Higher Cannabis Education – Bridging the Clinical Gap

Cannabis and its role as a medicine is gaining prevalence, despite a distinct lack of governmental recognition of its true medicinal value. Isn’t it about time doctors, all those professionals with their knowledge purportedly rooted in science and reality, gain an adequate Cannabis education? How else can doctors possibly give their patients guidance? Every health expert should know about the Endocannabinoid System (ECS) and that almost every living creature with vertebrae has one. Named after the plant that led to its discovery, Cannabis, the Endocannabinoid System is one of the most widespread and powerful physiological control systems in the human body. It helps balance nearly every metabolic process in the body, from fertility to pain perception to emotion and so much more.
endocannabinoid-homeostasis
Pointedly, several different chronic diseases and conditions are thought to be a direct result of an ECS imbalance or dysfunction. Understanding how the ECS works with respect to both our endogenous (from within) cannabinoids (endocannabinoids) and those exogenously (externally) produced, like in the Cannabis plant (phytocannabinoids), is undeniably vital to human physiology. Given its significance, most conventional health professionals know very little about Cannabis and ECS science. An independent survey by Dr David Allen, an American 30-year veteran heart and general surgeon, showed only 13.3% of the 157 accredited US medical schools taught or offered any type of endocannabinoid and/or Cannabis education. Dr Allen himself claims the ECS is the “single most important discovery in modern medicine since the recognition of sterile surgical technique”.Image result for ECS is the single most important discovery in modern medicineWith such little Cannabis education, it’s no wonder most doctors are so ill-equipped to effectively treat patients with Cannabis. The inability of physicians to guide patients in regard to Cannabis is essentially creating a “clinical gap” between patient and provider.  Cannabis is a versatile yet relatively safe and sophisticated living medicine. Millions worldwide turn to it for relief for numerous ailments every single day. Cannabis breaks the boundaries and limitations of single-molecule synthetic drugs and trumps other plant species with its intra-species diversity and vast clinical applications. For many patients however, navigating the waters of Cannabis therapy can be frustrating and difficult without expert, educated medical guidance on how to approach Cannabis treatment. While knowing that “CBD is good for inflammation” for example, educated Cannabis physicians will understand the lipophilic (“fat-loving”) nature of cannabinoids like CBD, and how they must be used consistently to allow for its “accumulation” in one’s body. The truth is, Cannabis is a complex and tricky plant.

tetrahydrocannabinol

Sceptics continue to decry, “there isn’t enough research!” Yes, we do need more research around Cannabis. Yet, we already know more about it than most realise. Go to PubMed.gov (US repository for medical literature) and you’ll find over 28,000 studies published on Cannabis, whilst the likes of Ritalin will give over 8,600 results. Aside from this, Cannabis has been recognised as a medicine for thousands of years. Prohibition is fairly recent compared to that and is backed by zero science.  Prohibition also fails to account for the body’s own Endocannabinoid System and how Cannabis has proven to be an excellent supplement for this system, relieving many different types of ailments and conditions. Countries like Israel are light years ahead in their Cannabis research and clinical experience. Image result for israel cannabis researchCannabis has a lot of catching up to do when it comes to large-scale, double-blind, placebo-controlled trials. However, we know enough about the plant and the Endocannabinoid System that this shouldn’t prevent us from embracing it now. The only way we can begin to optimise cannabinoid therapy for patients is by breaking the mould and integrating Endocannabinoid and Cannabis education into the medical curriculum, as well as those in other sectors of healthcare (e.g. nurses etc). In the US, while the DEA continues to stonewall research attempts due to federally restrictive scheduling of Cannabis, there is absolutely nothing stopping allopathic medical schools from teaching future doctors what we do know about the Endocannabinoid System (which is a lot). American Osteopathic and Naturopathic medical schools have already begun, putting them at a clear advantage over their allopathic counterparts.    0000ECSandBodilySystems

The Endocannabinoid System is arguably involved in almost every physiological and biological process involving who we are and the status of our health. We can either pretend this incredibly significant element of the human body doesn’t exist (not recommended), or we can do something about it and start implementing evidence-based Cannabis education into healthcare curriculums around the world. Patients deserve the best, safest and most effective care medicine has to offer. Humanity deserves the opportunity to continue its pursuit of knowledge of the biomechanical and physiological workings of the human body. The mainstream medical community can no longer stand on the sidelines as they do in the US, simply authorising patients for a ‘medical cannabis’ card is not enough. The time to bridge this clinical gap is now; not just for the sake of the patients and physicians, but for all of us.

Adapted from Higher Education: Bridging the Clinical Gap in Medical Cannabis

top

Advertisements

The Endocannabinoid System For Beginners

The Endocannabinoid System is made up of neurons, endocannabinoids and cannabinoid receptors. There are nerve cells called neurons throughout the brain and body which are linked together by neurotransmitters. These neurotransmitters are molecules called agonists that move from one neuron to another through the minute space between them, which is called the synapse. The agonists plug into neural receptors, causing a chain reaction. In the case of the Endocannabinoid System, these receptors are called CB1 (Cannabinoid receptor 1) and CB2 (Cannabinoid receptor 2). CB1 receptors are mainly found in the brain, with some in the liver, lungs and kidneys. CB2 receptors are found throughout the body. There are more cannabinoid receptors in the brain than any other type of neural receptor and a common analogy is that the agonists are keys and the receptors are locks.


The Endocannabinoid System sends signals within the brain and around the body.
Cannabinoids transmit signals from one neuron to another.
CB1 = Cannabinoid Receptor 1, found mostly in the Brain
CB2 = Cannabinoid Receptor 2, found mostly in the BodyCB1-CB-2-receptors-1024x1024


The Endocannabinoid System is activated by cannabinoids. The cannabinoids naturally produced by the body, which are known as endocannabinoids, and cannabinoids found in Cannabis, known as phytocannabinoids. The key and lock analogy is based upon the CB1 and CB2 receptors only being activated by cannabinoids, not any other type of agonist molecule. The cannabinoid ‘keys’ are the only ones that will fit the receptor ‘locks’.

Phyto = prefix meaning a plant or plants
Endo = prefix meaning within or inside
Phytocannabinoids, also called classic
cannabinoids, 
come from plants

Endocannabinoids come from inside the body

CB1 receptors are activated by the phytocannabinoid, tetrahydrocannabinol or THC, so when the ‘head-rush’ effect caused by sativa-dominant, THC-heavy strains is mentioned, there’s a literal quality to that statement! CB2 receptors are activated by the phytocannabinoid cannabidiol or CBD, giving a relaxing, body-centric effect. This makes the location of, and difference between, the two receptors easy to remember!

CB1 = THC = head
CB2 = CBD = body

Image result for homoeostasis
The Endocannabinoid System regulates the body’s systems to maintain homoeostasis: the state of balance necessary for healthy function. Homoeostasis can be thought of as the narrow range of states within which bodies work as they should. For example, blood sugar levels, internal temperature, pH levels of blood, regulation of water and minerals in the body and the removal of metabolic waste are all governed by homoeostatic processes.

endocannabinoid-homeostasis
Most agonists only travel in one direction. Cannabinoids are unusual in that they can travel both ways between neurons. This is known as a negative feedback loop. It is what makes the Endocannabinoid System such an essential system for most lifeforms. It tells the body when to begin a process (for example, sweating to cool down) but also when to stop it (otherwise we’d all be sweating constantly).
What is the endocannabinoid system and how does it work? Explained in an infographic.Bodies constantly make endocannabinoids to interact with their Endocannabinoid System, ensuring homoeostasis continues. If not enough endocannabinoids are created, it is thought  Clinical Endocannabinoid Deficiency may occur. It is also thought this can be treated by introducing phytocannabinoids, something humanity has been doing with varying degrees of therapeutic success since before recorded history.

Image result for endocannabinoid system homoeostasis


The reason Cannabis can treat so many different conditions is that the
Endocannabinoid System is spread throughout the body and responsible for
the correct functioning of so many different parts and aspects of it.


All vertebrates (creatures with a backbone) and invertebrates (creatures without a backbone) have an Endocannabinoid System. This explains why Cannabis products are having such success when used on pets and have the potential to treat a virtually unlimited number of species. There are a few species that don’t have one, such as sea sponges, nematode worms and anemones, since their evolution diverged so long ago. The earliest lifeform known to have cannabinoid receptors is the sea-squirt.  This primitive tube-shaped creature evolved more than 600 million years ago and vomits up its internal organs as a self-defence move! There is even a type of slime mould that “possesses a rudimentary endocannabinoid system”. You might think, since the Endocannabinoid System is so ancient, so vital and so common in lifeforms, it would have been discovered long ago. You would be wrong. The Endocannabinoid System was only confirmed in the form that we know it today (CB1 and CB2 receptors, triggered by two known endocannabinoids) in 1995!

1940 – CBD first isolated
1963 – CBD first synthesised
1964 – THC first synthesised
1988 – CB1 identified (in rats)
1991 – CB1 in humans successfully cloned
1992 – Anandamide, the first endocannabinoid, discovered in human brain
1993 – CB2 identified in humans and successfully cloned
1995 – 2-AG, the second endocannabinoid, discovered

The phytocannabinoid CBD was first isolated in 1940, but not until 1963 did Professor Raphael Mechoulam and his team discover its chemical structure and successfully synthesise it. Their feat was replicated with THC a year later. In 1988, the first Cannabis receptor was identified, and in 1993, the second. The first endocannabinoid, Anandamide, was only discovered in 1992 and the second, 2-Arachidonoylglycerol, known as 2-AG, followed in 1995. Professor Mechoulam, said, with simple eloquence:

“By using a plant that has been around for thousands of years, we discovered
a new physiological system of immense importance … We wouldn’t
have been able to get there if we had not looked at the plant”.

Image result for endocannabinoid system
Adapted from What is the endocannabinoid system and how does it work? A beginner’s guide
top

How Cannabis Works to Control Pain and Anxiety

Image result for the limbic system

The Limbic System

Cannabis is well known as a herbal painkiller, but is also increasingly being used in other conditions involving the limbic system, sometimes referred to as the mid or so-called reptilian brain. So, just how does Cannabis cause these effects? Cannabis contains over 500 compounds, 80 of which are cannabinoids. Many of these compounds have medicinal value and research continues to provide more knowledge about how they work. The medicinal effects of Cannabis are mediated by the Endocannabinoid System (ECS). The system includes two neurotransmitters (anandamide and 2AG) two receptors (CB1 and CB2) and two enzymes (MAGL and FAAH). The ECS is responsible for modulating neurotransmission and cannabinoids regulate the ECS. There are two types of cannabinoids, those produced by the human body, endogenous cannabinoids, and those sourced from the Cannabis plant, the phytocannabinoids. An increase in cannabinoids, either endogenous or phyto, increases the amount of the neurotransmitter dopamine to the brain.

endocannabinoids

Cannabinoids work differently to any other neurotransmitter. Instead of stimulating the next neuron on the pathway up the central nervous system, endocannabinoids actually double back to the presynaptic neuron from the post synaptic neuron they just stimulated and de-polarise the pre-synaptic neuron. This is referred to as retrograde inhibition. This depolarisation of the pre-synaptic neuron occurs by causing release of dopamine, which reverses the concentration of sodium and potassium inside and outside the cell. This depolarisation makes it harder for the pre-synaptic neuron to be stimulated by the next neural impulse being transmitted by the nervous system. The effect of this is a slowing down of neurotransmission which is ideal in pain management and control.

Image result for retrograde inhibition

Endocannabinoid Retrograde Inhibition

Migraines are caused by an overload of the electrical circuits in a certain part of the brain, so slowing down the speed of neurotransmission leads to fewer neural impulses. This in turn decreases the likelihood or severity of a migraine. That is not the only effect, CaImage result for reptilian brainnnabis is an anti-nauseant as well, but probably exerts that effect in some other manner. The same thing is true of people who have panic attacks, if the negative thoughts are moving to the brain at warp speed, the limbic system (emotional control centre of the brain), is overwhelmed and there is little or no time for the frontal cortex to override the more primitive mid or reptilian brain. This makes us more likely to act before we think. That is because the reptilian brain sees things in terms of black and white, life and death. This mechanism may have served our ancestors well in the time of sabre-toothed tigers, but in modern day it is more often not very helpful. Much in modern life is shades of grey and more nuanced than life and death.

Cannabis slows down the speed of neurotransmission, exposing the cerebral cortex to fewer slower moving neural stimuli. This allows the higher centres of the brain to more rationally assess relative danger or the negativity and put a more rational point of view on that sensory input, often taking the edge off anxiety or preventing a panic attack. In medical school, doctors are taught 70% of the brain exists to turn off the other 30%. Dopamine is one of the “off switches” that helps modulate sensory input. One suggestion is that Cannabis and cannabinoids increase the amount of free dopamine in the brain by preventing the dopamine from binding to another neurochemical dopamine transporter. The transporter and dopamine form an electrochemical bond that ties up the dopamine so that it is not free to act as an “off switch”. These cannabinoids replace the dopamine and the amount of free dopamine available to depolarise the presynaptic neuron also increases.

dopamine

And that’s just pain and anxiety. There are a host of conditions that appear to be tied to an endocannabinoid deficiency syndrome that has been postulated by such scientists as pharmacologist Danielle Piomelli, PhD and neurologist, Ethan Russo, MD. The possible cause of an endocannabinoid deficiency syndrome is most likely genetic and due to the fact that most, if not all, human characteristics are distributed on a bell shaped curve – some of us have less of the constituents of the ECS and some have more. It is not clear that is the explanation or the only explanation for Clinical Endocannabinoid Deficiency  (CECD), however, if there is a lower amount of free dopamine present in the brain, neural impulses will likely move more rapidly.

Image result for endocannabinoid deficiency syndrome

This mechanism of slowing the speed of neurotransmission, retrograde inhibition, contributes to the treatment of many conditions that respond to cannabinoids and Cannabis. Cannabinoids compete with dopamine for the binding sites on the dopamine transporter, and in sufficient quantity they win, which frees up more dopamine to slow down the speed of neurotransmissions. This, according to many cannabinoid researchers, is responsible for much of the therapeutic value of Cannabis in such conditions as migraines, seizure disorder, ADD, ADHD, Crohn’s disease, Irritable Bowel Syndrome (IBS), Social Anxiety and Autism Spectrum Disorder, to name some of the more obvious.

Adapted from How Cannabis Works to Control Pain and Anxiety by Dr David Bearman, with Granny Storm Crow’s List and Hemp Edification

top