This article is about medical cannabis. There are records of medical cannabis use
in China from nearly 5,000 years ago, and their use of hemp stalks and seeds dates back
even further. While some have viewed cannabis negatively
over the past century – after several successful campaigns to paint the plant in a negative
light, and subsequent prohibition – opinions have been shifting over the past few years
as more countries, including Canada, legalize cannabis. But is cannabis use actually safe, and does
it offer any medical benefits? Current data indicate that cannabis works by interacting with a complex system in the body called the endocannabinoid system, or the ECS. Cannabinoids are active compounds found in cannabis which have effects in the body. Endocannabinoids are cannabinoids that our
bodies naturally produce. Although we don’t have adequate research on the ECS, scientists theorize that the body produces substances that stimulate its cannabinoid receptors which are located in the brain, muscles, fat, and digestive tract. The ECS helps our bodies regulate pain, mood, appetite, motility in the gut, memory, emotions, stress response, immune function, and more. When a person ingests the plant-based cannabinoids in cannabis, such as THC and/or CBD, which are similar molecular shapes to endocannabinoids, they fit into the same receptors and trigger reactions that result in either very high or very low levels of specific neurotransmitters, which the cells of the nervous system, as well as other systems in the body, use to communicate with each another. THC is the psychoactive component that causes individuals to feel high when they consume cannabis, but it offers useful medical effects, such as pain relief. CBD also has medical benefits, such as reducing
seizures and inflammation, but it does not contribute to the intoxicating effects of
cannabis. Each strain of cannabis has a specific THC to CBD ratio and successful treatment means getting this ratio right for the individual. The functioning, or lack of functioning, of the ECS might have an important relationship to the pathology of chronic conditions and could be tied to the efficacy of cannabis products. Conditions that might be improved by cannabis use include inflammatory bowel disease, multiple sclerosis, neuropathic pain, chemotherapy-related nausea and vomiting, pediatric seizure disorders, and a wide variety of other illnesses. Patients who have tried numerous medications without getting adequate symptom relief are hopeful that cannabis will work for them. While many patients claim cannabis reduces their gastrointestinal symptoms, there is little clinical research to date. Part of this is related to the illegal state
of cannabis and past stigmatization, so researchers in many countries face legal barriers studying its medical effects on humans. Other difficulties in conducting good clinical trials are the relative inability to blind the subjects from knowing which treatment is placebo and which is the active therapy, and that the symptoms being measured are often subjective. However, the evidence is building, and we hope
to see more studies as legalization of cannabis increases across the globe. So far, research shows that cannabis is effective for managing some types of chronic pain, including abdominal, and is useful for reducing diarrhea, nausea, poor appetite, and weight loss. Some studies show that cannabis might be an effective alternative to opioid medications with fewer side effects. Population studies on those with inflammatory bowel disease show that cannabis can successfully induce symptom relief. At this point, it is unclear whether cannabinoids reduce inflammation, or if they work by improving symptoms. We need more research on the topic but, at this time, cannabis can be a useful treatment, especially in conjunction with other medications,
to reduce symptoms associated with inflammatory bowel disease and other conditions. However, there are some negative effects to note. Cannabis might not be suitable for all individuals, especially those younger than 25 years-of-age, those with a personal or familial history of schizophrenia, and women who are pregnant, as it could pose risks to these groups. There is some support for using cannabis in pediatric seizure disorders, but only a qualified neurologist or neuro-specialist physician
should be recommending the use in children. Since it can impair motor skills, short-term
memory, and reaction times, it isn’t safe to drive while under the influence of cannabis. Some individuals experience negative side
effects from cannabis, including anxiety, panic, increased heart rate, and raised blood
pressure, as well as dry mouth. With long-term use, dependence or addiction
is possible. However, cannabis is generally safe, as it has no overdose potential. No one has died solely from consuming too
much cannabis, although its effects can impair judgement and decisions, or interact with other medications, causing harm. In some cases, long-term cannabis use can
cause a GI disorder called cannabinoid hyperemesis syndrome. Its symptoms including nausea, vomiting, and colicky abdominal pain that the patient can relieve temporarily by taking hot showers, or permanently by ceasing all cannabis use. It is also important to note that while cannabis
might have medicinal purposes, smoking is still dangerous. To get the medicinal effects of cannabinoids without the risk from smoking, use other methods of administration such as vaporization or
ingestible products. Depending on where you live, you might be able to purchase products containing cannabinoids – such as ingestible oils, oral sprays and capsules – that make it safer to consume cannabis. If you do wish to use cannabis for medical purposes, it is important to go through official heath care channels, by speaking with your physician or nurse practitioner for a prescription or medical document and getting information
and guidance from regulated health care professionals such as nurses and pharmacists, rather than buying it from recreational sellers. While some physicians are wary about prescribing cannabis, many are comfortable doing so. If your physician doesn’t want to prescribe cannabis, then request a referral to a physician who will take your symptoms and disease into account and provide an appropriate dosage recommendation. When using medical cannabis, always follow
the advice and recommendations of your health care professionals. On behalf of the Gastrointestinal Society, this article was submitted by Dr. James Gray.
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