What is special k drug like marijuana
From the drug marijuana to the medicinal plant cannabis: How do the cannabinoids THC and CBD work?
As hashish, marijuana, or simply cannabis, it has established its dubious reputation as an intoxicant. In the active ingredients of the plant, however, there is a completely different potential, far removed from the drug scene: The active ingredients of the hemp plant are used in medicineCannabis sativa L. For more than 30 years as so-called phytocannabinoids or their synthetic analogues (i.e. in the form of artificially produced active ingredients), used specifically for the treatment of nausea, vomiting or loss of appetite (e.g. due to chemotherapy or AIDS), to alleviate spastic cramps in MS , for the therapy of epilepsy, in geriatric patients or in palliative medicine as well as for the treatment of severe pain. It is important to note that not all cannabinoids have the same effect. THC and CBD have different areas of application.
Many studies have already looked at the effects of cannabinoids. Although further investigations are still pending for some areas of application, it can be said today: The therapeutic benefit of the active ingredients from the cannabis plant is considered proven.
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Why are cannabinoids from hemp used in medicine?
The answer to why cannabinoids are used as medicinal products is simple: They are the active substances that address special receptors in the body's own cannabinoid system (or endocannabinoid system) and can act through them. The discovery and exploration of this system are relatively recent. Although cannabis has been used as a medicinal plant for over 5,000 years, the mechanisms behind its effectiveness have long remained in the dark. Although it was not exactly understood at the time how the use of cannabis as medicine worked, the effects of the plant were already being relied on at the end of the 19th century. Cannabis was used to treat pain, spasms, asthma, insomnia, depression, and loss of appetite. After a period of increasing insignificance in the first half of the 20th century, it was finally possible in 1964 to identify THC (also called dronabinol) as an intoxicating and important ingredient in the hemp plant.
In the 1990s, scientists finally discovered the human body's own cannabinoid system. They found that the body has its own cannabinoids and cannabinoid binding sites (receptors) that can influence various processes in the nervous and immune systems as well as many other body cells. Endogenous - i.e. the body's own - cannabinoids are released in the brain as well as in the immune system, in the blood, in many tissues of the body and fulfill a wide range of functions that are so far only incompletely known. Among other things, they are likely to be involved in the regulation of the immune system, movement, learning processes or pain processing. In any case, studies have shown that herbal or synthetic cannabinoids can achieve effects comparable to those of the endocannabinoids if they are ingested.
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Which cannabinoids from the hemp plant are there?
Here is a brief overview of the substances that can be used medicinally today:
Dronabinol - pharmaceutical grade tetrahydrocannabinol (THC)
Tetrahydrocannabinol (THC) is probably the most famous active ingredient fromCannabis sativa L.. THC is considered THE intoxicating substance in cannabis, which is consumed as a drug. In medical applications, the phytocannabinoid THC is also known as dronabinol. It is usually prepared as drops or capsules and is used, among other things, in chemotherapy for nausea and vomiting, in addition to increasing appetite in HIV and AIDS patients and in chronic pain that cannot be adequately treated with typical pain preparations.
How does THC work in the body?
- THC and some other cannabinoids dock on the cannabinoid receptors (CB1 and CB2).
- In this way, they modulate neuronal excitability and plasticity.
- They inhibit excessive nerve activation.
- In the body's endocannabinoid system, THC reduces anxiety, pain, muscle tone, and motor activity.
- This receptor system also brings about a reduction in nausea, calming down and the deletion of certain unpleasant memory contents.
- The wide occurrence of cannabinoid receptors in the whole body, especially in the immune system, central and peripheral nervous system and its effects on metabolic regulation lay the basis for the wide range of applications of THC (dronabinol).
Nabilone - a man-made THC-like molecule
Nabilone is exclusively produced artificially and has a very similar structure and effect to herbal THC.
- Nabilon (Canemes®) is approved for the treatment of nausea and vomiting in the context of chemotherapy.
- In Austria, nabilone is approved on the market as a 1 mg capsule and is approximately seven to eight times more effective than dronabinol at the same dose.
Nabiximols - combination of THC and CBD
Nabiximols is a mixture that, in addition to THC, also contains the non-intoxicating cannabidiol, or CBD for short. Nabiximols is administered in the form of an alcoholic solution as an oral spray, THC and CBD are contained in approximately equal parts (2.7 to 2.5 mg per spray). Nabiximols is only approved in Europe for the treatment of therapy-refractory (= resistant to other therapies) spasticity in multiple sclerosis. All other possible applications are - as with nabilone - outside the approved field of application ("off-label").
Important: THC and CBD sometimes have opposite effects. THC stimulates the appetite, but CBD suppresses the appetite. For the treatment of loss of appetite in AIDS or chemotherapy patients, CBD, and thus Nabiximols, is therefore not suitable.
CBD - the novel food without intoxicating effect
Cannabidiol (CBD for short) is a cannabinoid (phytocannabinoid) found in the cannabis plant, the consumption of which does not produce an intoxicating effect. CBD is well tolerated and, in high doses, has anti-epileptic, anti-inflammatory and anti-psychotic effects. The strong depressant, intoxicating and hallucinogenic effects of THC-based products are missing. In Austria, the substance is neither an addictive nor a medicinal product, but rather a "novel food" (EU regulation on "novel food"). However, official approval as a "novel food" is still pending, so CBD may not be sold as a food.
In Austria, cannabidiol is only allowed to be dispensed in pharmacies for medical purposes as a prescription drug. The manufacture is carried out according to the doctor's prescription.
The prescription drug Epidiolex® is the first herbal, more than 99% pure CBD drug, which was only approved in the USA in 2018 for the treatment of certain rare and difficult-to-treat forms of epilepsy in children aged two and over. Approval as a finished drug in Europe is due for 2019.
Stay away from cannabis extracts, hashish & Co!
Cannabis extracts - not recommended
In addition to pharmacologically produced individual substances from the hemp plant, which have a therapeutic justification, numerous cannabis extracts are offered for sale, which are completely uncontrolled in effectiveness and composition. These are so-called Multi-substance mixturesthat can contain a number of cannabis ingredients and should not be confused with the legally approved cannabis-based drugs such as nabiximols. There are no reliable clinical study results on these extracts, which are prohibited in Austria.
Cannabis flowers - the real drug, marijuana
The female inflorescences of various hemp plants contain THC in different concentrations. However, there are also around 100 other phytocannabinoids and more than 500 plant substances (terpenes, flavonoids, etc.) with different - partly unexplored and possibly harmful - biological effects. The various drug hemp flower varieties differ considerably in terms of both the THC and CBD content and all other cannabinoid compositions.
How much THC and CBD are in marijuana?
A commonly used characteristic is the ratio of THC to CBD content. This varies greatly depending on the type of plant and the respective growth conditions. A general statement about the actual medical and biological effectiveness of cannabis flowers is therefore difficult, as is a reproducible exact dosage.
Cannabis flowers are banned in Austria - even for medicinal use - if they contain more than 0.3% THC. There is also a lack of usable efficacy and safety data from controlled clinical-scientific studies with medical cannabis flowers - not least because of the more than 1,000 different cannabis varieties.
Can I drive after taking THC?
The well-known effect of THC as an intoxicant is one of its main main effects. The doctor who prescribes the drug is responsible for informing the patient, preferably in writing. If, after the adjustment phase with longer, stable dosing without additional other sedating medication and psychophysical impairment, the subjective and objective fitness to drive is given, you can participate in road traffic - according to the patient's current responsible self-assessment before starting the journey.
Contrary to what is often assumed - also by authorities - Dronabinol & Co do not automatically lead to a kind of twilight state. Those affected should be able to legitimize themselves as cannabinoid patients with a medical certificate (cannabinoid ID card with dose and type of drug) during routine drug controls. However, if an accident happens under the influence of THC, patients must also expect tougher penalties under the traffic regulations or the criminal code.
Contraindications (contraindications) for THC and CBD:
- In principle, cannabinoids are considered to be well tolerated in the long term, although extensive long-term application studies are still lacking.
- Pregnancy, breastfeeding, childhood and adolescence are contraindications for dronabinol, as disorders of brain development cannot be ruled out based on experimental findings.
- The treatment of children and adolescents can only be considered as an 'ultima ratio' in very specific palliative situations; In all of these cases, extensive palliative and pain therapy experience on the part of the doctor, the lack of effective or less risky therapeutic alternatives and close monitoring are necessary.
- Patients with psychoses should also not be treated with THC.
The effectiveness of THC and other cannabinoids varies greatly from person to person and also depends on how much the endocannabinoid system is changed in chronic pain. A chronic neuropathic pain disorder can be expected to have greater therapeutic success, with acute pain cannabinoids are practically ineffective, apart from migraine attacks. In contrast to opioids, hardly any development of tolerance with regard to the effectiveness of dronabinol has been observed to date after oral intake.
In the following video you can find out more about how THC and CBD work (Credit: Fundación Canna):
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Univ.-Prof. Dr.Dr.med. Hans-Georg Kress
Mag. Julia Wild
Gottschling, Dr. Sven (Ed.): Teaching & Practice, Issue 9, Volume 4 10/2018
Johnson JR et al .; Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC: CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage. 2010.
Portenoy RK et al .; Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain. Vol 13, No 5 (May), 2012: pp 438-449.
Hauser et al .; European Pain Federation (EFIC) position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management; European Journal of Pain; 2018.
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