Your Dose of Cannabis Education

Your Dose of Cannabis Education

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CB1 receptors are found mainly in the central nervous system, and their primary role is to inhibit the release of neurotransmitters. CB2 receptors’ primary role is to modulate cytokine release and immune cell migration. Does the location of CB1 and CB2 receptors impact the effect the cannabinoid system may have on the nervous system?
Yes, "colocalisation of cannabinoid receptors with other types of nervous system receptors allows them to interact with many other transmitters such as dopamine, noradrenaline, acetylcholine, gamma-aminobutyric acid, serotonin, and glutamic and aspartic acids."
Śmiarowska M, Białecka, Machoy-Mokrzyńska Cannabis and cannabinoids: pharmacology and therapeutic potential Neurologia i Neurochirurgia Polska Polish Journal of Neurology and Neurosurgery 2022, DOI: 10.5603/PJNNS.a2022.0015 Copyright © 2022 Polish Neurological Society ISSN: 0028-3843, e-ISSN: 1897-4260
CB1 receptors are abundant in the central nervous system, including areas involved with pain transmission. CB2 receptors are mostly located on peripheral tissues and immune cells. Are CB2 receptors involved with pain transmission?
Yes. When activated, CB2 receptors may modulate peripheral afferent pain fiber activity as well as immune-mediated neuro-inflammatory processes. For instance, CB2 activation may lead to the inhibition of prostaglandin synthesis and/or mast cell degranulation, and the inhibition of these cellular activities may lead to a decrease in the likelihood of the initiation of and/or prolongation of chronic pain states.
St. Marie RM, Leo RJ. Cannabinoid-based Medications For Pain. Current Psychiatry Vol 20. No5. (May 2021).
Are there any possible detrimental effects of combining cannabis while undergoing immunotherapy?
"Recent data indicate that there could also be a detrimental effect of combining cannabis while undergoing immunotherapy, which may be related to the anti-inflammatory effects of cannabis, similar to the use of steroids during immunotherapy. These preliminary reports provide important questions about the risks associated with cannabis use during active cancer treatment."
Gowin K, Muminovic M, Zick S, et al. Integrative Therapies in Cancer Care: An Update on the Guidelines. ASCO Educational Book (asco.ord/edbook) Vol 44, Iss 3. Mar 31 2024.
"When examining ways to mitigate adverse effects (AEs) associated with cancer treatment, patients with hematologic malignancies face additional challenges as they cannot take nonsteroidal anti-inflammatory drugs. Therefore, cannabis may serve as a suitable option for managing pain, according to Lindsay Wilde, MD" Why can't patients with hematologic malignancies take nonsteroidal anti-inflammatory drugs?
“Patients [with hematologic malignancies] are unable to use Tylenol or nonsteroidal anti-inflammatory drugs of any kind because of the risk of masking a fever or bleeding [as] they’re thrombocytopenic, so we don’t have a lot of [agents] to use for things like cancer-associated pain...It’s an area where there’s not clear research about the benefit of medical cannabis; but if we have another tool that’s safer and doesn’t affect things such as fever and platelet count in the way that other pain medications do, it [would be] another tool that we’ll be able to use to manage treatment and disease-related symptoms.” *Don't forget to read tomorrow's "Your Dose of Cannabis Education" to learn if there may be a detrimental effect of combining cannabis while undergoing immunotherapy.
Hollasch M. A Medical Oncologist’s Insights on Cannabis Use in the Care of Patients With Hematologic Malignancies. Apr 2, 2024.
Compared to other routes of administration, such as oral ingestion and inhalation, the topical application of cannabinoids has been shown to have poor bioavailability. How can the bioavailability of a topical CBD product be improved?
"In one preclinical study with canines, for example, systemic bioavailability of topically-applied CBD was approximately 90% lower compared to two oral CBD formulations of the same dose. That said, the bioavailability of topically-applied cannabinoids can be improved via certain skin permeation enhancers. In vitro studies utilizing models of human skin have shown that the permeability of several cannabinoids (e.g., CBD, cannabinol (CBN), Δ9-THC) are enhanced in the presence of chemicals such as ethanol, oleic acid, and dimethyl sulfoxide (DMSO). In addition, preclinical studies have also found that transdermal delivery of cannabinoids can be increased by permeation enhancers. For example, in a study with guinea pigs, Transcutol HP increased CBD concentrations in plasma by 3.7-fold when added to a topical CBD gel... In addition to chemical permeation enhancers, physical permeation enhancers (e.g., microneedles, ultrasound) have also been proposed as possible mechanisms to increase transdermal cannabinoid absorption, though research in this area is limited ."
Zamarripa CA, Tilton HE, Lin S, Cone EJ, Winecker RE, Flegel RR, Kuntz D, Beals M, Jaques M, Clark M, Welsh ER, Wagner L, Bonn-Miller MO, Vandrey R, Spindle TR. Pharmacokinetics and Pharmacodynamics of Five Distinct Commercially Available Hemp-derived Topical Cannabidiol (CBD) Products. J Anal Toxicol. 2024 Jan 11:bkae001. doi: 10.1093/jat/bkae001. Epub ahead of print. PMID: 38217086.

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