Accurate Education – Marijuana (Cannabis): The Endocannabinoid System

Marijuana (Cannabis)

The Endocannabinoid System (ECS)

The endocannabinoid system (ECS) is a naturally occurring neuroendocrine communication network that is present throughout the brain, nervous system and the rest of the body and plays a role in many physiological processes. The ECS regulates many physiologic functions including gastrointestinal (GI) function, appetite and metabolism, pain, memory, movement, immunity, and inflammation.

 

See:

Marijuana – Legislative Update for Louisiana

Marijuana – Medical Use Overview

“Medical Marijuana” – Getting Started

 

Cannabis-Based Medications:

Over-the-Counter Cannabinoid Medications:

Marijuana – Cannabidiol (CBD)

 

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana Prescription Cannabis-Based Products – “Medical Marijuana”

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Pain (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Botanical

Marijuana – Pharmacokinetics

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids

 

Cannabinoids and Terpenes:

Cannabinoids & Terpenes – An Overview (coming soon)

 

Cannabinoids:

Marijuana – Cannabidiol (CBD)

 

Terpenes:

Terpenes – An Overview (coming soon)

   

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

  

 

 

 

 

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

cannabis-caduceus 

This section remains incomplete and is still being edited for accuracy and completeness.

The Endocannabinoid System

Cannabinoids: Endocannabinoids and Phytocannabinoids

There are a number of physiologically active constituents of the cannabis (marijuana) plant, some of which have shown therapeutic benefits in a broad range of conditions. One group of compounds found to be uniquely abundant in cannabis is the “cannabinoids.”  Originally thought to be unique to cannabis, naturally occuring cannabinoids (endocannabinoids) were subsequently discovered in humans and animals (all vertebrates). An entire endocannabinoid system consisting of multiple types of endocannabinoids and cannabinoid receptors is distributed throughout the body.

 

Cannabinoid receptors are distributed in the central nervous system and many peripheral tissues including spleen, white blood cells (leukocytes), reproductive, urinary and gastrointestinal tracts; endocrine glands, arteries and heart. These receptors respond to the presence of cannabinoids in many differenst ways, whether the cannabinoid is plant-based (phytocannabinoids), naturally occuring in the body (endocannabinoids), or synthetically manufactured. The entire field of cannabinoid pharmacology remains in its infancy but is now offering many potential clinical applications, although at this stage it is providing more questions and possibilities than answers or confirmed benefits.

 

The endocannabinoid system of naturally occuring endocannabinoids and receptors is similar to the opioid system of naturally occuring opioids (endorphins) and receptors in the body. The endocannabinoid system (ECS) regulates many physiologic functions ranging from the immune system to the nervous system and affects sleep, appetite, mood, pain and other functions. For this reason, marijuana has attracted a great deal of attention from a pharmacotherapy perspective for its potential to affect many physiologic functions with possible benefit.

 

The ECS is comprised of two G-protein-coupled receptors (GPCRs): cannabinoid receptors 1 (CB1) and 2 (CB2). CB1 receptors are predominantly found in the central nervous system (CNS) where they have  psychoactive effects as well as being found in the central nervous system (CNS), Gastrointestinal (GI) system, adipocytes (fat cells), liver tissue, and skeletal muscle.

 

In contrast, CB2 receptors are more limited in their distribution where they are primarily found on immune cells located in the tonsils, thymus, spleen, and bone marrow, as well as in the enteric nervous system within the GI tract. Activation of these receptors is dependent on endogenous endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG).

 

The medicinal properties of cannabis are attributed primarily to the phytocannabinoids ∆9-THC (THC) and cannabidiol (CBD). THC and CBD, the most pharmacologically active phytocannabinoids, mimic AEA and 2-AG, respectively. THC binds to the CB1 receptor in the nervous system and CBD binds strongly to the CB2 receptor where it exerts effects on the immune system and together  they impact pain, especially neuropathic pain.

 

Many preclinical animal and labatory-based studies have shown that modifying the activity of the ECS affects many medical conditions including: mood, anxiety disorders, movement disorders, neuropathic (nerve) pain, epilepsy, multiple sclerosis, spinal cord injury, cancer, atherosclerosis, myocardial infarction, stroke, hypertension, glaucoma, obesity/metabolic syndrome, insomnia, drug addiction, Alzheimer’s disease, and osteoporosis.  However, there is a lack of good quality human-based research to confirm the specifics of what these preclinical studies suggest.  It is been believed that some conditions including migraine headaches, fibromyalgia, and Irritable Bowel Syndrome (IBS) may be the result of an underlying endocannabinoid deficiency, indicating they may be effectively treated with cannabinoid medications.

 

Pain

The analgesic effect of cannabinoids as a result of binding of cannabinoids to cannabinoid receptors has been confirmed, and the role of the endocannabinoid system in pain relief has been verified in various types of pain: somatic, visceral and neuropathy. Classical analgesics, nonsteroidal anti-inflammatory drugs,  opioids, and antidepressants increase the activity of the endocannabinoid system.

  

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

www.Healer.com

This website appears to be good resource for exploring medical marijuana.

 

References:

Politics of Medical Marijuana – Consequences

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. Effects of Legal Access to Cannabis on Scheduled II-V Drug Prescriptions. – PubMed – NCBI
  3. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  4. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. – PubMed – NCBI
  5. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  6. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  7. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  8. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  9. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  10. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  11. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  12. Cannabis and the Opioid Crisis – 2018
  13. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  14. Building smart cannabis policy from the science up – 2017

Politics of Medical Marijuana – Louisiana

  1. louisiana-medical-marijuana-expansion-bill-signed-into-law-may-20-2016
  2. louisiana-2016-sb180-chaptered
  3. medical-marijuana-in-louisiana-who-will-get-access-june-2015
  4. now-in-effect-louisiana-medical-marijuana-law-shields-patients-and-caregivers-from-prosecution-aug-5-2016
  5. La house committee passes bill to allow medical marijuana prescription 4-5 2018

    

Politics of Medical Marijuana – Colorado

  1. The Clinical Conundrum of Medical Marijuana – 2017

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendationsCanadian Family Physician – 2014

 

Medical Marijuana – Potential Harms Associated with Cannabis Use

  1. Brief Review of Human Studies Regarding Increased Risk of Harm with Cannabis Use – State of Minnesota – 2016

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

Medical Marijuana – Opioid Drug Interactions

  1. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014
  2. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011

Medical Marijuana –Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017

 

Medical Marijuana –Sleep & Sleep Apnea

  1. Medical Cannabis and the Treatment of Obstructive Sleep Apnea – An American Academy of Sleep Medicine Position Statement – 2018
  2. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. – PubMed – NCBI
  3. Misc Abstracts @ Obstructive Sleep Apnea – 2017
  4. Cannabinoid May Be First Drug for Sleep Apnea – 2018
  5. Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial – Effects of Dronabinol in Obstructive Sleep Apnea – 2018

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015

Emphasis on Education

 

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