What Effect Will Medical Cannabis Have on Medicine?

In our article ‘Will Medical Cannabis Play a Part in the Pharmacies of the Future?,’ we look at the impact of cannabis on pharmaceutical preparations and the methodologies by which we test them. Some of the ideas we covered include:

• The development of botanical medicines that target multiple receptor systems in the body by utilizing cannabinoids, terpenes, and flavonoids, which could help reduce or replace some types of medications. This has the added advantage of having a better safety profile than most current medications, as the human body breaks down compounds like cannabinoids, terpenes, and flavonoids (which are terpenophenolic compounds) very efficiently. These types of compounds are found in plants beyond cannabis, although the cannabis plant can be seen as a “terpenoid factory” when it comes to cannabinoids and terpenes specifically.
• Use of cryptocurrencies and blockchain technology to facilitate cannabis purchase, research, and broader impacts on healthcare (e.g., insurance claims).
• Improved data collection methods and gathering real-world data (RWD) to assess the efficacy, safety, and impact of medical cannabis (and other plant medicines) on a wide range of groups, including ones that may not be eligible or represented in clinical trials.
• The change from “Newtonian” medicine to “quantum” medicine, which will allow us to develop medications suited to the individual and the environment they are in.

So, let’s look at what impact the discovery of the endocannabinoid system (ECS) and the development of medicinal cannabis products could have on medicine.

The Importance of the Endocannabinoid System (ECS) and Its Discovery

It is possible that, had cannabis not become such a maligned plant, Raphael Mechoulam and his team would have been awarded the Nobel Prize for the discovery of the ECS. Thankfully, they have at least been awarded many other prizes, so we can be assured that there is at least some sense in the world. After all, “If viagra can win the Nobel Prize, why not cannabis?” (Please watch The Scientist to get this reference.) [1]

These scientists have won so many prizes for a good reason, which is that, in discovering the ECS, they’ve changed the way we look at the human body and medicine. Many used to believe that targeting one receptor using one highly purified drug was necessary, but the discovery of the ECS has changed their mind. Nowadays, much of the talk around developing safe pharmaceuticals concerns itself with the ECS [2] and multimodal treatments.

Indeed, so significant is the discovery of cannabinoids and the endocannabinoid system that it may help us answer one of life’s most fundamental questions: “How and why are we here?” This is because cannabinoids play a crucial role in the beginnings of life, both in the evolutionary sense [3] and in the sense of brain development in both pre- and post-natal life [4]. The ECS is an older and less specialized receptor system compared to other receptor systems like opioid or dopamine receptors. The human body breaks down plant-based cannabinoids (phytocannabinoids) far more efficiently than it does exogenous dopamine, opioid, and serotonin receptor agonists and antagonists, meaning that deadly overdose is far less likely.

Furthermore, the ECS is a “master regulator” [5] and plays a fundamental role in homeostasis (the self-regulating processes by which the body maintains stability). This is because of two main reasons:

1. The ECS is a retrograde system [6], functioning post- to pre-synapse. “Retrograde signaling” is where a signal travels backward from a target source to its original source, allowing humans and other mammals to cope [7] with environmental stressors and adapt and acclimatize to them. This is another one of the reasons why the ECS plays such a large role in the evolution of mammalian species. The ECS arguably allowed for the development of complex neurological and locomotive toolsets, helping govern the energy balance of mammalian bodies [8].
2. There are cannabinoid receptors throughout the body, including neurons in the brain and spinal cord, the immune system, and the gastrointestinal (GI) system [9]. Moreover, the ECS can influence the behavior of other receptor systems (e.g., opioid receptors [10], dopamine receptors [11], and serotonin receptors [12]). This means that cannabinoids can be used to target a number of different areas of the body, on top of helping reduce or replace intake of more addictive pharmaceuticals like opioids or sedatives. This is one of the reasons why medical cannabis may help manage so many different health problems.

So, gaining more understanding of the ECS will be a huge factor in furthering our knowledge of the human body and how to treat many different conditions. Here are three key areas of medicine and pharmaceuticals that medical cannabis will affect.

1. Our Understanding of the Immune System

If there is one thing the COVID-19 pandemic has taught us, it is that having a strong immune system and a variety of ways of fighting an infection is essential to our survival and the development of new medications. There are two key ways in which medical cannabis may help us in this regard:

• Cannabinoids are immunomodulators [13], meaning that they can be used to dampen an overactive immune response, acting as anti-inflammatory or immunosuppressive agents. This means that medical cannabis could play a role in managing many immune-mediated conditions and conditions where inflammation plays a huge role, including autoimmune diseases (e.g., lupus, IBDs like Crohn’s), arthritis, various types of cancer, asthma, AIDS/HIV, irritable bowel syndrome (IBS), multiple sclerosis (MS), long COVID, and more. The immunosuppressive properties [14] of cannabinoids like cannabidiol (CBD) may be of interest to organ transplant patients [15], who take harsh immunosuppressants with a number of short- and long-term side effects. There are some studies showing that there is a significant drug-drug interaction between CBD and tacrolimus [16], an immunosuppressive drug often prescribed to prevent rejection of heart, kidney, liver, or lung transplants. CBD increases tacrolimus concentrations in the body, as CBD desensitizes cytochrome P450 enzymes. CBD could theoretically be used to reduce some classes of immunosuppressants.
• Terpenes and flavonoids, which not only have anti-inflammatory properties but also antimicrobial ones [17], may also help. Cannabis produces a whole host of terpenes (e.g., pinene, beta-caryophyllene) and flavonoids that function as antibacterials, antivirals, and antifungals. This could help us reduce our reliance on antibiotics and potentially help overcome antibiotic resistance [18], as well as develop new classes of antimicrobial medications to treat a number of different infectious diseases.

2. Managing Metabolic Diseases and Diseases Associated with Aging

As the world continues to advance and we develop better personal and public health measures to effectively treat many acute and infectious conditions, there is the challenge of managing and treating other health problems that arise, including:

• Diseases associated with increased food availability and decreased energy expenditure, which usually refers to metabolic diseases like hypertension, obesity, and diabetes, the combination of which is called “metabolic syndrome.” Some studies suggest that “Modernization of the world has further increased food availability and decreased energy expenditure, thus shifting the eCB/CB1R system into a state of hyperactive deregulated signaling that contributes to the 21st-century metabolic disease pandemic.” [19] Modulating the ECS by a combination of lifestyle factors (i.e., diet, exercise) and appropriate application of cannabinoids can help reduce stress and inflammation associated with metabolic diseases, as well as reduce insulin resistance, manage weight, and decrease blood pressure due to hypertension.
• Health problems associated with aging, such as osteoporosis, arthritis, Alzheimer’s and other neurological conditions, and chronic pain due to the increased incidence of chronic conditions as we age. Cannabinoids may be useful for boosting brain cell growth, which could help manage dementia and tremors associated with Parkinson’s [20] or Lewy bodies [21]. Moreover, the ability of medical cannabis to potentially reduce or replace other medications can help reduce the number of side effects associated with these drugs (in turn also helping reduce the chances of contraindications or unintended synergies), pill/treatment fatigue induced by having to consume a large number of medications [22], and ultimately improve quality of life (QoL) in older patients [23] who may be trying to manage many different kinds of pain.

Metabolic disorders are beginning to make a greater impact on health worldwide, with increasing amounts being spent on managing them and associated health problems like stroke and heart disease. Indeed, metabolic syndrome is often considered a “global epidemic” [24] or even a pandemic [25]. Medical cannabis could help prevent metabolic disorders from becoming an even bigger and more expensive problem.

3. Understanding How Our Body’s Receptor Systems Communicate with Each Other

We mentioned above that the ECS “talks” to other receptor systems and how they behave, which may help us discover new drugs [26]. Some say that the ECS works like a “phone operator,” [27] relaying messages between different receptor systems and ensuring the correct messages get through at the appropriate time. When this phone operator (the ECS) works well, messages between receptor systems are relayed efficiently and effectively, and our bodies function optimally. When the phone operator is not working well, messages are not being sent through properly, and confusion and disarray take over. In the long term, this can cause persistent inflammation or dysinflammation.

Overall: Towards the Development of Personalized Medicine?

What if we could develop medicines and treatment methods targeted toward you and your body specifically by using precision medications and interventions tailored specifically to your needs? In the past, this may have been a pipe dream. Nowadays, with the advent of genome sequencing [28] and the discovery of the ECS, this pipe dream is now possible as we learn how our bodies behave holistically when reacting to a drug or other intervention. As the ECS is unique to each person, everyone has their own ECS “map,” which we can use to navigate the body.

Having a greater understanding of the ECS will help us communicate better with other receptor systems in the body, and could help us produce a more detailed, up-to-date “map” of our nervous system and how all the different paths diverge and intersect in different parts of the body. This can allow for the development of highly targeted drugs and treatment methods. Moreover, you could even potentially use this map to see instances of inflammation and perhaps even prevent more serious conditions from taking hold. Medical cannabis could be one of the ushers of a whole new era of medicine and make the idea of personalized, precision medicine possible!

References

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