Medicinal use of Cannabis and Cannabinoids

Mead A (2004) International control of cannabis changing attitudes. In Guy G, Whittle B, Robson P (eds) The medicinal use of cannabis and cannabinoids. Pharmaceutical Press, London... 

Russo, E.B. (2004) The history of cannabis as medicine, in Medicinal Uses of Cannabis and Cannabinoids. B.A. Whittle, G.W. Guy, and P Robson, Eds. Pharmaceutical Press, London. 

Much debate has been waged over medicinal uses of cannabis. Several therapeutic uses have been proposed, including antiemetic, analgesic, appetite stimulant, and muscle relaxant. A synthetic cannabinoid, dronabinol (Marinol) has been marketed for clinical treatment of appetite loss, nausea, and vomiting. Although synthetic, it is identical to the main psychoactive chemical constituent of cannabis (A9-THC). 

Work on the medicinal use of cannabis restarted when the major, and essentially only, psychoactive constituent of cannabis, THC (see Figure 18.2), was isolated in pure form. The structure of THC was elucidated in 1964. Simple synthetic routes became available and the pharmacological activity of numerous cannabinoids was examined in animals and humans. 

The appetite-stimulating effects of marijuana have been known for centuries and constitute one of the established medicinal uses of cannabis preparations. Today THC (dronabinol/Marinol) is clinically used for the treatment of cachexia-anorexia in human immunodeficiency virus (HIV) and palliative care patients. There have also been very promising advances in the development of a cannabinoid receptor antagonist (SR141716A, now named Rimonabant or Acomplia) for the treatment of obesity. 

Several of the traditional medicinal uses of cannabis have been substantiated by intense research in recent years. As a result two cannabinoids, a natural and a synthetic one, A -THC and nabilone, have become official drugs. We strongly believe that in the future we shall see cannabinoid analgetics, anticonvulsants,... 

Biologically active platinum complexes, which cross-link defined regions of DNA in cells, possess antitumour activity, and these are evaluated in Chapter 4. In Chapter 5, the present status of the medicinal uses of Cannabis is discussed, particularly as two cannabinoids are now official drugs. The latest methods of treating insulin-resistant diabetic patients with hypoglycaemic agents which do not act by increasing insulin release are described in Chapter 6. 

McPartland JM, Guy G. (2004) The evolution of Cannabis and coevolution with the cannabinoid receptor — a hypothesis, in Guy, G. Robson, R. Strong, K. Whittle, B. Eds. The Medicinal Use of Cannabis, pp. 71-102. London Royal Society of Pharmacists. 

Concerns have been raised about the possible adverse effects of acute as well as chronic medicinal and recreational use of cannabis on cognition and the body (104). The author, while acknowledging the therapeutic role of cannabinoids in the management of pain and other conditions, expressed concern that in recent years the prevalence of recreational cannabis use (especially in the young) and the potency of the available products have markedly increased in the UK. 

A -frar s-Tetrahydrocannabinol (THC) is the major psychoactive (euphoriant) constituent of marijuana. Cannabis sativa. The synthetic form of THC (dronabinol) was approved approximately 20 years ago to treat nausea and vomiting associated with cancer chemotherapy, and it has been used for a lesser amount of time to treat appetite loss in patients with HIV/AIDS (44). More recently, an approximately 1 1 mixture of THC and the structurally related marijuana constituent cannabidiol has been approved in Canada for the alleviation of neuropathic pain and spasticity fcr patients with multiple sclerosis and is administered in low doses as a buccal spray (53). Ccnsiderable interest exists in using cannabinoid derivatives based on THC for medicinal purpcses, but it is necessary to minimize the central nervous system effects of these compounds. 

In agreement with this, Joy, Watson, and Benson (1999) of the Institute of Medicine observed (p. 106) that people with schizophrenia or with a family history of schizophrenia are hkely to be at greater risk for adverse psychiatric effects from the use of cannabinoids, and there is litde evidence that cannabis alone produces a psychosis that persists after the period of intoxication. ... 

The A -THC-rich chemotype of C. saliva constitutes nowadays the most widely utilized ilhcit recreational drug in the world, and the cultivation and use of psychotropic Cannabis, even for medicinal purposes, is illegal in many countries due to the potentially harmful acute and short-lasting effects of this drug. Many interesting comments on the impact of C. saliva and cannabinoids on society, on criminology, and even on art (e.g., the Qub des Hashischins of the French artistic community [5]) could be done, but they are beyond the scope of this chapter. 

Cannabis sativa is the genus and species name of a flowering plant which has been used medicinally for thousands of years. Delta-9-tetrahydrocannabi-nol (A -THC) is responsible for almost all the psychoactive effects of cannabis, but is only one of more than 60 similar compounds found in cannabis which, together, are collectively known as cannabi-noids. Cannabinoid agonists that share the basic chemical structure of delta-9-tetrahydrocannabinol have been increasingly studied in recent years for potential benefits in various types of pain and pain syndromes. 

Cannabis Cannabis sativa) has a long history of medicinal and non-medicinal use and records date back 4,000 years. Naturally occurring cannabis contains a unique class of compounds known as cannabinoids. Over 60 members of this family have been identified but only a few have been well studied. The two best known and most studied cannabinoids are delta-9-tet-rahydrocannabinol (THC) and cannabidiol (CBD) (Fig. 1). These two compoimds show markedly different pharmacological activity. THC is best known for its psycho-activity but also displays analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, and anti-emetic activity. CBD... 

The long history of marijuana use both as a recreational drug and as an herbal medicine for centuries has been reviewed (3). Cannabis sativa contains more than 450 substances and only a few of the main active cannabinoids have been evaluated. Cannabis is the most commonly used illicit drug. In 2001, 83 million Americans and 37% of those aged 12 and older had tried marijuana (4). 

Cannabis is undoubtedly one of the world s most remarkable plants. Virtually every part of it has been used and valued at one time or another. Its roots have been boiled to make medicine its seeds have been eaten as food by both animals and men, been crashed to make industrial oils, and been thrown onto blazing fires to release the minute intoxicating cannabinoids within the fibers along its stem have been prized above all others because of their strength and durability and its resin-laden leaves have been chewed, steeped in boiling water, or smoked as a medicine and an intoxicant. 

It was not until the late 18th and early 19th centuries that an analytical investigation of the active components of medicinal plants and herbal remedies was pursued. This resulted in the discovery of alkaloids such as atropine, morphine, codeine, and papaverine, which eventually became the major constituents of many modem analgesic and cardiac medicines. The discovery of aspirin (from Willow bark), the cannabinoids (from cannabis sct- ya), and digitalis (from foxglove leaf) also came many years, in some cases thousands of years, after these remedies were being used for pain relief, sedation, and dropsy (5-9). 

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