Cannabinoids (Can-nab-i-noids)

There are over 500 compounds known to be present in marijuana (cannabis). There have been 113 identified cannabinoids (substances found in cannabis), many of which are biologically active. Some have psychoactive properties. The human body also has an endocannabinoid system where humans can produce cannabinoids internally and produce cannabinoid receptors (these are proteins on a cell’s surface which binds to cannabinoids). Cannabinoid receptors are present many different cells and organs including the brain/central nervous system. The endocannabinoids are generally not as potent as external cannabinoids and tend to be shorter-lived regarding their actions as compared to external cannabinoids from cannabis.

There is extensive ongoing medical and scientific research being done on the marijuana plant due to its many definitive benefits on healing, inflammation, pain reduction, and anxiety relieving properties just to name a few.

The two main compounds in cannabis/marijuana are tetrahydrocannabinol (THC) and cannabidiol (CBD), which all patients should familiarize themselves with these compounds.

THC:

·       Psychoactive

·       Can cause potential dependency

·       Sativa-based (energizing, stimulating effects)

·       Produced from THCA

·       Has great effects on pain, fatigue, appetite loss, ADHD and many other effects

CBD:

·       No psychoactive property

·       Does not by itself cause dependency

·       Indica-based (calming, relaxing, soothing effects)

·       Produced from CBDA

·       Has great effects on anxiety, difficulty with sleep, epilepsy, inflammation, spasms/cramps and many other effects

CBDA: Cannabidiol Acid. Converts to CBD. Non-psychoactive

CBGA: Cannabigerol Acid. Converts to THC/CBD. Non-psychoactive

CBG:   Cannabinol. Known as the stem cell of all cannabinoids in the cannabis plant. Works as a precursor or “chemical parent” to other cannabinoids. Non-psychoactive.

Marijuana may have some limited interactions with some pharmaceutical medications but is generally considered safe with many medications. It is a great adjunct to treatment for opioid use disorder in individuals on medication assisted treatment/therapies. Cannabis can help lower the need for opiates and thereby help lower the doses of opioids or even eliminate their use thus lessening the risk for potential overdose from opioids. It is also helpful in reducing the need for sedatives/benzodiazepines and can help lower the dose of sedatives/benzodiazepines and or even eliminate their use thus lessening the risk for potential overdose from sedatives.

While there are many cannabinoid receptors in the human body there are no receptors in the brain stem which is part of the brain that has the centers that control breathing and the heart rate. Therefore, cannabinoids do not affect that part of the brain. Studies on whether there is a lethal dose of marijuana show that if marijuana were consumed at exceedingly high doses more than 3000 mg/kg that it could be potentially/theoretically toxic. However, there has not been record in the extensive medical literature describing a proven, documented cannabis-induced fatality. However, caution should always be taken when using cannabis especially when utilizing high doses of THC. Individuals who are not accustomed to THC including the elderly or the very young, should always start with very low doses and low concentrations of THC when required and gradually increase the dose to allow the body to accommodate to higher concentrations depending on the medical condition and medical needs.

A word of caution when smoking or vaping marijuana: patients should always smoke or vape marijuana in a room where there is access to a window which can be opened in order to not deplete oxygen from the room as low levels of oxygen or the lack of oxygen can potentially cause loss of consciousness or possibly even death.

It is noteworthy that every person responds/reacts differently to marijuana, which has to do with certain types of proteins in the human body called receptors. Some people have more marijuana receptors (known as cannabis receptors), and some have less in various locations throughout the body. Therefore, the initial phases of trying new marijuana products comes with a degree of a trial and error process in order to determine which strains or products from different strains work best. The good news is that the learning curve with marijuana experimentation is not steep and patients typically find strains quite quickly that produce phenomenal effects and results.