Chapter 8: So Where Does this Leave us?

When Raphael Mechoulam discovered the ECS in 1964, he opened the doors to the potential medicinal effects of marijuana. Since then, there have been numerous studies prevalent to the effects of medical marijuana on the human brain. In the article from Chapter 4, Cannabinoid Effects on Anxiety-Related Behaviors and Hypothalamic Neurotransmitters, the side effects of THC are discussed (Arévalo et al. 2001). THC one of the many cannabinoids extracted from the marijuana flower of a female plant, which proves to cause some psychoactive effects and short-term anxiety. Some of the other organic properties in marijuana include CBD, CBC, CBN, CBG and THCV, each possibly exhibiting crucial roles as anti-psychotics. It is interesting to learn that marijuana has been used for both medicinal and mood-altering purposes since 7000 B.C.E. Branching off of that, we start to think about the purpose of this plant is in relation to medicine and treatment. The article in Chapter 5, titled Modulation of the Endogenous Cannabinoid System [ECS] as a Therapeutic Target in the Treatment of Mental Health Disorders, focuses directly on how effective medical marijuana can be in treating psychological disorders (Allen et al. 2013). From the previous chapter, it was determined THC should be at a lower content when treating psychological disorders, due to the side effects. Here, Allen et al. have claimed that “the ECS could be involved in regulating emotional memory and this may explain why we see antidepressant effects with THC administration”. This article was written a year ago, which was twelve years after the previous article. It is interesting to see how science changes and develops so rapidly.

 

Image courtesy of: http://themarijuanareport.com/funny-or-not-so-funny-medical-marijuana-cartoons/

In order for the effects of medical marijuana on patients with psychological disorders to be fully understood, more research needs to be conducted. In attempt to undergo research on this topic, Dr. Sue Sisley (mentioned in Chapter 7) uses previous knowledge of medical marijuana to design and implicate a study conducted on veterans suffering from PTSD. Because marijuana is categorized as a schedule 1 substance, Dr. Sisley runs into a complicated process of approval to conduct a study on human patients. A quote given by Governor Lincoln Chafee of Rhode Island brings up a good point, “It defies logic in this day and age that marijuana is still in schedule 1 alongside heroin and LSD when there is so much testimony to what relief medical marijuana can bring”. It is important to understand that the medical marijuana has yet to be linked to serious health risks, and the benefits definitely outweigh them.

Image courtesy of: http://www.budsmagazine.com/wp-content/uploads/2013/01/481954_254009108035949_433750382_n.jpg

Medical marijuana proves to be a credible treatment in many fields of medicine. The cannabinoids produced by the marijuana plant have therapeutic effects and can help patients suffering from psychological disorders. Cannabinoids, such as THC, CBD, CBN, CBG and CBC, can be used to alter the function of the ECS through agonistic effects in patients suffering from affective disorders like bipolar disorder, major depressive disorder, dysthymic disorder and cyclothymic disorder. In theory, scientists believe that medical marijuana can treat many other psychological disorders like eating disorders, mood disorders, somatoform disorders, sleep disorders, anxiety disorders and personality disorders. This type of pharmacotherapy could be of much use in patients suffering from any of these disorders. Along with psychotherapy, medical marijuana will increase the quality of life and ease the daily struggles that come with most psychological disorders. This topic is so interesting and I am definitely intrigued to track more research being done on the medicinal properties this plant beholds!

Resources:

http://ac.els-cdn.com/S0091305701005780/1-s2.0-S0091305701005780-main.pdf?_tid=97e3eac8-4f1e-11e4-93d0-00000aacb35f&acdnat=1412795534_f9189ed7405c60a1fe57a2d078254b05

Chapter 7: Medical Marijuana Research Hits Wall of U.S. Law

Image courtesy of: http://www.nytimes.com/2014/08/10/us/politics/medical-marijuana-research-hits-the-wall-of-federal-law.html?_r=0

While searching through the New York Times, I came across the article Medical Marijuana Research Hits Wall of U.S. Law, written by Serge F. Kovaleski, about a psychiatrist at the University of Arizona. Dr. Sue Sisley (pictured below) turns to the federal government to seek approval in researching the therapeutic effects of medical marijuana on patients, specifically war veterans, suffering from post-traumatic stress disorder (PTSD). Exposure to a terrifying or life-threatening event can lead to PTSD. This condition is an example of an anxiety disorder induced by traumatic stress. Dr. Sisley aims to expose and support medical marijuana as treatment for other diseases and disorders as well. Kovaleski states the purpose of her study and how it could be critical to therapeutic effects of medical marijuana research in PTSD patients:

“Dr. Sisley’s predicament shows that even in states like Arizona, where medical marijuana is legal, the matter remains politically volatile. [July of 2014], Arizona authorized the use of marijuana for patients undergoing conventional treatments for post-traumatic stress disorder. Dr. Sisley’s study is supposed to use five different strains of marijuana that would be smoked or vaporized by 70 veterans. The goal is to develop a marijuana drug, in plant form that would be smoked or vaporized, approved by the Food and Drug Administration.” (1)

Unfortunately Dr. Sisley runs into many issues with the legal aspects of the study and the approval process in which she must compete. Medical marijuana is legal in Arizona, however legal applications to the Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), and National Institute on Drug Abuse (NIDA) pend approvals, further delaying the study. Kovaleski talks about these controversial accounts between Dr. Sisley and three political stakeholders, Andrew Biggs, Tim Bee and Ann Weaver Hart. Mr. Biggs is the Arizona State Senate president. He claims that Dr. Sisley’s study is biased because she is involved in pro-legalization of medical marijuana campaigns. Thus, Mr. Biggs reaches out to Mr. Bee with his complaints that Dr. Sisley is too aggressive and inappropriate in her approach. Mr. Bee contacts Ms. Hart with the complaints he had received and Dr. Sisley is given a warning to resign. Three months later, she was notified that her contract at the university would be terminated. This causes great distress for Dr. Sisley and her team because they cannot continue their research on patients with PTSD. In order to resume the study, Dr. Sisley and her team must either be reinstated or find a new university to study at.

Image courtesy of: http://www.nytimes.com/2014/08/10/us/politics/medical-marijuana-research-hits-the-wall-of-federal-law.html?_r=0

As a side note, Kovaleski states:

“There are signs, though, of a possible shift in attitude within the federal government. In May, the DEA issued new rules to increase the government’s production of marijuana for research this year to 650,000 grams from 21,000 grams.” (1)

This means that the United States will increase the manufacturing of medical marijuana by about 31 percent. Serge Kovaleski gave an immense amount of research to support his claims. This article shows the difficulty in the process behind funding research of medical marijuana. Because the drug is categorized as a schedule 1 substance, pending approval demonstrates to be a complicated process. Kovaleski writes about Dr. Sisley’s short-end of the stick, also giving further evidence behind all parties in the situation. Using his research, he gives clinical details behind the therapy of medical marijuana and why Dr. Sisley seems to be on the right track with hers. Kovaleski emphasizes this quote given by Governor Lincoln Chafee of Rhode Island:

“It defies logic in this day and age that marijuana is still in Schedule 1 alongside heroin and LSD when there is so much testimony to what relief medical marijuana can bring.” (1) 

The main point of this article is to publicize the need for supplementary research in medical marijuana. Serge Kovaleski discusses the flaws and shortcomings within the approval system with funding clinical studies. The organization of the points is clearly noted alongside Dr. Sisley’s account. Medical Marijuana Research Hits Wall of U.S. Law is a report describing the complications behind the endorsement of research in medical marijuana, even though there is clear therapeutic evidence.

Resources:

(1) http://www.nytimes.com/2014/08/10/us/politics/medical-marijuana-research-hits-the-wall-of-federal-law.html  

(2) http://www.psychologytoday.com/conditions/post-traumatic-stress-disorder

Chapter 6: Frequently Asked Questions About Medical Marijuana

Image courtesy of: http://ncnorml.files.wordpress.com/2014/04/image_doctor-marijuana-leaf-001.jpg 

How strong is marijuana today?

The regulation of both medical and recreational marijuana is the reason why there is such a wide variety of THC levels in products. The Food and Drug Administration (FDA) found that high CBD content in marijuana can in fact be effective in treating nausea, vomiting and wasting diseases. A wasting disease can be defined as a constant debilitating disease that deteriorates body and muscle mass. Unfortunately, selective breeding and hybridization can cause different potencies in the plant which can make it hard to predict how strong marijuana is nation-wide. With lower THC content, the less psychoactive the drug will be.

Is it true that marijuana is a gateway drug?

Ever since I was little, I have been told that marijuana is in fact the gateway drug. This cannot be true because the population that uses marijuana usually uses it for different effects than more illicit drugs.  Medical marijuana contains properties unlike most drugs with natural components versus synthetic chemicals. Actually, there is evidence suggesting that medical marijuana can function as an "exit drug" helping people reduce or eliminate use of more harmful drugs, like cocaine, heroin and LSD, by easing the symptoms of withdrawal.

Does marijuana impair driving?

Marijuana has properties in which it could cause impairment to driving. These properties affect the perception and psychomotor performance while under the influence. However, these effects do not interfere with the actual handling of a car behind the wheel. The main property of concern is the side effect of drowsiness. Like sleep medications, there could be a risk of falling asleep at the wheel and should be taken as a precaution.

Does marijuana have long-term cognitive effects?

Like most drugs, medical marijuana has short-term side effects including cognitive changes in immediate or temporary thoughts, perceptions and information processing. This is described to only last the duration of the “high”. There is no causational evidence linking medical marijuana to defective cognitive thought. Actually, there is no evidence in any cases that have been documented stating the cause of death to be induced by medical marijuana.

Does marijuana affect mental health?

There is no proven association of marijuana as an effector of onset to mental health issues. However, there is evidence suggesting that the stimulation of the endocannabinoid system (ECS) releases chemicals that reduce the risks of depression and other psychological disorders. Cannabidiol, combined with minimal quantities of THC, serves as an anti-psychotic. With all evidence given, it is understood that marijuana serves as a medicinal treatment for mental health issues.

Resources:

http://www.drugpolicy.org/drug-facts/10-facts-about-marijuana

http://medical-dictionary.thefreedictionary.com/wasting+disease

Chapter 5: How Altering the ECS Could be Affective in Patients with Psychological Disorders

How is this possible?

The endocannabinoid system (ECS) is defined as a network of lock-and-key chemical receptors that respond to the “signals” of cannabinoids. Specific receptors found in this system involve different stimuli within the body, which can further be directed towards various functions. Focusing on where exactly the ECS is located, the image projected below can be used to identify specific locations of these receptors on different body cells.

Image courtesy of: http://the-human-solution.org/education-resources/education/cannabis/the-endocannabinoid-system/

There are two endogenous cannabinoids, natural chemicals stimulating the endocannabinoid system: Anandamide and 2-Arachidonyl-glycerol. Cannabinoids, such as THC, CBD, CBN, CBG and CBC, present in marijuana are used to alter the function of the ECS through agonistic effects. An agonist is defined as a substance that initiates a physiological response when combined with a receptor. Most studies focus on the aspects of receptors located in the ECS, called CB1 and CB2. Each of these receptors signal specific means of regulation of hormones throughout the body. While doing research on these mechanisms, I found an article published on the OMICS Group website titled Modulation of the Endogenous Cannabinoid System as a Therapeutic Target in the Treatment of Mental Health Disorders. In 2013, Darien Allen, Michael Shafer, Harrison Stratton and Jie Wu published this article in the Journal of Biochemistry and Pharmacology. This article gives specific examples of therapeutic possibilities in affective disorders; “investigating the ECS could enhance our ability to treat mental health disorders in the future by providing alternative molecular routes for modulating serotonin and norepinephrine”. Serotonin is a neurotransmitter that is derived from tryptophan. It is specifically involved in sleep, depression, memory and other neurological processes. Norepinephrine is involved in the "fight or flight" response, which is defined as sudden energy resulting from stress. This leads us to believe that this type of pharmacotherapy inhibits the reuptake of serotonin and norepinephrine may be effective to treat affective disorders. Evidence of this phenomenon is explained through the reaction of CB1 receptors; “the ECS could be involved in regulating emotional memory and this may explain why we see antidepressant effects with THC administration”.

Figure caption: The left side of the figure below depicts the molecular structure of of Δ⁹ -THC, anandamide, and 2-arachadonylglycerol, which are all agonists at cannabinoid receptor binding sites. The complex interaction of many different partial agonists gives cannabinoid receptors their own unique pharmacological profile and makes them more difficult to profile. On the right, a simple depiction showing how CB receptors tend to be located pre synaptically in order to act as retrograde signaling elements with their own form of synaptic plasticity. When an action potential is received potassium is evacuated from the bouton and calcium enters, triggering neurotransmitter release. Neurotransmitter binding on the post synaptic surface then induces the creation of endogenous cannabinoids from precursors found within the plasma membrane. These precursors are enzymatically activated and released into the synaptic cleft.

Table courtesy of: http://omicsgroup.org/journals/2167-0501/2167-0501-S1-008.php

The focus of this study is described to diagnose the functional uses of cannabinoid (CB) receptor psychopharmacology. The use of this therapy is significant in people suffering from affective mental disorders, including Bipolar Disorder, Major Depressive Disorder, Dysthymic Disorder and Cyclothymic Disorder. After further research, techniques for regulating the symptoms these psychological disorders can be applied in neural science and pharmacotherapy.

Why is this so interesting?

To start off, I’d like to say these findings are very interesting to me. THC is known to have psychoactive affects, yet seems to be the main ingredient to have pharmacological effects on mental disorders. However, other cannabinoids can play a key role in regulating mental health as well. In 1964, Raphael Mechoulam changed the world of psychology for his discovery of the ECS. Mechoulam founded this system by studying a specific extract of the marijuana flower, THC. Now we can use his advancements as well as new concepts and theories to test the effects of medical marijuana in treating psychological disorders. 

Resources:

http://the-human-solution.org/education-resources/education/cannabis/the-endocannabinoid-system/

http://omicsgroup.org/journals/2167-0501/2167-0501-S1-008.php

https://www.google.com/search?client=safari&rls=en&q=agonist+definition&ie=UTF-8&oe=UTF-8&gws_rd=ssl

http://dictionary.reference.com/browse/serotonin

http://bipolar.about.com/od/glossary/g/gl_norepinephri.htm