endocannabinoid system

What is Medical Cannabis

What is Medical Cannabis (Cannabis Based Medical Products)

What is Medical Cannabis? What is it used to treat?

Cannabis Based Medical Products (CBMPs) or Medical Cannabis are medications derived from the cannabis plant, containing cannabidiol (CBD) and/or Tetrahydrocannabinol (THC – which is the psychoactive substance in cannabis). In the UK medical cannabis has been legal since 2018 for the treatment of psychological, neurological, and chronic pain conditions as well as, palliative and/or end of life care: for sake of brevity a full list of conditions treated in the UK is highlighted in eligibility section of this website.

What’s the eligibility criteria?

With cannabis based medical products (CBMPs) being unlicenced, the census would be for patients to evidence unmet clinical needs i.e., their health is not improving despite having ongoing treatment or interventions via conventional healthcare services. It is important for all patients to recognise that due to cannabis containing a psychoactive substance, for the safety of potential patients, if you have any of the diagnosis listed in the exclusion criteria, you will not be eligible. We would advise these patients to liaise with their consultants at the NHS and explore an alternative treatment method to support their health needs.

Patients have a right to a second opinion, provided they do not have any counterindications listed in the exclusion criteria below. Patient’s must be over 18 years of age.

Exclusion Criteria?  

Like all medications, CBMPs is not advisable to use if you struggle from one of the following: –

  • Suffer with high BP (If this is not stable)
  • History of psychosis
  • Diagnosis of schizophrenia
  • Heart condition (Which has NOT been stable for 6+ months)
  • Pregnant or breast-feeding

What are the side effects of medical cannabis?

Side effects of CBMPs include:

  • Drowsiness
  • Confusion
  • Imbalance
  • Euphoria
  • Diarrhea
  • Dry mouth
  • Anxiety and/or Depression
  • Heart Palpitations
  • Psychological Dependence
  • Tolerance
  • Cannabis hyperemesis syndrome (CHS)

Adverse reactions include:

  • Headaches
  • Migraines
  • Nausea
  • Vomiting
  • Diarrhoea

If you experience an adverse reaction, it is important that you report your symptoms to the MHRA via yellow card, who are the medicines and healthcare products regulatory agency. To report a yellow card, please follow this link and fill out the form: Yellow Card | Making medicines and medical devices safer (mhra.gov.uk). It is also vital that you inform your clinic, to ensure this medication is not prescribed to you again in the future.

Cannabis dependence:

Cannabis dependence is known clinically as cannabis use disorder, and user’s of any form of medicines, including medical cannabis are prone to psychological dependency.

Signs of Psychological dependence include:

  • Not using medications as prescribed -> using more than required or larger dosages and/or more frequently
  • Withdrawal
  • Developed a tolerance and require more
  • Failed repeated attempts to control or stop use
  • Physical or psychological concerns related to use (i.e., respiratory concerns or fluctuation in mood)
  • Missing relevant appointments or work to use
  • Craving for purposes other than prescribed

If you experience any of the following, please get in touch with your prescriber, so that they may manage this concern accordingly.

Cannabis Hyperemesis Syndrome (CHS)

Cannabis hyperemesis syndrome, also known as cannabinoid hyperemesis syndrome, can affect people who are exposed to prolonged, high doses of cannabis: this can also occur with medical cannabis use.

Signs of Cannabis Hyperemesis Syndrome include:

  • Intense nausea and vomiting
  • Projectile vomiting (can happen without warning, up to 5x an hour)
  • Extreme Diarrhea
  • Lack of appetite
  • Weight loss

Although this is uncommon, if you experience any of the following, please reduce use or stop where possible and urgently alert your prescriber. If symptoms are uncontrollable, please seek urgent medical intervention as you are at risk of dehydration.

Monitoring BP / Warfin prescription

Medical cannabis can for some people cause heart palpations, it is important that people with a history of high blood pressure or a heart condition to be mindful of this, particularly those on warfarin as cannabis can impact the liver enzymes, interacting with other medications. It is important that you work alongside your GP and relevant health care professionals to adequately address your heart.

If you are someone who meets this criterion, regularly monitoring your blood pressure would aid in ensuring your safety and enables you to appropriately reach out for support.

Blood pressure guidance:

Low 90/60 or below Inform GP and clinic, if unwell seek medical attention
Ok 90/60 – 140/90 Continue to monitor – update clinic at FUP appointment
Raised 141/91 – 179/119 Raised, monitor and inform GP and clinic
High 180/120 or more Significant risk, needs urgent review – update GP and clinic

 

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A Table To Help Manage ECS

Understanding the Endocannabinoid System

Introduction

The endocannabinoid system (ECS) plays a crucial role in maintaining balance and homeostasis within our bodies. It consists of a complex network of receptors, endocannabinoids, and enzymes that interact with cannabinoids found in cannabis plants. For medical cannabis patients in the UK, understanding the ECS is essential for maximising the therapeutic benefits of cannabis-based treatments. In this article, we will delve into the intricacies of the endocannabinoid system, its functions, and how it relates to medical cannabis.

The Endocannabinoid System: An Overview

The ECS is composed of three primary components: endocannabinoid receptors, endocannabinoids, and enzymes. The two main receptors within the ECS are CB1 and CB2 receptors. CB1 receptors are primarily found in the central nervous system, while CB2 receptors are predominantly located in the immune system and peripheral tissues. Endocannabinoids, such as anandamide and 2-arachidonoylglycerol (2-AG), are naturally occurring compounds produced within our bodies that bind to these receptors. Enzymes, specifically fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL), break down endocannabinoids once their purpose is served.

Functions of the Endocannabinoid System

The ECS plays a vital role in regulating numerous physiological processes, including:

a. Pain and Inflammation: Activation of CB1 receptors in the central nervous system can help modulate pain perception, while CB2 receptors in the immune system regulate inflammation and immune responses.

b. Mood and Stress: The ECS influences mood regulation by interacting with neurotransmitter systems. Activation of CB1 receptors has been associated with the alleviation of anxiety and depression symptoms.

c. Sleep and Appetite: The ECS is involved in the regulation of sleep-wake cycles and appetite. CB1 receptors in the hypothalamus and limbic system influence food intake and energy balance.

d. Memory and Learning: The ECS is implicated in memory formation and neuroplasticity. CB1 receptors in the hippocampus and cerebral cortex contribute to these cognitive functions.

Medical Cannabis and the Endocannabinoid System

Medical cannabis, containing cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD), interacts with the ECS to exert its therapeutic effects. THC binds to CB1 receptors, producing psychoactive effects and influencing pain perception, appetite, and mood. CBD, on the other hand, has a low affinity for both CB1 and CB2 receptors but modulates the ECS indirectly by interacting with other receptor systems. CBD has shown promise in reducing seizures, managing pain and inflammation, and aiding with anxiety and sleep disorders.

Optimising Medical Cannabis Use in the UK

For medical cannabis patients in the UK, optimising the use of cannabis-based treatments involves several key considerations:

a. Strain Selection: Different cannabis strains contain varying ratios of cannabinoids and terpenes, each with unique therapeutic properties. Working with a healthcare professional or pharmacist experienced in medical cannabis can help identify the most suitable strains for individual conditions.

b. Dosage and Administration: Accurate dosing is essential to achieve desired therapeutic effects while minimising side effects. Patients should start with low doses and gradually increase until they find their optimal dosage. Various administration methods, such as inhalation, oral ingestion, and topical application, offer different onset times and durations.

c. Monitoring and Adjusting: Regular monitoring of symptoms and side effects is crucial to evaluating treatment efficacy. Adjustments to dosage, strain, or administration method may be necessary to optimise therapeutic outcomes.

A Table To Help Manage ECS

Optimising Your Endocannabinoid System (ECS): A Comprehensive Guide on Evidence-Based Interventions →

Conclusion

Understanding the endocannabinoid system is fundamental for medical cannabis patients in the UK seeking effective relief from various conditions. By comprehending how the ECS functions and interacts with cannabinoids, patients can make informed decisions about strain selection, dosing, and administration methods. Additionally, working closely with healthcare professionals ensures safe and personalised treatment plans. The evolving landscape of medical cannabis research may further enhance our knowledge of the ECS and unlock new possibilities for therapeutic interventions in the future.

References:

  1. Pacher, P., & Kunos, G. (2013). Modulating the endocannabinoid system in human health and disease: successes and failures. The FEBS Journal, 280(9), 1918–1943.
  2. Pertwee, R. G. (2008). The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. British Journal of Pharmacology, 153(2), 199–215.
  3. Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245–259.
  4. Zuardi, A. W. (2008). Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Revista Brasileira de Psiquiatria, 30(3), 271–280.

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