Understanding Cannabinoids and Their Medical Uses

Cannabis is a term used to describe all products derived from a specific type of cannabis plant that consists of more than 500 chemicals. The two main types of cannabis are indica and sativa.

Cannabinoids are a group of chemicals or compounds found in the cannabis sativa plant. This includes tetrahydrocannabinol (THC), cannabidiol (CBD), and hundreds of other substances.

Cannabinoids may also be naturally present in the human body and are referred to as endocannabinoids.

Cannabinoids are commonly used to minimize symptoms associated with pain conditions such as neuropathy, rheumatoid arthritis, and chronic pain. They may also be used for a variety of other conditions, such as epilepsy and cancer-related side effects. Additional research is needed to establish and understand their appropriate use and place in therapy.

This article will define cannabinoids and discuss what the research says about them.

What Are Cannabinoids and What Do They Do?

Cannabinoids are the chemical components of cannabis. They work like messengers, interacting with the endocannabinoid system in our bodies and working on receptors that can help regulate mood, memory, appetite, and pain.

Additionally, cannabinoids activate receptors throughout the body, affecting the central nervous system and immune system.

Examples of Cannabinoids

THC and CBD are the two main types of cannabinoids. Cannabinol (CBN) is a less popular type of cannabinoid. Medications that contain cannabinoids typically include THC, CBD, or both.

THC is mainly responsible for the psychoactive (mind-altering) and intoxicating effects that are commonly associated with cannabis use. CBD is known for its potential therapeutic benefits, which range from pain relief to anxiety management.

CBD and CBN differ from THC in that they are not psychoactive, meaning they do not cause changes to the mind, mood, or mental state. Unlike THC, CBD should not cause mental impairment or a "high" feeling.

While CBD and CBN work similarly, CBD has been more widely studied. More research is needed to better understand the therapeutic potential of CBN.

Medications on the Market

The United States Food & Drug Administration (FDA) has not approved the cannabis plant itself for medical use. However, several FDA-approved medications contain individual cannabinoids.

Cannabis-related compounds are created in a lab and can be used to manufacture drug products. Cannabis-derived compounds are found naturally in the cannabis plant and can also be used to manufacture medications.

The following synthetic cannabis-related medications are currently on the market:

• Marinol, Syndros (dronabinol)
• Cesamet (nabilone)

Epidiolex (cannabidiol) is a cannabis-derived medication that is also approved by the FDA to treat very specific types of seizures. It contains a purified form of CBD.

Marinol and Syndros contain artificial THC, and Cesamet contains an artificial substance that mimics THC.

Many cannabis products remain unapproved by the FDA, and their safety and efficacy have not been studied.

Beyond THC, CBD, and CBN, researchers are exploring the potential of other cannabinoids to better understand their varying effects on health and well-being.

How Do Cannabinoids Work?

Cannabinoids interact with the body's endocannabinoid system, which is found throughout the brain, nervous system, and other tissues in the body. This system acts as a messenger.

When cannabinoids are consumed, they send signals to the body, influencing various processes and responses. For example, some cannabinoids may trigger feelings of happiness and relaxation; others may help alleviate pain or cause drowsiness.

There are two main types of cannabinoid receptors: cannabinoid 1 receptor (CB1) and cannabinoid 2 receptor (CB2).

CB1 receptors are primarily located in the brain and central nervous system. They are responsible for the effects of cannabinoids on the mental state. CB2 receptors are found mostly on immune cells and peripheral tissues. They regulate inflammation and immune function.

Depending on the specific cannabinoid and its concentration, cannabinoids can produce a wide range of effects, including pain relief, relaxation, appetite stimulation, and mood changes.

Understanding how cannabinoids interact with the endocannabinoid system is crucial for exploring their potential therapeutic benefits and ensuring safe and effective use.

How Are Cannabinoids Used?

Cannabinoids are used for different purposes and are being studied for a wide range of medical uses. The majority of people who take cannabinoids use them for chronic pain and mental health conditions.

Until more research is conducted, it is important to use cannabinoids only as instructed by your healthcare provider to prevent long-term complications.

Current Uses

Epidiolex contains a purified form of cannabis-derived CBD. It is FDA-approved for the treatment of seizures associated with two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, that typically begin in early childhood.

Epidiolex can be used in people 2 years of age and older to reduce the frequency of seizures in those with either condition.

Marinol, Syndros, and Cesamet are used to treat nausea and vomiting caused by cancer chemotherapy. Marinol and Sydnros are also used to treat appetite and weight loss in people with HIV/AIDS.

Clinical studies suggest that CBD can be used to reduce anxiety and help reduce symptoms associated with mental health disorders.

In addition to the FDA-approved formulations, over-the-counter (OTC) CBD products may be easily accessible depending on location and state laws. These products are much less regulated, making it difficult to know exactly what they contain, and therefore, raises safety concerns.

Studied Uses

Some promising areas of research for cannabinoid use include:

• Sleep problems
• Post-traumatic stress disorder (PTSD)
• Movement disorders

Side Effects and Safety of Cannabinoids

Cannabinoids are generally well tolerated with minimal known risks; however, like most drug products, there are some side effects and safety concerns associated with their use.

It is unknown what makes someone more likely to experience negative effects, but factors such as genetics and personality may play a role.

It is recommended that cannabinoids be taken by mouth rather than inhaled. Smoking cannabinoid products used for medical purposes can increase exposure to gene-altering and cancer-causing substances.

You are more likely to experience serious side effects associated with cannabinoid use if you are taking higher doses.

Side Effects

Side effects associated with THC are different than CBD. In general, dizziness and fatigue are the most common adverse events people using THC or a combination of THC and CBD experience.

THC use may negatively affect memory and lead to decreased ability to engage in activities that require hand-eye coordination. CBD, on the other hand, has shown benefit in reducing the negative mental effects of THC when they are used together.

The severity of side effects usually correlates to the dose, meaning that as the dose of cannabinoids increases, so does the likelihood of side effects.

The most common side effects associated with THC when used alone include:

• Dizziness
• Drowsiness and fatigue
• Dry mouth
• Nausea/vomiting
• Cognitive effects such as elevated mood (euphoria) and confusion
• Problems with balance and coordination

The most common side effects associated with CBD use include:

• Diarrhea
• Drowsiness
• Fever
• Decreased appetite
• Vomiting
• Upper respiratory tract infection
• Elevated liver enzymes

Research studies show that even though side effects may occur in those using cannabinoids, there is no major concern for serious side effects when they are used as directed.

Drug Interactions

Cannabinoids do have several potential drug interactions, and these should be taken into consideration when determining if treatment is appropriate.

There is a risk of drug–drug interactions between some cannabinoids and the following medications:

• Anticholinergic medications (such as amitriptyline)
• Benzodiazepines
• Opioids
• Nicotine
• Specific types of medications to treat cancer (such as Keytruda)

Alcohol should also be avoided and not used at the same time as cannabinoids.

More studies are needed to evaluate potential drug interactions further. It is important to consult with a healthcare provider before use, especially if you are taking other medications.

Who Shouldn’t Use Cannabinoids?

You should avoid cannabinoid use if you:

• Are under 25 years of age
• Have liver disease, including Hepatitis C
• Are pregnant or breastfeeding
• Have a personal or family history of psychosis or schizophrenia
• Have a history of substance abuse disorder

The health risks and concerns associated with cannabinoid use in these populations may vary, but in some cases, the benefits may outweigh the risks. You should consult with your healthcare provider to determine if cannabinoid use is safe and appropriate.

Legal Status of Cannabinoids

The legal status of cannabinoids, particularly THC and CBD, is a complex and evolving topic, as laws and regulations can vary greatly across the United States. Of note, it is technically illegal under federal law.

In some states, cannabinoids are strictly regulated by the law, and in other states, cannabinoids may be legal for medical use, recreational use, or both.

There are protocols in place for cannabinoid use in research. Researchers must work with the FDA to submit the proper applications and documentation.

Depending on the particular state, whether or not CBD products are legal depends on whether it is hemp-derived or cannabis-derived. Regardless of the source, products containing THC or CBD cannot be sold legally as dietary supplements.

It is important to be aware of the laws regarding cannabinoid use in your state and places you may travel to.

Summary

Cannabinoids are found in the cannabis sativa plant and include hundreds of compounds, including the two most common types, THC and CBD.

Cannabinoids can help regulate mood, memory, appetite, and pain. THC is mainly responsible for the mind-altering effects that are commonly associated with cannabis use. CBD is known for its therapeutic benefits without impacting the mental state or causing a high.

Despite conflicting federal and state regulations for cannabinoids, there are a few cannabinoid-containing medications approved by the FDA. The legal status of cannabinoids is constantly evolving as laws change and new research becomes available.

Understanding cannabinoids and their effects is crucial for navigating the complex landscape of cannabis-based therapies and supplements.

Discuss the risks and benefits of cannabinoid use with your healthcare provider to help determine whether a cannabinoid-based therapy may be an appropriate treatment option for you.