Medicinal Cannabis and Its Therapeutic Frontier: An In-depth Exploration

November 28, 2023 Arshad Shafi

The medicinal application of cannabis, a topic once mired in stigma and skepticism, has thrust itself into the therapeutic limelight, experiencing a revolution fueled by a mix of advanced scientific research, changing regulatory landscapes, and shifting sociocultural attitudes. At the heart of this renaissance are the plant’s active compounds, known as cannabinoids, which interface with the body’s endocannabinoid system (ECS) – a complex signalling network that plays a pivotal role in maintaining physiological homeostasis.

Here, we delve into the science of medicinal cannabis, exploring how its potential therapeutic benefits are being redefined and how it might benefit patients suffering from various medical conditions.

1. Chronic Pain: Chronic pain, a pervasive condition often resistant to traditional treatments, could potentially be managed with the application of medicinal cannabis. The cannabinoids THC (delta-9-Tetrahydrocannabinol) and CBD (cannabidiol) interact with the body’s CNS and immune system. They bind to CB1 and CB2 receptors (primarily found in the brain and immune cells respectively) in the ECS, helping to regulate the release of neurotransmitters and attenuate the inflammatory response, thus mitigating pain sensation at the source.
2. Epilepsy: In recent years, CBD has been proven markedly efficient in mitigating treatment-resistant seizures in severe forms of epilepsy. GW Pharmaceuticals’ CBD-based drug Epidiolex, FDA-approved for Dravet Syndrome and Lennox-Gastaut Syndrome, is a testament to this potential. The precise mechanism by which it works remains unclear. However, the prevalent hypotheses suggest its ability to influence abnormal function in calcium channels and glutamate receptors related to neurotransmission.
3. Multiple Sclerosis (MS): MS, a chronic demyelinating disease of the CNS, can lead to persistent and severe muscle spasticity. Mounting evidence points to the efficacy of a THC:CBD oral spray, Nabiximols (Sativex), in managing this symptom. The spraying action allows for the oromucosal absorption of the cannabinoids, which then bind to cannabinoid receptors in the nervous system to alleviate muscle stiffness.
4. Chemotherapy-Induced Nausea and Vomiting (CINV): FDA-approved synthetic versions of THC, Dronabinol and Nabilone, have shown efficacy in alleviating intractable CINV. The antiemetic effect of these cannabinoids is derived from their interaction with the CB1 receptors present in the brain’s vomiting centers – the Dorsal Vagal Complex.
5. Post-Traumatic Stress Disorder (PTSD): The potential of cannabinoids in managing PTSD lies in their influence on memory processing, particularly ‘fear extinction learning’ – key in helping patients modify their responses to traumatic memories. Additionally, conditions like anxiety and insomnia associated with PTSD could potentially be alleviated by the anxiolytic and sleep-promoting properties of certain cannabinoids.
6. Palliative Care: Cannabis could be an invaluable addition in palliative care settings, offering relief from multiple distressing symptoms. Particularly noteworthy is its potential to stimulate appetite and alleviate cancer cachexia, probably mediated by THC’s agonist action on the hypothalamic CB1 receptors, which play a role in regulating food intake.
7. Parkinson’s Disease: Anecdotal evidence and preliminary studies suggest that medicinal cannabis could help manage various Parkinson’s symptoms, like tremors and sleep disturbances, most likely due to the presence of cannabinoid receptors in basal ganglia circuits affected in this neurodegenerative disorder.
8. Glaucoma: THC has been found to reduce intraocular pressure (IOP) – a key risk factor for glaucoma. This action may be mediated by enhancing uveoscleral outflow and decreasing the formation of aqueous humor, thus alleviating the pressure on the optic nerve.

The increasingly compelling role of medicinal cannabis in health care underscores the necessity for thoroughly understanding its science and its potential therapeutic breadth, from mitigating chronic pain to helping manage neurodegenerative disorders. As science uncovers more about the devotion and remarkable possible benefits of this ‘forbidden’ plant, it fosters a keener understanding of our own biological intricacies, especially the nano details of our endocannabinoid system.

However, gaps remain in our knowledge, mainly due to the dearth of large-scale randomized clinical trials, often down to past and present regulatory barriers. It’s therefore paramount to approach medicinal cannabis with scientific rigor, critical thinking, and an unwavering focus on patient safety and efficacy. Overcoming these hurdles and engaging in unprejudiced scientific exploration presents an opportunity to revolutionize how we perceive and utilize this intriguing plant, potentially augmenting our therapeutic repertoire for the better.

The medicinal application of cannabis, a topic once mired in stigma and skepticism, has thrust itself into the therapeutic limelight, experiencing a revolution fueled by a mix of advanced scientific research, changing regulatory landscapes, and shifting sociocultural attitudes. At the heart of this renaissance are the plant’s active compounds, known as cannabinoids, which interface with the body’s endocannabinoid system (ECS) – a complex signaling network that plays a pivotal role in maintaining physiological homeostasis.

Cannabinoids and the Endocannabinoid System

The ECS is a complex system composed of endocannabinoids, their receptors, and the enzymes that synthesize and degrade them. Endocannabinoids are molecules produced naturally by the body, while cannabinoids are derived from the cannabis plant. The ECS plays a crucial role in regulating a wide range of physiological processes, including pain, inflammation, mood, sleep, and appetite. Cannabinoids interact with the ECS by binding to CB1 and CB2 receptors, which are found throughout the body. These interactions can modulate the release of neurotransmitters, hormones, and other signaling molecules, leading to a range of physiological effects.

Therapeutic Potential of Medicinal Cannabis

A growing body of research suggests that medicinal cannabis has the potential to treat a wide range of medical conditions, including:

• Chronic Pain: Studies have shown that cannabinoids can be effective in managing chronic pain, particularly neuropathic pain, which is caused by damage or dysfunction of the nervous system. Cannabinoids can help to reduce pain intensity and improve quality of life for patients with chronic pain. (Ref: Russo et al., 2007; Whiting et al., 2015)
• Epilepsy: Cannabidiol (CBD), a non-psychoactive cannabinoid, has been shown to be effective in reducing seizure frequency in children with severe forms of epilepsy, such as Dravet syndrome and Lennox-Gastaut syndrome. (Ref: Devinsky et al., 2017; Guberman et al., 2019)
• Multiple Sclerosis (MS): Cannabinoids can help to reduce muscle spasticity, a common symptom of MS. A THC:CBD oral spray, Nabiximols (Sativex), has been shown to be effective in managing spasticity in patients with MS. (Ref: Zajicek et al., 2012; Wareham et al., 2022)
• Chemotherapy-Induced Nausea and Vomiting (CINV): Cannabinoids can help to alleviate CINV, a common side effect of chemotherapy. Synthetic THC analogs, such as Dronabinol and Nabilone, have been approved by the FDA for the treatment of CINV. (Ref: Strasser et al., 2006; Antonijevic et al., 2020)
• Post-Traumatic Stress Disorder (PTSD): Cannabinoids may have the potential to help manage PTSD symptoms, such as anxiety, insomnia, and nightmares. However, more research is needed to confirm these findings. (Ref: Zohar et al., 2017; Blessing et al., 2015)
• Palliative Care: Cannabinoids can be used in palliative care to relieve symptoms such as pain, nausea, and loss of appetite. (Ref. Bar-Lev et al., 2014; Levy et al., 2020)
• Parkinson’s Disease: Preliminary studies suggest that cannabinoids may help to improve motor symptoms and sleep disturbances in patients with Parkinson’s disease. However, more research is needed to confirm these findings. (Ref. Agbogun et al., 2014; Chagas et al., 2021)
• Glaucoma: Cannabinoids may be able to reduce intraocular pressure (IOP), a risk factor for glaucoma. However, more research is needed to confirm this effect. (Ref. Gueguen et al., 2013; Bergamasco et al., 2020)

Future Directions

The potential of medicinal cannabis is vast and continues to be explored in clinical trials and research studies. As our understanding of the ECS and the therapeutic effects of cannabinoids deepens, we can expect to see even more innovative applications for this plant in the years to come.

References

• Agbogun, O. C., Schwitter, M. J., & Seeman, P. (2014). The potential of cannabinoids for the treatment of Parkinson’s disease. Frontiers in pharmacology, 5, 117.
• Antonijevic, I., Petrovic, S., & Kostic, M

Here are the links to the references:

1. Russo et al., 2007:?Link
2. Whiting et al., 2015:?Link
3. Zajicek et al., 2012:?Link
4. Antonijevic et al., 2020:?Link
5. Blessing et al., 2015:?Link
6. Zohar et al., 2017:?Link
7. Wareham et al., 2022:?Link
8. Strasser et al., 2006:?Link
9. Guberman et al., 2019:?Link
10. Devinsky et al., 2017:?Link

Learn more:

1. academic.oup.com 2. jamanetwork.com 3. jnnp.bmj.com 4. medrxiv.org 5. link.springer.com 6. link.springer.com 7. molecularneurodegeneration.biomedcentral.com 8. agupubs.onlinelibrary.wiley.com 9. cambridge.org 10. nature.com 11. onlinelibrary.wiley.com 12. iopscience.iop.org 13. link.springer.com 14. academic.oup.com 15. core.ac.uk 16. mayoclinic.elsevierpure.com 17. anstd.ans.org 18. research-information.bris.ac.uk 19. journals.sagepub.com 20. europepmc.org 21. nejm.org 22. cambridge.org 23. mdpi.com 24. jnnp.bmj.com 25. link.springer.com 26. journals.sagepub.com 27. researchpublications.qmul.ac.uk 28. tandfonline.com 29. academic.oup.com 30. frontiersin.org 31. scholar.google.com 32. search.bvsalud.org 33. nature.com 34. psychiatrist.com 35. scholar.google.com 36. link.springer.com 37. journals.plos.org 38. discovery.ucl.ac.uk 39. researchoutreach.org 40. academic.oup.com 41. whitehouse.gov 42. handbook.cochrane.org 43. york.ac.uk 44. clinicaltrials.gov 45. sciencedirect.com 46. bristol.ac.uk 47. doi.org 48. doi.org 49. creativecommons.org 50. https 51. dx.doi.org 52. doi.org 53. doi.org 54. doi.org 55. doi.org