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The Benefits and Challenges of Medicinal use of Marijuana

            Globally, more nations and states are passing laws to legalize marijuana for medicinal use. As such, there has been an increasing need for accurate information concerning the therapeutic value of marijuana. Some scholars and scientists argue that marijuana is effective in the treatment of conditions like neurological disorders, HIV, cancer, autoimmune and inflammatory pain diseases, and that it should be medically used (Kramer, 2015). However, others hold a contrary view. While debates continue to abound about the fate of the medical worth of marijuana, this paper advances that the same should be legalized for medical use in the treatment of the conditions, like HIV and cancer, which are wreaking havoc globally.

Overview of Marijuana’s Biological Mechanisms

Marijuana comes from the buds and leaves of the cannabis sativa plant. Cannabis plants comprise of at least 350 secondary metabolites, most of which have bioactive influences. Among the metabolites, Belendiuk et al. (2015) note that two (CBD and delta 9-THC) have been identified as the most bioactive. Cannabis also contains terpenoids, a component that is responsible for cannabis’ aroma, and flavonoids. Endogenous cannabinoids (endocannabinoids or body generated cannabinoids) comprise bioactive lipids, most of which are derived from arachidonic acid: arachidonoyl-ethanolamide (AEA) and 2-arachidonoylglycerol (2-AG), among many others (Owen et al., 2014). Cannabinoid receptor type 2 (CB2) as well as cannabinoid receptor type 1 (CB1) are the two main cannabinoid receptors in cannabis plant. These cannabinoid receptors are spread in all the regions of human brain as well as in the bordering nervous system, with significant concentration in hippocampus, amygdala, thalamus and the cortex’ association regions (like cingulate) (Lotan et al., 2014). These parts constitute the interoceptive of human brain circuity, which role play in mood support, pain, bodily sensations, anxiety, depression, memory, other mental functions. Put differently, interoceptive brain circuity assists in the translation of sensation to perception (Salomonsen-Sautel et al., 2012). Thus, binding of a cannabinoid to any of these receptors lead to the activation of G-protein, eventually affecting different cellular roles depending upon the kind of cell (See figures 1 and 2 below).

Most metabolites of the endocannabinoids trigger several other receptors that have been shown to role play in inflammation, thus associating endocannabinoids with the role of regulating inflammations (Pisanti et al., 2014). Additionally, CB1 receptors are available on the mitochondrial membrane, a region wherein stimulation can directly regulate energy production, generation of reactive oxygen species, and cellular respiration (Belendiuk et al., 2015). Another component of cannabis is Phyto-cannabinoids, with the major one being THC. THC is responsible for about 20% of the cannabis plant’s weight and about 20% of the plant’s bioactivity (Sansone & Sansone, 2014).  THC directly binds CB2 and CB1. THC has a low attraction for CB2 and CB1 receptors intrinsically; however, it stops fatty-acid from binding protein that is responsible for the transportation of endocannabinoids to be hydrolyzed (Pisanti et al., 2014). This way, it prolongs the activation of CB1 receptors (Kleckner et al., 2019). It equally modulates other receptors like the peroxisome proliferator-activated receptor γ (PPAR-γ) and 5-hydroxytryptamine (5-HT1A) serotonin receptor, among others (Salomonsen-Sautel et al., 2012).

Figure 1. Strategies via which cannabinoids affect various disease symptoms (Kleckner et al., 2019).

Figure 2. Description of the mechanisms via which cannabinoids affect symptoms (Kleckner et al., 2019).

Marijuana and Various Symptoms of Medical Conditions/Diseases

The use of cannabis has been shown to be a promising strategy to symptom management in many clinical conditions. Studies have indicated that cannabis has the capability of preventing Alzheimer’s, treating glaucoma, relieving arthritis, controlling epileptic seizure, easing pain resulting from multiple sclerosis, decreasing anxiety, helping in reversing the carcinogen tobacco effects (Pisanti et al., 2014). It has also been shown to improve lung health, minimize severe pain, nausea from chemo, as well as rouse appetite (Roberson et al., 2014). Salomonsen-Sautel et al. (2012) add that it can slow/stop cancer cells from spreading, treat inflammatory bowel illnesses and safeguard the brain from trauma and concussion (Sharkey et al., 2014). A few explanations are provided below on how marijuana is of great medicinal value. 

Nausea and Vomiting

Chemotherapy-induced nausea and vomiting (CINV) is presently a highly widespread, with most commonplace chemotherapy routines categorized as ‘moderately’ or ‘highly’ emetogenic. Generally, contemporary anti-emetic regimes are awfully helpful at averting emesis. Nonetheless, these regimens are much less effective in regulating nausea (Roberson et al., 2014). Regulation of nausea, therefore, remains poor, with about 40-75 of patients reporting nausea whenever they have received moderately or highly emetogenic chemotherapy (Badowski, 2017).

Agents of chemotherapeutic encourage surplus serotonin discharge from enterochromaffin cells in the gastrointestinal (GI) tract line, and raised concentrations of serotonin bind upon neighbouring vagal nerve afferents to 5-hydroxytryptamine 3 (5-HT3) receptors, which relay information regarding surplus chemicals to the human brain and directly encourages emesis (Belendiuk et al., 2015). Similarly, poisonousness to enterochromaffin cells have the ability of causing cell death as well as chronic boost of serotonin along with other produced substances, which subsequently prepare the body’s vagal nerve and cause deferred nausea and vomiting (Salomonsen-Sautel et al., 2012). The widely used anti-emetic for patients, especially cancer patients, is 5-HT3 receptor antagonist, and cannabinoids equally directly inhibit these receptors (Kramer, 2015). Particularly, it is thought that CBD has the ability of acting as 5-HT3 receptor’s modulator and an indirect agonist upon the 5-HT1A auto-receptors, which eventually minimizes the accessibility of serotonin (Birdsall et al., 2016). Increasing pre-clinical evidence advocates that the endocannabinoid system role plays in the regulation of vomiting and nausea (Kleckner et al., 2019). Thus, there is evidence that cannabis relieves or treats CINV.

Loss of Appetite and Anorexia

Anorexia and decreased appetite are categorized among the most upsetting negative effects of a number of diseases, especially cancer and HIV treatments. At least a half of patients suffering from advanced HIV and cancer exhibit weight loss and experience lack of appetite (Sansone & Sansone, 2014). Presently, appetite-stimulating drugs used include megestrol acetate, metoclopramide, steroids, and dronabinol. Except dronabinol, all these drugs are endorsed for short-term use owing to their possible negative effects. Additionally, irradiation of salivary glands and mouth has been shown to cause dysgeusia (taste distortion) suffering, anatomical intraoral shortcomings, or even damage of oral mucosal which can result in loss of body mass and appetite (Sansone & Sansone, 2014). Endocannabinoids controls eating behaviour through various biochemical pathways in the periphery and brain: the hindbrain and hypothalamus, the limbic system, the intestinal tract, as well as adipose tissue (Owen et al., 2014). These pathways control peptides that are involved in regulation of appetite, include melanocortins, leptin, and ghrelin (Badowski, 2017). Thus, THC and medical cannabis help in boosting appetite and reducing body weight loss in human beings and lab animals.

Pain

Most patients experience varied amount of pain, particularly cancer and HIV patients, at some stage of their sickness. Evidence has shown that marijuana can affect sensation and perception (Kleckner et al., 2019). Nociceptors possess CB1 receptors, thus, allowing cannabinoids to have an analgesic impact by moderating nociceptor activity within human brain’s periphery. Both CB2 and CB1 receptors across the immune and nervous system allow for parallel cannabinoids’ mechanisms in regulating pain sensation (Sharkey et al., 2014). Similarly, there is proof that cannabinoids have a potential of painkilling properties of opioids, therefore, permitting for reduction of dose of opioids (Roberson et al., 2014). Studies have shown that cannabinoid receptor can minimize cancer-associated pain behaviours. A study by Belendiuk et al. (2015) indicated that that marijuana is effective in treating chronic pain, multiple sclerosis, dementia and Tourette syndrome, among others, in people and not necessarily cancer patients.

GI Distress

GI distress (like crumps, diarrhoea, bloating, abdominal pain and flatulence) is linked to deteriorating quality of life, and equally contributes to fatigue, depression, malnutrition, anxiety, dehydration, and other signs and symptoms (Birdsall et al., 2016).  Under chemotherapy, these symptoms have been shown to be so devastating that some patients minimize their lifesaving chemotherapy prescriptions, defer treatments, and completely end chemotherapy treatment (Kleckner et al., 2019).  However, Lotan et al. (2014) has shown that the use of marijuana alleviates both constipation and diarrhoea. Other studies have also equally shown that marijuana minimizes GI distress.

Psychological Distress

Depression, anxiety and other forms of mental challenges are common issues that patients face. Anxiety can show itself as difficulty concentrating, worry, recurrent panic attacks, poor quality of sleep, among others, while symptoms of depression include energy levels, changes in appetite, listlessness and suicidal ideation (Kramer, 2015). In some countries, endocannabinoid system is used in regulation of mood as well as marijuana-derived treatments have also been shown to regulate progression or development of mood disorders.

Fatigue and Sleep Disorders

Most patients have troubled sleeping. Metabolic dysregulation and inflammation are possible contributing mechanisms for interrupted circadian rhythms (Badowski, 2017). Sleep disorders are also associated with illnesses-related fatigue, which is among the most debilitating side effects of illnesses and their treatments (Lotan et al., 2014). Human endocannabinoid system is joined into sleep-wake cycles and circadian rhythm. In human beings, 2-AG has been shown to peak at around 13:00 and attains its minimum at about 02:00 (Owen et al., 2014), suggesting that endocannabinoids control circadian rhythm, as opposed to other activities of a human being’s sleep-wake cycle that impact cannabinoid activity and concentration (Badowski, 2017). Particularly, CBD may assist in inducing sleep, with less of resultant ‘hangover’ effect compared to sleep aids like benzodiazepines (Sharkey et al., 2014).

Adverse Effects and Risks of Using Marijuana Medicinally

Studies have indicated that the same is associated with several risks and dangers. Smoked marijuana may cause agitation/anxiety, hallucinations, feelings of depersonalization, temporal slowing, feelings of depersonalization, impaired attention/judgment, red eyes, tachycardia, increased appetite, and mouth dryness. Cannabis can impact a person’s cognition for between 5 and 12 hours after smoking. Similarly, in case of high doses, acute confusion, hypothermia, and hypotension (Belendiuk et al., 2015).

Conversely, oral intake of marijuana may not cause substantial signs and symptoms since the bioavailability is substantially minimized (Lotan et al., 2014). However, there is insufficient data regarding oral or mucos marijuana adverse effects and risks. Owen et al. (2014) state that the most obvious negative effect for oral administration seems to be dizziness and fatigue. Other negative effects also include depressive disorder, anxiety, and exacerbation of agitated disorders in individuals with bipolar, amplified risk of psychosis and schizophrenia, as well as cannabis hyperemesis syndrome (Birdsall et al., 2016). Other dangers are from possible vascular effects, like marijuana-induced arteritis, myocardial infarction, and posterior circulation stroke (Lotan et al., 2014). Heavy marijuana smoking is linked to large airway inflammation and may as well cause signs and symptoms associated with chronic bronchitis (Kramer, 2015). Nonetheless, Pisanti et al. (2014) reason that occasional marijuana use does not seem to a danger factor for chronic obstructive pulmonary disease.  Nonetheless, the list of side effects of marijuana use is inexhaustive.

This paper has comprehensively weighed into the benefits and negative effects of the use of marijuana medicinally. From the analysis, it can be seen that benefits far much outweigh the side effects of using marijuana as a medicine. As such, this paper holds the view that marijuana should be approved for use in the treatment of some of the diseases, like HIV and cancer, that are currently inflicting havoc. Nonetheless, there is need for further studies on the health benefits of marijuana.