Cannabis

A Clinician's Guide

Betty Wedman-St.Louis

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781138303447
• eBook ISBN: 9781351398039
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Cannabis is one of the oldest cultivated plants dating back 12,000 years and demonstrates medicinal properties including immune support, anti-inflammatory effects, and cancer-fighting potential. As cannabis receives regulatory approval in the United States, clinicians will need guidelines to prescribe medical marijuana for various health conditions. This book presents information to healthcare professionals focusing on medical cannabis. It is a science-based overview providing clinical recommendations and dosing guidelines for practitioners to advise patients appropriately.

Features:

• Discusses the endocannabinoid system role in homeostasis, pain control, and regulatory function in health and disease
• Advises clinicians on cannabis use in patients with cancer; cardiovascular, brain, and liver function; mood disorders; and patients receiving palliative care
• Includes information on cannabis nutrition as well as the cannabis microbiome
• Features information on cannabis quality control for safe and effective delivery

Cannabis: A Clinician's Guide is written for clinicians providing a resource guide to help them assess the medicinal value of cannabis, answer patient and consumer questions, and recommend its use optimally. The book is divided into three sections covering cannabis science, use in clinical practice, and regulations and standards. It includes practical information on dosing guidelines and dispensary insights, personal cannabis stories, and an in depth look at the nutritional benefits of cannabis and how to use it in daily life.

From the Author: "As a clinical nutritionist, I have been involved in the use of cannabis since 1981 while researching diabetes in India. Ayurvedic medicine listed cannabis as a beneficial herb with curing properties. In 1983, a Chinese medicine doctor in the Peoples Republic of China gave me a cannabis herbal supplement for sleep that he claimed Chairman Mao took regularly. Upon returning to the United States, no one would even talk to me about cannabis because of its Schedule I status. During an Antioxidants class taught for Everglades University, I included information on cannabis, but was restricted from including it in the course description. Cannabis: A Clinician's Guide unveils deceit on this herbal medicine used for thousands of years providing insight into the science behind its use and how to incorporate cannabis into daily life, especially for those suffering from neurological disorders, cancer, and mood disorders."

section two

Clinical Practice

chapter ten

What should we tell our patients about marijuana?

Joseph Pizzorno

Contents

Exogenous toxins

Endogenous

Toxins of choice

Cannabis (marijuana)

Toxicity in unadulterated cannabis

Contaminants

Pesticides

Solvents

Heavy metals

Microbial

Synthetic cannabinoids

Detoxification

Clinical indications of toxicity

Intervention

Conclusion

References

Long-time readers Integrative Medicine—A Clinician’s Journal are well aware of the many editorials I have written on how a growing body of research is showing that toxins have become a major cause of chronic disease. As I study toxicity, my understanding has broadened to include not only environmental metals and chemicals but also endogenously produced toxins such as those from homocysteine, gut bacteria, and nonoptimally detoxified hormones. To this list I now add what I call “toxins of choice.” Few of our patients are intentionally exposing themselves to neurotoxic organophosphate pesticides, endocrine-disrupting polychlorinated biphenyls (PCBs), insulin receptor site-blocking phthalates, or lung-damaging mold from damp buildings. However, many of our patients are intentionally consuming known toxins such as alcohol and marijuana and are unlikely to realize that at modest dosages salt, high-fructose corn syrup, phosphates, and nonsteroidal anti-inflammatory drugs (NSAIDs) are toxic as well. Added to this that by also considering genetic susceptibility, even sources of gluten can be toxic. The huge load of environmental, endogenous, and choice toxins adds up to deplete stores of protective glutathione and cause physiological and structural damage in many ways.

The following is my current list of many toxins that stress physiology and cause disease in our patients.

Exogenous toxins

•OTC and prescription drugs

•Chemicals: inorganic, organic, fluoride, persistent organic pollutants, solvents

•Metals: arsenic, cadmium, lead, mercury

•Microbial

•Mold (damp buildings)

•Particulate matter

•Radiation: light at night, medical, cell phone

Endogenous

•Catecholamines (if COMT SNP)

•Gut-derived toxins

•Homocysteine

•Non-end product metabolites

•Poorly detoxified hormones

Toxins of choice

•Alcohol

•Marijuana

•Food constituents

•High-fructose corn syrup

•Phosphates

•Salt

•Smoking

•Wheat (if zonulin is produced)

Cannabis (marijuana)

Although the federal government has classified cannabis as a controlled substance illegal for use, many states have now decriminalized its use. Twenty-four states and the District of Columbia have passed laws allowing medicinal use of marijuana, and 14 states have decriminalized its use. The percentage of Americans who say they have tried marijuana has steadily increased from 4% to 43% in 2016 [1].

Cannabis production has become a multibillion dollar industry in the United States, and legal markets for cannabis are projected to reach $11 billion by 2019 [2]. The federal illegality of cannabis has resulted in not only limited clinical research but also a production environment with few standards and very little regulation. As most is currently grown indoors, heavy use of agricultural chemicals is common. Toxicity may be due to not only constituents of marijuana itself but also contaminants such as solvents, pesticides, and heavy metals, with most extracts adding solvent residues. This likely helps explain some of the discrepancies in the research.

Toxicity in unadulterated cannabis

Almost 500 compounds have been extracted from cannabis, of which 65 are classified as cannabinoids. The most abundant cannabinoids include delta-9-tetrahydrocannabinoic acid (THCA), cannabidiolic acid (CBDA), cannabigerolic acid (CBGA), and their decarboxylated derivatives delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabigerol (CBG) [3]. These compounds are converted into their more active decarboxylated counterparts by heat (smoking, evaporation, baking), light, or natural degradation. THC is the most psychoactive component of cannabis and alters cognition primarily through the activation of CB1 receptors on presynaptic axons, though several other mechanisms have been identified [4,5]. The content of THC in marijuana has increased from 3.1% in 1992 to 5.1% in 2002 [6,7].

THC itself has low toxicity, and modest use has shown minimal long-term physical or psychological effects when not used to excess [8,9]. Acute high-dose intoxication occurs quickly but is short term. Typical symptoms include nausea, anxiety, paranoia, short-term memory loss, confusion, and disorientation [10]. THC impairs gonadal function by blocking gonadotropin-releasing hormone (GnRH) release. This results in lower levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which causes reduced testosterone production by the testicular Leydig cells [11].

The research on the toxicity of whole plant marijuana is inconsistent, probably due to lack of control for contaminants, poor assessment of dosage, small sample size, limited number of heavy users, mode of use, and not adjusting for other factors such as alcohol, tobacco, and other recreational drugs [12].

The method of use significantly affects the toxicity of marijuana. The most common use is inhalation of the smoke of the dried plant. This results in higher ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgments
• Introduction
• Editor
• Origins and history of cannabis
• Contributors
• Section I: Cannabis Science
• Section II: Clinical Practice
• Section III: Regulations & Standards
• Appendix A: Glossary
• Appendix B: Recipes
• Index