Medicinal Cannabis: What Does the Science Say? | Jamie George
From today (November 1st), doctors in the UK will, for the first time, be legally allowed to prescribe medical cannabis to their patients. The shift in policy was announced in July by home secretary Sajid Javid following the prominent media attention given to the cases of Billy Caldwell and Alfie Mawson, two young epilepsy sufferers who use cannabis oil to help reduce the frequency and intensity of their seizures.
The rapid implementation of this change represents a welcome shift in policy from the Home Office that may finally open the door for scientists to collect the kind of hard, objective data that researchers and lawmakers have been crying out for for decades.
Advocates for the relaxation of cannabis laws have long espoused its medicinal benefits, claiming that it can be used to treat/manage a wide and varied range of conditions, including multiple sclerosis, Huntington’s disease, inflammatory bowel disease, cancer, insomnia, anorexia…the list could go on and on.
On the flip side, though, those who are staunchly opposed to the relaxation of cannabis laws have claimed that its use can actually increase the risk of developing a number of conditions, including lung cancer, stroke, diabetes, and cardiovascular diseases, and that the claim of medical benefits are little more than a pseudo-scientific excuse to get high.
There are even instances where both sides claim that cannabis can either cause or treat the exact same condition, most notably asthma, bronchitis, and psychological conditions like depression, anxiety and schizophrenia. Needless to say, it can be pretty confusing knowing who to listen to for those who find themselves sitting on the fence.
The major issue with any of these claims is that the vast majority of them are purely anecdotal, and any ‘evidence’ supplied by either side is often flimsy or difficult to corroborate. We humans are all, at one time or another, guilty of succumbing to the confirmation bias, the psychological concept that suggests we naturally gravitate towards information that aligns with our preconceived opinions. Cannabis legislation is a divisive and long-enduring issue that is argued passionately on both sides of the divide, so it makes sense that advocates for and against will take as fact anything they hear that helps strengthen their argument, no matter how bizarre, unsubstantiated, or self-contradictory the claims may be.
Until today, cannabis had been categorised as a schedule 1 controlled substance, meaning it was not considered to have any therapeutic value. This has meant that the amount of hard scientific research done on the efficacy of the plant as a medicine has been painfully limited, especially when it comes to conducting clinical trials with human subjects, which is pretty much a rite of passage for any medicine to be taken seriously across the board.
That isn’t to say that research hasn’t been done, it’s just that there’s nowhere near enough data in existence to draw any definitive conclusions. Until that changes, we’re going to have to continue to dealing with the games of who can shout the loudest.
So then, what does the science actually tell us?
The Endocannabinoid System
First, we need to talk a little about how and why our bodies actually respond to cannabis in the first place. The cannabis plant contains around 80 chemicals known as cannabinoids, the most well-known of which are tetrahydrocannabinol, or THC, the psychoactive compound that produces the distinctive high, and cannabidiol, or CBD, which is non-psychoactive but is frequently noted for its various therapeutic aspects, such as its anticonvulsant and anxiolytic properties.
After many years of research, in the 1980’s it was discovered that our bodies had an in-built system for receiving and interacting with these chemicals, which came to be known as the endocannabinoid system (‘endo’ means within). This system plays an essential role in regulating how a person feels, thinks, and moves, among other things.
The cannabinoids bind with receptors found throughout the body, but most prominently in the nervous (CB1) and immune (CB2) systems.
What this means is that compounds like THC and CBD can essentially ‘hijack’ the system, altering certain processes by either slowing them way down or sending them into overdrive. The focus and severity of these alterations appear to vary from person to person, dependent on circumstantial factors such as state of mind, individual physiology, and general tolerance level, explaining why some people may be more prone to spikes in anxiety and paranoia, while others typically experience a more balanced effect.
Our bodies contain a number of endogenous (naturally occurring) cannabinoids, such as anandamide (the bliss molecule), which helps to regulate mood as well as to promote a generally healthy equilibrium between body and mind (homeostasis).
Our bodies aren’t perfect though, and sometimes, whether through genetics or environmental factors, we can develop endocannabinoid deficiencies, vastly limiting the body’s ability to regulate essential processes like mood, pain, and appetite, which, if left untreated, can soon lead to or exacerbate devastating conditions like depression, fibromyalgia, and obesity/anorexia, respectively.
As stated earlier, the molecular composition of phytocannabinoids like CBD and THC are remarkably similar to those that occur in the body naturally, and as such, many researchers, including Dr Ethan Russo of the International Cannabis and Cannabinoid Institute (ICCI), believe that these chemicals may be used to supplement and re-balance the system, thus helping to alleviate, or even eliminate, the symptoms.
Cannabis and Epilepsy
The effectiveness of cannabis (specifically, CBD) in treating epileptic seizures is probably the most well-known among the general public thanks to the prominent media attention given to a number of cases in recent years, most notably that of Charlotte Figi in the United States, whose treatment with a CBD-rich strain of cannabis oil helped her go from up to 400 seizures per week to as little as 1, and more recently in the UK with the cases of Alfie Dingley and Billy Caldwell mentioned at the beginning of this article.
The brain is a vastly interconnected system of electrical impulses and chemical activity. A seizure occurs when a surge or break occurs, disrupting the system and sending it into uncontrollable overdrive.
So how does cannabis help? When administered for epileptic seizures, CBD appears to act as an anticonvulsant, meaning it has the ability to truncate the electrical activity in the brain and keep it balanced. This is the ultimate aim of all drugs that treat epilepsy, though their efficacy can vary from patient to patient, often being a case of trial and error until the right drug, or combination of drugs, can be found.
So could CBD be the final solution? We can’t know for sure, at least until we see more substantial data; much of the research has been largely inconclusive due to the lack of controlled studies and the unreliability of anecdotal evidence.
A New Treatment for Cancer and Alzheimer’s?
Cannabis is already used in cancer treatment as a way of alleviating some of the worst side effects of chemotherapy, namely through pain and nausea relief. However, there is growing evidence to suggest that cannabis may itself be effective in killing cancer cells and shrinking tumours when applied synergistically alongside chemotherapy. This is a fairly new development, but the research that has been done, as discussed in a recent paper by Dr Russo, has been encouraging and is a growing cause for optimism and excitement among the scientific community.
Alzheimer’s is an irreversible neurodegenerative disease that affects cognition, motor skills and leads to progressively worsening dementia. Though there is no cure for the condition, THC and CBD has been used in trials hoping to help secure a better quality of life for those suffering from the condition. These trials have proven promising, with patients displaying improved motor skills and coordination, increased appetite, and general decreases in irritability.
Clearly, we’re still only scratching the surface of cannabis’ potential as a medicinal substance, and there are many other conditions I could have talked about in this post, including Parkinson’s Disease, Multiple Sclerosis, Anxiety, and many more. It’s obvious that scientists need to be allowed to undertake more focused, targeted research to get clearer insights into how to make the most of this miracle plant.
Greater access to cannabis could potentially offer a lifeline to people who are suffering, with that suffering being exacerbated further due to frankly nonsensical laws. The move today by the UK government is an enormous step in the right direction, let’s just hope it paves the way for finding the definitive answers that we so desperately need.
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