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Comprehensive Cannabis Course Topic I: The Endocannabinoid System and Phytocannabinoids
The Endocannabinoid System (ECS):
In order to fully appreciate the rationale for the clinical use of medical cannabis, it is essential that one has knowledge of the endocannabinoid system, an endogenous regulating system found in all vertebrates (1, 2). It is also important to understand the clinical sequelae that might develop as a result of endocannabinoid system dysfunction.
It has been proposed that a properly functioning endogenous cannabinoid system is essential for good health and that certain disease types may be the result of deficiencies within this system (3). "Modulating the activity of the endocannabinoid system … hold[s] therapeutic promise in a wide range of disparate diseases and pathological conditions, ranging from mood and anxiety disorders, movement disorders such as Parkinson's and Huntington's disease, neuropathic pain, multiple sclerosis and spinal cord injury, to cancer, atherosclerosis, myocardial infarction, stroke, hypertension, glaucoma, obesity/metabolic syndrome and osteoporosis, to name just a few" (4). In this introductory section, we will discuss the endocannabinoid system, Clinical Endocannabinoid Deficiency Syndrome and phytocannabinoids.
For more information, please review The Medical Use of Marijuana Course Table of Contents.
Editors' Note: Medical marijuana has become an important area of study in healthcare. Doctors and healthcare professionals must understand the medical, legal, social and political issues to best respond to their patients' questions and attend to their needs. This content area is not intended to encourage or dissuade the use of medical marijuana, but has been created to provide a balanced portrayal of the research in this area.
The endocannabinoid system (ECS) is an internal homeostatic regulatory system that influences multiple physiological processes, including the modulation of pain, seizure threshold, appetite, digestion, mood and other processes. The ECS may also play a role in regulation of the immune system, tumor surveillance, fertility, bone physiology, the hypothalamic-pituitary-adrenal axis and intraocular pressure (3).
This homeostatic system was only discovered within the last three decades and was referred to as the endocannabinoid system because it is an endogenous system whose components interact with or resemble a compound derived from the cannabis plant called delta-9-tetrahydrocannabinol or THC.
Cannabis is a genus of flowering plants that includes multiple subspecies. One species is Cannabis sativa. Scientists have identified over 400 chemical compounds produced by the cannabis plant. Well over 80 of these compounds are unique to the cannabis plant, and they are called cannabinoids (or phytocannabinoids). Examples of phytocannabinoids include delta-9-tetrahydrocannabinol (THC), tetrahydrocannabivarin (THCV), cannabidiol (CBD), cannabichromene (CBC), and cannabigerol (CBG).
THC and the analogues of THC that are derived from the cannabis plant and interact with endocannabinoid receptors or otherwise affect the endocannabinoid system are called phytocannabinoids. Phytocannabinoids have pharmacological activity due to their receptor-based effects on the endocannabinoid system. Additional pharmacological effects, such as anti-inflammatory mechanisms, may be non-receptor mediated.