Hashish produces a variety of bodily and cognitive adjustments by interacting with receptors designed for our personal inside cannabinoids, that are referred to as “endocannabinoids.” These results are the product of many chemical compounds in hashish, equivalent to terpenes, flavonoids, and, as this text will concentrate on, cannabinoids like THC (tetrahydrocannabinol).
Scientists have discovered methods to synthesize man-made cannabinoids, a few of which have been FDA-approved medicines for a number of a long time. However how do synthetic cannabinoids examine to the true factor? Are they equally efficient as medical marijuana for treating sickness or ache? Learn on to seek out out.
Marijuana Vs. Artificial Cannabinoid Medicines: What Works Higher?
There are three important sources of cannabinoids:
- Naturally occurring cannabinoids in hashish, equivalent to THC and CBD (cannabidiol). Hashish accommodates over 100 totally different cannabinoids, however THC and CBD are the best-known and most closely researched.
- Naturally occurring cannabinoids in your personal physique, equivalent to AEA (Anandamide) and 2-AG (2-Arachidonoylglycerol). All these cannabinoids are referred to as “endocannabinoids,” as a result of they’re produced inside your physique. (The prefix “endo-” merely means “internal” or “inside.”)
- Artificial cannabinoids which are produced in laboratories, quite than being produced by your physique or coming straight from the hashish flower.
All three work in the identical style: by activating receptors designated “CB1” and “CB2.” A few of these receptors are situated in your mind, whereas others are unfold all through your physique in different forms of tissue and organs.
By binding to those receptors, AEA and 2-AG regulate primary, core sensations and features, together with ache, starvation, and temper. Utilizing hashish causes THC and different cannabinoids to bind to the identical receptors, which is why marijuana works to fight ache, stimulate urge for food, and enhance temper.
Artificial cannabinoids can produce related results, although there are some points with efficacy, tolerability, and, on the analysis aspect, FDA testing. We’ll focus on these points in a couple of moments, however earlier than we proceed, it’s critically essential to make a distinction between FDA-approved artificial cannabinoid drugs, equivalent to Marinol (dronabinol), and avenue artificial cannabinoids which are used recreationally.
The latter class is commonly described as “artificial marijuana” and consists of substances like “Spice” or “Okay-2.” Not like artificial cannabinoid drugs, that are formulated by skilled chemists working underneath tightly managed situations, Spice or Okay-2 is solely plant matter that has been sprayed with. Nicely, that’s exactly the issue. It’s not possible for customers to know precisely what goes into these harmful, dangerous merchandise, which have been criminalized in most elements of the world on account of inflicting results that vary from convulsions to coronary heart assaults to, in excessive instances, deadly organ failure.
You must completely by no means buy or use these merchandise, no matter your medical background. I can’t emphasize that strongly sufficient. There’s a very actual danger of loss of life from utilizing Spice or Okay-2! There are a lot of different names for these form of avenue cannabinoids. Don’t be fooled.
Now that we’ve cleared that up, let’s check out how artificial cannabinoid drugs stack up in opposition to the precise hashish flower. To begin with, let’s establish a number of the important drugs which are at present accessible, and what each is primarily used to deal with.
First, there are FDA-approved artificial cannabinoids:
- Marinol – The energetic ingredient in Marinol, which is made by AbbVie Inc., is dronabinol, a man-made model of THC. Marinol is available in capsule kind and has two affected person teams: HIV/AIDS sufferers, who use it to enhance urge for food and struggle weight reduction, and most cancers sufferers, who use it to alleviate nausea and vomiting attributable to chemotherapy.
- Cesamet – Like Marinol, Cesamet is an older treatment that was launched to the buyer market throughout the 1980s. Cesamet’s energetic ingredient is nabilone, an artificial cannabinoid or man-made imitation THC. Meda Prescribed drugs, the corporate that at present owns Cesamet, describes it as “a prescription drugs that will assist relieve nausea or vomiting attributable to chemotherapy,” including, “It’s for individuals who proceed to really feel nauseous or vomit despite the fact that they’ve already taken drugs to deal with these signs.” The producer cautions that Cesamet, like inhaled hashish and oral cannabinoid-based drugs, is probably not protected for ladies who’re pregnant or nursing, or for individuals who have coronary heart situations.
Cesamet and Marinol have been round for many years, however extra lately, two extra drugs have been (or are on their option to being) FDA-approved. These are purified however derived from hashish, and embrace:
- Epidiolex – Epidiolex accommodates CBD, a naturally occurring cannabinoid in marijuana. Nonetheless, Epidiolex isolates CBD from the handfuls of different cannabinoids that are additionally current in marijuana. Epidiolex is made by GW Prescribed drugs, which describes this treatment as “a liquid formulation of pure plant-derived cannabidiol (CBD) as a remedy for numerous orphan pediatric epilepsy syndromes.” In different phrases, Epidiolex is a mouth spray for youngsters with very uncommon genetic causes of epilepsy — not widespread forms of epilepsy.
- Sativex – Sativex can be made by GW Prescribed drugs, which calls the product “an oromucosal spray of a formulated extract of the cannabis sativa plant that accommodates the principal cannabinoids THC and CBD in addition to particular minor cannabinoids and different non-cannabinoid elements.” This oral spray is supposed to alleviate muscle spasticity (stiffness and lack of management) associated to a number of sclerosis (MS).
Whereas these drugs will be considerably efficient – and a few, like Epidiolex, take pleasure in treating youngsters with out inflicting the “excessive” produced by ingesting or inhaling hashish – they undergo from an absence of “the entourage impact,” which is a time period describing the mixed results of all cannabinoids working collectively to alleviate signs. As I discussed earlier, hashish accommodates over 100 totally different cannabinoids – and admittedly, medical researchers simply don’t know the place the consequences of 1 finish and the consequences of one other start.
Consider it this manner: the English alphabet accommodates a mere 26 letters, which will be mixed to make hundreds of thousands of various phrases. Now multiply that by about 4, add terpenes and flavonoids to the equation, and you’ll think about how difficult it will be, even for a pc, simply to spit out each attainable mixture. Then, consider how lengthy it will take for researchers to get approval to check – then really check – each mixture on a sufficiently massive examine inhabitants.
It might require a number of lifetimes, even with an enormous workforce of researchers. The Meals and Drug Administration (FDA), which approves drugs to be used in the US, merely lacks the framework for dealing with botanical hashish like different substances. FDA testing rubric is ready up for single compounds, just like the atorvastatin in Lipitor, or the fluoxetine in Prozac – not for a whole bunch of compounds like these present in hashish. The FDA’s mannequin is basically “check substance x for sickness y,” which utterly overlooks and excludes the medical advantages of marijuana related to the entourage impact.
Lastly, most sufferers merely tolerate botanical hashish higher than artificial cannabinoid drugs. For most individuals, the acute (instant/short-term) unwanted effects of hashish are dry mouth, sleepiness, elevated urge for food, and presumably sore throat or coughing relying on the strategy of administration. Some individuals may also expertise short-lived anxiousness or paranoia, significantly if the dose is massive, or in the event that they’re in an surroundings the place they really feel uncomfortable.
By comparability, the unwanted effects of Marinol, in line with the drug’s official web site, embrace “lack of reminiscence, anxiousness/nervousness, lack of motor coordination, confusion, depersonalization, dizziness, paranoid response, sleepiness, irregular pondering, weak point, irregular or fast heartbeat, facial flush, stomach ache, nausea, and vomiting.”
Marinol is, fairly frankly, not used fairly often as sufferers report taking it solely as soon as after which vowing by no means to attempt it once more due to the acute intoxication.
Jordan Tishler, M.D. is a doctor, hashish specialist, and school at Harvard Medical College. He’s additionally the president of the Affiliation of Hashish Specialists, and CEO of InhaleMD — a non-public institute of hashish drugs. He has spent years helping sufferers with hashish. For extra info, or to arrange a session with the workforce at InhaleMD, name (617) 861-8519.