Editor’s note: This is the first article in a four-part series that will introduce you to the world of medical cannabis. In the series, we’ll cover: the endogenous cannabinoid system; the science behind medical cannabis; the plant’s chemical composition, including main components THC and CBD; the different varieties of cannabis and what they’re used for; delivery methods, dosing, interactions; and finally, cannabis advocacy and where we are in the fight to legalize medical cannabis in the United States.
As nurses, we are in a unique position. Not only do we advocate for our patients, we are active participants in each patient’s experience of health and illness. As nurses, we share relevant information with patients-about their medical conditions, treatment options and ways of coping with both.
Whether you work in one of the 25 states that allows the use of medical cannabis, work in one of the 17 states that has passed CBD-only laws, or work in a state that has no legislation at all, you need to understand the science behind the plant Cannabis sativa. Your patients deserve a nurse who is educated about the endogenous cannabinoid system (endocannabinoid system, or ECS) and how cannabis interacts with that system.
A Personal Interest
I have specialized in oncology my entire nursing career. I was already an experienced nurse when I began looking into alternative treatments for my sister’s spreading breast cancer. Upon hearing that cannabis had medicinal properties, I began researching its use and discovered the science of the ECS, a physiologic regulatory system that is responsible for maintaining balance within our body, especially with respect to how we eat, sleep, protect, forget and relax.1
Since that time, after seeing firsthand how the medicine eases pain and suffering, I have become a passionate advocate for medical cannabis.
A 3,000-Year History
Many people are surprised to learn that only during the past 76 years has cannabis not been a medicine in the United States. Humans have used cannabis to ease pain and suffering for more than 3,000 years. By the 19th century, cannabis showed up in many “tonics” and was considered to be something of a “cure-all” drug. Unfortunately, the potency of medicinal preparations was variable, and individual responses seemed unpredictable (or even erratic at times).2 While people understood that cannabis had healing properties, they didn’t understand how it worked.
In 1964, Israeli scientist Raphael Mechoulam and his colleagues isolated and synthesized delta-9-tetrahydrocannabinol (THC), a component of cannabis.3 During the subsequent two decades, scientists learned much about the clinical effects of cannabis, but no one understood how it worked on a molecular level to alter perception and achieve palliative results, such as relieving pain and nausea, increasing appetite, and suppressing seizures. It took until the early 1990s before researchers began to uncover the ECS and the brain receptors (CB1) and body receptors (CB2) that responded to cannabinoids.
The Endocannabinoid System
The ECS is a sophisticated network of neuromodulators (called endogenous cannabinoids), their receptors (CB1 & CB2), and the signaling pathways that help maintain homeostasis in the human body. The ECS, which is believed to be the largest receptor system in the human body, is found in the brain, organs, connective tissue, bones, adipose tissue, and nervous and immune systems.2
The ECS regulates internal processes such as movement, mood, memory, appetite and pain. Since it plays an important regulator function in the body, the ECS also plays a role in managing a variety of symptoms or underlying disease states. Clearly, a well-functioning endocannabinoid system is essential to our health and well-being.4
Patients experience the effects of cannabis because its compounds bind to and activate tiny molecular receptors encoded by our genes.5 These cannabinoid-capturing receptors, known as cannabinoid receptors, are proteins that are expressed on the surface of cells.5 Receptors may be thought of as locks, to which a corresponding chemical (natural or synthetic) will conform like a key, if it has the proper structure to conform to it.5
There are many different cells and tissue types in our bodies that express these cannabinoid receptors and are responsible for the diversity of cannabis’ effects.2
Cannabis’ “Power Couple”
At the present time, we know the most about the cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD), which are sometimes called “the power couple” of cannabis. Among cannabis’ many cannabinoids-there are more than 100- THC produces the well-known psychoactive effects of cannabis and is equally responsible for the majority of other pharmacological impacts, acting on both CB1 and CB2 receptors.6 Activating the CB1 receptors in the brain induces a sensation of “being high,” which is often described as a feeling of intoxication, relaxation, giddiness, introspective dreaminess, sleepiness, and time distortion.6 Activating CB2 receptors is known to relieve inflammation and allergic reactions.6
SEE ALSO: Poll: Medical Marijuana in the Workplace
CBD is non-euphoric and does not appear to bind to either CB1 or CB2 receptors.4 Cannabidiol shows great promise in treating many conditions, most notably seizure control in pediatric epilepsy patients. In addition, CBD offers anti-inflammatory, analgesic, anxiolytic, antipsychotic and anti-carcinogenic effects.
Effective use of medical cannabis often requires finding a balance between the “power couple’s” desired therapeutic effects and mitigating unwanted psychoactive effects. The extensive therapeutic action of THC is a very important component and should not be discounted.
Still a Schedule 1 Drug
At present, although legal in 24 states, the U.S. Drug Enforcement Administration (DEA) still lists cannabis and its cannabinoids as Schedule I controlled substances. This means that, despite the scientific evidence to the contrary, they are deemed to have no medical value and cannot legally be prescribed, possessed, or sold under federal law. So under federal law, physicians currently write “recommendations” for its use (rather than prescriptions), and patients need to visit a state-licensed dispensary instead of a local pharmacy in order to obtain the medicine.
Public opinion on the topic is shifting, however. In 2015, Senator Elizabeth Warren (D-MA), along with some of her other Democratic colleagues in the Senate, wrote to multiple food and drug officials and asked them to reclassify cannabis in order to facilitate research into the plant’s medical benefits. The DEA stated that it would respond to Warren’s request by mid-2016.
It is our ethical and professional obligation as a trusted member of the healthcare profession to be educated about medical cannabis. I hope you will join me next month, when I will discuss the differences between herbal cannabis and its varieties and other cannabinoid-based medicines.
Eileen Konieczny, RN, is the current president of the American Cannabis Nurses Association (ACNA). She is also the co-founder, lead strategist and director of patient services for Valley Agriceuticals; a medical practitioner at Green Health Consultants; and the founder of Olive’s Branch, an educational consulting firm striving to bridge the information gap between the medical cannabis and healthcare industries.
1. Di Marzo V, Melck D, Bisogno T, De Petrocellis L. Endocannabinoids: endogenous cannabinoid receptor ligands with neruomodulatory action.
Trends in Neuroscience. 1998; 21(12): 521-528.
2. Gerdeman GL, Schechter JB. The Endocannabinoid System. In: Holland J, ed. The Pot Book: A Complete Guide to Cannabis-
Its Role in Medicine, Politics, Science and Culture. Rochester, VT: Park Street; 2010:52-62.
3. Mechoulam R. The pharmacohistory of Cannabis sativa. In: Mechoulam R, ed. Cannabinoids as Therapeutic Agents.
Boca Raton, Fla: CRC Press; 1986:1-19.
4. Sulack D. Preventative Medicine and Health Promotion with Cannabis. Presentation given at Patients Out of Time:
Tenth National Clinical Conference on Cannabis Therapeutics. April 2016, Baltimore.
5. Grotenhermen F, Russo E. Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. New York, NY:
6. Grotenhermen F. Medically Active Components of Cannabis. Lecture. |