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Cannabis therapy -- Why bother?

8/25/2014

Credulous New Age acolytes regard cannabis as an earthy herb, a gift from Mother Nature that must surely be good for us, because it's "natural."

Credulous New Age acolytes regard cannabis as an earthy herb, a gift from Mother Nature that must surely be good for us, because it's "natural."

Seen from the other extreme, cannabis is a scourge sent by the Devil, and so-called "benefits" are all fictions.

There are two cannabis subspecies, C. sativa and C. indica, which can be hybridized by plant breeders to produce specific effects. Found only in cannabis, the botanical cannabinoids include the well-known THC, a principle psychoactive agent. But there are 60-some other cannabinoids, including agents like CBD and CBN.

Cannabis also produces terpenes, flavonoids and polyphenols, among others. While in isolation many of these are potent antioxidants and anti-inflammatories, the combined effect of all groups working in concert is different from their individual properties.

This is called the Ensemble Effect. It's well known in Western medicine -- multiple agents can have a magnified effect when taken together in one pill.

They can "potentiate" each other -- one plus one equals three. Or one can mitigate adverse effects of another -- adding a second blood pressure drug not only lowers pressure further, but reduces potassium loss caused by the first ingredient.

The traditional Western analytical paradigm separates botanicals into individual ingredients, then tests each in isolation. This can be useful to determine dosages, side-effects and duration of action. But it's wholly inadequate, and even misleading, for assessing a medicine which manifests the Ensemble Effect in real-life usage.

Isolated THC acts differently from THC administered in its original botanical context. THC is available as a legal pill, sold as Marinol, but few think it's a particularly useful preparation -- and it certainly can't serve as a surrogate for whole cannabis medically or experimentally.

There is as much genetic diversity among the hundreds of strains of cannabis as there is among dog breeds, and medical properties vary immensely; think Chihuahuas and St. Bernards. Some strains are no more appropriate for a given medical condition than Chihuahuas would be as sled dogs.

Failure to recognize this fact has frustrated much meaningful research, at least in this country, but we'll say more about that in a future segment.

Each of us makes our own cannabinoids, just as we make our own morphine. The "endocannabinoid system" depends in part on cellular receptors allowing cannabinoid molecules to "dock," attaching to the cell and then modifying its functions. These "CB receptors" are found in virtually every type of tissue in the body. It bespeaks their profound and pervasive role in regulating a wide variety of physical and psychological functions.

So cannabis therapeutics possesses an aspect essential if new pharmacological interventions are to be validated: We have a plausible mechanism for proposed effects.

The mechanism is complex, but its net effects can be determined with some specificity, providing the right experimental models are applied. That is, we have to listen to the whole orchestra, and not just the loudest snare drum. We have to assess the overall effect of a particular strain in humans with a specific syndrome or symptom.

Chronic pain has yielded to selected cannabis strains. In particular, one hard-to-treat misery, neuropathic pain, responds well. Common among people with amputations, diabetes, AIDS and cancer, neuropathic pain resists even opiates like morphine. Cannabis not only helps this pain -- as proven in FDA-approved gold-standard, double-blind, placebo-controlled studies -- but also improves appetite and reduces depression.

Some denialists object that too high a dose might increase rather than diminish pain. They misread the nature of cannabis' influence on focused sensory perception; but if this were really an issue, it would mitigate against escalating doses and addiction.

Other well-documented applications include the dramatic effect of high-CBD strains on severe, untreatable seizure disorders, particularly among children with Dravet's Syndrome. (This is what finally convinced TV-doctor Sanjay Gupta to abandon his opposition to cannabis therapy.)

Cannabis can interfere with short-term memory processes, an adverse effect in some circumstances. But since abrupt aberrant memory retrieval is a hallmark of post-traumatic stress disorder, we again have a mechanism underlying the demonstrated relief some PTSD sufferers have achieved, allowing them to discontinue a witches' brew of toxic drugs which didn't help their symptoms, but instead caused devastating side-effects.

Then there's cancer. The impact of THC in remitting a devastating form of brain cancer, glioblastoma multiforme, has been shown in Israeli studies. Cannabis doesn't cause cancer (if used without adding tobacco), and appears to decrease the risk of head and neck cancers. And we have -- a mechanism. Two, in fact.

One is "impaired angioneogenesis," reducing the formation of new blood vessels needed to support a growing tumor. The other is "premature apoptosis," in which cancer cells selectively commit suicide. Unlike many current agents, cannabis doesn't damage normal cells at the same time.

There are numerous other applications which have made cannabis therapy a staple in reputable institutions, such as AIDS hospitals and cancer wards -- where it is allowed by law, that is. It can sometimes alleviate underlying conditions that produce pain in the first place.

In 2003, the U.S. government successfully patented cannabinoids as "useful in the treatment and prophylaxis of a wide variety of ... diseases, such as ischemic, age-related, inflammatory and autoimmune ... " with "particular application for stroke, trauma, Alzheimers and Parkinsonism."

A Schedule I drug -- no legitimate medical use at all? But so beneficial the government itself patented its constituents?

* Next time: The downside.

Jon Hauxwell, MD, is a retired

family physician who grew up in Stockton and now lives outside Hays.

hauxwell@ruraltel.net

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