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5 Things You Need to Know About Medical Cannabis

5 Things You Need to Know About Medical Cannabis

Medical cannabis has gained much attention in recent years. As a result, health care providers and the public are increasingly interested in understanding how cannabis might work as a therapeutic agent. 

The stigma around medical cannabis has been decreasing worldwide, with more research underway to further understand the medical properties of the compounds found in cannabis (Baron, 2018). 

But medical cannabis is nothing new - in fact, the first evidence of medical cannabis use was found in written form in the 1st century BCE China. 

Today, there are many types of medical cannabis products available. They range from smoking or vaping dried cannabis to ingestible formats such as oils, capsules, and gummies. 

If you are a new medical cannabis patient, you might have many questions about the cannabis plant itself, the various compounds (cannabinoids and terpenes) found within and how they may provide benefit. 

This article will tackle the most common facts that you should know as a new medical cannabis patient or curious to learn more. 

1. There is a difference between THC and CBD.

Cannabis contains over 100 cannabinoids and up to 200 terpenes, depending on the cannabis plant variety, with ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD) thought to be responsible for the majority of the physiological effects induced by cannabis (Baron, 2018). 

While they are currently the most studied, THC and CBD are not produced in large amounts directly by the plant. Instead, cannabis synthesizes the acid forms of THC and CBD called tetrahydrocannabinolic acid (THCA) and cannabidiolic acid (CBDA), respectively. Upon heating these compounds to ~110°C, they become THC and CBD (Perrotin-Brunel et al., 2010).  

THC: 

THC is the main intoxicating molecule in cannabis and gives rise to the euphoria associated with being “high”. In addition, THC has the potential to relieve pain, inflammation and nausea/vomiting  (Baron, 2018). 

Intoxicationa condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgement, affect, or behaviour, or other psychophysiological functions and responses (WHO, 2010). 

CBD: 

CBD has rapidly come to prominence in medical applications due to its unique therapeutic profile and effects. CBD is non-intoxicating at therapeutically relevant doses and may reduce pain, anxiety and inflammation (Baron, 2018). It has also been shown to be an effective anti-epileptic (Lattanzi et al., 2018). 

Terpenes: 

Terpenes are the largest group of phytochemicals and are found in many different plants, not just in cannabis (Baron, 2018). Therefore, the terpene profile of a cannabis plant not only determines the scent and flavour of a product but may also influence how each cannabis cultivar impacts each person.

Cannabis Cultivarcultivar, or “cultivated variety”, is a cannabis variety that has been developed and approved for production and sale to patients and consumers.  

Terpenes may have medicinal properties of their own, in addition to working with CBD, THC, and other cannabinoids to produce the overall therapeutic effect of a product (Baron, 2018; Russo, 2011). Research is ongoing in this area to fully understand the effects of terpenes. 

Cannabinoid-derived therapies range from isolates of cannabinoids (such as a CBD isolate that solely contains CBD) to extracts, which include different ratios of cannabinoids and terpenes specific to each cannabis cultivar. 

Individual compounds, such as THC and CBD, have been shown to have many potential therapeutic benefits. However, recent studies have also suggested additive, therapeutic effects when the different compounds are combined. This hypothesis is also known as the Entourage Effect (Baron, 2018; Russo, 2011). 

For example, preclinical studies examining the anti-inflammatory effects of CBD found that extracts of CBD are more effective at reducing pain and inflammation than CBD isolates (Comelli et al., 2008; Gallily et al., 2015).   

Furthermore, in cultured brain cancer cells, THC and CBD together showed a synergistic effect in reducing cancer cell growth. However, the compounds independently did not have any effect (Torres et al., 2011). 

2. Cannabinoid receptors play a significant role in how medical cannabis functions.

To understand the effects experienced from consuming cannabis, we first need to learn about cannabinoids and how they function within our bodies.  

Cannabinoids are a class of diverse chemical compounds, which include endocannabinoids, phytocannabinoids and synthetic cannabinoids. 

Endocannabinoids are part of the physiological system called the endocannabinoid system (ECS) and interact with many different protein targets throughout the body to elicit their effects (Aizpurua-Olaizola et al., 2017; De Petrocellis & Di Marzo, 2009).   

Some examples of functions the ECS regulates include learning and memory processes, sleep, stress, emotions, pain and immune responses (Aizpurua-Olaizola et al., 2017). 

Phytocannabinoids, such as THC and CBD, and synthetic (man-made) cannabinoids, such as dronabinol and nabilone, interact with many of the same protein targets that endocannabinoids do. This is why their effects overlap with the activities of the ECS. 

3. Medical cannabis offers an alternative treatment for several medical conditions.

Though research is still ongoing, there is growing scientific evidence that medical cannabis can be an effective adjunct treatment for several medical conditions. 

Examples of symptoms/medical conditions where medical cannabis may be helpful are: 

• Mental health issues such as anxiety (Bergamaschi et al., 2011) or PTSD (Cahill et al., 2021) 

• Chronic pain (Bellnier et al., 2018; Cahill et al., 2021; Ware et al., 2015)

• Arthritis related symptoms (Cahill et al., 2021)

• Multiple sclerosis (MS) (United States of America’s National Academies of Sciences, 2017) 

• Cancer pain (Johnson et al., 2010) and chemotherapy-induced nausea and vomiting (Duran et al., 2010) 

• Epilepsy (Devinsky et al., 2019; Huntsman et al., 2019; Laux et al., 2019) 

      There are many other benefits of medical cannabis that may not have been mentioned above. And it is essential to remember that the ratio of THC:CBD and product format will influence the affects you experience when consuming cannabis products.  

      Be sure to talk to your healthcare provider about which medical cannabis product is right for you and your medical condition. You can view the recent publications and read about them here.

      4. There are many laws and regulations around medical cannabis that control its quality and use. 

      Since the legalization of medical cannabis in Canada in 2001, many laws and regulations have been put in place to ensure that medical cannabis patients access the best quality medicine. 

      Currently, Health Canada administers the Cannabis Act and Regulations, and authorizes and licenses indoor and outdoor cultivation, processing and sale (for medical purposes).  

      Licensed producers have to adhere to proper quality  and sanitation control measures before products can enter the market. You can read about regulations surrounding cannabis producers here.

      Health Canada also regulates individuals who require access to medical cannabis, specifically how they get access to their medicine. With authorization from a health care provider, medical cannabis patients can: 

      • Buy from a licensed producer 

      • Register with Health Canada to produce limited amounts

        5. There are many ways you can consume your medical cannabis besides smoking.

        Smoking or vaping cannabis may be two of the most well-known ways to consume cannabis. But you can also consume cannabis through oils, capsules, and other edibles and there are even cannabis creams you can use. 

        Each product format can lead to different onset and duration of effects. Thus, typically, the desired outcome will determine how a patient will administer their medical cannabis. 

        Vaping or smoking cannabis leads to a quick onset of effects (within seconds to minutes). These effects peak within 30 minutes and can last up to 6 hours (Minister of Health & Health Canada, 2017).  

        Alternatively, edible cannabis products can take up to 2 hours to have their effects, peaking within 4 hours. However, those effects can last up to 12 hours (Minister of Health & Health Canada, 2017).  

        So, if you want to feel the effects more quickly, smoking or vaping cannabis products is probably best. However, if you are more concerned with the effects lasting longer, an edible cannabis product would be the better choice. 

        Want to target a specific area of your body? Or simply not comfortable with the idea of smoking or ingesting cannabis? You can also try cannabis topicals. 

        Regardless of how you decide to use medical cannabis, it is best to start with a low dose and increase the dose slowly over time until you find the correct dose for you. Always remember to talk to your healthcare practitioner to help you choose the correct cannabinoid ratio and product for you. 

        At the end of the day, there’s no perfect way to consume cannabis - it all depends on your needs, preferences, and desired outcome. 

        Next Steps:

        If you have questions about medical cannabis, reach out to your healthcare practitioner. They are best suited to help you understand how cannabis may support your health. 

        If you still have any questions or want to learn more, you can call our Client Care team at 1-877-9AURORA MEDICAL (1-877-928-7672) or email askus@auroramedical.com. If you are looking to get a prescription, you can book an online appointment with our clinic partner, Canadian Cannabis Clinics.

        A qualified healthcare practitioner can determine if medical cannabis is right for you through a free online consultation and fill out your medical document. It’s quick and easy - you can book your appointment right here.



        References:
         

        Aizpurua-Olaizola, O., Elezgarai, I., Rico-Barrio, I., Zarandona, I., Etxebarria, N., & Usobiaga, A. (2017). Targeting the endocannabinoid system: future therapeutic strategies. Drug Discovery Today22(1), 105–110. https://doi.org/10.1016/j.drudis.2016.08.005 

        Baron, E. P. (2018). Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain : An Update on Current Evidence and Cannabis Science. Headache Currents58, 1139–1186. https://doi.org/10.1111/head.13345 

        Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. The Mental Health Clinician8(3), 110–115. https://doi.org/10.9740/mhc.2018.05.110 

        Bergamaschi, M. M., Queiroz, R. H. C., Chagas, M. H. N., de Oliveira, D. C. G., De Martinis, B. S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi, A. E., Martín-Santos, R., Hallak, J. E. C., Zuardi, A. W., & Crippa, J. A. S. (2011). Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology36(6), 1219–1226. https://doi.org/10.1038/npp.2011.6 

        Cahill, S. P., Lunn, S. E., Diaz, P., & Page, J. E. (2021). Evaluation of Patient-Reported Safety and Efficacy of Cannabis From a Survey of Medical Cannabis Patients in Canada. Frontiers in Public Health9, 626853. https://doi.org/10.3389/fpubh.2021.626853 

        Comelli, F., Giagnoni, G., Bettoni, I., Colleoni, M., & Costa, B. (2008). Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain: mechanisms involved. Phytotherapy Research22(8), 1017–1024. https://doi.org/10.1002/ptr.2401 

        De Petrocellis, L., & Di Marzo, V. (2009). An introduction to the endocannabinoid system: from the early to the latest concepts. Best Practice & Research Clinical Endocrinology & Metabolism23(1), 1–15. https://doi.org/10.1016/j.beem.2008.10.013 

        Devinsky, O., Nabbout, R., Miller, I., Laux, L., Zolnowska, M., Wright, S., & Roberts, C. (2019). Long-term cannabidiol treatment in patients with Dravet syndrome: An open-label extension trial. Epilepsia60(2), 294–302. https://doi.org/10.1111/epi.14628 

        Duran, M., Pérez, E., Abanades, S., Vidal, X., Saura, C., Majem, M., Arriola, E., Rabanal, M., Pastor, A., Farré, M., Rams, N., Laporte, J.-R., & Capellà, D. (2010). Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. British Journal of Clinical Pharmacology70(5), 656–663. https://doi.org/10.1111/j.1365-2125.2010.03743.x 

        Gallily, R., Yekhtin, Z., Ond, L., & Ondřej Hanuš, L. (2015). Overcoming the Bell-Shaped Dose-Response of Cannabidiol by Using Cannabis Extract Enriched in Cannabidiol. Pharmacology & Pharmacy6, 75–85. https://doi.org/10.4236/pp.2015.62010 

        Huntsman, R. J., Tang-Wai, R., Alcorn, J., Vuong, S., Acton, B., Corley, S., Laprairie, R., Lyon, A. W., Meier, S., Mousseau, D. D., Newmeyer, D., Prosser-Loose, E., Seifert, B., Tellez-Zenteno, J., Huh, L., Leung, E., & Major, P. (2019). Dosage Related Efficacy and Tolerability of Cannabidiol in Children With Treatment-Resistant Epileptic Encephalopathy: Preliminary Results of the CARE-E Study. Frontiers in Neurology10, 716. https://doi.org/10.3389/fneur.2019.00716 

        Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC: CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008 

        Lattanzi, S., Brigo, F., Trinka, E., Zaccara, G., Cagnetti, C., Del Giovane, C., & Silvestrini, M. (2018). Efficacy and Safety of Cannabidiol in Epilepsy: A Systematic Review and Meta-Analysis. Drugs78(17), 1791–1804. https://doi.org/10.1007/s40265-018-0992-5 

        Laux, L. C., Bebin, E. M., Checketts, D., Chez, M., Flamini, R., Marsh, E. D., Miller, I., Nichol, K., Park, Y., Segal, E., Seltzer, L., Szaflarski, J. P., Thiele, E. A., & Weinstock, A. (2019). Long-term safety and efficacy of cannabidiol in children and adults with treatment-resistant Lennox-Gastaut syndrome or Dravet syndrome: Expanded access program results. Epilepsy Research154, 13–20. https://doi.org/10.1016/j.eplepsyres.2019.03.015 

        Minister of Health, H. C., & Health Canada. (2017). Health effects of cannabis. www.ncbi.nlm.nih.gov/pubmed/22245559 

        Perrotin-Brunel, H., Verpoorte, R., Witkamp, G.-J., Spronsen, J. van, Roosmalen, M. J. E. van, Peters, C. J., & Buijs, W. (2010). Decarboxylation of Δ9-tetrahydrocannabinol: Kinetics and molecular modelling. Journal of Molecular Structure987(1–3), 67–73. https://doi.org/10.1016/j.molstruc.2010.11.061 

        Russo, E. B. (2011). Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology163(7), 1344–1364. https://doi.org/10.1111/bph.2011.163 

        Torres, S., Lorente, M., Rodríguez-Fornés, F., Hernández-Tiedra, S., Salazar, M., García-Taboada, E., Barcia, J., Guzmán, M., & Velasco, G. (2011). A combined preclinical therapy of cannabinoids and temozolomide against glioma. Molecular Cancer Therapeutics10(1), 90–103. https://doi.org/10.1158/1535-7163.MCT-10-0688 

        United States of America’s National Academies of Sciences, E. and M. (2017). The Health Effects of Cannabis and Cannabinoids : The Current State of Evidence and Recommendations for Research. http://eds.a.ebscohost.com.login.ezproxy.library.ualberta.ca/ehost/ebookviewer/ebook/bmxlYmtfXzE1MDAwMzBfX0FO0?sid=33b44e33-9e89-482c-9323-facf8f666fc5@sessionmgr4010&vid=0&format=EK&rid=1 

        Ware, M. A., Wang, T., Shapiro, S., Collet, J.-P., COMPASS study team, A., Esdaile, J. M., Gordon, A., Lynch, M., Moulin, D. E., & O’Connell, C. (2015). Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). The Journal of Pain : Official Journal of the American Pain Society16(12), 1233–1242. https://doi.org/10.1016/j.jpain.2015.07.014 

        WHO. (2010). WHO | Acute intoxication. WHO; World Health Organization. https://www.who.int/substance_abuse/terminology/acute_intox/en/ 

         

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