The cannabis plant has been used for thousands of years as a natural medicament. Evidence of its use can be dated back to the Chinese Emperor Fu Hsiculture in 2900 B.C., or to the Egyptian era as observed in the hieroglyphics embedded within the stone records of the Ramesseum III Papyrus (1700 B.C.), Eber’s Papyrus (1600 B.C.), the Berlin Papyrus (1300 B.C.E), and the Chester Beatty VI Papyrus (1300 B.C.).
The Eber’s Papyrus is the oldest known complete medical textbook in existence.
Cannabis works directly with a system within the body called the endocannabinoid system (ECS). This system is responsible for homeostasis and essential to our health and survival. It keeps the body’s internal environment, such as body temperature, hormone levels, heart beat, energy levels, detoxification, appetite, digestion, immune function, mood, sleep, memory, pain, pleasure, and inflammation stable. Endocannabinoids serve as neuromodulators in many physiological processes. Upon depolarization, once released from the postsynaptic neurons they activate presynaptic receptors. This inhibits the release of both excitatory and inhibitory transmitters. For this reason, the endocannabinoid system may have important roles in the regulation of synaptic brain function.
The endocannabinoid system contains receptors that are specifically designed to utilize cannabinoids. Anandamide (AEA) and 2-arachidonylglycerol (2-AG) are endogenous cannabinoids produced within the body. Due the destructive enzymes FAAH (a polyunsaturated omega-6 fatty arachidonic acid derivative aka fatty acid amide hydrolase) and monoacylglycerol (MAGL), anandamide and 2-AG are destroyed thereby leaving a deficiency of endocannabinoid system stimulation in most individuals. Adding products derived from cannabis will stimulate this system’s molecular signaling system thus allowing homeostasis to occur.
The endocannabinoid system receptor sites are labeled CB1 and CB2. Various constituents of the cannabis plant stimulate the ECS by influencing both CB1 and CB2 receptor sites. Cannabis products containing THC, also known as delta 9 (Δ-9-THC) or tetrahydrocannabinol, attach to the CB1 receptor sites located in the central nervous system. These receptor sites are located throughout the brain, glands, gonads, connective tissues, and central nervous system. CB1 receptor antagonists may prove beneficial in treating substance seeking behavior and relapse. Research shows positive outcomes in blocking the direct effects of cannabis, opioids, nicotine and ethanol. Additionally, studies demonstrate the potential for preventing relapse to the various drugs of abuse, including opioids, cocaine, nicotine, alcohol, and metamphetamine. CB1 receptor sites regulate:
- Pleasure, Joy, Delight
- Decreased motivation for maintaining substance-seeking behavior
The illicit schedule 1 placement of cannabis with drugs such as heroin, PCP, and LSD has fostered the theory of cannabis as being a gateway to other hard drugs. This could not be further from the truth. There is a long standing history of the therapeutic benefits of cannabis in the treatment of substance problems. Multiple surveys have indicated the effective use of cannabis for cocaine, alcohol, and nicotine addiction.
- Schedule 1
- No accepted medical treatment
- Not safe
- Highly addictive
- High potential for abuse
- Cannabis, Ecstasy, Peyote, GHB, Heroine
- Schedule 2
- Recognized medical value
- Safe when uses as prescribed
- Highly addictive
- Oxycodone, Opium, Codeine, Morphine, Hydromorphone (Dilaudid), Methadone, Demerol (meperidine), Fentanyl
Defining Drug Use
- Dependence: physical dependence; body adapts and increased amounts needed over time; withdraw symptoms when abruptly stopped
- Addiction: compulsive use, impaired control over use
- Tolerance: increased amounts are needed over time to achieve same results as the body adapts
When diagnosing an individual with drug addiction, criteria need to be identified. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5), published by the American Psychiatric Association, is utilized for the diagnosing of substance abuse disorders. Clinicians can identify the substance being misused and the intensity of the problem. A conclusive diagnosis is dependent upon the number of positively associated criteria per the DMS-5.
Substance use disorder is categorized as mild, moderate, and severe. Cannabis use disorder has 11 total listed criteria for abuse. Meeting 2 to 3 of these criteria will categorize a mild disorder. Meeting 4 to 6 criteria places the substance disorder into the moderate category, while 7 and up indicate a severe disorder.
Cannabis Use Disorder Criteria
- Using larger amounts for a longer period of time than expected
- Unsuccessful attempts to decrease or eliminate use
- Spending excessive time trying to acquire substance
- Having cravings or urges
- Failing to meet family, work, and/or social obligations
- Continued use despite personal problems
- Social and family activities reduced or given up
- Recurrent use in hazardous situations
- Continued use despite physical or psychological negative effects
- Development of a tolerance
- Development of withdrawal symptoms
There are issues concerning the criteria for cannabis use disorder. The development of a tolerance and the development of withdrawal symptoms per the DMS-5 should not be counted if it is prescribed by a physician. However, under federal law physicians are prohibited from prescribing cannabis. Additionally, many of the criteria applicable to individuals using cannabis are due to prohibition. This demonstrates the need to separate and distinguish criteria to avoid mis-classification errors of cannabis.
Common Addiction Rates
- Tobacco 32%
- Heroin 23%
- Cocaine 17%
- Alcohol 15%
- Cannabis 9%
A tolerance can develop with the regular use of a substance. Essentially, it takes a higher dose than previously needed to produce the same effect. The use of Marinol, a synthetic THC, can result in a quick tolerance. A tolerance build-up to cannabis can be avoided by using a variety of cultivars as well as abstaining for a day or two which will allow over-saturated receptors to reset.
The DSM-5 refers to cannabis withdrawal. At least 3 of the symptoms must be present within one week following the cessation of cannabis for this diagnosis.
- Abdominal pain
When considering a diagnosis of withdrawal, the clinician must discern withdrawal and the lack of cannabis previously being utilized for the treatment of the conditions presented. Cannabis withdrawal symptoms can be similar to those of caffeine withdrawal. No withdrawal symptoms of cannabis require hospitalization or are life-threatening.
There is an epidemic of roughly 78 deaths of opioid deaths per day. Americans consume 84% to 99% of global oxycodone and Vicoden. Many of these drugs are used for pain management. These pharmaceuticals have a high potential for abuse and tolerance. Higher doses are often required over time due to tolerance. Withdrawal symptoms are similar to the flu. Common symptoms are cramping, chills, shaking, and cravings.
Cannabis has a long history of in the treatment of substance use problems. Addictions result from self-medicating for symptom relief. Cannabis stimulates the body’s endocannabinoid system which restores balance. Three applications can be utilized when using cannabis with opioids.
- Used in place of opioids to manage pain
- During opioid withdrawal to manage symptoms
- As a prevention method to avoid opioid addiction
Combining opioids with cannabis will slow opioid tolerance and physical dependence. Opioid levels will lower resulting in pain reduction thus allowing fewer medications used with fewer side effects. Studies demonstrate a 44% decrease in opioid use in states where marijuana is legal resulting in a 25% decrease in mortality from opioid overdose. Cannabis has shown to be of particular use in the addiction of cocaine, alcohol, and nicotine addiction. Psychiatric treatment programs using naltrexone for heroine addiction showed better retention rates with cannabis as a tool. Managing addiction also includes detoxification and soothing symptoms. Cannabis can detox other medications from the body.
Cannabis as a maintenance drug for pain helps reduce addiction relapse
There is a dilemma when it comes to drug testing. Federal law prohibits physicians from prescribing narcotics to opioid addicts. Many physicians require random drug testing when prescribing opioids to avoid abusive patient behavior. This includes cannabis testing and is typically done with urinalysis where the metabolites from the prescribed medications are evaluated. Additionally, the testing is used to detect other medications and drugs. Unlike alcohol, cocaine, or amphetamines, cannabis metabolites are fat soluble and are slow to clear the body because the body’s endocannabinoid system does not see cannabis as a toxin.
Veterans often struggle with symptoms relating to PTSD (Post Traumatic Stress Disorder) and pain. The VA allows for vets to have a prescription through civilian physicians and considered a part of a comprehensive healthcare plan. Due to high opioid use among vets, the VA may not require drug testing for cannabis. It is recognized that cannabis with opioid use can reduce the potential hazards.
The management of the endocannabinoid signaling system not only to blocks the direct reinforcing effects of cannabis, opioids, nicotine and ethanol, but also used to prevent relapse to these various substances of abuse. While full spectrum cannabis derivatives are suggested, isolated CBD can be of great value in the management of substance use.
For more information on substance use disorder and cannabis, please visit us at 301 N. Salem Street in downtown Apex.
Your body is designed to heal 🙂