The Dutch scientist, who was in Delhi recently, speaks to Harikrishnan Nair on the relevance of medical cannabis and present status of research in the field
What is the latest and most exciting development in medicinal cannabis research?
A very exciting development is that more and more countries are allowing medicinal cannabis to be used by patients. As a result, research becomes easy and more sources of high-quality cannabis and allied products like oil are available to scientists. Until recently, it was almost impossible to deal in legal scientific research in most countries.
What are the effects of cannabinoids (found only in cannabis, hence the name) on the human body?
Cannabinoids interact with the human Endocannabinoid System. Every cell has receptors. When a molecule binds to its corresponding receptor, it urges the cell to do something. This is how cells produce chemicals. Now, cells have cannabinoid receptors CB1 and CB2. While CB1 can be found almost everywhere in the body, they are most prominent in the central nervous system (brain and spinal cord) particularly those which control sleep, appetite, perception of memory etc. CB2 on the other hand is found mostly in immune system where it can influence pain, inflammation and tissue damage. These receptors and their corresponding molecules form the endocannabinod system. This interaction provides many opportunities for treating difficult diseases and for the development of new medicines. This is not new. Think of opiates which interferes with corresponding opiate receptors and you have painkillers and anaesthetics.
In typical cannabis medication, is cannabinoid the only active ingredient?
The cannabis plant contains over 100 cannabinoids, many of which have a proven medical effect, at least for some medical conditions. That does not automatically mean that all cannabinoids are active, even though many patients believe this. Besides cannabinoids the plant contains many other groups of compounds. The one group that definitely seems to be involved in medical effects are terpenes, which give cannabis its taste and smell. Terpenes can be active by themselves, but also support the cannabinoids in their activity. Is it true that cannabinoids can help reduce pain?Yes, but not all types of pain respond in the same way to cannabis/cannabinoids. Specifically chronic neuropathic pain responds well to cannabis. Worldwide, cannabis is most often used as a medicine to treat pain. This is shown in almost every survey done among cannabis patients.
Isn’t it possible to artificially manufacture tetrahydrocannabinol (THC), the psychoactive constituent of cannabis, from the plant?
The main problem is that THC is a psychoactive drug and is strictly regulated worldwide. This is also true for synthetic THC. It is true that pharmaceutical researchers prefer to work with a pure compound because it makes their studies easier. Initially, they tried this, and made pharmaceutical drugs like Marinol and Nabilone. However, society kept using herbal cannabis, and the discussion became larger and larger. Currently, the support for herbal cannabis has grown so much that scientists are finally seeing that they need to study the herb. This is quite a shift in pharmaceutical research, also because cannabis is available in many different varieties and is consumed in many uncommon ways.
India has a long history with cannabis. So do you see a convergence between modern medicine and ayurveda?
Yes, the use of cannabis has been mentioned many times over in ayurvedic texts. The texts, however, also mention its toxic nature. So the physicians back then knew of the ill effects. But despite cannabis cultivation for medical purposes having legal sanction here, it has been very poorly researched in the country. But Bombay Hemp Company is now working with the NBRI (National Botantical Research Institute) on a genetic breeding programme which should give this a fillip.
If you were to call out one of the most shared claim on marijuana which is blatantly false, which would it be?
The one that worries me most is that “cannabis cures cancer”. The message is now mainly driven by manufacturers who produce cannabis extracts and oils. They want to advertise their products and make very big health claims: it cures cancer, epilepsy, PTSD etc. For many diseases this is not too bad, because if the product doesn’t work, you can stop and try something else. For example, you will not die from chronic pain, even if it is very uncomfortable. This is different for cancer, because you probably will die if you don’t choose the right treatment. Cannabis may work for some types of cancer, but much is still unknown. In many cases it may not work, and there are indications that some types of cancer may actually grow faster because of cannabis use.
Manufacturers often market their cannabis oil as food supplement, even when they know very well that people use it to treat their cancer. Companies make beautiful websites that make cannabis oil look totally safe, legal, and useful for all diseases. This creates a false sense of security among patients, and they get angry with their government about ‘covering up the truth’ about cannabis. Scientifically there is almost no proof that cannabis cures cancer in humans. There is only some proof that cannabinoids may work on isolated cancer cells in a petri dish, or in animals. However, there are many chemicals that can do that but they finally prove to be too risky for use in humans.
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