Cannabis has become more and more popular as states have legalized it's use and its medicinal properties have become widely accepted. I had a pain management practice in the state of Washington when marijuana was first legalized. It was an interesting time because as a clinician, and not just any clinician but a "pain management" doctor, I was still reluctant to use this herb given it's "bad reputation". I was the goody-goody two shoe, walk a straight line, rule follower kinda girl. I never smoked a joint until very recently when I punctured my tendon with a bicycle spoke and was in a lot of pain. Early on it came down to lack of knowledge and understanding of this herb. The more I understood, witnessed in clinical practice, and then experienced for myself in regards to pain, the more I became an advocate. Like with anything, too much of a good thing can be bad but there's no doubt in my mind that this herb has its place in an herbal dispensary. It's use has been incredibly beneficial to my patients with neurological diseases like Parkinson's and even for a child with anxiety and insomnia.
So let's take a dive into the science...
CBD vs THC
CBD, cannibidiol, was discovered first in 1940 but wasn't closely examined because it didn't have the same affects as the whole plant of Cannabis had. It was basically deemed as "inactive." In 1963, they finally had a chemical structure (as shown in image above). One year later, THC, tetrahydrocannabinol, was discovered. Delta-9-THC does create the affects the whole plant causes and thus started the research into this particular constituent, a chemical property to the plant that makes it medicinal. We now have identified an intricate system called the Endocannabinoid System, ECS, where you can find numerous receptor sites throughout the body that delta-9 THC and also CBD can affect.
An "endocannabinoid" is basically a fatty acid derived neurotransmitter (a chemical made in the brain) that's made on demand (as opposed to other neurotransmitters that are stored) and it has transport molecules and signaling molecules that allow for biological changes to occur. These changes can impact mood, pain, sleep, memory, tremors, among other things.
Endocannabinoid = what's being made naturally in the body
Phytocannabinoid = what's being injected by the plant, aka THC and CBD
There are 2 types of Cannabinoid Receptors:
First, a receptor is basically a lock on a cell wall that requires a specific Key to trigger a response. CB1 receptors, which are mainly located in the central nervous system, and CB2 receptors which you'll find in the lymph and immune tissues are basically the lock. Cannabinoids are the key.
In other words, where you find receptors in the body, there you will find the actions to a substance or chemical of interest.
So, CB1 receptors will mainly impact the nervous system and brain but also sporadically in immune, fat, liver, muscle, reproductive, kidney, and lung cells. CB2 receptors will modulate the immune system.
Why is this important?
Well, when you think about what CBD or THC is "good" for, you must consider where it's acting in the body. This is also important when researching this herb on various diseases.
THC is what can make people feel "high" because it's receptors are highly concentrated in the brain. It has more implications for pain, neurological disorders, and mood disorders.
CBD, the constituent the FDA has officially "approved", now has a pharmaceutical on the market called Epidiolex which is used to treat Epilepsy. So, it too has impact on the nervous system that can be beneficial, it's just far more subtle or gentler.
Brain Balance
The Endocannabinoid System is a modulator. In herbal medicine, this means that it balances out an overexcited system or an under stimulated system. It's almost like a harmonizer. When it comes to brain chemistry, you have excitatory signals and inhibitory or calming signals. Endocannabinoids will modulate BOTH. During seizure activity, you will find elevated endocannabinoids to help calm a hyperactive event thus you might consider phytocannabinoids, or cannabinoids that come from the plant, as anti-convulsants.
Another example is with GABA activity. It's modulated by G-proteins, proteins that also respond to cannabinoids. Endocannabinoids such as anandamide or AEA and 2-arachidonylglycerol (2-AG) act at the level of GABA receptor sites which helps relax people, calm their anxiety, and can actually help with dizziness and balance issues. There are also binding sites along the parts of our brain that respond to stress and sleep cycles, which is why you'll see improvement with insomnia.
Immune Modulation
There's a lot of people looking into CBD and immunity. The ECS, endocannabidiol system, stimulates a regulatory process within cells and cells around each other. For example, the cytokine storm people hear about in regards to COVID19, or SARS-cov2, is when the immune system and inflammatory response goes unregulated, starting a lethal cascade of events. Endocannabinoids can stimulate what's called the Paracrine system where cells self regulate. This system you'll see being activated with T-cells, B-cells, and NK-cells- all players that get involved during an infection. Phytocannabinoids have the potential to regulate this process, calming an overactive immune response and inflammation.
In Pregnancy: not safe
Anandamide, which is a chemical produced in the body, is seen as an agonist to CB1 (a cannabinoid receptor). High levels of anandamide has been shown to be detrimental to the fetus and placenta. Therefore, marijuana (CBD, THC, or Hemp), is NOT recommended during pregnancy or for those trying to conceive. BUT what's really interesting is that during labor, anadamide actually INCREASES naturally in the body. This might suggest more research in the use of this herb DURING LABOR for pain management.
Pain
Pain is felt in sensory nerve fibers and "nociceptors." Cannabinoid receptors are located on along these neurons in the brain and spinal cord and are often found next to opioid receptors. When CB1 receptors get activated either from the naturally occurring ECS in the body or from the plant itself, they block the signals that travel up the nerve to tell the brain there is pain. CB1 receptors also modulate that information that gets traveled from the brain back to the original location of pain. THC, delta-9-tetrahydrocannabinol, is the most potent cannabinoid for pain.
Interesting Fact:
There aren't any cannabinoid receptors in the respiratory center of the brain. So, you won't see a decrease in breathing/respiration like you would with opioids. This is a major cause of opioid mortality. Opioids do bind to receptors that control breathing, thus patients basically stop breathing when they overdose.
Other uses being researched:
GI diseases(IBS, Crohns, UC), Cancer, eating disorders (particularly anorexia), as a muscle relaxant for endometriosis, fibromyalgia, and interstitial cystitis, glaucoma, PTSD, among many more conditions.
Legal?
Depends on where you are which makes doing research also difficult. It's tricky because at the federal level the bottom line is its illegal. At the state level, its more individualized. Medical marijuana that actually includes THC is legal in many states but because its federally "illegal", many doctors get reluctant to prescribe this herb, even though there's plenty of argument for its use, especially with the opioid crisis.
CBD is a little bit less controversial because it doesn't have that same impact THC does. That's why you'll see CBD more readily available, but again, it will be different per state.
Regardless of legalities, Cannabis s. is an incredibly useful and highly beneficial herb in our tool box with an extensive list of indications. The benefits of this herb far outweigh it's risks. Sure, there are mild adverse side effects that have been reported but overall, it's a pretty safe and effective herb to explore...except during pregnancy. But during labor...? More studies could be done here. Bottom line, I've moved from the "goody-goody" two shoe who didn't have enough information into the girl who will say, "pass the joint" when she's in a lot of pain and into the provider who sees the extensive benefits this herb can provide medically.
To doctors who are still unsure..."whether you are pro, neutral, or against medical marijuana, patients are embracing it, and although we don’t have rigorous studies and “gold standard” proof of the benefits and risks of medical marijuana, we need to learn about it, be open-minded, and above all, be non-judgmental."(4)
Enjoy...but not too much ; )
Dr. Lexi
Resources:
1. The Endocannabinoid System and its Modulation by Cannabidiol (CBD). Jamie Corron, ND, MPH; Jake F. Felice, NC, LMP. Review article; Alternative Therapies, Vol 25 No. S2 page 14.
2. Plasma Levels of the Endocannabinoid Anandamide in Women—A Potential Role in Pregnancy Maintenance and Labor? Osama M. H. Habayeb, Anthony H. Taylor, Mark D. Evans, Marcus S. Cooke, David J. Taylor, Stephen C. Bell, Justin C. Konje, , The Journal of Clinical Endocrinology & Metabolism, Volume 89, Issue 11, 1 November 2004, Pages 5482–5487, https://doi.org/10.1210/jc.2004-0681
3. Cannabinoids in the management of difficult to treat pain Ethan B Russo Ther Clin Risk Manag. 2008 Feb; 4(1): 245–259. Published online 2008 Feb. PMCID: PMC2503660 Article PubReader PDF–204KCitation
4. Medical marijuana. Peter Grinspoon, MD. Harvard Health Blog. Harvard health publishing. Harvard Medical School. Posted Jan. 15, 2018 and updated April 10, 2020 https://www.health.harvard.edu/blog/medical-marijuana-2018011513085
5. CBD vs THC: What's the difference? https://www.webmd.com/pain-management/cbd-thc-difference#2
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