What is Medicinal Cannabis?
Medicinal cannabis is a medication that comes from the cannabis plant. The cannabis plant contains 80 to 100 cannabinoids of which two of these are Tetrahydrocannabinol (THC) and Cannabidiol (CBD). Currently there are over 100 different manufactured medicinal cannabis products available in Australia. Alternatively Medicinal cannabis can also be compounded. They come in various forms such as oils, pills, capsules and dried flower products.
Current indications for the use of medicinal cannabis include the following;
Side effects of Medicinal Cannabis
Side effects can inclue difficulty in concentrating, dizziness, drowziness, issues with balance, issues with thinking and memory, vertigo, nausea and vomitting, fever, decreased or increased appetite, dry mouth and diarrhoea. The aforementioned can be caused by both THC and CBD. THC use is mainly associated with the sedating, psychotropic side effects such as, convulsions, feeling high or feeling dissatisfied, depression, confusion, hallucinations, paranoid delusions, psychosis or cognitive distortions (having thoughts that are not true)
Can I drive whilst taking Medicinal cannabis?
Patients should not drive or operate machinery whilst being treated with medicinal cannabis, specifically with any medications containing THC. THC, the main psychoactive substance in cannabis, can be detected in urine many days after initial dose. It take 5 days for 80% to 90% of the initial dose to be excreted. Drug-driving is a criminal offence and patients should be aware of the implications of taking medicinal cannabis. CBD only formulations, whilst don't contain THC and have little psychoactive effect can still cause adverse effects (as aforementioned) that may warrent caution whilst driving or operating machinery.
How does Medicinal cannabis work? What is the Endocannabinoid System?
It is believed that cannabinoid molecules found in cannabis interact in our body via the Endocannabinoid system. The Endocannabinoid system (ECS) is a complex cell-signaling system that has functions in regulating sleep, mood, appetite, memory, reproduction and fertility, chonic pain, muscle formation, liver function, stress, learning, digestion and inflammation. This system exist in the body even if you do not consume cannabis. It is through endogenous cannabinoids or endocannabinoids (Cannabinoids that are produced by our bodies) that the ECS is modulated. Anandamide (AEA) & 2-arachidonoylglycerol (2-AG) are a couple examples of endocannabinoids.
The system also has Endocannabinoid receptors that allow signaling to occur. CB1 receptors are mainly found in the central nervous system (CNS) and CB2 receptors are found in the peripheral nervous system (PNS) especially in immune cells.
At current, THC and CBD interact with the above receptors resulting in various actions in the ECS. There are other cannabinoids other than THC and CBD. Below is a diagram showing a few others and their functions.
Above: List of actions associated with the cannabinoids. Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol 2011;163(7):1344–64. Upton R, ElSohly M, Romm A, et al (eds). Cannabis inflorescence. Scotts Valley, CA: American Herbal Pharmacopoeia; 2013. Elsohly MA, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci 2005;78(5):539–48. Howard P, Twycross R, Shuster J, et al. Cannabinoids. J Pain Symptom Manage 2013;46(1):142–9.
What are terpenes?
Terpenes can be considered as molecules of essential oil base. Terpenes are the molecules that are responsible for the differing scents and tastes in the various strains of cannbis. They exhibit different and diverse effects; interacting with cell membranes, enzymes, second messenger systems etc. Examples of such terpenes are as follows.
Above: List of actions associated with the terpene class Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol 2011;163(7):1344–64. Upton R, ElSohly M, Romm A, et al (eds). Cannabis inflorescence. Scotts Valley, CA: American Herbal Pharmacopoeia; 2013. Noma Y, Asakawa Y. Biotransformation of monoterpenoids by microorganisms, insects, and mammals. In: Baser K, Buchbauer, G (eds). Handbook of essential oils: science, technology, and applications. Boca Raton, FL: CRC Press; 2010.
What is the Entourage effect?
The Entourage effect is the concept of multiple phytochemicals having synergistic effects on each other. With regards to Cannabis, terpenes, cannabinoids, flavanoids and other components in Cannabis have an overall effect on the outcome of the specific strains. This concept of synergy and augmentation of differing components on varying effects is a common principle in naturopathic and herbal practitioners. With this in mind, varying the ratio and types of Terpenes in a CBD tincture can augment the effect a tincture/blend towards sedation or anti-anxiety or anti-inflammatory as an example. THC and CBD have an entourage effect on each other, hence THC is usually blended with CBD and not given independantly. Understanding the Entourage effect highlights the following synergistic mechanisms;
With varying blends of Terpenes, cannabinoids and other phytochemicals, the above can be changed to have a more targeted approach to treatment.