Clinical Cannabinoid Medicine in Action


Cannabis is an amazing herb. It is an anti-inflammatory, reducing swelling and pain. It has antispasmodic and anticonvulsant properties, reducing muscle spasms and seizures. It is antiemetic, preventing nausea and vomiting while simultaneously stimulating the appetite. It also protects nervous system tissue, including the brain, from degeneration and damage due to toxins and plaque buildup. Due to these properties, it has been found to be useful in the treatment of a number of health care conditions, including osteoporosis, cancer, Tourette’s syndrome and Alzheimer’s disease.

Cannabis contains multiple types of cannabinoids with over 80 now being clearly identified. Two of the most well-known and researched are Delta-9-tetrahydrocannabinol (∆⁹-THC) and Cannabidiol (CBD). Cannabinoids work by acting directly on the multiple cell receptors of the Endocannabinoid System. The Endocannabinoid system (ECS) is comprised of multiple cannabinoid receptors, including CB1 and CB2, their endogenous ligands (endocannabinoids) and the proteins and enzymes responsible for their metabolism. The Endocannabinoid System is one of the human body’s most important systems as it supports and regulates a variety of physiological processes essential to well-being, including nociception (pain-sensation), appetite, lipid metabolism, gastrointestinal motility, cardiovascular modulation, motor activity, and memory. The ECS is also strongly associated with human behavior through the modulation of neurotransmitters and the skeletal ECS supports bone health, growth and repair.

The Endocannabinoid System supports stress recovery and homeostasis, continually returning the body to a state of balance. Cannabis affects this system in a biphasic way, meaning small doses of cannabinoids have the opposite effect of large doses. For example, small doses of cannabis can produce an alert feeling in the body (stimulation), where large doses can cause sedation (inhibition). Also, the cannabinoids contained in cannabis have counter balancing effects on the body. For example, ∆⁹-THC is anxiety producing at doses of 2-5 mg and psychosis inducing in doses of 20 -25 mg in people naïve to cannabis use, while CBD induces alertness at 15 mg, sedation at 400mg, and has anti-psychotic effects at doses larger than 400mg. THC is psychotropic, causing an alteration of perception, and CBD is non-psychotropic. Health conditions which reveal an ECS deficiency include anxiety, depression, fibromyalgia, migraines and osteoporosis.  Health conditions which indicate an ECS excess include obesity, schizophrenia, metabolic syndrome, ADHD, and Parkinson’s disease.

Cannabis excess syndromes are an important topic of research as the number of people who use cannabis as medicine is increasing and only recently have appropriate dosage recommendations become available. Cannabis works by stimulating the cannabinoid receptors on cells located in the body in areas of varying density. The areas of the body which contain the most cannabinoid receptors include the brain, spinal cord, spleen, bone marrow, liver, lungs, heart, adrenal glands, reproductive organs, and fat cells. Receptors are also found on muscle tissues and multiple cell lines of the immune system. When endocannabinoid cell receptors are stimulated initially, they up regulate or increase in number and response, especially when this response will create greater homeostasis. When any cell receptor in the body is overstimulated due to excessive or chronic use beyond that which supports homeostasis, it down-regulates by decreasing in number or becoming desensitized. This can occur in chronic excessive users of cannabis. People with desensitized endocannabinoid receptors will notice that it takes larger and larger doses of cannabinoids to achieve a desired effect. Fortunately, the endocannabinoid system can be re-set and re-sensitized to the effects of cannabis medicine in less than a week’s time involving only a 48 hour period of abstinence followed by slow reintroduction at the minimal dose required to achieve the desired effect. This re-sensitization results in a more balanced homeostatic response to the cannabis, achieving better results with less medicine.

Cannabis dosing has been a question for a long time and it is still continuing to be answered. Since each person’s endocannabinoid system is unique, dosing is based on individual need taking into account the health condition being addressed, the age and weight of the person being treated, and their overall state of health at the time treatment is initiated. Recommending a form or specific dose of a cannabinoid medicine based on cannabinoid content alone is only a small piece of the picture. Cannabis also contains terpenoids. Terpenoids are the essential oils present in the cannabis plant that provide its fragrance and flavor. The Cannabis plant expresses over 200 different types of terpenoids. Each strain or cultivar (cultivated variety) of cannabis has a terpenoid content that is genetically determined, making the terpenoid profile or composition one way to identify specific strains or cultivars. While the cannabinoid content provides information regarding the strength, potency, and type of variety, the terpenoid content reveals how a specific cannabis strain or cultivar is meant to be used medicinally. For example, d-limonene found in lemon peels, lemongrass, and other citrus fruits is the second most widely distributed terpenoid found in nature. It is used for the treatment of anxiety and depression, as an anti-fungal due to its ability to increase the permeability of cellular membranes, and as a treatment for gastric reflux and other digestive system conditions. Research has shown it also plays an important part in tumor apoptosis or cell death.

When beginning treatment with cannabis compounds it is best to start with a low dose of a quality medicine. Since smoking cannabis is not always the preferred initial means of use, especially in the pediatric and geriatric populations, a tincture of cannabis infused in olive oil is a good initial introduction. Some individuals are so sensitive to cannabis, they will respond to one drop of oil placed on the wrist. Always test your own medicine at a low dose to determine how you will respond. Since the dosing of cannabinoid medicines and the health care conditions people are treating are usually quite complex, it is best to use cannabinoid medicines with the guidance of a physician trained in their use who can also integrate the cannabinoid medicines with other adjunctive treatments. Sometimes treatment is simple, sometimes complex. Healing takes time and energy. It is always about balance. Be well.