Since the Brazilian Health Surveillance Agency (Anvisa) regulated the procedures required for the manufacture and commercialization of Cannabis-based products in Brazil at the end of 2019, the medical community’s interest in studying this class of drugs has grown significantly.
Although cannabidiol (CBD) and tetrahydrocannabinol (THC) are the best known and most explored phytocannabinoids to date, we already know that there are about 150 cannabinoids among the more than 550 chemical in the Cannabis plant.
In this text, we will discuss the main therapeutic properties of these substances and show why you, as a physician, should incorporate them into your therapeutic arsenal to achieve better symptom control and more quality of life and well-being for your patients.
Main cannabinoids and their interactions with SEC
The scientific discoveries around the Endocannabinoid System (ECS) have intensified promising new studies into the medical attributes of Cannabis. Although the ECS was only unveiled by science in the second half of the 20th century, this vital regulatory system has been present in humans and all vertebrate animals for hundreds of thousands of years.
The ECS is involved in virtually all our physiological and pathological processes, through a collection of receptors, ligands, and enzymes that act as signaling pathways between cells. The primary function of this system is to restore the stability of physiological functions, in order to (re)establish the body’s homeostasis..
It is, therefore, a vital system for our health, as any imbalance in the Endocannabinoid System can be decisive for the development and/or progression of diseases. The interaction of the endocannabinoid receptors with their main ligands regulates and modulates a series of functions, such as cardiovascular and gastrointestinal functionand immune and inflammatory responses in addition to the processes of learning, memory and emotion regulation.
Cannabinoid substances can either be produced by our own bodies, which is why they are called endocannabinoids or endogenous cannabinoids – or they can be found in the Cannabis plant, –
which is called phytocannabinoids or exogenous cannabinoids. Not surprisingly, the interaction of endocannabinoids with the ECS can be stimulated by the chemical compounds in Cannabis, explaining the wide therapeutic potential of this plant.
Just as the diversity of cannabinoids is large, so is the range of situations for which these substances can be medically useful. Some examples include chronic pain, neurological disorders and psychiatric conditions. In addition, Cannabis can be a valuable adjuvant in the treatment of cancer. We will tell you more about cannabinoids below.
The cannabidiol (CBD) is the chemical element of Cannabis that has been most explored and widely used to date, due to its variety of therapeutic properties, including anti-inflammatory, anticonvulsant, anxiolytic, and also because it has less psychotropic potential when compared to THC.
The fear in the medical use of THC is often associated with its psychotropic potential, which can culminate in psycho-toxicity. However, in assertive prescriptive contexts, psycho-toxic reactions from the use of this substance are rare and appropriately manageable. Furthermore, it is important to emphasize that THC has important therapeutic attributes, even when compared to other phytocannabinoids, such as the CBD itself.
In our body, the CBD interacts with neurotransmitters such as adenosine, serotonin, and dopamine. As scientific studies suggest, these interactions have positive effects in different pathological contexts, such as in the control of anxiety, in the improvement of motor performance and in pain perception.
Several studies have shown the benefits of this phytocannabinoid in the treatment of pain, such as this North American work carried out with 214 patients suffering from chronic back pain. The results proved the effectiveness of CBD in this context, in which 66.7% of the patients reported pain relief.
There were positive responses in the treatment of:
- cervicalgia (37,0%);
- pain radiating to lower limbs (35,2%);
- pain radiating to upper limbs (9,3%)
Other favorable points of CBD use in these patients include:
- mprovement in insomnia conditions (25,9%);
- reduction in anxiety (20,4%);
- overall mood improvement (18,5%).
>> You can read the full study here: Prevalence of Cannabidiol Use in Patients With Spine Complaints: Results of an Anonymous Survey.
The tetra-hydrocannabinol (THC) is popularly known because of the psychoactive effects of its use. However, unlike in the context of recreational use of the plant, in the medical use of Cannabis, the psychoactivity associated with this substance is small and the risk of psycho-toxic reactions is rare.
The bioavailability of THC by inhaled and oral routes of administration are quite distinct, and the prescription of THC-predominant medications anchored in scientific knowledge and practical experience significantly minimizes potential adverse effects related to the substance.
It is of essential importance to have technical knowledge in order to exploit the therapeutic potential of this compound. This phytocannabinoid shows promising results for different clinical conditions, such as chronic pain, especially neuropathic pain, nausea, vomiting, and inappetence, and sleep disorders.
Because THC brings together a valuable set of therapeutic properties, it can be very useful as an adjuvant in the treatment of patients with cancer, relieving pain and discomfort resulting from radio and chemotherapy protocols and providing a better quality of life and well-being for people who are in this state of deep physical and psychological suffering.
Would you like to learn more about the therapeutic attributes of THC? Learn about the particularities of this phytocannabinoid and deconstruct the myths and stigmas associated with the substance.
We can say then, that choosingTHC freeproducts is not always the best decision. Depending on the clinical condition, the THC will have a more impactful therapeutic potential than CBD itself. In addition, the presence of THC is important for the Entourage Effect, , in which the synergistic action of all the chemical elements of the plant is responsible for potentiating the therapeutic effects of cannabinoids and modulating possible adverse effects.
Other promising cannabinoids
Most scientific research on medical Cannabis has CBD and THC as the protagonists. However, there are several studies investigating the therapeutic properties of other cannabinoids. One example is this research suggesting the potential of Canabinol (CBN) in chronic muscle pain conditions, such as temporomandibular disorders and fibromyalgia.
>>You can read the full research here: Cannabidiol, cannabinol and their combinations act as peripheral analgesics in a rat model of myofascial pain.
Another example of a cannabinoid that may be useful in clinical practice is the tetrahydrocannabivarin (THCV)as this research that investigates the benefits of the substance in controlling levodopa-induced dyskinesia in Parkinson’s disease shows.
>>You can read the full research here: Beneficial effects of the phytocannabinoid Δ 9-THCV in L-DOPA-induced dyskinesia in Parkinson’s disease.
The Cannabigerol (CBG), in turn, has been drawing the attention of the scientific community for its supposed antineoplastic potential. This research, for example, evaluated the relationship between CBG use and the reduced progression of glioblastoma, the most aggressive primary brain cancer.
>> You can read the full study here: Cannabigerol Is a Potential Therapeutic Agent in a Novel Combined Therapy for Glioblastoma..
The cannabidiolic acid (CBDA) – CBD in its acid form – also combines interesting therapeutic properties. One of the best known is its potential to inhibit nausea and vomiting. This is what this researchreveals, comparing the use of CBD and CBDA for this purpose. The CBDA, in addition to showing greater potency in combating vomiting, also proved to be a viable alternative in the management of anticipatory nausea, for which there is still no specific.
>>You can read the full research here: Cannabidiolic acid prevents vomiting in Suncus murinus and nausea-induced behavior in rats by enhancing 5-HT1A receptor activation..
Another phytocannabinoid under research is the tetrahydrocannabinolic acid (THCA) – THC in its acid form. Unlike THC, this cannabinoid does not have important psychoactive effects, and is therefore an option with a relevant safety profile.
Among the properties already evidenced, it is noteworthy that this research shows how THCA can substantially improve the symptoms of obesity-associated metabolic syndrome and inflammation, by preventing hepatic steatosis, adipogenesis, and macrophage infiltration of adipose tissues.
>>You can read the full research here: Tetrahydrocannabinolic acid A (THCA-A) reduces adiposity and prevents metabolic disease caused by diet-induced obesity.
Other cannabinoids, such as cannabichromene (CBC) and cannabidiolivarin (CBDV), are also targets of scientific research. The former is believed to be able to increase the levels of the body’s natural endocannabinoids, such as anandamide, which is related to feelings of well-being and happiness.
The the CBDV, a varinic form of CBD, on the other hand, has properties very close to CBD and is shown to be potentially useful in controlling neurobehavioral symptoms. This is what this study which investigated the use of CBDV in Rett Syndrome, both to treat seizures and to rescue memory performance impaired by the disease.
>> You can read the full study here: Chronic treatment with the phytocannabinoid Cannabidivarin (CBDV) rescues behavioural alterations and brain atrophy in a mouse model of Rett syndrome.
New discoveries about cannabinoids
The recent discovery of the heptylphytocannabinoids cannabidiol (CBDP) and Δ9-tetrahydrocannabiforol (Δ9-THCP) has added to the debate a number of questions related to the abundance of these new unknown compounds in Cannabis and their medicinal potential, as it is shown in this research which investigated the presence of these compounds in 49 samples of the plant, representing four different chemovars.
>>You can read the full research here: The novel heptyl phorolic acid cannabinoids content in different Cannabis sativa L. accessions.
It is also worth noting the recent discussions about synthetic cannabinoids (SCs), since many of these substances are also targets of scientific research. One example is this bibliographic review which investigates the therapeutic potential of SCs and the possible adverse effects observed. In this and other studies, adverse effects were found to be more intense in the use of synthetic cannabinoids compared to the use of natural cannabinoids from the plant.
>> You can read the full review here: Focus on cannabinoids and synthetic cannabinoids.
All this evidence on phytocannabinoids makes it clear why it is important to be up-to-date and know the subject. Although a number of therapeutic properties of these substances have already been scientifically evidenced – especially in relation to the CBD and THC – it is crucial to emphasize that an assertive prescriptive practice is determinant to achieve good results.
This means that it is necessary to base therapy with Cannabis-based medications on the particularities of each clinical condition and the context of each patient.
The WeCann Academy helps you to get ready for this scenario. We connect experts from around the world with extensive therapeutic experience in a global study community to unite scientific knowledge and practical experience in a highly qualified way.
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