Medical Cannabis Benefits and Risks [The science behind a misunderstood drug]

by Richard Lewis | Apr 17, 2020 | MEDICAL INNOVATION

Table of Contents

Medical Cannabis Legitimacy
Research Into Medical Cannabis 
The Endocannabinoid System (ECS)
How Cannabis Works With the ECS
The Benefits of Medical Cannabis
Cannabis and Health Disorders
Cannabis as a Recreational Drug
Cannabis Side-Effects and Harms
Cannabis and Schizophrenia
Synthetic Cannabinoids
Common-Sense in Legalization

Medical Cannabis Legitimacy

Cannabis (Marijuana) is the most popular recreational drug worldwide after alcohol and tobacco. As a commodity with outstanding attributes, cannabis offers hemp fiber, oils, and other derivatives.  But the plant’s medical and recreational use needs a lot more research and understanding. What are the cannabis benefits and risks?

World governments are still in the throws of recognizing the legitimacy of this plant. For years cannabis has been ostracized. Even though there’s a growing trend to legalize medical cannabis, conservative mainstream health institutions have remained reticent, and it will take many years for cannabis to be a mainstream medicine.

“The FDA understands that there is increasing interest in the potential utility of cannabis for a variety of medical conditions, as well as research on the potential adverse health effects from the use of cannabis. To date, the FDA has not approved a marketing application for cannabis for the treatment of any disease or condition.”

U.S. Food & Drug Administration

Note: The agency has approved Epidiolex (cannabidiol) and three other synthetic cannabis-related drug products.

For more than half a century, the World Health Organization disapproved of the medical use of cannabis as having no benefits. It was only in 2018, after an extensive report, that WHO recommended cannabis be downgraded as a Schedule 1 drug. The decision has not been readily publicized.

Pharmaceutical companies are gradually starting to offer cannabis compounds for medical use. Opiates are still the dominant mainstream prescription drug that is easier to manufacture. But opiates are much more addictive and dangerous. Cannabis appears a safer option, but how much is understood about this controversial drug?

Research Into Cannabis For Medicinal Use

Cannabis seems to have numerous healing attributes that can potentially help the physical and mental well-being of millions globally. It’s certainly a drug that needs greater recognition by the general scientific community, and appropriation of health budgets.

In the last sixty years, leading researchers have made significant strides in understanding the interaction of cannabis with the brain and its effect on the human body. But there is a long way to go.

Professor Raphael Mechoulam, an organic medicinal chemist at the Hebrew University of Jerusalem, Israel, has been the dean of the transnational cannabinoid research community. Together with Professor Yechiel Gaoni, they made the first significant discoveries regarding cannabis and its effect upon the human body’s endocannabinoid system (ECS).

Following their discovery of tetrahydrocannabinol (THC), a marijuana cannabinoid, in the early 1960s, Manchoulam and Gaoni went on to discover the ECS, deriving the name from the plant in the 1990s. Further studies from Lisa Matsuda’s team at the National Institute of Mental Health identified THC sensitive brain receptors.

In 2000, Mechoulam & Hanus identified two endogenous cannabinoids the body naturally produces, anandamide, and 2-arachidonoylglycerol. In the last two decades, thousands of papers have furthered these studies.c

The Endocannabinoid System

The endocannabinoid system (ECS) is responsible for regulating many functions in the body, and its purpose is to achieve homeostasis, generally maintaining the body’s health and balance.

Some of the functions that the endocannabinoid system regulates:

• The length and quality of sleep
• The intensity of mood
• Cognition, how we perceive things, and creativity
• Short and long-term memory
• The feeling of appetite and nausea
• Muscle control and spasms
• Sensitivity to pain
• The central and local control of reproductive functions

The ECS consists of endocannabinoids, enzymes, and cannabinoid receptors, naturally produced in the body.

Endocannabinoids are lipid metabolites (fats for energy, also involved in the construction of cell membranes). Endocannabinoids such as anandamide and 2-arachidonoyl glycerol interact with cannabinoid receptors that regulate many of the body’s sensory, behavioral, and memory functions.

Enzymes that break down endocannabinoids. These are fatty acids, such as amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL). When endocannabinoids work has achieved homeostasis in the body, the enzymes break them down.

Cannabinoid receptors are G protein-coupled receptors activated by endocannabinoids. There are two types of cannabinoid receptors, named CB1 (found mainly in the brain, central nervous system, lungs, liver, and kidneys) and CB2 (found in the immune system and stem cells).

When the body is out of balance, the ECS synthesizes endocannabinoids that are neurotransmitters acting upon cannabinoid CB1 and CB2 receptors. These receptors act differently for each type of cannabinoid, transmitting signals for regulating physiological processes.

The control of traditional neurotransmitters, such as serotonin, happens through reuptake in neurons. ECS doesn’t operate the same way. There is no reuptake of endocannabinoids. Instead, once the body reaches homeostasis, such as regulating pain or hunger, enzymes break down the endocannabinoids. These enzymes act to end the neurotransmitter signals inhibiting the continuation of the body’s metabolic, hunger, and pain response.

How Cannabis works with the endocannabinoid system

Researchers have discovered that cannabis contains around 426 chemical substances, at least 113 of which have been isolated as cannabinoids. These cannabinoids, named phytocannabinoids, are very efficient in acting as endocannabinoids in the EC-system.

Phytocannabinoids interact very naturally with the ECS cannabinoid receptors to influence the signal responses sent to the body for appetite, metabolism, pain control, memory function, and more. These compounds play a significant role in medical cannabis. Recreational users also enjoy the psychoactive and physical effects of these cannabinoids.

Two well-known phytocannabinoids are delta-9-Tetrahydrocannabinol (d9THC), which is psychoactive, and Cannabidiol (CBD), a non-psychoactive pain-relieving compound.

Both cannabinoids are found in high concentrations in the flowering buds of female plants, in the sticky trichome resin covering its budding flowers. These elements work on the brain’s endocannabinoid system regulating memory, mood, pain sensitivity, and appetite.

From a legal perspective, Hemp is cannabis with less than 0.3% THC. Medical and recreational cannabis contains more than 0.3% THC.

Cannabis has three strains, C.Sativa, C.Indica, and C. Ruderalis. The Sativa and Indica, or a hybrid of the two, are the strains most cultivated for medical or recreational use. The Indica strains generally have a higher CBD content, and less THC. Sativa typically has a higher THC to CBD ratio.

Other notable compounds derived from cannabis are the terpenes and flavonoids that give rise to the plant’s strong odor and an array of colors in different varieties of bud. Flavonoids offer significant health benefits, acting as an antioxidant and a natural anti-inflammatory, also benefiting the immune system. Studies have shown that flavonoids may serve as a preventative to cancer. It is the entourage effect of cannabinoids, terpenes and flavonoids working together, that makes medical cannabis so effective.

The benefits of medical Cannabis

As medicine, cannabis is effective in treating chronic pain, incontinence, and muscle spasms. Consequently, in countries where medical cannabis has been legalized, it is prescribed for people with multiple sclerosis (MS) and spasticity, relating to speech problems, difficulties in walking, and body movement.

The key to the successful use of medical cannabis it the selection of the type of dose and frequency of use. The dosage needs to be appropriate for each kind of illness and symptom.

Medical marijuana is relatively still in its infancy compared to other prescription drugs. Expert clinical use is both a science and an art. Doctors prescribing cannabis, require an understanding of the illness, a person’s individual physical and mental circumstance, as well as the attributes of each type of cannabis plant, and their cannabinoid composition. 

Clinical medical cannabis application is a subject that requires learning and experimentation by trial and error. Cannabis should not be prescribed by doctors that have not been trained in its use.

For further information about medical clinics, go to the end of the post on Which health conditions cannabis helps?

To learn more about cannabis medication, see the article about the Worlds best medical cannabis brands.

Medical Cannabis for various health disorders

Looking at its medical use today, what are the cannabis benefits and risks? Clinicians now use medical cannabis such as Epidiolex, a pharmaceutical-grade, highly-purified form of cannabidiol (CBD) for epilepsy seizures. Medical cannabis relieves pain related to Fibromyalgia. Sativex, a THC/CBD cannabinoid oral spray, helps with muscle stiffness related to muscular dystrophy (MS).

Medical cannabis has been a lifeline for AIDS patients, that spurred the movement for cannabis research in the last 40 years. Consequently, numerous patients suffering from the effects of chemotherapy cancer treatment use medical marijuana to alleviate nausea and increase appetite.

Marijuana also relieves the symptoms of Rheumatoid Arthritis and Osteoarthritis. Cannabis aids sleep for people with insomnia. Research is now underway in the use of cannabinoids in the treatment of anxiety and depression, as well as diabetes, asthma, Alzheimer’s, Crohn’s disease, and more.

For a further understanding of ongoing medical cannabis research and for which disorders clinicians are using marijuana or its derivatives, check out Which health conditions cannabis helps?

The cross-over from medical to recreational use of marijuana is its use in treating stress-related disorders. Stress has increased exponentially over the last 30 years, with the rise of traumatic events and stressful work conditions affecting people globally.

If you’re self-aware, you will be conscious when you’re experiencing stress. But stress can also be experienced sub-consciously, with people being unaware of their condition. External pressure is not necessarily a bad thing, and in some cases, can make a person more productive. 

Yet, there are stress conditions that are destructive to the mind and body, increasing heart rate, blood pressure, and aggravating several medical conditions. 

Beyond the popular excuse to get high, cannabis is commonly used to counteract the effects of stress. But recreational users often lack knowledge of what their getting themselves into, and should really use Cannabis with a lot more caution. 

Cannabis as a recreational drug

In recent years, due to the increase in demand for recreational cannabis, growers have been incentivized to breed plants with higher levels of THC, even above 21%, for higher psychoactive potency— hybrids for a head-high. These strains have a high THC to CBD ratio and can induce anxiety and panic attacks, expressly if someone’s not used to these potencies, and has not developed tolerance.

It’s the CBD content that moderates the adverse effects of THC. Of late, recreational users have increased demand for lower levels of THC, around 15% with a higher percentage of CBD, the outcome, a more balanced and pleasant high. To put things in perspective, in the 60s and 70s apart from types such as Thai-sticks, most cannabis had around a 4% THC content.

Cannabis side-effects and harms

Medical and recreational users take marijuana to relieve stress. Cannabis is also popular with artists, musicians, and even business people, as it increases creativity. 

But cannabis has benefits and risks, and the problem is many users are ignorant about the content of cannabis they’re taking. 

It’s important to differentiate between casual recreational use and frequent use over a prolonged period.

Especially if purchasing from black-market sources, dealers offer weed with very high THC content, and low CBD, which include chemical feed-types and pesticides. 

Users need to understand which cannabis breed they are ingesting, especially with frequent use.

The intake method of cannabis makes a massive difference in absorption to the body. Smoking is the fastest acting, but much of the active compounds burn at higher temperatures, decreasing the efficiency of delivery. Vaping heats cannabis at a lower temperature and is also fast-acting. It is more effective and efficient but has a different effect than smoking.

The effects of smoking and vaping cannabis, stay in the system, a much shorter time, than digesting cannabis. Edible cannabis takes longer to absorb into the system, but once absorbed will remain in the system for much longer, even days. Also, the effect of eating marijuana can give a negative psychoactive experience, especially if you are new to cannabis, with a low tolerance. It is much harder to measure how much you are taking when using edibles. Be warned.

For an enlightening discussion about using cannabis for medical and recreational purposes, check out this podcast from the Joe Rogan show. Advocate Dr Michael Hart, Medical Marijuana clinician, and critic Alex Berenson, author and former reporter for the New York times, together with Joe, discuss in-depth the pros and cons of cannabis use.

The minimum age doctors advise if you’re going to try cannabis, is 25 years. The brain is still developing until that age. Youngsters until that age should avoid cannabis altogether, unless for genuine medical reasons. Treatment should be carried out only under strict supervision and prescription from a qualified physician. The clinician must fully understand the specific medical case and understand the clinical application of medicinal cannabis.

“There are suggestions that cannabis can have a longer-lasting impact on the health of adolescents, given that their brains are still developing.”

Deborah Hasin, Professor of Epidemiology at Columbia University

If you are 25 years of age or above, new to cannabis, and want to try it, ask yourself these questions.

Know Your Weed – Questions you should be asking

• Why are you taking cannabis?
• What is your current mental state? Are you anxious? Do you have mental health issues?
• Have you spoken to a professional that’s knowledgeable about cannabis and your health circumstance?
• Are you sure you know the variety?
• Is your source reliable and of good quality? What is your supplier’s rating?
• Do you know the composition and quantities of THC and CBD?
• Are you aware of the presence of other cannabinoids, terpenes, and flavonoids? What’s the entourage effect?
• Do you know the outcome of different ingestion methods? Smoking, vaping, or edibles.
• How will this hybrid affect your mental and physical state?
• How long will the cannabinoids stay in your system and affect your function?
• Where are you taking it? Is it a pleasant, comfortable environment, where you feel safe?
• Who are you with, and are they responsible?
• How will it affect your work or relationship with those around you?
• What will be your frequency of use? Are you lightly to become dependent?

As mentioned previously, cannabis, when taken responsibly from a reliable source, and on a casual basis, is less harmful than alcohol. But, out of ignorance and the effects of prolonged, frequent use, as a recreational drug, it is easily abused. More worrying than anything is the prevalent use of marijuana among teenagers whose brains are still in development. Often overlooked is the cocktail of drugs used together with cannabis that have a compounding detrimental effect on health.

Long-term regular use can impair mental function, affecting cognitive skills; its prolonged usage can make it more difficult to memorize information.

Continuous use is linked with depression and even psychotic episodes in some users. Studies have shown that 10% of recreational users become dependent, with symptoms of reduced appetite, weight loss, mood swings, and restlessness. 

When trying to withdraw from excessive regular use, smokers commonly experience a psychological need out of habit. Smokers that frequent weed with high levels of THC, lacking CBD become mentally conditioned to a psychoactive high. This mental state leads to demotivation in school studies and older users’ lack of productivity at work. Many parents complain their kids have become different people. 

Cannabis should not be used at all by children, teenagers, or young adults (until the age of 24) without supervision from a trained physician for medical purposes. 

Cannabis and Schizophrenia

A hot topic associated with cannabis use is the link with Schizophrenia. It is not surprising that marijuana is associated in this way, as cannabinoids serve the purpose of mimicking endocannabinoids that are psychoactive, regulating mental health and the body’s response to disorders.

There is a legitimate concern that the unregulated use of THC, the psychoactive cannabinoid, will lead to the development of psychosis in users. High doses of THC, especially in users with a low tolerance, can lead to a psychotic break episode.

However, there is inconclusive evidence that cannabis has long-term effects leading to Schizophrenia, as there have been so few epidemiological studies. Generally, there are no significant statistics on Schizophrenia in the U.S. at all.

We can say is that from known historical records, schizophrenic cases have decreased over the last few decades, while the usage and potency of cannabis for recreational purposes has significantly increased. But that’s not sufficient evidence to write off a correlation between the two. More research is needed. 

One thing to think about is that Schizophrenia is significantly less common than stress, anxiety, depression, and bipolar disorders. It is more significant to study correlations between the frequent use of cannabis and the trend in these mental health disorders. For sure, there are arguments on both sides.

There has been a significant increase in mental health disorders amongst teenagers, but it is more likely due to engagement with social media than cannabis use. One thing is for sure, cannabis is harmful to brain development in younger users and should be discouraged. 

Regardless of age, vulnerable users that become dependent on recreational cannabis are a concern. Black-market marijuana that’s unregulated is dangerous, and only emphasizes the importance of legalizing cannabis.

Making weed legal and working with producers, makes it much easier to regulate potency, with balanced, measured ratios of THC and CBD.

Of significant concern is the over-use of cannabis for recreational purposes, like alcoholics, life without it, seems bland. It appears that marijuana is less harmful than alcohol, but heavy use significantly impacts users appreciation of life, when not stoned.

Synthetic Cannabinoids produced in laboratories

Beyond natural endocannabinoids and phytocannabinoids, is the creation of synthetic cannabinoids in laboratories. Commonly known on the recreational market, as Spice. 

Pharmaceutical companies developed synthetic d9THC to be patented and sold as medicinal drugs. However, the effects were so strong; they didn’t receive approval. The problem was that these drugs overstimulated the CB1 neuroreceptors, with horrific results. 

After many years of remaining dormant, black-market gangs developed these drugs once again, as they were undetectable to urine tests. Synthetics worked well for prisoners, athletes, or even employees wanting to avoid drug detection tests at work. These artificial creations have disastrous effects on young kids, causing hundreds of deaths, seizures, and heart attacks. 

There are some developments of synthetic cannabinoids for medical uses that have received approval by the FDA. 

A Common Sense Approach to Cannabis Legalization

As stated previously, overall, cannabis as a drug is safer than alcohol and cigarettes. It is quite ironic that recreational cannabis remains illegal in so many states, and that liquor and cigarettes are sold almost everywhere. The sale of alcohol should be much more strictly regulated, and tobacco banned altogether. There is talk of car manufacturers integrating breathalyzers in car ignition systems. Perhaps future systems can check for drugs as well.

For sure, the research of medical Cannabis should receive a much higher proportion of budgets set aside to health authorities and medical researchers. Medical authorities worldwide need to recognize its importance and work towards offering approved medical Cannabis as a mainstream prescription drug. Opiates are much more addictive and dangerous, many people committing suicide or dying from an overdose each year. No one dies as a direct result of ingesting Cannabis. But further research is required to understand accidents relating to cannabis intoxication.

By legalizing Cannabis for recreational use, it would demotivate many of the illegal farms commonly run by gangs from operating. These gangs often use illegal immigrants and even children to manage their operations. Policing costs would be reduced, and taxes earned on sales as with cigarettes and alcohol, shown to be accurate in states that have legalized.

By regulating Cannabis use, the retail distribution of Cannabis can be licensed and controlled. The types of hybrids offered to the public would have complete transparency of the cannabinoid, terpenes, flavonoid content, and growing methods. Just as with food, people would know what they are getting. 

As stated in the title of this post, let’s give medical Cannabis the respect it deserves. That means increasing approved studies of its benefits and harms. 

One Final Comment 

When considering using Cannabis, each person must understand the circumstance of their health, both mentally and physically. If you are honest with yourself and unsure in any way whatsoever, be sure to seek professional advice. 

Special thanks to the work of Professor David Nutt, Director of the Neuropharmacology unit, at Imperial College London. His outstanding work and level headed approach to understanding the effects of drugs and alcohol should be adopted by governments worldwide. I strongly recommend reading his book Drugs without the hot air available at Amazon.