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In the second half of the 20th century, discoveries around the Endocannabinoid System (ECS) triggered a series of studies on Cannabis as a modulator of said vital system, contextualizing the therapeutic properties of the plant in a number of clinical situations. Since then, scientific research around Endocannabinoid Medicine has been consolidated in several parts of the world.
In Brazil, although this subject is still surrounded by misunderstandings and stigmas, Endocannabinoid Medicine gained strength with advances in legislation regarding this subject.
In 2020. Resolution 327 of the Brazilian Health Surveillance Agency (Anvisa) entered into force, providing guidance on the process of regularizing cannabis products for medicinal purposes.
>> Read the post about Cannabis and Anvisa: what is and what is not allowed in Brazil?
In this context, many doctors and other health professionals saw the need to catch up on said subject. After all, cannabinoid derivatives prove to be an indispensable therapeutic tool in Future Medicine.
With that in mind, we elaborated this content explaining what Endocannabinoid Medicine is, what opportunities it brings and its main applications. In this material, you are going to see:
- What is Endocannabinoid Medicine
- Opportunities for Endocannabinoid Medicine
- Endocannabinoid System
- Main applications in medical specialties
What is Endocannabinoid Medicine
The use of cannabis for medicinal purposes has ancient origins, although since the middle of last century little was understood about this subject. It was only in the second half of the 20th century that scientific research on Endocannabinoid Medicine began to grow exponentially, as a result of the discovery of Endocannabinoid System.
This vital regulatory system is involved in virtually all of our physiological and pathological processes. The interaction of endocannabinoid receptors with their main ligands is able to regulate and modulate a number of conditions, such as energy expenditure, cardiovascular function, immune system, inflammatory processes, learning and memory processes, among others.
The consolidation of medicinal cannabis in this scenario occurred because the various chemical compounds present in the plant help to balance the functioning tone of the endocannabinoid system. Thus, by means of the therapeutic properties of phytocannabinoids, it is possible to improve symptom control and bring better quality of life to patients in the most diverse clinical contexts.
>> Read the post about Fitocanabinoides e o vasto arsenal terapêutico da Cannabis medicinal.
Opportunities for Endocannabinoid Medicine
Despite the political and social stigmas behind the plant, the thousands of scientific studies on endocannabinoid system were decisive in helping more than 40 nations to legalize the medicinal use of cannabis, projecting a billion-dollar market for the coming years.
Warmed global market
The regulatory landscape on the medicinal use of cannabinoids is gaining new contours very quickly.
Countries such as Netherlands, Canada, Uruguay and the United States are some of the main references in this context. The most recent announcement on legalization came from Mexico which, like the United States, has a strong history of cracking down on cannabis in other times.
In Brazil, the ANVISA resolution in 2019 rekindled debates around the regulation of the medicinal use of Cannabis. The document governs the rules for the marketing of products derived from Cannabis in the country.
In parallel to advances in regulatory issues, scientific studies continue in full steam ahead, contributing to the debate on historical, botanical, physiological, clinical, and also legal aspects around the medicinal use of cannabis – which is essential to fight misinformation and facilitate the wide access to this valuable therapeutic tool by the Brazilian population.
Expansion of scientific research
The advance in regulatory processes and the thousands of scientific studies published in various parts of the world have helped to fight stigmas and deconstruct the myths surrounding the medicinal use of cannabis, especially related to THC, a chemical element with the greatest psychoactive potential in the plant.
An example is this literature review that relates said psychoactive agent in Cannabis to its interactions with the ECS in anxiety, depression, neurogenesis, cognition, and learning and memory processes.
>> You can read the full review here: The endocannabinoid system and the brain.
A series of researches evidence the therapeutic attributes of THC , quwhich also has medicinal properties that stand out in the management of severe and disabling symptoms, such as:
- symptoms associated with cancer patients;
- modulation of painful stimulus perception;
- muscle relaxation;
- appetite induction;
- sleep induction
>> Read about the medicinal attributes of THC and its therapeutic properties
In other clinical contexts, scientific publications on the therapeutic properties of Cannabis are also expanding, consolidating the importance of Endocannabinoid Medicine in Brazil and worldwide.
Currently, there are more than 25,000 scientific articles published on this subject in PubMed, which explore the therapeutic attributes of Cannabis for the most diverse conditions, including:
- Chronic pain and neuropathic pain;
- Anxiety and depression;
- Post-traumatic andstress disorder;
- Symptoms of the climateric period;
- Muscle spasticity in multiple sclerosis;
- Reduced appetite and weight loss in HIV/AIDS;
- Severe and refractory epilepsy.
- Autism Spectrum Disorder (ASD)
- Parkinson’s disease and Alzheimer’s.
>> The WeCann Academy is committed to your learning journey in Endocannabinoid Medicine. Learn more about us and get ready to access this new frontier of Medicine!
Endocannabinoid System
We have seen that the scientific discovery on the Endocannabinoid System boosted research around medicinal cannabis. This system consists of a set of receptors, ligands and enzymes that act as signalers between cells, modulating a myriad of functions in the organism to establish homeostasis in different organs and tissues.
Deficiencies in the functioning of the endocannabinoid system significantly interfere with the development and progression of diseases. Therefore, the balance of this system is essential for our health.
The endocannabinoid receptors and substances are present throughout the organs and body systems, performing different tasks always aiming at this balance.
The main endocannabinoid receptors studied so far are CB1 and CB2.
The first is widely present in the Central Nervous System, mainly in the cortex, cerebellum, hippocampus and basal ganglia. But it is also present in the Enteric Nervous System (ENS), in adipose cells, endothelial cells, liver and gastrointestinal tract.
CB2 is widely distributed in cells and tissues in the immune system, showing its anti-inflammatory and immunomodulatory potential. Our body is capable of producing its own cannabinoids, namely, anandamide and 2-arachidonylglycerol, which bind to endocannabinoid receptors to exert characteristic effects according to each binding.
The phytocannabinoids, Cannabis terpenes and flavonoids also fulfill their function, acting as balancing agents in the endocannabinoid system.
When endocannabinoid receptors are stimulated by those compounds, physiological mechanisms are triggered that regulate several functions, such as inflammatory processes and neuronal signaling.
Endocannabinoid System and the Entourage Effect
The Cannabis plant brings together more than 500 chemical compounds, including cannabinoid and non-cannabinoid substances.
Most have been the target of scientific research for their therapeutic potential. Flavonoids and terpenes, which we mentioned above, are also among said compounds. It is possible to optimize therapeutic results in Endocannabinoid Medicine precisely when all these elements are used together.
This phenomenon is called the Entourage effectresulting from using the whole plant extract instead of isolated parts. Together, these substances act synergistically to optimize therapeutic responses in the medicinal use of Cannabis and, at the same time, modulate its potential adverse effects.
An assertive prescription must consider, among other aspects, the individualization of therapy according to the history of each patient, as each one of us has a unique biochemical structure, as well as a unique ECS.
>> Want to learn more about prescriptive concepts in Medicinal Cannabis? Then meet this team of experts and connect with our global community of studies in Endocannabinoid Medicine!
Still on the Entourage effect of Cannabis, this bibliographic review highlights the importance of the synergistic action of cannabinoids, terpenes and flavonoids in cannabis. The review reinforces the analgesic and anti-inflammatory properties of said compounds in the treatment of chronic pain, with emphasis on migraine, other types of headaches and orofacial pain.
>> You can read the full study here: Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science..
In the context of chronic pain, it is worth noting that Endocannabinoid Medicine is an important alternative in patients who regularly take opioids, and it can help in dose reduction and long-term weaning of these substances.
Specialties
In this text, we have seen that scientific research on medicinal cannabis shows the therapeutic properties of the plant in a number of pathological contexts, so that Endocannabinoid Medicine can be useful to several medical specialties.
Some examples include psychiatric disorders, gynecological disorders, gastrointestinal disorders and cancer.
Psychiatric disorders
Endocannabinoid Medicine brings positive responses for symptom relief and can be a therapeutic alternative in the context of different psychiatric disorders, such as anxiety disorders, psychotic disorders and post-traumatic stress disorder.
Several studies have already shown the anti-psychotic properties of Cannabidiol, CBD. It is not by chance that studies present positive responses arising from the use of this cannabinoid derivative in the context of psychotic disorders such as schizophrenia.
This is shown, for example, by this experiment carried out on a group of schizophrenic patients.
Part of the group were given CBD along with conventional care, while the other part were given placebo. After 6 weeks of treatment, patients who were given CBD had lower levels of psychotic symptoms compared to those who took conventional care alone.
>> Read the article at: Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial.
Gynecological diseases
The Medical Cannabis analgesic,, anti-inflammatory and relaxing properties of cannabinoids have consolidated the use of said substances also in the management of gynecological disorders.
The main uses include the relief of menstrual cramps, climacteric symptoms and endometriosis complications. More advanced studies also suggest the relationship between Cannabis and breast cancereither because of the antitumor potential of cannabinoids, or as an adjuvant in the management of symptoms that often accompany cancer patients.
An example is this North American researchwhich evaluated a group of 725 breast cancer patients, with 42% of the participants taking medicinal cannabis. The results demonstrate the potential of cannabinoids both to fight the side effects of chemotherapy (pain, nausea and loss of appetite) and the symptoms of the disease itself, such as anxiety (57%), stress (51%) and insomnia (70%).
>> See the full experiment here: A survey of cannabis use for symptom palliation in breast cancer patients by age and stage.
Cancer
Regarding the antineoplastic potential of Cannabis, researches still lack more robustness. However, some literature reviews suggest that cannabinoids are able to inhibit the proliferation, adhesion, migration, invasion and angiogenesis of tumor cells, including breast cancer cells.
An example is this review including preclinical studies in which agonists to CB1 and CB2 cannabinoid receptors – such as the endocannabinoid anandamide and phytocannabinoid THC – have been shown to inhibit the proliferation of breast cancer cell lines expressing estrogen receptors (ER+).
>> Read more here: Cannabinoids and Hormone Receptor-Positive Breast Cancer Treatment
The more scientific research advances, the more Endocannabinoid Medicine is consolidated as safe and promising in different clinical contexts.
Medical doctors, in turn, need to be aware of this scenario. A proper medical training is essential so that they can effectively and safely incorporate cannabinoids in their prescribing practices.
The WeCann Academy helps you to get prepared for the Future Medicine. We connect the best experts in the world in a global community of studies in this field, linking scientific knowledge and practical experience.
Would you like to join us? Learn more about our course exclusively aimed at medical doctors and get ready for this new frontier of Medicine!
References:
Mechoulam R, Parker L A. The endocannabinoid system and the brain. Annu Rev Psychol. 2013.
Barron R, Cubala W J, McGuire P, Morrison P D, Robson P, Taylor A, Vasile D, Wright S. Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. Am J Psychiatry. 2018.
Baron E. 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. 2018.
Weiss M C, Buckley M, Hibbs J, Leitenberger A, Jenkins M, McHugh T W, Green N, Larson S.
A survey of cannabis use for symptom palliation in breast cancer patients by age and stage. Journal of Clinical Oncology. 2020.
Borštnar S, Debeljak N, Dobovišek L, Krstanovic F. Cannabinoids and Hormone Receptor-Positive Breast Cancer Treatment. Cancers. 2020.
