Introduction
Medical cannabis is a substance that can affect the human nervous system. Low doses of this herbal raw material can be an excellent medicine. The medical indications currently included in the spectrum of cannabis indications are those for which sufficient information has accumulated to allow for the routine issuance of cannabis use authorizations for their treatment. Medical cannabis has also been used to slow the growth of opioid overdoses in the U.S. (Shover et al., 2019). Hemp entered the medical textbooks of European doctors in the middle of the 19th century at the instigation of British physicians, who brought knowledge of the medicinal herb from colonial India. They appreciated the analgesic, sedative, and anti-inflammatory effects of cannabis. The main problem was that the concentration of the active ingredient in cannabis was quite unstable, although the dosage had to be observed precisely. In the 21st century, pharmacologists already know what is useful in cannabis: of the 480 chemical compounds known to date, the main active ingredient (from the pharmacologists’ point of view) is delta-9-tetrahydrocannabinol.
The idea of using cannabis for medicinal purposes dates back many centuries: “Most of the pharmacological properties of Cannabis were indeed already known and used in medicine for the treatment of numerous pathologies in ancient times” (Pisanti & Bifulco, 2019, p. 8342). The first known written references to the use of cannabis to relieve pain and seizures are found in 3000 BC in ancient China. Two thousand years later, India created a drink made from cannabis and milk, which was used as an anesthetic. Ancient Indians also used hemp to treat leprosy, dysentery, and fever and improve sleep quality.
Diseases for Which Cannabis Helps
Scientists discovered specific cannabinoid receptors in the brain, the immune system, and several other organs a few years ago. Especially many of these receptors are in those parts of the brain responsible for pain perception. This is why cannabis is often tried for chronic pain (migraine, degenerative changes in the musculoskeletal system, nerve damage). The ability to suppress nausea and stimulate appetite in AIDS and cancer patients is best studied. For example, patients with severe forms of malignant tumors often suffer from the effects of chemotherapy and radiation therapy, the most common of which is nausea. It can be so powerful that patients often cannot eat. Moreover, since the substances in cannabis, in addition to suppressing nausea, also stimulate the appetite, their use could prevent patients from gaining weight loss (we should add: if cannabis use is allowed).
Cannabis has also been clinically studied and confirmed to have a positive effect on eye diseases associated with increased intraocular pressure (the impact of cannabis lowers the pressure inside the orbit by 50%). Most primary care providers surveyed in Minnesota between January 23 and February 5, 2018, thought cannabis could effectively treat disease-related symptoms (Philpot et al., 2019). As for cannabis overdose, this condition is dangerous only for the patient’s psyche because there are no receptors for cannabis in the vital centers of the medulla oblongata. Despite the listed benefits, cannabis is officially banned in most countries.
There is an opinion that cannabis can be used by patients suffering from depression. This opinion is partly true, but only in certain forms. Cannabichromene and especially cannabidiol have very serious antidepressant effects. There is no evidence yet for the effectiveness of cannabinoids in treating depression, but this is an area worth continuing to explore. Another interesting application is its use in patients with social phobia. There is a special simulator: the patient is seated in front of a screen and imitates a public speech, which induces in such people a strong fear. The results of studies have shown that cannabidiol is quite effective in treating social phobia. It is not easy to treat, and many doctors know how disabling this condition can be.
Cannabis Addiction
Whether cannabis is addictive is a major issue of debate in countries where there is public discussion about the legalization of medical cannabis. The U.S. National Institute on Drug Abuse claims that about 30% of people who use cannabis may develop an addiction, with adolescents at risk. Physicians should monitor patients’ cannabis use to prevent abuse (Sagy et al., 2019). The composition of hemp includes the same chemicals found in tobacco plants. Therefore, there are concerns that the prescription of medical cannabis in the form of cigarettes or inhalers can adversely affect the bronchi and lungs of patients, according to the website of the American Lung Association.
Further clinical studies are needed to identify all possible side effects. It is now known that some patients complain of dizziness, impaired concentration and memory, increased appetite, increased heart rate, and hallucinations after using medical marijuana. Patients with cardiovascular diseases have an increased risk of stroke or heart attack.
The Way Medical Cannabis is Used
One of the uses of marijuana is smoking. Smoking is problematic because it can cause side effects, from coughs to lung cancer. The biggest problem: If a substance is used by smoking, it cannot automatically be called medicine. For any medication, there has to be a dosage option. People smoke differently, inhale differently, and do different adsorption. Because of the inability to control the dose, it is not a medicine (medication). There is a device called a vaporizer. The device heats the cannabis leaves to a certain temperature, and each inhalation will give a strictly defined amount of the substance. This method of use brings cannabis closer to medication.
There are several types of cannabis-based drugs. Some of them are synthetic. Synthetic drugs are approved in the United States to treat vomiting, nausea, and appetite stimulation, and Nubian is used for cancer and HIV patients. Synthetic molecules are just as effective as a plant extract. The drug is also available as a regular nasal spray, which is used to relieve pain and cramps associated with multiple sclerosis.
Cannabinoid Receptors
Cannabinoid receptors are extremely important to the normal functioning of the human nervous system, but the exact mechanism of their action is hardly common knowledge. Although most know that cannabis has medical potential, the physiological processes that positively affect health and well-being are not yet fully understood. Cannabinoid receptors themselves are a class of receptors conjugated to G-proteins. They function as activators of intracellular signal transduction pathways, are part of the endocannabinoid system, and are responsible for various physiological functions and overall homeostasis.
Three main groups of molecules activate cannabinoid receptors. These are endocannabinoids, produced by our bodies; phytocannabinoids, which come from plants; and synthetic cannabinoids, such as Marinol. Two subtypes of cannabinoid receptors are currently known and studied: CB1 and CB2, although many more are thought to exist. They are found in almost all body parts and present in all mammals, fish, birds, and reptiles. The endocannabinoid system is most developed in mammals. Each type of C.B. receptor subtype, located in different body parts, has another purpose.
Legalization of Medical Cannabis
The legalization of medical marijuana was first discussed in the United States, where several referendums were held in the 1990s. Canada is ahead of the rest and has not only developed a national program for the use of cannabis for medical purposes but also fully legalized its recreational use (Turna, 2020). Most European countries have already fully or partially legalized the use of cannabis or cannabis-based products for medical purposes. Either way, patients need permission to use cannabis: “Patients receiving cannabis for medical purposes must possess a license to use it”(Boehnke et al., 2019). Marijuana is consumed by inhalation and herbal tea, but smoking the substance is not recommended. In the Czech Republic, patients can buy up to 180 grams of cannabis a month, and not all doctors can write prescriptions.
Despite modern research, the U.N. Single Convention on Narcotic Drugs has since 1961 classified cannabis as a dangerous drug and placed it on par with heroin and tramadol. It was not until 2019 that the United Nations Commission on Narcotic Drugs voted to remove medical cannabis (as well as cannabis resin) from the list of most dangerous drugs. The U.N. decision does not obligate countries to change their policies on cannabis, but removing it from the list is seen as having important symbolic value for marijuana legalization advocates. It may make it easier to conduct medical research involving cannabinoids.
Conclusion
In any case, the medical use of cannabis requires more research. To better manage the use of this substance, I would suggest developing a specific policy. It would be that the patient could use cannabis only under a doctor’s supervision and purchase exactly the amount recommended for his disease. Doctors have to let the person know that cannabis is part of the treatment, not a recreational activity. Only in this way will the patient take the use more seriously and not abuse it.
References
Boehnke, K. F., Gangopadhyay, S., Clauw, D. J., & Haffajee, R. L. (2019). Qualifying conditions of medical cannabis license holders in the United States. Health Affairs, 38(2), 295-302.
Philpot, L.M., Ebbert, J.O. & Hurt, R.T. A survey of the attitudes, beliefs, and knowledge about medical cannabis among primary care providers. BMC Fam Pract 20, 17 (2019). Web.
Pisanti, S., & Bifulco, M. (2019). Medical Cannabis: A plurimillennial history of an evergreen. Journal of cellular physiology, 234(6), 8342-8351.
Sagy, I., Bar-Lev Schleider, L., Abu-Shakra, M., & Novack, V. (2019). Safety and efficacy of medical cannabis in fibromyalgia. Journal of clinical medicine, 8(6), 807.
Shover, C. L., Davis, C. S., Gordon, S. C., & Humphreys, K. (2019). Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proceedings of the National Academy of Sciences, 116(26), 12624-12626. Web.
Turna, J., Balodis, I., Munn, C., Van Ameringen, M., Busse, J., & MacKillop, J. (2020). Overlapping patterns of recreational and medical cannabis use in a large community sample of cannabis users. Comprehensive Psychiatry, 102, 152188. Web.