically prohibited under EU law.

What Is Cannabis?

Cannabis, a member of the Cannabaceae family, is a genus of flowering plants that includes hops and Celtis trees. These plants exhibit dioecious characteristics, meaning they have separate male and female individuals. When it comes to consuming cannabis products for recreational or medicinal purposes, the majority are derived from the flowers of female cannabis plants.

The taxonomy of cannabis plants is a topic of ongoing debate, but they are generally classified into the following species: cannabis indica, cannabis sativa, and cannabis ruderalis.

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Understanding Cannabis Compounds

The cannabis plant is rich in more than 400 chemical compounds, with over 100 of them being cannabinoids. These cannabinoids have the ability to interact with cannabinoid receptors either directly or indirectly.

Among the various compounds, THC (tetrahydrocannabinol) and CBD (cannabidiol) are the most widely recognized. THC is primarily found in marijuana and is responsible for its psychoactive effects. On the other hand, CBD is often found in higher quantities in hemp or specially bred cannabis strains known for their CBD content.

In addition to cannabinoids, cannabis harbors essential compounds called terpenes. These aromatic molecules are present in the plant’s essential oils and contribute to the distinctive fragrances associated with cannabis.

The chemical composition of each cannabis plant is unique. Variations in concentrations of cannabinoids and terpenes can be observed across different plants, which can be attributed to the genetic characteristics of specific cultivars.

The Entourage Effect

Much of the research conducted on cannabis has focused on investigating the isolated effects of individual compounds. While this approach provides valuable insights into these specific compounds, it has also raised inquiries regarding the unique properties of cannabis as a whole.

The concept of the “entourage effect” was coined by renowned Israeli cannabis researcher Raphael Mechoulam. In a 1998 publication in the European Journal of Pharmacology, Mechoulam and his team introduced the entourage effect, highlighting that the effects of cannabis are not solely attributed to individual chemicals but also arise from the interactions among these compounds within the body.

An illustrative instance of the entourage effect can be observed in the interplay between THC and CBD. Extensive research has demonstrated that CBD has the potential to mitigate the intoxicating effects of THC by influencing its binding capacity to CB1 receptors in the brain and body[3].

 

When comparing the effects of synthetic cannabinoid isolates like dronabinol (pure synthetic THC) to natural cannabinoids, significant differences become evident. Dronabinol is known to produce distinct effects that are separate from those of THC, with intensified and prolonged side effects.

Although dronabinol shares a structural similarity with THC, the dissimilarities in their effects can be attributed to the entourage effect. Dronabinol consists solely of pure THC, while cannabis contains a diverse array of additional components. This multifaceted composition of cannabis likely plays a crucial role in shaping the overall effects experienced.

Understanding Your Endocannabinoid System

To grasp the concept of medical cannabis, it is crucial to delve into the intricate workings of the endocannabinoid system (ECS), which serves as the mediator for the effects of cannabis within our bodies.

Regarded as a fundamental regulatory system, the ECS plays a vital role in maintaining homeostasis. Many experts even consider it as the primary mechanism responsible for achieving a delicate equilibrium, ensuring optimal functionality of our bodies.

The system primarily comprises three key components:

• Endocannabinoids, namely anandamide and 2-AG, are natural compounds produced by the body that bear similarities to the cannabinoids found in cannabis.
• Cannabinoid receptors, namely CB1 and CB2, play a crucial role in receiving endocannabinoids. CB1 receptors are abundantly present in the brain, while CB2 receptors are primarily found in immune cells.
• Enzymes, including fatty acid amide hydrolase and cytochrome P450, play vital roles in the synthesis, transportation, and metabolism of cannabinoids.

Endocannabinoids are naturally synthesized by the body in response to various stimuli, such as exercise, stress, and the circadian rhythm. During times of stress, the body releases endocannabinoids as a protective mechanism to mitigate the adverse effects of stressors.

Once produced, endocannabinoids are carried and bind to specific receptors in the body. To illustrate this process, you can envision the cannabinoid receptors as locks and the endocannabinoids as keys. When an endocannabinoid attaches to a receptor, it initiates a distinct response within the body.

Currently, scientific research indicates that the endocannabinoid system plays a role in a wide range of physiological processes. These encompass:

Cannabis As Medicine

The discovery of the endocannabinoid system occurred in the 20th century when scientists sought to comprehend the mechanisms behind the unique intoxicating effects of cannabis. Presently, the ECS is considered a potential target for therapeutic interventions in a diverse range of conditions, leading to an increasing popularity of cannabis-based therapies.

Historically, most research in the field of medicinal cannabis has primarily focused on THC and CBD. THC acts as a CB1 receptor agonist, directly binding to CB1 receptors and producing various effects. These effects can vary based on factors such as the administration method, dosage, individual differences, and sensitivity to cannabis.

CBD presents a more intricate picture compared to THC. Unlike THC, CBD does not possess a strong affinity for cannabinoid receptors. Instead, it interacts with various receptors such as serotonin, vanilloid, GABA, gamma, and many others. In fact, CBD has been observed to influence around 60 distinct molecular pathways.

The use of medicinal cannabis revolves around leveraging the components of cannabis to restore equilibrium within the endocannabinoid system, offering relief from a wide range of conditions and their associated symptoms.

Nevertheless, comprehending the complexities of cannabis and its diverse effects on the body can be challenging.

Is CBD Effective Without THC?

CBD has shown efficacy even in the absence of THC. Numerous individuals have experienced positive outcomes by using CBD oil products with minimal THC content.

Certain patients and companies advocate for isolating specific cannabinoids to harness their individual effects and achieve higher doses of isolated compounds. While some individuals have reported positive results with this approach, emerging research suggests the advantages of utilizing the entire cannabis plant as nature intended.

Cannabis flowers contain a rich array of over 100 cannabinoids and more than 200 terpenes. While these compounds can produce distinct effects on their own, they also have the potential to interact synergistically, leading to what is known as the entourage effect. Ongoing research suggests that cannabinoids and terpenes may work together to enhance therapeutic outcomes. This includes the collaborative effects of CBD and THC, both individually and in combination.

There is a common misconception that CBD is solely responsible for the non-psychoactive medicinal properties, while THC is associated with recreational and psychoactive effects. However, this oversimplification does not reflect the full picture. Numerous ongoing studies are exploring the medicinal potential of THC, indicating its significance beyond recreational use.

The growing recognition of THC as a valuable medicinal cannabinoid is evident in the involvement and investments of pharmaceutical companies. One notable example is Insys Therapeutics, which developed a synthetic version of THC called dronabinol.

What’s intriguing is that the United States Food and Drug Administration (FDA) has approved this medication as safe and effective for treating HIV/AIDS-induced anorexia and chemotherapy-induced nausea and vomiting.

In a notable shift, the Drug Enforcement Administration (DEA) reclassified dronabinol from schedule I to schedule II, recognizing its therapeutic potential. However, cannabis remains classified in the most restrictive category.

Research On Medical Marijuana

• Inflammation

Extensive research indicates that the endocannabinoid system plays a crucial role in regulating inflammatory processes, as supported by numerous studies. Preclinical investigations have demonstrated the potential of cannabinoids in reducing inflammation in animal models associated with various health conditions.

A review conducted in 2018 highlights the promising potential of cannabinoids in alleviating symptoms of osteoarthritis. The activation of the endocannabinoid system catalyzes anti-inflammatory, analgesic, and antinociceptive effects that contribute to relief. However, it’s important to note that only a limited number of clinical trials have been conducted to assess the safety and efficacy of medical cannabis in this specific area.

• Pain

The endocannabinoid system is significantly involved in the perception and response to pain. Extensive research has identified cannabinoid receptors located at presynaptic sites throughout the central and peripheral nervous systems. By interacting with these receptors, cannabinoids have the ability to modulate the transmission of pain signals. As a result, cannabinoids have garnered significant attention as potential treatments for various types of pain, including nociceptive pain stemming from injuries and neuropathic pain associated with conditions such as multiple sclerosis.

• Skin Conditions

The endocannabinoid system, present in the skin, can be effectively stimulated using topical cannabis products such as creams, balms, oils, and other formulations. This breakthrough has led to the emergence of a thriving industry focused on topical cannabis products that offer potential benefits for various skin conditions including acne, allergic reactions, dermatitis, psoriasis, and more.

 

• Mental Health Conditions

Despite the limited research on cannabinoids for mental health conditions, preliminary studies indicate their potential neuroprotective effects. Additionally, cannabinoids are believed to support neurogenesis, the generation of new brain cells, in crucial brain regions associated with mental well-being. However, further research is needed to fully understand the impact of cannabinoids on mental health.

• Tumours

The endocannabinoid system plays a crucial role in the regulation of cell growth and apoptosis. This has sparked considerable interest in exploring the potential of cannabinoids for treating tumors. Although it is still in the early stages, emerging research indicates that cannabinoid therapies may hold promise in modulating tumor growth and metastasis.

• Nausea, Vomiting, Appetite

Studies have revealed a correlation between THC, CBD, and their effects on nausea and vomiting in animal models.

• Sleep Disorders

Considering the frequently observed sedative properties of THC-dominant cannabis, particularly in higher doses, it is plausible that cannabis could serve as a promising sleep aid. However, robust scientific research in this field is currently limited. Nevertheless, numerous anecdotal reports exist on the sleep-inducing effects of potent indica strains, suggesting that individuals seeking a faster path to sleep might find THC-rich cannabis beneficial. Additionally, ongoing studies are investigating the potential of CBD in this regard, although conclusive results are still pending.

How To Access Medical Marijuana

Several countries across the globe have embraced the legalization of cannabis for its medicinal properties. These include the Netherlands, Luxembourg, Germany, Canada, Australia, and various states within the United States. Despite variations among their respective medical marijuana programs, there is a shared objective of granting access to cannabis for specific health conditions. Individuals afflicted with these conditions must undergo a diagnosis by a qualified healthcare provider to receive a prescription for cannabis or obtain a medical marijuana card. This documentation enables them to procure cannabis from authorized dispensaries or pharmacies.

Marijuana Laws and Synthetic Cannabinoids

While medicinal use of cannabis remains prohibited in numerous European countries, there has been a notable shift in certain governments towards loosening restrictions on cannabis-based medications. These medications typically take the form of patented and synthetic compounds designed to replicate the therapeutic effects of cannabis. While a limited number of countries permit the use of cannabis flowers for medicinal purposes, this practice is less prevalent.

Some examples of such products include:

How To Use Medical Marijuana

Medical marijuana is accessible in various forms, which encompass the following:

• Cannabis tinctures and oils: Tinctures involve the extraction of cannabis in high-proof alcohol, while oils incorporate a carrier oil like MCT, hemp seed oil, or olive oil. These preparations can encompass CBD, THC, and other compounds present in cannabis. Certain products may include additional ingredients to provide targeted relief for specific ailments or symptoms. Tinctures and oils are typically administered under the tongue, allowing absorption through the oral mucosa and delivering effects within approximately 15 minutes.
• Edibles: A wide range of cannabis-infused edibles exists, available in various forms. These edibles can contain potent doses of cannabinoids and require digestion to initiate their effects. The onset of action can take up to an hour or more, but it offers a sustained and prolonged release of cannabis within the body.
• Capsules: Cannabis capsules encompass a single dose of cannabis oil and are designed to be ingested. Similar to edibles, they undergo breakdown by the digestive system to initiate their effects.

• Topicals: Cannabis topicals, such as creams and balms, are directly applied to the skin and can be formulated with diverse ingredients to combat symptoms like inflammation, itching, redness, pain, acne, rashes, and other concerns. The effects of topical cannabis products are typically felt within 10 minutes. While the cannabinoids in these products provide localized relief, they do not enter the bloodstream.
• Flower: Dried cannabis flowers possess abundant trichomes, which house the cannabinoids, terpenes, and other compounds responsible for the distinct medicinal attributes of cannabis. Typically, these flowers are smoked or vaporized, but they can also be infused into oils, butter, and various other preparations. Medical cannabis plants can be cultivated either from seeds or clones, depending on the availability and specific requirements of the growing environment.
• Concentrates: Cannabis concentrates are produced through the extraction of essential components from cannabis plant material, resulting in a concentrated and potent extract. These extracts are known by various names such as hash, oil, dabs, and more. While they are commonly vaporized using vaporizers or specialized pipes, they can also be smoked or incorporated into edible preparations.
• Transdermal patches: Transdermal cannabis patches, as their name implies, are patches applied topically that facilitate the delivery of cannabinoids through the skin and into the bloodstream. This sets them apart from other topicals, as they provide a consistent and sustained release of cannabinoids, ensuring a prolonged effect within the body.

How To Dose Medical Cannabis

Precise dosing plays a crucial role in the utilization of medicinal cannabis. However, due to the individual variations in how cannabis affects people, there are currently no standardized guidelines for accurately measuring cannabis-based medications.

For patients using THC, microdosing with 2.5mg has emerged as a popular trend. Microdosing enables patients to alleviate symptoms without encountering the potent intoxicating effects associated with higher THC doses. It allows for a more subtle and controlled therapeutic experience. Conversely, some patients may require larger doses to achieve the desired relief from their symptoms, as individual responses can vary.

Determining the appropriate dosage of CBD is highly individualized and often requires a process of trial and error for patients. Typically, patients are advised to commence with small CBD doses and gradually increase them over time. The objective is to incrementally reach a dosage that provides optimal relief while minimizing the likelihood of side effects.

Regrettably, there is even less available information regarding the dosing of other cannabinoids such as CBN, CBG, and CBC. These compounds have been the subject of significantly fewer studies compared to THC and CBD, leading to a limited understanding of their optimal dosages and effects.

Medical Marijuana Side Effects

Similar to all medications, cannabis carries its own array of side effects. Unlike opioids and certain drugs associated with frequent overdoses, cannabis does not depress the respiratory system in the brain. Consequently, instances of cannabis overdose are exceedingly rare.

Nonetheless, cannabis can exert both short-term and long-term effects on individuals. Particularly, there are significant concerns regarding cannabis use among teenagers and the potential adverse effects it may have on the developing brain[19].

The side effects of cannabis vary based on the primary cannabinoid involved. THC and CBD, for instance, generate distinct effects.

Potential side effects associated with THC encompass:

Possible side effects from CBD include:

Is Medical Marijuana Addictive?

While the risk is generally considered low, it is possible for individuals using medical marijuana to develop an addiction to cannabis, leading to a condition known as marijuana use disorder. This disorder can affect the brain’s reward system and potentially induce alterations in the dopamine system[20], which plays a role in experiencing pleasure.

Studies indicate an increase in cases of marijuana use disorder[21] in American states that have implemented recreational cannabis legalization measures. The data suggests that a considerable portion of both adult and adolescent cannabis users are at a heightened risk[22] of developing this condition, even if their initial cannabis use is infrequent.

Nevertheless, the legalization of marijuana in these regions seems to be associated with a decrease in fatal opiate overdoses[23].

Similar to dependence on any substance, marijuana use disorder manifests as the persistent use of the herb, feelings of dependency, and the potential occurrence of withdrawal symptoms[24].

The majority of research conducted thus far primarily examines cannabis addiction in relation to high-THC cannabis. However, researchers are now exploring the potential of CBD to aid in combating addiction[25], with specific studies[26] focusing on cocaine and methamphetamine addiction.

The Future of Medical Marijuana

The field of medical marijuana is still in its early stages. With the gradual relaxation of prohibition worldwide, scientists are now able to delve into cannabis with greater depth and comprehension. As researchers unveil the effects of numerous other cannabinoids and terpenes and study their synergistic interactions, we can anticipate significant advancements on the horizon.

While CBD and THC exhibit promise, they represent only a small fraction of the chemical complexity found within cannabis. In the future, it is highly likely that we will witness the emergence of personalized combinations of cannabinoids and terpenes tailored to individuals and specific health conditions.