Raphael Mechoulam, an Israeli Pharmacologist, and his research partners kick started the research into the science of Cannabis in the 1960’s. They were able to isolate and study 2 main chemical constituents of the cannabis plant: Cannabidiol (CBD) which is non-psychoactive and, delta 9 Tetrahydrocannabinol (THC) which has a psychoactive effect. Further discovery led them to uncover our own endogenous cannabinoid system known as the ENDOCANNABINOID SYSTEM (ECS).
The ECS is a biological system composed of endocannabinoids, which are lipid-based retrograde neurotransmitters that bind to cannabinoid receptors (CB1 & CB2) located throughout the central and peripheral nervous system. These endocannabinoids play an important role in regulating our physiology, mood and memory. Dr. Mechoulam and his team identified 2 ECS ligands: Anandamide and 2-Arachidonoylglycerol (2-AG) with each having a phytocannabinoid (from the Cannabis plant) counterpart: THC & CBD respectively.
Anandamide is synthesized in the areas of the brain that are important in memory, thought process and, control of movement and, has a stronger affinity for CB1 receptors found predominantly in the brain. It’s phytocannabinoid counterpart is THC. 2-AG plays a role in immune system function and pain and, has a stronger affinity for CB2 receptors found predominantly in the peripheral nervous system. It’s phytocannabinoid counterpart is CBD.
Based on this physiologic insight, it is easier to understand how Cannabis can exert such vast therapeutic benefits such as; pain control, anxiolytic, anti-depressant, immune system modulation, increased appetite and anti-inflammatory to name a few.
Fortunately, CB1 & CB2 receptors are very sparse in the brain stem, thus there is no concern regarding lethal overdose. In addition, there are many ways to use cannabis such as topical, sublingual and oral administrations. However, there have been no studies linking smoking cannabis with lung cancer – but on the safe side, vaporizing cannabis which does not produce any combustion and, hence, potential for carcinogens, is preferred over smoking.
Caution should be used with patients with a history of anxiety, cardiovascular and, some mental health conditions as high concentrations of THC may cause anxiety, paranoia and, tachycardia in some. CBD is a P450 3A4 enzyme inhibitor at substantial doses (studies vary but indications of 25mg to 40mg and above) therefore caution should be used with medications that are substrates of this enzyme, especially the anxiolytics, hypnotics and opioids.
With regard to Cannabis and coagulation, studies are inconclusive as to whether or not cannabis induces anti-coagulation or vice versa. Therefore, caution should be exercised with a recommendation that cannabis medications be discontinued and re-introduced accordingly where interventions that could increase bleeding are being undertaken.
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