Jewel
My last article on medical marijuana touched on its history, its psychoactive compounds and two examples of drugs licenced for use in the UK. This blog post will touch on the endocannabinoid system (what it does and how it works), restraints on medical marijuana research and risks associated with its use.
The endocannabinoid system (ECS) is a complex network of receptors, neurotransmitters and enzymes that play a vital role in maintaining homeostasis within the body. It was named as such due to the fact it was discovered in the 1990s during research on the effects of cannabis on the body. ECS primarily consists of 2 types of cannabinoid receptors: CB1 and CB2. CB1 receptors are primarily found in the central nervous system while CB2 receptors are predominantly located in immune cells and peripheral tissues. The ECS modulates functions such as mood, appetite, pain sensation, immune response and sleep cycles to just name a few.
Endocannabinoids are naturally occurring neurotransmitters that help with many bodily functions- they are produced by the body on demand (which makes it challenging to establish standard levels). The main endocannabinoids identified are anandamide (AEA) and 2-arachidonoylglycerol (2-AG). Experts suspect that there may be more- but their functions and roles remain uncertain.
Endocannabinoids can bind to either cannabinoid receptor, resulting in various outcomes depending on the receptor’s location in the body- for instance, they might interact with CB2 receptors in immune cells, indicating inflammation or they might interact with CB1 receptors in spinal nerves to alleviate pain. The body regulates blood sugar, temperature and appetite in homeostasis- experts believe that if the body strays out of the normal range for these, the ECS assists in restoring them to the optimal range and preserving homeostasis.
THC mimics the effects of endocannabinoids, primarily interacting with CB1 and CB2 receptors within the ECS (however it does actually have a higher affinity for CB1 receptors). Once bound, the receptors are active, leading to a cascade of cellular responses that produce various effects. These can include euphoria, altered perception, relaxation and appetite stimulation. Also, THC can modulate the release of neurotransmitters such as dopamine and serotonin- these play key roles in mood regulation and reward pathways. It is these interactions with the ECS that are utilised for therapeutic purposes- for example, nabilone is believed to work by interacting with CB1 receptors in the CNS and inhibiting serotonin release in certain parts.
Unlike THC, CBD has a low affinity for CB1 and CB2 receptors and doesn’t directly bind to them. Instead, CBD modulates the ECS indirectly. For example, it may inhibit the breakdown of endocannabinoids- leading to higher levels of these neurotransmitters in the body and prolonged signalling and responses
However, legal and regulatory barriers pose significant challenges to research on medical marijuana. In the UK, it is currently classified as a Class B drug, however, in 2018 cannabis-based medicinal products were rescheduled to Schedule 2 of the Misuse of Drugs Regulations 2001. This allowed specialist doctors to legally prescribe the cannabis-based medicinal products (and others) mentioned. Nonetheless, access to medical cannabis remains tightly regulated and prescriptions are typically reserved for patients that fit strict criteria.
Whilst medical marijuana has shown promise in treating certain medical conditions, it is important to consider the risks associated with its use. THC can cause intoxication, impairment and cognitive side effects such as memory loss, impaired judgment and altered perception, furthermore, those who have a past or pre-disposition of mental illness may be susceptible to anxiety, depression and even developing psychotic illnesses such as schizophrenia. Importantly, regular marijuana usage in adolescents has been associated with impaired cognitive development and memory alongside an increased risk of mental health disorders later in life. This highlights the need for strict regulation of medical cannabis to ensure patient safety, appropriate dosing and access to standardised, quality-controlled products.
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