Tuesday, July 3, 2012

Endocannabinoids Emerge Out of the Shadows
- Ed Glick

The Seventh National Clinical Conference on Cannabis Therapeutics met in Tucson, Arizona on April 26-28, 2012. As is customary with this series of conferences, Patients Out of Time brought together a wide variety of clinical, research and experiential presenters who described the expanding universe of endocannabinoid therapeutics. However, this conference became a benchmark in understanding these complex systems. Where previously, underlying mechanisms of action were vaguely understood, today these biochemical pathways have been described in detail. Where previously, researchers (and patients) knew that cannabinoids dampen down excitatory sensory impulses, today they know how this is accomplished. Additionally, research continues to expand the understanding of anti tumor effects of cannabinoids.

Most of the endogenous (anandamide), or exogenous (herbal cannabis), effects are through neuro modulation at the synapse. (Neuro modulation is the activity of a chemical signal which stimulates or dampens the release of neuro transmitters at the space between two nerve cells.) This complicated process acts like a feedback mechanism to the cells pushing them towards homeostasis- or balance. The reason cannabinoids benefit so many different disease states is precisely because this neuromodulation is occurring as a process of homeostatic re-regulation. Since all mammals have evolved the endocannabinoid signaling system over millions of years, the use of cannabis to selectively activate it is nothing short of a profound medical breakthrough-(which patients have been aware of for generations!)

The ocular neuro protective effects of endocannabinoids are also becoming understood and were described by Professor Melanie Kelly of Dalhousie University in Nova Scotia Canada. When nerve cells (neurons) are degraded or inflamed, local endocannabinoid production is increased in that location. Blocking CB1 or CB2 receptor activity increases the susceptibility of that neuron to stroke and trauma. Cannabinoids display neuro protective effects in experimental models of trauma. Again, the activation of cannabinoid receptors (CB1 or CB2) through either endogenous release of anandamide, or through the exogenous use of herbal cannabis, stimulates a return toward homeostasis by decreasing neurological stress and inflammation.

Another researcher, Martin Lee described his research into unlocking the mechanisms of cannabdiol (CBD)- the non-psychoactive cannabinoid. Most readers understand that THC is the cannabinoid in cannabis that is primarily responsible for the euphoria that is prized by recreational users and that was intentionally bred into most strains. What is much less known are the various important effects of the non-psychoactive CBD. Apart from the obvious benefit to some -that it stimulates endocannabinoid signaling without the person getting high -CBD also reduces breast and glioblastoma cell proliferation, may protect neurons against cellular degradation, promotes stem cell neurogenesis (growth), exerts anti psychotic influences, suppresses cardiac arrhythmia, is anti biotic, and has anti-oxidant properties. Interestingly, CBD has little affinity for the cannabinoid receptors, rather it works by activating non cannabinoid receptors and "enhances endocannabinoid tone by inhibiting FAAH ... a key endocannabinoid metabolizing enzyme." FAAH breaks down endocannabinoids, CBD slows the degradation and enhances cannabinoid signaling. (Since it's therapeutic re-discovery in 2009, CBD-rich strains like Cannatonic and Harlequin are being grown specifically for patients who want pain control with less psycho activity.)

In addition to numerous speakers, the Seventh National Clinical Conference on Cannabis Therapeutics was the site for a meeting of the American Cannabis Nurses Association. Founded two years ago, the ACNA is the professional organization for nurses and others who are interested in the unique interaction of nurses and cannabis patients. Nurses all over the country are caring for and in contact with cannabis patients and have little understanding or awareness of its mechanism of action or of the many complex legal issues presented by the Federal governments ongoing war on cannabis patients. How should a nurse counsel a patient about safe use of cannabis? Nursing as a specialty is concerned with the provision of direct patient care, and the subspecialty of cannabis nursing lends itself to this role.

The conference was also attended by a number of physicians, some of whom participated in the first credentialing seminar hosted by the American Academy of Cannabinoid Medicine. This seminar provided physicians with advanced practice certification.

The conference and the venue were enhanced by the sponsorship of the Arizona Center for Integrative Medicine in Tucson. Dr Andrew Weil, author of From Chocolate to Morphine spoke to the gathering exhorting participants to take control of this issue, rather than let it be continually framed by drug war proponents and conservative media. He described the huge education gap of clinicians and the "deep-rooted irrationality" surrounding cannabis. His talk ranged over the limitations of conventional pharmaceutical treatments, contrasting the risk/benefit relationship of cannabis.

The Seventh National Clinical Conference on Cannabis Therapeutics was well attended by over 250 participants, and was held at Loews Ventana Canyon Resort, in the canyons north of Tucson. This spectacular setting was matched by the culinary offerings created by the Loews Chef, who offered many dishes created with hemp.

The field of cannabinoid research has been hampered for decades by overreliance on the single-molecule profit-based health care industry of America. As Dr. Weil pointed out, this accounts for much of the obstruction, insanity, and senselessness of the continuing federal prohibition on cannabis. The very fact that millions of patients can "dispense" with their muscle relaxants, opiates, sedatives and tranquilizers by using a safe and powerful remedy must make pharmaceutical industry accountants break into a cold sweat. Nevertheless, as this conference showed, the re-integration of cannabis into the Pharmacopoeia is now inevitable, and the legal prohibitions are destined to fall like dead leaves on a tree.

The Seventh National Clinical Conference on Cannabis Therapeutics marked, for the first time, the emergence of cannabinoid science from a poorly understood complex process into an increasingly cohesive body of clinical and experiential wisdom which represents the last new frontier of conventional medical advancement. This is, of course, something millions of patients have known for centuries. Their cumulative experience has precipitated this beginning revolution in medical care. Patients are, after all, the leaders here.

Patients Out Of Time (www.medicalcannabis.com)

American Cannabis Nurses Association (www.cannabisnurse.org)

American Academy of Cannabinoid Medicine (www.aacmsite.org)

Arizona Center for Integrative Medicine (www.Integrativemedicine.arizona.edu)

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