The medicine of plants. The cannabinoid alternative.

The properties of opiates completely remove physical pain, reduces coughing, reduces stomach flows and is largely used to combat insomnia.

The controversial plant with multiple uses in pharmaceuticals

Since the beginning of the concept of medicine and even before the socially established basis of conventional medicine, narcotic drugs have been present as a treatment for certain diseases. In terms of Chinese medicine, (Pen-ts’ao-Ching) attributed to Shen-nung, red emperor includes the Cannabis indica species to treat rheumatic pains and for its properties to treat digestive problems.

The extract of opium in alcoholic tincture called laudanum, the sponge used for anesthesia made with mandrake and opium or other opiate-based drugs such as teriaca have been essential against pain. Opium originates from the juice of the green bark of the opium poppy which is a variety of the poppy known by its scientific name Papaver somniferum that has been replaced by morphine or others such as meperidine.

The human being has been looking for relief to his pains in different medicinal plants, he has also found in his search for sedation and euphoria. In the continuous use of the same medicine in a systematic way, the effect of tachyphylaxis is observed, which is nothing more than the loss of the efficacy of such medicine, thus losing the effectiveness of the medicine and increasing its toxicity. In these cases of addictive substances, the use of these drugs is strictly reduced to medical use with a clear and strict regulation, something from which alcohol and tobacco have been spared. At certain times and places in history, alcohol consumption was prohibited, thus increasing smuggling. There are less harmful substances such as the use of Cannabis sativa, although in this case it is too benign.

The use of the Cannabis sativa plant is subject to and surrounded by different social, religious, political and, therefore, economic controversies that place the species in a complicated place to say the least. The White House requested a review of the potential benefits and risks of marijuana and its various cannabinoids from the Institute of Medicine in 1997.

Effects of cannabinoid substances

In 1999 a report was published that analyzed the effects of cannabinoid substances, which are summarized below.

1. Pain relief
2. Appetite stimulation
3. Treatment of pain and nausea in diseases such as AIDS or patients undergoing chemotherapy.
4. They can offer relief from a wide range of symptoms not found in other medications alone.

Not all forms of marijuana use are fully beneficial. The use of cannabis through inhaled combustion provides in the varieties that contain it the incorporation of THC among other cannabinoids into the body, in addition to other harmful substances. These harmful substances are mostly found in tobacco smoke.

What is the future of Cannabis drugs?

Any plant provides a series of active biological compounds that cannot be predetermined or established as stable values (or at least it is very complicated to obtain stable values), precisely because they are living beings and all of them provide different amounts as a unique individual of their species. According to conventional medicine, the future of Cannabis drugs lies in its chemically defined alkaloids that act directly on the cannabinoid receptors existing in the human being. These cannabinoids have been shown to be involved in the modulation of pain, movement and memory. On the other hand, we obtain a multifunctional role in the immune system, although it remains unclear. Through different investigations it was shown that cannabis creates a much lower dependence than that coming for example from barbiturates, benzodiazepines, opiates, nicotine or cocaine.

The withdrawal of cannabinoids observed in these studies showed that the adverse effects of the substance were lower than for many other drugs.

Throughout history, the policy regarding cannabis has changed a lot. Mainly thanks to the different studies demonstrating medical uses of cannabis and, on the other hand, due to its mismanagement in prohibitionist policies. That is why many countries or parts of countries (such as the United States) have legalized its medical and even recreational use.

For many years, doctors have maintained that drug addiction is a problem of common interest for public health. Specifically, the Cannabis sativa plant contains about 480 cannabinoid compounds, of which about 66 can be observed to have only detectable effects. The main psychoactive cannabinoid compound is delta-9-tetrahydrocannabinol (THC) which has a relaxing effect and pain palliative effects. Together with cannabidiol (CBD) they are the main cannabinoid compounds accumulated. CBD has no psychoactive effects and therefore has generated a lot of interest in the medical world for its palliative effect.

The U.S. Food and Drug Administration (FDA) approved the production and sale of capsules of two synthetic cannabinoids to treat chemotherapy emesis and AIDS cachexia. These compounds are called nabilone and dronabinol. There is a third one approved in Europe and Canada called nabiximol, a compound used in the production of the drug Sativex. In the latter case it is not a synthetic cannabinoid, but an extract extracted from a selected and stabilized phenotype that provides a known amount of THC and CBD cannabinoids.

Cannabis and its effects on multiple sclerosis, movement disorders and epilepsy.

A systematic review on Cannabis and its effects was conducted between 1948 and 2013. The AAN (American Academy of Neurology) highlighted 34 studies that applied symptomatic treatments in multiple sclerosis disease, movement disorders and in epilepsy.

In these trials, different compounds were used to treat the diseases. One of them was cannabis extract administered orally, another was Sativex and finally THC alone. High values of placebo effect were observed in the study, namely 70% and side effects such as nausea and increased asthenia. Changes in mood and behavior, dizziness, vasovagal symptoms, hallucinations were also observed, and with patients treated with THC, cases of psychosis, anxiety and dysphoria were also observed.

The study showed that cannabinoids have an important role in the control of central pain and pain associated with spasticity in multiple sclerosis. The serious psychopathological adverse effects in the study were almost 1%. So far there were no comparative studies of the efficacy of marijuana with other drugs. The use of massive cannabinoid components as recreational use at young ages is an indicator of poor mental health where the possibility of being treated in psychiatric hospitals is increased. By inhaled use, marijuana causes problems similar to those of tobacco, predisposes to anxiety, decreases attention and cognition, causes less coordination and predisposes to schizophrenia in people with a family history, although it is not considered a significant problem to be taken into account.

Why might cannabis predispose to the use of harder drugs?

Because of its prohibition, cannabis use may predispose to the use of harder drugs. This is because prohibition reminds users of the black market drug trade, where suppliers of the substances do not usually work solely with cannabis.

It is estimated that of the 180 million cannabis users, only 13 million can be considered addicts, usually young people living in northern or developed countries.

For the detoxification of other narcotics, marijuana is a good product to alleviate the effects of abstinence and it is even efficient to treat alcoholism problems.

Interest in the Cannabis sativa plant is increasing in several medicinal areas. Anti-inflammatory and immunological effects have increased thanks to the presence of CB2 receptors in the lymphatic system. There is also much interest in the plant because of its neuroprotective effects in animal models of diseases such as amyotrophic lateral sclerosis.

For this type of studies based on the Cannabis sativa plant and its effects on health, they are usually derived from public funds from the State (where it is keeping the monopoly) or in other cases from the pharmaceutical industry. Although it is true that this is not always the case.

Education in the medicinal area with respect to Cannabis sativa should be significantly increased. All the knowledge available to experts and current tools are needed to challenge the current situation of cannabis. With caution, as the changes submitted to the pharmaceutical industry are here to stay. We should not wait for pharmacists to represent a population that is asking, in many cases, for a more dignified life in the case of uses such as pain palliation.

References:

• Jácome-Roca A. Historia de los Medicamentos, 1ª. Ed. Academia Nacional de Medicina, 2003.
• Joy JE, Watson SJ, Benson JA, Editors; (Marijuana and Medicine: Assessing the Science Base) Institute of Medicine. ISBN: 0-309-51408-8, 288 pages, 1999.
• PDF available from the National Academies Press at: http://www.nap.edu/catalog/6376.html
• Hill K P. Medical marijuana: more questions tan answers. J Psychiatr Pract. 2014; 20(5): 389 91.
• Koppel BS, Brust JCM, Fife T et al. Systematic review, efficacy and safety of medical marihuana in selected neurologic disorders. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2014; 82 (17): 1556-1563
• Nussbaum AM, Thurstone C, McGarry L, Walker B, Sabel AL. Use and diversion of medical marijuana among adults admitted to inpatient psychiatry. Am J Drug Alcohol Abuse. 2014 Nov 6:1-7 (Epub ahead of print)
• Schubart CD, Boks MP, Breetvelt EJ, van Gastel WA, Groenwold RH, Ophoff RA, Sommer IE, Kahn RS. Association between cannabis and psychiatric hospi-talization. Acta Psychiatr Scand. 2011;123(5):368-75
• Grant I, Atkinson JH, Gouaux B, Wilsey B. Medical marijuana: clearing away the smoke. Open Neurol J. 2012; 6:18-25.
• Sagie S, Eliasi Y, Livneh I, Bart Y, Monovich E. Short-and long-term effects of cannabinoids on me – mory, cognition and mental illness. Harefuah. 2013; 152(12):737-41, 751.
• Davis GP, Compton MT, Wang S, Levin FR, Blanco C. Association between cannabis use, psychosis, and schizotypal personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Schizophr Res. 2013; 151(1):197-202.
• Kashyap S, Kashyap K. Medical marijuana: A panacea or scourge. Lung India. 2014; 31(2):145-8
• Degenhardt L1, Ferrari AJ, Calabria B, Hall WD et al. The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 study. PLoS One. 2013; 8(10):e76635.
• Swartz R. Medical marijuana users in substance abuse treatment. Harm Reduct J. 2010;7:3-5
• Reiman A. Cannabis as a substitute for alcohol and other drugs. Harm Reduct J. 2009; 6:35.
• Collier R. Prescribing marijuana? You have more than 200 options. CMAJ. 2014; 186 (12):E440.
• Nutt DJ, King LA, Nichols DE. Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nat Rev Neurosci. 2013; 14 (8):577-85
• Restrepo-Guzmán R. Marihuana para uso médico: Del debate a la realidad. Periódico El Pulso, Febrero 2010. http://www.periodicoelpulso.com/html/1002feb/general/general09.htm
• Hakkarainen P, Frank VA, Barratt MJ et al. Growing medicine: Small-scale cannabis cultivation for medical purposes in six different countries. Int J Drug Policy. 2014 Jul 21.S0955-3959(14)00173-X (Epub ahead of print)