| One-Minute Clinician

Cannabis and the Endocannabinoid System

The endocannabinoid system is something that most primary care physicians really have never heard of, and it’s a shame because the endocannabinoid 1 receptor is really the single most densely populated G-protein coupled 7 transmembrane domain receptor in the human brain. So why do we and all animal species, down through sponges, have this system of cannabinoid receptors?  It’s because just like endorphins, we also make our own endogenous cannabinoids – the so-called endocannabinoids. And it has been postulated that the reason we have cannabinoid receptors and endocannabinoids is to help us to forget pain. 

Cannabis was removed from the US pharmacopoeia in 1942.  So most physicians--I’ll say all physicians, have been trained during the era of cannabis prohibition where not only did we not learn about the endocannabinoid system and cannabinoid receptors, but we don’t learn anything about cannabis as medicine. But I believe that primary care physicians need to learn about what cannabis is and what it does and what its potential medical utility is in therapeutic settings. The knowledge base is still not as complete as we’d like it to be largely due to cannabis being considered a schedule 1 substance with a high potential for abuse, and this makes it quite difficult to study. So the research looking at potential benefit of the plant itself is not really there, but there is enough that we were able to say that cannabinoids and cannabis may be useful for pain, for chemotherapy-induced nausea and vomiting and for spasticity associated with multiple sclerosis. Some states that are approving medicinal cannabis are now requiring a certain amount of education for primary care physicians, and I would urge people to take advantage of those offerings and learn what cannabis is and what it isn’t. it’s going to be hard for the cart to catch up to the horse, if you will, because patients are telling us that this stuff works for a number of different conditions, but physicians want randomized placebo controlled double blind clinical trials, and they’re just not there yet.

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