Medical Use of Cannabis: Benefits and Risks
What scientific data are available so far, and why do we know more about the medicinal use of cannabis?
What are researchers studying?
Most researchers are interested in a specific component of cannabis called cannabinoids.
From a researcher’s point of view, cannabis is a “dirty” drug, in contrast to a “pure” body that contains only one species. In fact, the plant contains hundreds of ingredients whose effects are not well known. Therefore, researchers are focusing on only one type of cannabinoid at a time. To date, only two cannabinoids from plants (THC (tetrahydrocannabinol) and cannabidiol) have been extensively studied, but there may be other cannabinoids that are not yet known to have therapeutic effects.
THC is the main active ingredient in cannabis. It activates cannabinoid receptors in the brain, causing the “high” effects well known to cannabis users, but it also affects the liver and other parts of the body. The only two cannabinoids approved by the FDA (Food and Drug Administration) that doctors can legally prescribe are laboratory-synthesized drugs that reproduce the effects of THC. They are prescribed to increase appetite and prevent muscle loss in certain cancers and AIDS.
On the other hand, cannabidiol (also known as CBD) does not interact with cannabinoid receptors. It also does not generate “high”. In the United States, 17 states have passed legislation that allows certain patients access to CBD.
Our body naturally produces cannabinoids and endocannabinoids. Researchers are developing drugs that can change the functions of receptors for these substances in order to better understand how they work in our bodies. These studies aim to find a cure that allows us to use naturally occurring cannabinoids to treat chronic pain and epilepsy instead of using plant cannabis.
We often hear that cannabis is a potential cure for many illnesses. To illustrate the current state of research on the therapeutic effects of cannabis, let’s take a closer look at two conditions: chronic pain and epilepsy.
Can Cannabis Help with Chronic Pain?
Research results show that some people with chronic pain self-treat with cannabis. However, not enough research has been done in humans to find out if cannabis or cannabinoids actually relieve chronic pain.
Human studies show that certain illnesses, such as chronic pain from nerve damage, are sensitive to the effects of smoke or vaporized cannabis, and the FDA-approved drug-based TCA, dronabinol. It has been. In France, Dronabinol (Marinol, under its trade name) only benefits from a registered Temporary License (ATU).
However, most of this study is based on subjective statements, personal assessments of pain, and limits its relevance. Very few controlled clinical studies have been conducted to date, and it is unclear whether cannabis is an effective pain treatment.
Another approach is to look at different drug combinations, that is, experimental cannabinoid drugs related to already known drugs. For example, a recent study in mice combined low-dose THC drugs with aspirin-like drugs. However, this combination better blocks nerve ending-related pain than any of these drugs alone.
Theoretically, such a combination would reduce the amount of each substance used, thus reducing side effects. In addition, some people are more likely to accept one substance than others, and the combination is more likely to work in more patients. However, no such studies have been conducted on humans.
Effect of cannabis on epilepsy
Despite some sensational articles and speculation on the internet, the therapeutic use of cannabis to alleviate epileptic seizures has so far been confirmed only by experiments with rodents.
In humans, the evidence of its effectiveness is far less proven. There are many anecdotes and studies praising the advantages of cannabis flowers or cannabis extracts for the treatment of epilepsy. However, these statements can determine whether a particular type of seizure responds positively to the effects of cannabinoids and provide stronger clues as to how most people respond to this substance. It cannot be compared with well-managed clinical studies. ..
Although CBD is gaining attention as a potential treatment for human seizures, nothing is known about the physiological relationship between substances and their effects. As with chronic pain, some clinical studies conducted included a very small number of patients. By studying a larger group, you can find out if only certain patients are accepting CBD.
You also need to know more about cannabinoid receptors in the brain and body and understand which systems they regulate and how CBD affects them. For example, CBD may interact with antiepileptic drugs, but it is not yet known in which direction it will go. It can also affect the developing brain and the adult brain differently. Special care should be taken if children and adolescents want to be treated with CBD or cannabis products.
Cannabis research is difficult
Only through thorough research can we understand the potential therapeutic virtues of cannabis. However, the study of cannabis and cannabinoids is very difficult.
In the United States, cannabis and its constituents, THC and CBD, are closely monitored by the US Drug Enforcement Administration, DEA, along with ecstasy and heroin.
To study cannabis, each researcher must first seek permission from the state and federal levels. A very long analytical process followed by inspection guarantees a high level of security and maximum traceability for research.
In our laboratory, even the smallest amounts of cannabinoids used in mouse research are under close scrutiny. This regulatory burden discourages many researchers.
Another difficult task is the design of the experiment. Many studies are based on user memory: they explain their symptoms and the amount of cannabis consumed. This same bias is found in all studies based on the behaviors described. In addition, laboratory studies generally include only moderate to frequent users and are not representative of the general public as they have already developed an addiction to the effects of marijuana. In addition, these studies have been limited to the use of cannabis in its “whole” form, which contains many types of cannabinoids, and little is known about its effects.
Placebo studies are also complicated by the euphoria often associated with cannabis use, which makes it easy to identify the substance, especially when it contains high doses of THC. People know when they are “high” and when they are not.
There is another bias known as expectation bias that has special implications for cannabis research. This bias is based on the idea that, to our knowledge, we tend to experiment with what meets expectations. For example, people report that they are more awake after drinking “normal” coffee, even if it is actually decaffeinated coffee. Similarly, participants in the cannabis study reported relief after cannabis intake because they believed that cannabis would relieve pain.
The best way to overcome this bias is to set up a more advanced placebo test. Unlike simple placebo studies, where participants do not know what they are getting, they are said to be receiving a placebo or cannabis, but that does not necessarily reflect reality.
Cannabis research should also include objective biological measurements such as THC levels in the blood, or physiological or sensory measurements commonly found in the field of biomedical research. Currently, cannabis research focuses on self-reported measurements rather than objective measurements.
Cannabis use is not without risk
The potential for overuse exists in all drugs that affect brain function, and cannabinoids are no exception. Cannabis can be compared to tobacco in that many of its users find it difficult to quit smoking. And like tobacco, cannabis is a natural product that is selectively grown for its stronger effects on the brain and is not without its risks.
Many cannabis users can quit without problems, but 2-6% of US users have difficulty quitting. Repeated use of the drug is a sign of addiction, despite the urge to reduce or stop the drug.
The number of addicts can increase as more states in the United States pass legislation supporting the medicinal or recreational use of cannabis.
It’s too early to say that the potential benefits of cannabis outweigh the risks it poses to those who use cannabis. However, as restrictions on the US cannabis (and cannabidiol) law have been relaxed, it’s time for some studies to establish the facts.
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