By Hermione Cabie Santos
A 55-year old patient has been taking pain medications round the clock for several months. Unable to sleep most nights and taking high doses of anti-anxiety medications, he seeks other means of addressing his condition.
Finally, he reads about medical cannabis, discovers its benefits and now enjoys
a more pain-free way of life!
We all have come across medical cannabis (also called medical marijuana) from the media, health practitioners, family and friends. There are endless questions about its efficacy and use, given its long tainted history of being a widely used recreational drug.
Most may still maintain the belief that all cannabis (medicinal or recreational) are one and the same, despite the wealth of literature that has become available about medical cannabis today.
What we may need to first understand is what cannabis is and what is the endocannabinoid system.
Cannabis, also called marijuana, refers to a group of plants (Cannabis sativa, Cannabis indica and cannabis ruderalis) with psychoactive properties – meaning, a plant that affects how the mind works. A native of central Asia, this plant has been grown and cultivated in China since 6000 B.C.
It is made up of 400 to 500 components, including more than 100 cannabinoids that have been identified to date.
Cannabinoids are the chemical ingredients produced by the cannabis plant.
The two most researched and studied cannabinoids produced by the cannabis plant are delta-9-tetrahydrocannabinol (known as THC) and cannabidiol (known as CBD).
Both THC and CBD have long been the subject of scientific study and deeper investigation into their pharmacologic properties.
Tetrahydrocannabinol vs Cannabidiol:
THC (tetrahydrocannabinol) is the cannabinoid known to cause psychoactive effects such as euphoria or the ‘high’ sensation derived from cannabis. The side effects of short-term or chronic, regular use of cannabis are directly related to the THC content.
Studies have shown that THC is primarily used to relieve chronic pain conditions, inflammation, sleep disturbances such as insomnia and have been beneficial as an appetite stimulant in cancer and HIV/AIDS patients.
On the other hand, CBD (cannabidiol) has been shown to have a protective and moderating effect on pain, anxiety, depression, appetite and other brain activities.
It works in concert with THC in the central nervous system but has the added protective effect against certain negative psychological effects of THC.
CBD helps regulate the ‘high’ sensation and reduces the paranoia caused by THC.
Although CBD, technically, is also psychoactive (affects how the mind works),
it does not result in euphoria or intoxication.
What is the Endocannabinoid System (ECS)?
The endocannabinoid system plays a significant role in maintaining homeostasis
(a state of equilibrium in living systems). It is present nearly everywhere in the human body and is involved in many processes including memory, mood, sleep, pain sensation and appetite.
The ECS produces substances chemically similar to those found in cannabis.
These substances carry messages to/from the brain and to the rest of the body through nerve cells and receptors (usually cell surface protein receptors).
This system plays a critical role in human survival, as it affects the balance in
the endocrine system, brain functions and our immune system.
Some diseases affect the proper functioning of the body’s endocannabinoid
system. This is where medical cannabis becomes helpful, when the cannabinoids (THC and CBD) supplement and subsidize the chemicals normally produced by the ECS.
The Difference Between Medical and Recreational Marijuana
Historically, in 2001, Canada became the first country to offer medical marijuana to eligible patients. Seventeen years later, in October 2018, the federal government legalized recreational marijuana through the full implementation of the Cannabis Act.
What mainly differentiates medical from recreational cannabis/marijuana?
- Medical cannabis is used for the treatment of various medical symptoms
and conditions. - Medical cannabis usually contains a higher CBD content than recreational cannabis. Popular medical cannabis preparations tend to have a 2:1 or 1:1 ratio (ratio of CBD to THC) versus recreational cannabis which contains a much higher ratio of THC to CBD.
This explains why recreational cannabis produces the psychoactive effect
of being ‘high’ and euphoric. - Medical cannabis must be recommended/prescribed by a medical practitioner. This means you need to have a medical reason/indication to qualify for its prescription, use and renewal via Licensed Producers (LPs).
Recreational cannabis, on the other hand, can be bought by anyone,
depending on the governing laws in a certain jurisdiction.
What is Medical Cannabis Used For?
Some of the common medical conditions for medical cannabis use are noted below.
- Appetite loss (for HIV and cancer patients)
- Alzheimer’s disease
- Crohn’s disease
- Cancer
- Eating disorders
- Mental health conditions (such as in depression due to chronic conditions)
- Muscle spasms
- Multiple sclerosis (for symptomatic relief of neuropathic pain in adults with MS)
- Pain (such as in cancer related and non-cancer related pain)
- Nausea (for chemotherapy patients)
- Insomnia (due to chronic conditions)
A Medical Practitioner will help evaluate how much to prescribe, how often/ duration of therapy, route of administration (vape, smoke or oral intake) including monitoring of side effects and adverse effects related to the components of medical cannabis.
Under Health Canada’s Access to Cannabis for Medical Purposes Regulations
(ACMPR), the regulating body of medical cannabis industry in Canada, only an
authorized healthcare practitioner may prescribe medical cannabis.
What Are the Most Common Side Effects of Cannabis Use?
People have different responses to therapy. A careful discussion of expected side effects, noted below, may help improve compliance.
- Red eyes
- Dry mouth and throat
- Feeling light-headed and faint
- Increases in appetite/ heart rate
- Changes in blood pressure, balance and stability
- Drowsiness /restlessness
- Cognitive impairment
- Impairment in reaction time (affecting a person’s ability to operate heavy
machinery or drive) - Euphoria/ relaxation
Although medical cannabis has gained momentum and explosive marketing in recent
years, it should not be regarded as the first line therapy for medical conditions and
related symptoms. It may be indicated in certain patient groups, yet contraindicated in others. It is potent with a thoroughly elucidated health risks profile in clinical trials.
The takeaway is that it is not for everyone. A careful patient evaluation/history is necessary to safely assess appropriateness of use.
The future of medical cannabis is still full of possibilities.
In current practice, it is best regarded as a therapeutic armamentarium, promising in alleviating conditions/ symptoms refractory to treatment.
Note: Please consult your Medical Practitioner for full information on medical cannabis.
This article does not replace professional medical advice.
References:
Health Canada, Information for Healthcare Professionals
National Association of Pharmacy Regulatory Authorities (NAPRA)
Center for Addiction and Mental Health
Multiple Sclerosis Society of Canada