OGDEN — It turns out that humans have a built-in neurotransmission system that appears well-designed to respond to cannabis for treating chronic pain, anxiety, nausea and a host of other symptoms caused by various diseases and conditions.
The endocannabinoid system is recognized in other countries, but here in the U.S. where the federal government classifies marijuana as an illicit Schedule I drug, very few medical professionals receive any training regarding its potential benefits for patients.
To Jim Hutchins, a Weber State University neuroscience professor and medical cannabis advocate, that’s unfortunate and signals the need to change existing laws.
“From my perspective, the risk is pretty minimal and the reward is pretty great,” Hutchins said of the use of marijuana to treat chronic pain — instead of the more conventional and powerful opiates that have proven to be addictive and too often deadly.
According to Medscape, endocannabinoids constitute “a unique and ubiquitous cell-signaling system that is just beginning to be understood.” Both humans and animals naturally produce endocannabinoids, and these chemical compounds are known to play key roles in regulating biological processes. They also activate the same receptors in the body as tetrahydrocannabinol (THC), the psychoactive component in marijuana.
“Endocannabinoids are receptors throughout the human body,” Hutchins said. “In general, there are two kinds — CB1 seem to have more to do with brain, CB2s more to do with inflammation and modifying the immune system.”
Planta non grata
For several decades in the U.S., marijuana has been maligned as a dangerous gateway drug — its Schedule I status ranks it alongside heroin, LSD, ecstasy, quaaludes and peyote. As such, the U.S. Drug Enforcement Administration deems cannabis to have no currently accepted medical use.
A study published in January in the European Journal of Internal Medicine, “Practical Considerations in Medical Cannabis Administration and Dosing,” details the plant’s deep roots
”Cannabis has a history of medical application likely exceeding that of the written word ... It is only in the last century that quality control issues, the lack of a defined chemistry, and above all, politically and ideologically motivated prohibition relegated it planta non grata,” according to the study.
Andrew Talbott, a pain management physician who practices in Park City, began learning about medical uses of cannabis after finishing his traditional training. He attended medical school from 1998 to 2002, then served a residency from 2002 to 2006 followed by a fellowship from 2006 to 2007.
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“I don’t recall ever learning or studying about the endocannabinoid system in any of that training,” Talbott said. “In fact, only 9 percent of American medical schools have any type of documented, pertinent cannabis content in their curricula.”
But when his mother had a hip replacement and ended up taking a synthetic form of THC called Marinol to reduce symptoms of severe nausea, it sparked his interest and launched him on a journey to learn more. That quest led him to a continuing medical education course taught by Dr. Stephen Corn that focused on the body’s endocannabinoid system, therapeutic uses of medical cannabis, pain medicine and opioid prescribing.
And now, three to five patients ask him every day about medical cannabis, Talbott said.
Walking the line
“I don’t officially recommend it because it remains illegal in Utah, so I tell them not to break the law,” Talbott said. While somewhat hamstrung in how he can treat patients, he can freely share what he knows about medical cannabis.
“I feel very comfortable talking to patients about the different formulations they could use, different dosing strategies, risks of the medication and chance of interaction,” Talbott said. ”I just can’t officially recommend it.”
In the 29 states where cannabis has been legalized, different varieties are marketed with odd names such as Sour Diesel or Girl Scout Cookies.
“I don’t really like to use those names,” Talbott said of the plant’s differing strains or chemical varieties. “I tell them what to look for in a chemovar,” a term that pertains to the balance of psychoactive THC and the more than 100 cannabinoids found in cannabis.
Many medical professionals object to marijuana’s lack of clear dosing guidelines, believing that medicine should come in pill form or something measurable that can be purchased from pharmacies.
“When people say they have no idea how to dose, we do have some idea based on titration,” Talbott said of the “start low and go slow” philosophy that applies well beyond cannabis. “If they experience side effects you might have to change it a little. If they get full benefit without side effects, you stop right there.”
Talbott pointed to Gabapentin, a drug for nerve pain, as an example of titration: “Some patients get 100 milligrams three times a day, some 1200 milligrams four times a day. So I start low and have them gradually increase — we can do that with cannabis.”
Outfitted with about 25 hours of cannabis education, Talbott still feels he’s only scratched the surface.
“The endocannabinoid system is just amazing to me, and how varied and widespread its effects are on our physiological functioning,” Talbott said.
One of the body’s endocannabinoids, named anandamide after the Sanskrit word for bliss, is thought by some to be responsible for that euphoric sense of well-being runners enjoy after going the distance.
While endorphins have typically received that credit, one 2015 study on mice determined that endorphin molecules were too large to make it through the blood-brain barrier, but smaller endocannabinoids were definitely up to that task.
For WSU’s Hutchins, the runner’s high theory makes sense — he ran every day for 3 1/2 years until an injury last fall led to a hip replacement.
“There were times there was a feeling of being at one with the universe. I also meditate, and it’s a similar feeling of belonging and being at peace,” Hutchins said. “I do think its due to a release of a neurotransmitter in the brain — everything is.”