The range of cannabis or hemp-based products available to the public is increasing over time. Variety is most welcome, as each of these products caters for different needs. Hempseed oil, cannabis oil, CBD oil … there are many options, that can be confusing to the average consumer. In this article, we break down the differences between hemp oil, also known as hempseed oil, and CBD oil.
Hempseed oil 101
Hempseed oil is, as its name indicates, extracted from pressing hemp seeds. Hemp seeds are not psychoactive (4mg of THC/kg) upon consumption of any kind. Hemp oil is legal in most countries, and can be found in food markets, together with other types of oil.
CBD oil 101
CBD oil is obtained via extraction made from cannabis flowers, preferably of a cannabis and hemp strains extremely rich in CBD (cannabidiol). Proper CBD oil can only be found in places where it has specifically been made legal.
Both CBD oil and hempseed oil share the particularity of not being psychoactive, a fact that plays a major part in their respective popularity. Especially in a context where cannabis is not legal in all countries, it makes for a safer alternative, as opposed to consuming cannabis. It also allows underage consumption for medical reasons.
Refined hempseed oil is generally considered a food item, thus making it legal in most countries. It is known for its countless health benefits, making it part of the very sought-after group of superfoods.
Rich in proteins
Full of polyunsaturated fatty acids, such as omega 6 and omega 3
Vitamin E antioxidants
Linoleic acid (affects aging/skin conditions)
It is to be noted that hempseed oil contains some CBD. However, such small concentration would only affect positively patients suffering from non-severe to mild conditions.
CBD oil is made from cannabis flowers, from which resin and CBD are extracted, via an array of different available methods. It is recommended to seek information about the method used, and general quality of the product before acquiring CBD oil produced by a third party. Listing all the medicinal properties of CBD oil remains difficult to this day, as scientific research as well as anecdotal evidence keep uncovering more of them over time.
Visible differences between hempseed oil and CBD oil may depend on the quality of either of them. Indeed, refined hempseed oil as well as CBD oil can appear to be of a lighter or darker colour, depending on quality, age, method of preservation, etc. These two types of oil are extracted from the same polymorphic species, which explains why they look identical in most cases.
Both show a rich, golden-green colour, not unlike olive oil.
Hemp oil is known under different names: hempseed oil, hemp oil, culinary hemp oil, and at times, cannabis oil. While ‘hempseed oil’ is by far the most self-explanatory of all, it is also the most accurate. In order to determine if a product called ‘hemp oil’ or any of the aforementioned terms is in fact, hempseed oil, consult the list of ingredients. While various marketing and packaging reasons may justify the use of an erroneous or vaguer term in place of ‘hempseed oil,’ the ingredients should clear this up.
CBD oil, on the other hand, is almost unmistakable for another product, as far as names go. In the majority of cases, the name ‘CBD oil’ will be used in the product’s description, or on its packaging. In rare occurrences, the words ‘cannabis oil’ are displayed; however, CBD being a staple of the medicinal cannabis industry, not mentioning the presence of it in a product would be counterproductive to say the least. Thus, it is likely a mention of it adorns some other corner of the package.
There are thousands of disorders out there that have remained understudied due to their rarity and complexity. Cannabis and cannabinoid compounds may provide complex solutions to these complex diseases. Medicinal cannabis programs are now helping to discover these solutions and deliver them to the patients that desperately need them.
Tuberous sclerosis complex
A rare genetic disorder that causes benign tumours to grow within the brain, eyes, and other vital organs.
Global prevalence of 10-16 in 100,000
Usually diagnosed during infancy or childhood.
Tuberous sclerosis complex (TSC) can cause autism, epilepsy, developmental delay, behavioural problems and various other symptoms, although symptoms vary widely between individuals.
In TSC, genetic mutations alter the expression of two proteins, hamartin and tuberin. In healthy individuals, these two proteins work together to control various aspects of cell growth, division and death, and act as tumor growth suppressors. In TSC, the two proteins are inhibited, allowing unchecked cell growth and ultimately the formation of tumours.
The endocannabinoid system is deeply involved in cases of TSC. Research has suggested that children with TSC show abnormally high expression of CB₁-receptorsduring early brain development. It is well-known that the EC system plays a crucial role in processes related to cell division and death. Furthermore, CBD is an important anti-epilepsy drug that can manage seizures in TSC.
A group of genetic disorders affecting the mitochondria, the energy-generating “engines” of cells.
Global prevalence of around 11-12 in 100,000.
Children born with MD usually display symptoms by age 10.
MD causes neurological impairment, seizures, chronic pain, muscle weakness, poor hearing and vision, learning disabilities, multi-organ disease and respiratory disorders.
The symptoms of MD may be related to oxidative stress, a buildup of reactive oxygen species within the cell. Thus, existing (limited) treatments include antioxidants able to penetrate the cell membrane.
Recognition of cannabis’ ability to treat symptoms of MD has come primarily from patient groups. Patients state that cannabis oil notably improves management of seizures, and eases chronic pain. In the US state of Georgia, MD is now on the list of approved conditions for medicinal cannabis patients.
It is thought that the antioxidant abilities of some cannabinoids may work directly to improve mitochondrial function. Several studies have investigated this relationship, but research is in its infancy. A discussion of existing studies can be found in the paper Cannabinoid receptor agonists are mitochondrial inhibitors (A. Athanasiou et al., 2007).
An autoimmune disorder in which the immune system attacks healthy blood vessels, causing inflammation.
Rare in North America and Northern Europe (1 in 15,000 to 1 in 500,000)
More common in certain regions of Asia and Africa (80-300 in 100,000 in Turkey, the worst-affected country).
Behçet’s disease (BD) can cause skin and genital lesions, joint swelling, chronic pain, swelling in the brain, blood clots, and aneurysms. It is thought that a combination of as-yet-undetermined genetic and environmental factors cause BD. There is no known cure, but anti-inflammatory drugs may provide some relief, and immunosuppressive drugs are also used.
Several cannabinoids including THC and CBD are known for their anti-inflammatory effect, and some US BD patients have reported subjective relief of symptoms when using cannabis. Indeed, the state of Illinois has included BD on its list of approved disorders.
Neuromyelitis Optica (Devic’s syndrome)
A rare autoimmune disease that causes recurrent inflammation and demyelination of the optic nerve and spine.
Global prevalence of 1-2 in 100,000.
Often mistaken for multiple sclerosis (MS), which causes difficulty in establishing prevalence.
Neuromyelitis Optica (NMO) causes ongoing loss of vision and spinal cord function; the latter can lead to muscle weakness, lack of coordination and bowel/bladder control, and loss of sensation.
NMO is very similar to MS, as the latter is also characterised by inflammation and demyelination of nerve tissue. However, a different autoimmune response is involved. NMO can cause much more rapid physical decline, and around 30% of sufferers die within five years of diagnosis. Conversely, the majority of MS sufferers can expect to live a normal or slightly reduced lifespan. As with MS, there is no cure for NMO, but some medications can ease symptoms.
In a 2013 study into neuropathic pain and hypersensitivity resulting from NMO, the endocannabinoids 2-AG and anandamide were both elevated in patients compared to healthy controls. The authors concluded that these endocannabinoids are released in higher levels in NMO sufferers, in order to reduce pain and sensitivity and prevent hyperalgesia.
An autoimmune condition causing progressive weakening of the muscles.
Global prevalence of 5-20 in 100,000.
The main signs and symptoms of myasthenia gravis (MG) include drooping eyelids and facial features, difficulty with chewing, swallowing and speaking, and respiratory difficulty. MG is caused by antibodies that block the normal transmission of acetylcholine, the neurotransmitter responsible for coordinating nerve impulses with muscle movement. There is no cure for MG, but some anticholinesterase medications may have some effect.
Acetylcholinesterase is the enzyme that degrades acetylcholine, so inhibiting the former can effectively raise levels of the latter at the neuromuscular junction (where nerve meets muscle). Higher levels of acetylcholine allow more nerve signals to get through, and improve the response of the muscles.
Various studies have demonstrated THC, CBD and other cannabinoids’ ability to inhibit acetylcholinesterase and reduce the degradation rate of acetylcholine. One US state, Illinois, includes MG on its list of approved conditions, and California-based doctor Allan Frankel has been treating MG patients with a combination of THC, CBD and THC-A, apparently with good results.
A group of genetic disorders affecting the skin and the connective tissues of the joints.
Global prevalence of around 20 in 100,000.
Ehlers-Danlos syndrome (EDS) can cause hypermobile, unstable joints, hyperelastic skin, chronic pain, muscle spasms, deformities of the joint and spine, and cardiovascular complications. EDS is caused by mutations in certain key genes, which control the expression of proteins crucial to collagen production.
EDS sufferers have anecdotally reported subjective relief from neuropathic pain and spasms when using cannabis and cannabinoid-based treatments. The compound palmitoylethanolamide (PEA) has also been used to control neuropathic pain in EDS, and is available under the brand name PeaPure in some countries.
Although not a classical cannabinoid, PEA is known to have affinity for the GPR55 and GPR119 receptors, which are part of the endocannabinoid system, and is also known to augment the effects of anandamide.
A rare group of autoimmune disorders affecting the skin and the mucous membranes, particularly the mouth.
Global prevalence of pemphigus is estimated at 10-50 in 100,000.
Certain ethnic groups (particularly Ashkenazi Jews) are more affected than others.
Pemphigus causes itchy, often painful blisters and sores that can spread to cover a large percentage of the body. If untreated, it can cause runaway infections, which can be fatal. The most common treatments include several high-strength steroids including prednisone, which have a range of serious side-effects including intestinal perforations.
Pemphigus is caused by pathogenic antibodies attacking a protein known as epithelial cell adhesion molecule. Without this protein, cells cannot stick together as normal, and the outer layer of the skin and mucous membranes gradually sloughs off.
Cannabis-based treatments have been shown to be effective against several autoimmune disorders affecting the skin, including psoriasis and epidermolysis bullosa. In general, it is the CB₂-receptors that mediate the immunological and anti-inflammatory effects of cannabinoids – and these receptors are highly concentrated in the epidermis.
Furthermore, cannabinoid treatments (specifically topical creams and ointments) may also confer important antibacterial, antiviral, and antifungal effects, helping to prevent secondary infection. Several patent applications for cannabis-based topicals for pemphigus have been submitted, and there are several anecdotal reports of patients experiencing relief from symptoms.
Myoclonus diaphragmatic flutter
An extremely rare condition causing rapid, involuntary spasms of the diaphragm.
Only 50 people worldwide diagnosed thus far.
Also known as belly dancer’s syndrome.
Myoclonus diaphragmatic flutter (MDF) causes the diaphragm to contract between 35 and 480 times per minute, causing a spasmodic, rippling effect somewhat reminiscent of a belly dancer. This extremely rare disorder may be caused by nutritional disorders, dysfunction of the central or peripheral nervous systems, pharmaceuticals, or possibly even anxiety.
MDF is not generally thought to be fatal, but causes discomfort and difficulty with breathing and eating. There is no standard pharmaceutical treatment, but symptoms can be instantly relieved by temporarily blocking the phrenic nerve that runs past the lungs to reach the diaphragm.
In one celebrated case, a young man suffering from MDF, Chaz Moore, was reported to have found that medicinal cannabis was the only effective treatment for his symptoms. Due to its extreme rarity, there is little research on the disease. However, cannabinoids with antispasmodic and anticonvulsant effects, such as CBD, are likely to be of most interest.
Familial Mediterranean fever
An inherited inflammatory disorder that particularly affects the chest, abdomen and joints.
Global prevalence estimated at 10-50 in 100,000; in worst-affected areas prevalence may be as high as 500 in 100,000 (1 in 200).
Familial Mediterranean fever (FMF) causes attacks of pain, fever and inflammation in the chest, abdomen and joints, which last several hours and recur intermittently. First attacks occur by the age of 18 in 99% of patients.
FMF is thought to be caused by mutations in genes that control expression of a protein known as pyrin, which is deeply involved in regulating inflammatory processes. Analgesics, NSAIDs and certain other drugs including colchicine may have some effect.
Cannabis was first described as a possible treatment for FMF in 1997. In a double-blind placebo-controlled crossover trial conducted on a single patient with FMF, THC was found to markedly reduce the need for opiate-based painkillers. However, it does appear that there has been any further research since then.
An extremely rare genetic disorder linked to the X-chromosome, causing seizures and developmental delays.
167 cases registered worldwide so far.
Primarily associated with girls.
This rare and recently-discovered condition causes severe seizures, developmental delays, scoliosis, microcephaly, poor motor control, limited speech, and various other abnormalities. It is associated with mutations in the CDKL5 gene, which is located on the X-chromosome.
Very little is known about this disorder thus far, and there have been no formal studies into the potential of cannabis as a treatment. However, several families of children with the condition have reportedly seen great improvements after using CBD. In 2014, an 11-month-old girl was reported to have exhibited improvements in muscle control, eye contact, alertness and overall progress after using CBD.
In 2016, 6-year-old Harper Elle Howard tragically lost her battle against CDKL5. At just two weeks old, she began to experience life-threatening seizures that failed to respond to conventional treatments.
If you had found your way to the Cannabis College and asked the same question, however, it’s likely that one of the volunteers would have drawn you a basic pie chart to explain the balance of the three cannabinoids that had been studied most:
Tetrahydrocannabinol (THC), Cannabidiol (CBD), and Cannabinol (CBN). At the time, CBN was thought to be an entirely separate cannabinoid to the other two; we now know it’s actually a metabolite of THC, which is converted into CBN as the THC ages.
The Cannabinoid Pie-Chart
The pie-chart explanation was a greatly over-simplified way of explaining the reasons behind the effects of different types of cannabis – after all, there are over 85 different types of cannabinoids that occur in cannabis, not just three – but it got the job done.
If the THC slice of pie was larger than the CBD and CBN slices put together, the effect was going to be high and uplifting. If the reverse was true and the THC was the smallest slice of pie, then the effect would be more relaxed and soporific. Virtually everyone understood this immediately.
Since the THC component is the one causing the soaring, giggling, energetic high that was pursued by a great many people, a great deal of time, energy and resources were devoted to breeding cannabis seed strains with as high a THC level as possible.
The success of this trend culminated – at least in the Netherlands – with proposals from concerned (and generally ill-informed) parties to make the sale of cannabis containing more than 15% THC illegal in coffeeshops.
On the mainly 90s – 00s quest to find the ultimate cannabis high, strains such as Silver Haze and Mother’s Finest were gained but CBD and CBN were overlooked or forgotten by many of the commercial branches of the cannabis industry as a whole – except for the scientific and medical communities.
As previously mentioned, CBN is created when THC degrades; the two cannabinoids occur in inverse proportion to each other. This explains why, when harvested cannabis is kept for a long time (and especially if exposed to light and air) the buds can produce a stoned effect even if the plant has mostly Sativa genetics.
CBN is only mildly psychoactive, and so far has not produced effects beyond those that THC (highly psychoactive) and CBD (which moderates the effects of THC) already cause to a stronger degree.
CBD, on the other hand, has displayed a host of properties that continue to have a significant impact on the field of medicinal cannabis use.
The Entourage Effect
By 2016, CBD has become far more widely known and been the subject of many more in-depth studies. These have shown that, despite being regarded as non-psychoactive, CBD does have a soporific effect and acts as a moderator for the effects of THC.
Experiments on the effects of THC when administered with and without CBD have shown that, when used alone, THC is more prone to cause feelings of anxiety and even morbidity.
When used in conjunction with CBD – as, let’s not forget, nature intended – the uplifting, euphoric, giggle-inducing effect that most of us identify as the sign of a good sativa is strongly experienced.
Outside of the laboratory, it is virtually impossible to consume pure THC as, in all natural forms of cannabis, all the other cannabinoids come along with it, tempering its effect in ways that actually enhance the high for the user. This has been called ‘the entourage effect’.
It is research such as this which strongly suggests that medications isolating THC or made from synthetic THC, such as Marinol, are both less effective and produce far more unwanted side-effects than the unprocessed, natural plant form.
Since cannabis contains such a large range of cannabinoids that we currently know little about, and produces them in a delicate and complex balance that science cannot, currently, hope to emulate, it is not very surprising that the vast majority of medicinal cannabis users opt for the un-tempered herbal form.
CBD without THC – pain relief without the high
However, when CBD is administered without THC, there are none of the aforementioned negative effects of THC alone.
CBD appears not to need THC in order to be a well-received treatment, and this is one of the most exciting facets of its medicinal potential: it can be used for the relief of various afflictions and diseases without causing a noticeable psychoactive effect.
CBD is now being viewed as having even greater medical potential than its more famous cousin THC. Despite the accusations, not always unfounded, that medicinal users “just like to get high”, there are numerous people for whom the “getting high” part is an unwanted and even unpleasant side-effect of their medication.
Cannabis that has been specifically bred to have a high CBD and low THC content would be an ideal solution for patients who simply want relief from pain without any psychoactive experiences.
In Israel, which has benefited from legal medicinal marijuana for more than a decade and boasts a medicinal program with around 22,000 patients, a breeding program to create precisely this type of cannabis has now been in progress for over ten years.
The Israeli company Tikun Olam has succeeded in creating a strain that has less than 1% THC and an unprecedented 15.8% CBD.
This new strain showed very positive results right from the start, as it was made available to licensed patients before clinical trials had even commenced.
Just as an aside, take a moment to think about that. Cannabis is so safe that an experimental new form of it can be issued to patients before they’ve even got around to testing it on mice. That’s how safe it is as a drug.
A new way of ingesting pure CBD – oils and e-liquids
As technology moves forward, the latest advances in the field of CBD are CBD oil, used as a dietary supplement, and CBD e-liquids, for use in e-cigarettes and vape pens. Sensi Seeds has perfected our own versions of each.
Both CBD liquids use cannabinoids extracted from hemp grown by HempFlax. This ensures exceptional quality, and full traceability of the products from field to customer. Sensi Seeds CBD Oil is in a hemp oil base, for added health benefits.
So what exactly does CBD do that is so amazing?
In addition to moderating the effects of THC in various ways, including a reduction in the well-known experience of short-term memory loss, CBD alone can do some pretty spectacular things. Despite the reputation of ‘stoners’ for being withdrawn and anti-social, CBD actually has anxiolytic (anti-anxiety) and anti-depressant effects which can help to reduce social anxiety, among other things. CBD also acts as a proven analgesic, relieving localized pain without numbing the area.
Research is currently underway into the neuroprotective properties of CBD; neuroprotection, put simply, shields the delicate structures of the central nervous system and brain from damage caused by stress, disease or other trauma. This is the property at work in the treatment of Dravet’s syndrome, when cannabis with a high CBD percentage can dramatically reduce the number of seizures experienced by sufferers. And, perhaps most amazingly, CBD has been proven to inhibit the proliferation of cancer cells in certain types of cancer.
Cannabis doesn’t cure cancer – yet.
It is this last fact that has led to the cry of “Cannabis cures cancer!” which, though incredibly exciting in its potential, is a statement made far too early and based on far too little. What we can say at this stage is that CBD may be able to eliminate certain types of cancer in some cases.
Dr Lester Grinspoon, one of the foremost experts on medicinal cannabis and author of the ground-breaking book ‘Marijuana Reconsidered’, has this to say on the topic:
“There is little doubt that cannabis now may play some non-curative roles in the treatment of this disease (or diseases) because it is often useful to cancer patients who suffer from nausea, anorexia depression, anxiety, pain, and insomnia. However, while there is growing evidence from animal studies that it may shrink tumor cells and cause other promising salutary effects in some cancers, there is no present evidence that it cures any of the many different types of cancer. I think the day will come when it or some cannabinoid derivatives will be demonstrated to have cancer curative powers, but in the meantime, we must be very cautious about what we promise these patients.”
Lighting up a joint or packing a vaporizer – even using the strongest, most CBD-rich variety you can find – is not going to save your life, nor is it going to guarantee you a cancer-free existence. But it can make you really effectively relaxed, and dissipate muscular aches and pains, from menstrual cramps to MS.
New applications are being discovered for CDB on a near-monthly basis, perhaps most excitingly its astonishing effect on sufferers of Dravet’s syndrome, and it is sure that this cannabinoid slice of the pie will continue to reveal its properties as further research takes place.
‘E-liquids’ is the collective term for a wide range of slightly different fluids also known as ‘CBD vape oil’ or ‘CBD vape juice’ used in a vaporizer or inhaled using e-cigarettes, or e-cigs, which are designed to be an alternative to smoking. Many e-cigarettes resemble traditional cigarettes, some are similar to large pens, and it is even possible to obtain e-pipes, for people desiring a Sherlock Holmes look.
Advantages of CBD e-liquids
The advantages of vaping CBD e-liquids are manifold. Although the full range of its medicinal properties are still at the testing stage, there is an ever-increasing amount of scientific and anecdotal evidence that the anti-emetic, anti-convulsant, anti-inflammatory and anxiolytic effects of CBD are safe, effective and highly beneficial in treating a wide range of afflictions in humans.
Since CBD is not psychoactive, all these effects are obtainable without the side-effect of getting high, which for some patients is the factor that deters them from trying any type of cannabis extract. And since e-liquids are vaporized, this removes the other common deterrent: having to smoke cannabis to achieve the effects of CBD.
A brief history of e-cigarettes
“Vaping”, defined as “breathing in the vapour produced by an electronic cigarette”, was the Oxford English Dictionary’s Word of the Year for 2015, but e-cigarettes have been around for a lot longer than that, at least on paper.
In 1965, an American named Herbert A. Gilbert received a patent on his “Smokeless Non-Tobacco Cigarette” from the U.S. Patent Office. Sadly for him, not many people were interested in it; maybe it would have taken off if he’d had the opportunity to incorporate CBD in his e-liquids. By the time present-day interest in vaping occurred, his patent had long since expired.
Credit for the invention of the modern e-cigarette in 2003 goes to Hon Lik. A Chinese chemist who also studied traditional Chinese medicine, Hon Lik was looking for easier ways of ingesting remedies such as ginseng and deer antler when he hit upon vaporizing. In a way, using an e-cigarette to vape CBD liquid is closer to the original intention of the device than using it to vape nicotine.
What else is in CBD e-liquids?
E-liquids most commonly have a base of propylene glycol (PG) and vegetable glycerol (VG), to which a variety of other ingredients are added, depending on the desired effects. These ingredients include flavourings, nicotine, and – of most interest to us – the cannabinoid CBD.
Propylene glycol has a wide range of applications, from being the humectant food additive E1520 to a carrier ingredient in injectable, topical and oral drugs. A very small amount of people are allergic to it, reacting with sore, dry skin on the face and/or a rash of small red dots on the body, so watch out for this if you are vaping for the very first time. However, most allergy sufferers are already aware of their condition, since PG is used in so many everyday items, including aerosol cream, ice-cream, soft drinks, and cosmetics.
VG is also used as a humectant, solvent, and sweetener, and has been used for many years as an alternative to alcohol in tinctures and herbal extracts to preserve their quality. Both PG and VG are clear, odourless, slightly sweet tasting semi-viscous liquids which, when heated, produce a vapour that can be inhaled as a carrier for the other ingredients.
Flavourings are included simply to create a pleasant inhalation experience, referred to in e-liquid circles as ‘throat hit’ and ‘mouth feel’. Flavours range from basic (fruity, smoky, mint) to exotic (tequila, ylang-ylang, orange blossom) to downright confusing (Greek yoghurt, peanut butter, Christmas pudding).
Obviously, if you are not already a tobacco user, it’s not a good idea to start inhaling e-liquids containing nicotine since you will swiftly develop one of the most pointless addictions of the modern age.
On the other hand, if you are a tobacco user, switching to e-cigarettes with an e-liquid containing nicotine has the advantage of eliminating the tar and chemicals that are inhaled along with the smoke, and may make make it easier to quit using nicotine altogether.
This paper includes the information that “Orally administered cannabinoids result in slow and erratic absorption with limited and highly variable bioavailability. Smoking and intravenous administration […] respectively carry toxic risks and loss of active drug by combustion, or are invasive.
Intrapulmonary administration of cannabinoids is regarded as an effective mode of delivery since it results in fast onset of action and high systemic bioavailability. The vaporisation of cannabinoids […] is a safe method of intrapulmonary administration because it avoids risks associated with smoking and the formation of pyrolytic toxic compounds as a result of combustion.”
In layperson’s terms, eating CBD is hit-and-miss; injecting it is dangerous; smoking it is dangerous and inefficient; vaping it is the best option, and the one that looks set to become the next wave of medicinal consumption for this exciting and beneficial cannabinoid.
Cannabis passes through a series of stages in its life. The most important of these are the germination, seedling, growth and flowering stages. Each stage brings its own challenges. Novice growers need to be aware of these, to be sure of giving their plants the attention and care that they deserve.
Plants are living beings. They are at the base of the evolutionary tree, they heal our bodies and souls, they delight our senses. I think all our readers know by now which is our favourite plant: Cannabis sativa L. – a fantastic crop and medicinal plant, and one of the oldest plant genera in the world.
No matter why cannabis is being cultivated, to see with your own eyes how a small seed grows into a bulky plant, which then starts flowering, is a moving experience every time.
Cannabis is an annual plant, so its entire lifecycle takes place within a single year, with most varieties reaching the end of their life after between four and ten months. In general terms, the following four stages of life can be distinguished:
A quick glance is usually enough to determine the current stage. Over time, it is not just the appearance of the plant that changes, its needs also change. Different stages require different quantities of light, water and nutrients. Furthermore, if you want to determine the sex of the plant or prune it, it is useful to know which stage the plant has currently reached.
1 – Germination stage (1 to 2 weeks)
All forms of life start from a seed of some kind. High-quality seed is the single most important factor for successful cultivation. Cannabis seeds should be hard, dry and brownish in colour. There are a number of different ways of getting the seeds to germinate. The easiest is the paper towel method.
The germinated seed can now be placed carefully into the growing medium. The plant will start to grow and force its way upwards.
While the first two cotyledons (seed leaves) are being formed, the plant shrugs off the protective seed husk. That signifies the end of the germination stage.
2 – Seedling stage (2 to 4 weeks)
Particular care is necessary at this stage in the lifecycle. Seedlings are susceptible to illnesses and mould. Many novices get carried away with watering and give the seedlings too much fertiliser. Even if you plan to grow outdoors, it may be useful to give the plants a healthy start indoors, assuming that a location is available with adequate light (e.g. a windowsill). The plants need as much light as possible at this stage.
How long the seedling stage lasts depends on the variety and on the environmental conditions. The main focus of the plant is on developing a root system. This forms the foundation for its later growth.
Meanwhile the plant will grow its first “real” leaves with the characteristic marijuana shape.
The leaflets are long and jagged. Initially a leaf has just one leaflet, although a mature cannabis plant will have five to seven leaflets per leaf.
Once the plant produces the full count of leaflets for each new leaf, the seedling stage is over.
3 – Growth stage or vegetation stage (2 to 8 weeks)
Now the plant starts its main growing phase. Provided it receives enough light, it can grow up to two inches (5 cm) in a single day. It is obvious that the plant needs to be repotted if it is still growing in a small pot.
Leafy plants like a healthy soil that is rich in nutrients. The production of chlorophyll and proteins depends on a supply of nitrogen. It is worth investing in the right kinds of fertiliser or even producing them yourself.
As it grows, the plant also needs more water. Young plants are best watered close to their stem, but later on water should be distributed more widely so that the tips of the roots can absorb water more efficiently.
Have you ever heard of topping, super-cropping or lollipopping? Using these techniques you can train cannabis or manipulate the shape of the plant. Growers use them to develop stronger plants with more buds. Opinions vary, however, on whether these techniques actually deliver results. They are only necessary for special cultivation methods such as the Screen of Green (SCROG).
How long the growth phase lasts is not a simple question to answer. Auto-flowering cannabis varieties move automatically on to the flowering stage within 2 or 3 weeks. Regular or feminised varieties only start flowering once the days become shorter (outdoor cultivation) or the grower reduces the lighting period to 12 hours (indoor cultivation).
4 – Flowering stage (4 to 12 weeks)
For most people, the flowering stage is the most exciting stage in the lifecycle of a cannabis plant. Once the days become shorter and the plant receives less light, it starts to take care of reproduction.
Only now can the sex be determined with any certainty. While male plants produce pollen, the female plants pour their energy into producing flowers or buds. Most growers want to prevent their female plants from getting pollinated, because then they start to produce seeds. That is why male plants should be removed from the growing area.
Some growers use special fertilisers during this stage to stimulate bud formation. During the flowering season, cannabis plants need plenty of water. They may need to be staked to help support the weight of the buds. In order to avoid disrupting hormone development, the plants should not be pruned after the second week of the flowering stage.
The length of the flowering stage again depends on the varieties being grown. Auto-flowering cannabis can be ready to harvest within as little as one month, while Indicas need about 6 to 8 weeks. For some Sativa varieties it can take longer than 3 months for the right harvest moment to arrive.
Terpenoids and terpenes are aromatic compounds that are found in thousands of plant species, and are responsible for the various flavours and fragrances of cannabis. We have known about their presence in cannabis for decades, but it is only recently that awareness of their potential therapeutic properties has begun to expand.
What are terpenes & terpenoids?
Terpenes are a large class of naturally-occurring organic compounds; they are also known as isoprenes, as their structure is based on repeating isoprene (C5H8) units. Terpenes are major constituents of plant resin and essential oils extracted from such plants.
Terpenes are basic hydrocarbons, whereas terpenoids contain extra functional groups that could be comprised of a range of chemical elements. However, it is common for the term ‘terpene’ to also include terpenoids in many existing writings. Terpenoids, also known as isoprenoids, are the largest group of organic compounds found thus far, comprising at least 20,000 distinct molecules.
The isoprene rule
Limonene, which is comprised of two linked isoprene units, can be expressed as (C5H8)2, which equates to C10H16. Several other terpenes also have this structure, but the two isoprene units are arranged differently; collectively, they are known as monoterpenes (the mono- prefix refers to the number of complete terpene units; i.e. one terpene unit equals two isoprene units).
Terpenoids with three linked isoprene units are known as sesquiterpenes (sesqui-meaning 1.5), and those with four are diterpenes, and so on. The formula (C5H8)n, where n is the number of linked isoprene units, is known as the isoprene rule, and is one of nature’s most common building blocks.
The cannabis plant produces cannabinoids through a convoluted series of chemical reactions that is thought to involve terpenes as ‘building blocks’. Cannabinoids are known as terpenophenolic compounds, as they are comprised of terpene blocks attached to phenol (C6H6O) groups; as terpenes are precursors to cannabinoids, abundance of terpenes is usually a sign of high cannabinoid levels.
Which of these compounds are present in cannabis?
It is thought that cannabis contains over 120 terpenes, although many of these are found in trace amounts and may have negligible, if any, effect.
The primary terpenes and terpenoids that have been identified in cannabis are limonene, myrcene, pinene, linalool, eucalyptol, ?-terpinene, ß-caryophyllene, caryophyllene oxide, nerolidol and phytol.
These compounds, unlike cannabinoids, are not unique to cannabis (although there are now indications that other plant species do contain some phytocannabinoids) and many are in fact very familiar to us.
Limonene is the monoterpene primarily responsible for the fragrance of citrus fruits—specifically, the D-isomer. D-limonene smells strongly orange-fragranced in its isolated form, and is in widespread use as a flavour additive in food production and an aroma compound in perfumery. It is also in use as an alternative medicine, due to its observed ability to reduce heartburn and gastric acid reflux.
As well as this, it is used as a natural, renewable solvent in cleaning products, due to its ability to dissolve oils and other lipids; it is even capable of stripping paint and is considered an effective substitute for turpentine. It must be handled with care by humans, as in high concentrations it can act as an irritant.
D-limonene is now also added to cannabis extracts as a flavour enhancer, as many of the existing terpenes are lost in processing.
Myrcene is another monoterpene, and is the most abundant terpene found in cannabis, making up over 60% of the essential oil of some strains. It is also found in bay leaves, wild thyme, hops, ylang-ylang, lemongrass and verbena.
Myrcene is responsible for the ‘green hop aroma’ found in dry-hopped beers (beers that have hops added post-fermentation, at low temperatures, to enhance their ‘hoppy’ flavour); the aroma itself is described as resinous, herbaceous, and slightly metallic—and very pungent at high concentrations.
Another plant that contains significant myrcene is Myrcia sphaerocarpa (Myrcia is the genus for which myrcene is named), a small shrub with astringent leaves and roots which is native to Brazil and has long been in use there as a treatment for dysentery, diarrhoea, diabetes and hypertension.
Myrcene has been demonstrated to produce analgesic effects in laboratory testing on rats; myrcene and limonene, along with the terpenoid citral (found in many citrus fruits, lemon myrtle, lemongrass and lemon verbena) have also been found to exert sedative and motor relaxant effects in mice.
Pinene is another monoterpene, which occurs naturally as two isomers (molecules with the same chemical formula but different structures). These isomers are known as a-pinene and ß-pinene; they are usually sourced from turpentine (produced by dry distillation of coniferous wood) and make up 58-65% and around 30% of its total volume, respectively.
As well as in cannabis, both a- and ß-pinene are found in pines and other conifers, as well as in Salvia (sage), Artemisia (sagebrush), and Eucalyptus. A-pinene is also found in olive, rosemary, sassafras and bergamot; it is the most widespread naturally-occurring terpene. B-pinene is also found in hops and cumin.
A-pinene is known for its inhibitory effect on root growth in many plant species, thought to occur through the production of reactive oxygen species that cause oxidative stress within the root system; it is believed that many plant species exude it from their leaves as a natural herbicide, preventing other plants from competing against them for resources. In small doses, it also acts as a bronchodilator in humans, and exhibits anti-inflammatory, antibacterial and antibiotic properties.
Linalool is a monoterpenoid with the chemical formula C10H18O; it is found in hundreds of plant species
including mint, laurel, cinnamon, birch, and some citrus. Linalool is a chiral molecule, meaning that it has two enantiomers, or two isomers that are non-superimposable mirror images.
The ‘left’ enantiomer is known as S-linalool, is found in coriander, palmarosa grass and sweet orange, and has a sweet, floral scent; the ‘right’ enantiomer is known as R-linalool, is found in lavender, basil and bay laurel, and has a woody, astringent aroma.
Linalool’s main medicinal function is as an anxiolytic—an anxiety-reducing drug. Lavender has been in use as a calmative for thousands of years, and recent tests on rats have borne out its sedative and motor relaxant effects.
Other terpenes & terpenoids in cannabis
Eucalyptol, a monoterpenoid, is abundant in nature. As well as in cannabis, it is found in eucalyptus, tea tree, bay leaves, basil and sage; it is well-known for its antiseptic, antibacterial and anti-inflammatory properties.
G-terpinene, a monoterpene found in various citrus fruits and herbs such as oregano and marjoram, is known to have antioxidant properties; phytol, a diterpenoid, is used by insects as a deterrent to predators, and is also used in various household products such as detergents and soaps.
B-caryophyllene, a sesquiterpene found in cloves, rosemary and hops, exhibits anti-inflammatory effects and has been demonstrated to act as a selective agonist of the CB2-receptor (no other terpenes or terpenoids have been found to affect the CB receptors). Caryophyllene oxide is the substance in cannabis that is identifiable by drug-sniffing dogs.
Nerolidol, present in neroli, ginger and jasmine, is a sesquiterpenoid with a fresh, woody scent; it is currently being investigated both as a facilitator for transdermal delivery of drugs (due to its ability to penetrate the skin) and as an inhibitor of Leishmania protozoa.
Differences between types of cannabis
Of course, terpene and terpenoids concentration will vary between strains, between related individuals, and even between two clones of the same individual, if subject to different environmental conditions while growing.
However, researchers have noted that plants of the wide-leafed Afghani Cannabis indica type are more likely to contain high ratios of guaiol, isomers of eudesmol, and other unidentified compounds; plants of the narrow-leafed C. indica type that is indigenous to the valleys of the Himalayas are higher in trans–ß-farnesene.
Guaiol is a sesquiterpenoid found in cypress and Guaiacum (a genus of five slow-growing shrubs and trees native to the tropical Americas); guaiacum itself has been in use as a treatment for coughs, arthritis and syphilis for centuries. Eudesmol, another sesquiterpenoid, is used as a fixative in perfumery, while trans–ß-farnesene acts as a natural insecticide in many plant species, including potatoes.
The health benefits of these compounds are not fully understood, but they may contribute to the differences in medicinal properties found between the different subtypes of cannabis. As our understanding grows, so too will knowledge of how best to develop and utilise new medical strains.
Fibromyalgia is one of those disorders with an unknown cause but highly incapacitating symptoms. It is precisely because its etiopathogenesis (cause) is not known, plus the lack of specific effective treatment, that it has taken the medical community so long to recognise it as an illness.
An observational study carried out in Barcelona was published recently, in which the perceived benefits of self-medication with cannabis were evaluated in a group of women with this condition. This is one of those rare scientific studies where the results can be immediately clinically useful to patients and doctors alike.
While there are different theories that attempt to go some way towards explaining its causes, today it is widely accepted that fibromyalgia is an illness of organic origin, with recognised physical causes, despite the fact that there are as yet no clinical markers on which to base a diagnosis, and that a diagnosis can only be given based on clinical manifestations from patients.
The theories to explain the causes range from a deregulation of neurotransmitters (principally dopamine and serotonin) to a dysfunction of the physiological mechanisms of stress regulation (what is known in medical jargon as the hypothalamic-pituitary-adrenal, or HPA axis).
Other theories base their explanations for the symptoms on a disruption to the immune system. Whatever the causes, it seems that treatment with cannabis fits in with every one of these theories given that, for example, we know that the endocannabinoid system is involved in physiological functions that include the regulation of the dopaminergic and serotonergic systems, the regulation of the physiological response to stress and on top of this, that the immune system is richly populated with CB2 receptors, which is why it can be highly influenced by cannabinoids, both endogenous and exogenous.
In fact, the main symptom of fibromyalgia is a very low pain threshold and the subjective feeling of pain is mediated, among others, by the three physiological processes mentioned, which is why, irrespective of what the causes may be, it makes sense to think that the treatment of fibromyalgia with cannabinoids could be a therapeutic option worth contemplating.
This is all the more so when you take into account the fact that other disorders that also involve neuropathic pain and that also have a disruption of the immune system as an etiological basis, such as multiple sclerosis, are treated with cannabinoids (Sativex, the first medicine based on cannabis extracts on the market, has recently been authorised in Spain for the treatment of multiple sclerosis). There is in fact a diverse group of functional clinical syndromes, in addition to fibromyalgia, for which no clear medical explanation has been found to date, such as migraines or irritable bowel syndrome, for which treatment with cannabis has proved helpful in some patients.
The investigator Ethan Russo has suggested as an explanation for this that the common cause of these disorders is rooted in a deregulation of the endocannabinoid system (http://es.scribd.com/doc/43672268/Clinical-Endocannabinoid-Deficiency-CECD-Russo), which seems the most plausible idea – even if it is only at this time another hypothesis to explain these clinical syndromes – given that they share a certain level of effectiveness of treatment with cannabis. Other symptoms inherent to fibromyalgia, apart from the pain – which is the main symptom – are chronic fatigue, morning stiffness, constant tiredness and affective disorders.
A total of 56 women participated in the study, with an average age of 50 years, all suffering from fibromyalgia, of which half (28) self-medicated with cannabis and the other half didn’t. All the women had a degree of illness between moderate and severe in accordance with the classification by the American College of Rheumatology. The women were recruited from fifteen different associations for patients afflicted with fibromyalgia and from a cannabis consumers’ club, all in Barcelona. Both groups were matched in terms of sociodemographic variables, clinical manifestations of the illness (type of symptoms suffered) and pharmacological treatments received, both allopathic and based on complementary medicine. 40% of the women in the cannabis group had a history of consumption of less than one year, 32% of between one and three years, and the remaining 29% of more than three years.
Only eight of the 28 women had consumed cannabis recreationally prior to suffering the illness. All of them consumed marihuana, 54% by smoking it, 46% by consuming it as food and 43% by combining both. Eleven women consumed it daily, five between twice and four times a week, three less than twice a week and eight only occasionally. One consumption meant between one and two marihuana cigarettes for the women who smoked it, or one spoonful when it was consumed in food.
Twelve women smoked one marihuana cigarette per day, five between two and three, and three, more than three a day. For the source of supply, fourteen women obtained the marihuana through family and friends, seven acquired it on the illicit market, five from home-grown sources, and two obtained their supply from an association of cannabis consumers. Of all the women from the cannabis group, 19 had informed their doctor of their consumption. Lastly, 19 (68%) of the women from the cannabis group reported having reduced pharmacological treatment with prescription medicines thanks to self-medication with cannabis. Patients who used cannabis as self-medication used it both to relieve pain and to reduce the other symptoms associated with fibromyalgia.
Both groups were administered a series of scales to evaluate the level of severity of the illness, called the ‘Fibromyalgia impact questionnaire’ (http://www.institutferran.org/documentos/FIQ_espa%C3%B1ol_IFR.pdf), The Pittsburgh Sleep Quality Index, (http://www.drmonteverde.net/files/GMM_2008-…pdf) and a questionnaire on quality of life called SF-36, (http://www.chime.ucla.edu/measurement/SF-36%20Spain.pdf). In addition to this, the women in the cannabis group were asked to indicate, on a scale of one to five, their perceived relief from the consumption of cannabis for a series of symptoms: pain, sleep problems, muscle stiffness, mood disorders, anxiety, headaches, tiredness, morning tiredness and digestive problems. The patients reported relief in almost all the symptoms in proportions ranging from 81% for sleep disorders to 14% for headaches. Not one woman reported a worsening of symptoms secondary to consumption.
The women were also asked to rate from 0 to 100, two hours before and two hours after consuming cannabis, the relief felt in a series of symptoms: pain, stiffness, relaxation, tiredness, wellbeing. In all of these symptoms there was a significant improvement when the ratings from two hours after were compared with the ratings from two hours before consuming cannabis. Finally, of the three aforementioned scales given to all the patients, only in the ‘mental health’ subscale from the SF-36 were there differences between the groups, with higher points from the cannabis group, which implies that the subjective benefits referred to do not necessarily manifest themselves in a clinical improvement. Future investigations must therefore elucidate whether the benefit referred to by the patients with fibromyalgia who self-medicated with cannabis is relevant from a clinical point of view.
Cannabis vs Pharmacological treatments
In summary, this is a naturalistic study, which has intrinsic limitations in terms of extracting definitive conclusions, but at the same time high ecological validity in terms of accurately reflecting the day-to-day life of patients with this type of pathology. It is worth highlighting in any case that the patients from the cannabis group were refractory to habitual treatments and that they had turned to cannabis as a last resort.
It would be interesting to investigate whether, in women suffering from this condition who are less resistant to treatment, cannabis could be more useful than the pharmacological treatments used, which have more side effects. In any case, the fact that thanks to consuming cannabis, these women were able to reduce their intake of other medications, didn’t report suffering any major side effects from its consumption and subjectively perceived relief in the majority of the symptoms suffered, bearing in mind that the medication in current use shows little effectiveness in treating the symptoms, finding some type of relief at a negligible physiological cost could in itself represent huge progress in the treatment of their illness.
On another level as well, studies like this one will allow us to clarify in the future whether illnesses such as fibromyalgia are due to a deregulation of the endocannabinoid system and in this way gain an insight into the etiopathogenesis of this highly debilitating illness.
Crohn’s disease is a type of inflammatory bowel disease that is believed to be caused by a combination of bacterial, immunological and environmental factors. The disease is progressive and incurable, and causes a range of severe and debilitating symptoms. Substantial evidence indicates that cannabis can help to manage symptoms.
Inflammatory processes are the primary mechanism of Crohn’s disease. The disease may affect any part of the gastrointestinal (GI) tract from the mouth to the anus, but the most commonly affected areas are the colon and the ileum (the large and small intestine), particularly the terminal section of the ileum that connects to the colon.
Patches of chronic inflammation can lead to diarrhoea, bleeding and tearing of the GI tract lining, and bowel obstructions. In severe cases, portions of the intestine may need to be removed entirely.
Cannabis is used as a means of self-medication by a significant proportion of Crohn’s sufferers, and is anecdotally reported to provide substantial subjective improvements to the majority of symptoms, including inflammatory pain.
Inflammation is well-known to be regulated by the endocannabinoid system, which—as the gut contains very high levels of cannabinoid receptors—has a fundamental role to play in inflammatory diseases of the GI tract.
In various studies, use of exogenous cannabinoids including delta-9 THC and CBDhas been shown to activate the cannabinoid receptors of the GI tract and assist in the reduction of chronic inflammation. Both CB1- and CB2-receptors are present in the GI tract; the latter are usually less common than the former, but are present in far greater concentrations in individuals suffering from inflammatory bowel disease. It has been postulated that the CB2-receptors have an important role to play in modulating inflammatory pain, particularly that originating in the gut.
Diarrhoea is the most common primary symptom of Crohn’s disease. Depending on what part of the GI tract is affected, the stool may be mixed with mucus, pus or blood, and may be more or less watery. A sensation of urgency to defecate is common, along with a sensation of incomplete evacuation (known as tenesmus).
Cannabis has been used to treat diarrhoea for millennia, and modern research has provided empirical evidence of its efficacy. Crohn’s sufferers are thought to experience diarrhoea due to inflammation of the intestinal mucosa (the mucous membrane that lines the GI tract), as well as increased fluid secretion, reduced ability to absorb fluid, and presence of bacterial agents. Cannabis may ease symptoms of diarrhoea in Crohn’s due to its antibacterial properties, as well as its anti-inflammatory effects.
Activation of the CB1-receptors in the GI tract may also play an important role in improving symptoms of diarrhoea by reducing intestinal motility and fluid secretion; it is believed that this occurs through inhibition of acetylcholine released from the enteric nerves (i.e. those found in the peripheral nervous system, which helps regulate the GI tract). Acetylcholine, a neurotransmitter with a wide range of important functions, is well-known to increase peristalsis (gut motility).
3. Analgesic – pain reducing
Up to 70% of Crohn’s sufferers suffer from chronic pain. In the early stages of terminal ileitis (the form of Crohn’s that affects the terminal ileum), pain in the lower right side of the abdomen is common, and is often mistaken for appendicitis.
Pain is generally a result of chronic inflammation, but may be a result of tearing or denudation of the intestinal lining, abdominal distention or bowel obstructions.
Cannabis may help improve symptoms of pain in Crohn’s sufferers by directly acting to reduce inflammation, by reducing the severity of abdominal distention, and by easing the symptoms of diarrhoea through reduction of gut spasms and inhibition of fluid release.
Although no formal studies into the effects of cannabis use on Crohn’s-related pain have been conducted thus far, there have been several questionnaires and surveys of patients, who have reported significant improvements in management of chronic pain.
A pilot study conducted in California in 2005 questioned 12 Crohn’s sufferers on their perception of various major symptoms before and after commencing use of cannabis.
Cannabis use was reported to improve all evaluated signs and symptoms, including pain—which was reported to rank up to 6.5 out of 10 on a subjective scale of severity prior to cannabis use, and just 2 out of 10 subsequent to cannabis use.
4. Appetite stimulant (orexigenic)
The aforementioned pilot study also found that patients reported a marked improvement in appetite when using cannabis, from approximately 1 out of 10 to almost 7 out of 10 on the scale. Appetite loss is a common symptom of Crohn’s, and often occurs as a result of chronic nausea and abdominal pain.
Severe appetite loss can lead to dramatic unintentional weight loss in particularly bad flare-ups. As well as improving appetite, cannabis use led to less frequent defecation due to its influence on gut motility; these two factors combined caused the majority of patients to achieve weight gain after commencing use of cannabis.
Cannabis use can increase appetite in Crohn’s sufferers by reducing abdominal pain and inhibiting excessive peristalsis; however, it also helps to increase sensations of hunger by directly agonizing certain receptors in the GI tract that usually respond to the presence of ghrelin (an important ‘hunger hormone’ that has also shown signs of being a useful treatment for Crohn’s).
Various studies have shown that presence of ghrelin or cannabinoid agonists such as THC cause increased production of an enzyme—AMP-activated protein kinase (AMPK)—in the hypothalamus.
The enzyme is crucial to the metabolic processes that regulate energy homeostasis (energy balance) in the body, and is produced in response to stimulation of the GHS-R1a ghrelin receptors found in the GI tract.
One of the main symptoms of Parkinson’s disease is a deterioration of motor functions, which can be grouped into four different categories: tremor, rigidity, slowness of movement and postural instability. Tremors are certainly the most visible and well-known of the motor symptoms, but there are numerous other specific motor symptoms that patients can suffer from, depending on the individual.
In addition to the motor symptoms, there are also neuropsychiatric symptoms of Parkinson’s disease that can include a deterioration of certain cognitive functions, mood disorders or behavioural disorders. These disorders largely manifest themselves as problems with concentration, memory, language and visuospatial skills. The progressive deterioration of this cognitive capacity can, over the long-term, result in a much more severe manifestation of dementia.
Since the 1970s, the scientific community – prompted by frequent reports from patients opting for self-medication – has been able to focus its research on cannabinoids for the treatment of Parkinson’s disease. The number of studies conducted on the subject continues to be relatively low, despite recent renewed efforts in this direction owing to the frequency of cases reported by patients suffering from the disease.
One of the physiopathological characteristics of Parkinson’s disease is the malfunctioning of the dopaminergic system, whereby certain brain structures suffer from a deficiency of dopamine as well as several other neurotransmitters, leading to the cell degeneration which is at the root of cognitive function impairment.
In 2004, tests of synthetic cannabinoids on rats provided unequivocal proof that treatment based on cannabinoids could be the key to effective treatment of this disease.
In the first instance, the rats were injected with a laboratory drug that played the role of a THC (one of the major psychoactive substances in marijuana) agonist, then with a toxin that provoked the same effects as those of Parkinson’s disease. The researchers discovered that it was almost impossible to distinguish the brains of the infected rats from the brains of the healthy rats.
Secondly, a group of different rats was injected with the toxin, then with the agonist, to confirm that cannabis also has neuroprotective properties. Here again, the results were positive when THC and cannabidiol were injected (THC alone giving similarly positive results but to a lesser degree), slowing down the progression of the disease for a period equivalent to several years in human terms.
The discovery of pain as a symptom of Parkinson’s disease is relatively recent. Even though pain exists in 50% to 80% of patients, it had not previously been linked to the disease in any conclusive way. However, this pain is often severe to the point of surpassing the other symptoms in terms of severity, and it can have psychological repercussions in the long term such as depression and anxiety.
Pain can be a direct consequence of the motor disorders, such as pain suffered as a result of prolonged muscle rigidity, or even pain linked to dystonia, postural problems, and more rarely, coming directly from the cervical region.
The study was able to examine eight different genes known to be involved with pain in general in a group of 237 Parkinson’s disease sufferers. The researchers then discovered that these genes reacted to pain in a recognisable way, i.e. by demonstrating characteristics typically linked to the endocannabinoid system and to the consumption of substances such as marijuana.
The laboratory was able to conclude that the pain experienced as part of the disease could be calmed by consuming marijuana; the researchers have however recommended continued research in order to optimise potential treatment based on the individual characteristics of the patients’ gene mapping.
Dystonia and dyskinesia
Research focused on cannabinoids has already proven – for numerous illnesses – that these have an impact on a wide range of motor symptoms manifested by tremors, spasms or by muscle rigidity; this is in fact one of the properties of the mouth sprays based on cannabis concentrate such as Sativex, currently used in patients with multiple sclerosis.
In Parkinson’s, certain treatments intended to relieve these symptoms can themselves lead to additional movement disorders on top of the already severe motor symptoms caused by the illness. These disorders often being considered the most debilitating characteristics of this disease, it is hardly surprising that the main body of research is focused on these.
A study that started in 1985 was already based on tests carried out on a patient who had suffered from Parkinsonism for many years, showing dystonia in all limbs as well as L-Dopa-induced dyskinesia, i.e. dyskinesia provoked by long-term treatment with one of the most effective remedies used in Parkinson’s disease and Parkinsonism: L-Dopa.
Varying dosages of pharmaceutical drugs commonly used to combat the symptoms of Parkinson’s disease – including dyskinesia – have shown results that, while positive, were only marginal. However, tests that included varying dosages of cannabidiol, one of the cannabinoids most researched for its medicinal benefits, have shown more than significant results. A dose of between 100 mg/day and 200 mg/day of cannabidiol was able to reduce the clinical fluctuations normally experienced and alleviate dyskinesia by up to 30%.
No further improvement was observed for greater doses, while side effects did appear such as vertigo, drowsiness and an increase in the severity of the symptoms of Parkinson’s.
Putting a stop to the administration of cannabidiol caused severe generalized dystonia and increased sensitivity to previously ineffective treatments.
In 1986, a similar study carried out on patients suffering from dystonia confirmed these results, with an improvement in dystonia of between 20% and 50% as reported by the patients.
In 1998, research confirmed that the concentration of cannabinoid receptors in the globus pallidus could explain the impact of synthetic THC on dystonia and dyskinesia as this brain structure controls the regulation of voluntary movements.
In addition to these advances in terms of the proven efficacy of cannabis to combat the symptoms of Parkinson’s, there are regular discoveries linked to the endocannabinoid system and its functions that continue to enrich the limited knowledge on the pathology and physiopathology of this disease that is currently employed by modern medicine.
In 2007, a team of researchers from Stanford university thus made an important discovery relating to a brain structure called striatum, known for its activity relating to dopamine levels. Two types of cells found in this structure were distinguished for the first time, the first being responsible for initiating movement and the second for inhibiting involuntary movements. It transpires that a low dopamine level – one of the bases of the physiology of Parkinson’s disease – has a direct impact on the type of cells responsible for inhibiting movement, making them hyperactive, which would explain the difficulties with initiating a voluntary movement in sufferers.
Several tests were carried out to address this hyperactivity. The combination of a drug emulating dopamine and a drug intended to slow down the deterioration of the endocannabinoid system by concentrating on the enzymes responsible has shown impressive results, opening many avenues for future research on palliative treatment as well as on a cure.
Dosage and recent advances in research
Since the start of the 21st century, researchers have focused on one of the principal parameters preventing the development of a treatment based on cannabinoids validated by the medical community: dosage (see: Dystonia and dyskinesia, end of the 2nd paragraph).
In fact, although numerous patients disregard these recommendations for reasons that are fairly self-evident, the doctors most au fait with the research do not necessarily recommend self-medication. The risk faced in the case of overdose is an increase in the severity of the symptoms, which is of some significance – especially if we consider the complex and variable pharmacology of cannabinoids in all their forms.
This is why a certain number of observational studies have emerged in the last few months based on reports from hundreds of patients who have turned to cannabis for day-to-day relief.
In June 2013, an Australian laboratory published a study using the UPDRS (Unified Parkinson’s Disease Rating Scale), which measures the severity of the symptoms of the disease. The laboratory compared levels on this scale, in particular relating to the four cardinal signs of the motor symptoms of Parkinson’s disease, before and after taking cannabis. It was thus uncovered that the cannabinoids contained in the plant (or phytocannabinoids) had an impact not only on the tremors suffered but also on the muscle rigidity and akinesia (scarcity and slowness of bodily movement).
Tests were carried out on patients with an average age of 66 and were conducted before consuming cannabis, then 30 minutes after consuming cannabis. The differences in the scores obtained on each of the key motor symptoms were conclusive, especially insofar as these patients had been diagnosed on average 7.5 years previously.
The patients tested had a common variable: they were all regular consumers of cannabis, having opted of their own accord for self-medication. According to these patients, one “dose” of cannabis, i.e. one cannabis cigarette or one dose of vaporised cannabis, could provide relief for 2 to 3 hours.
Finally, an observational study presented by Israeli neuroscientists in March 2014proved for the first time the efficacy of cannabinoids on a group of symptoms of Parkinson’s disease, including both motor and non-motor disorders. These findings represent incredible progress as these types of tests have always been difficult, or near impossible, because of the limited availability of medicinal cannabis for use in research.
According to the scientists concerned, the thorough nature of this study could be a catalyst for initiating the development of treatments based on cannabinoids; a treatment that could soon become a reality for the 7 million patients all over the world who suffer from Parkinson’s disease.
Epilepsy refers to a group of conditions characterised by recurrent seizures, which may be convulsive or non-convulsive. Cannabis and cannabis-based therapies have been shown to have beneficial effects on several types of epilepsy, through a variety of biological mechanisms.
Around 60% of all epileptic seizures are convulsive, which means that they are characterised by rapid, involuntary contractions of the muscles that can cause the entire body to shake or jerk uncontrollably.
The most common type is the tonic-clonic seizure, which involves a short period of immobility followed by uncontrollable shaking. Both convulsive and non-convulsive epileptic seizures are caused by excessive activity in the neurons of the brain; if severe and prolonged, seizures can result in damage to brain tissue—particularly in young children, when the brain is still developing.
Dravet syndrome is just one type of childhood-onset epilepsy that can cause neurological impairment.
1. Anticonvulsant Benefits of Cannabis for epilepsy
The anticonvulsant properties of cannabis have been known to humans for centuries, if not millennia. Cannabinoids were tested for their anticonvulsant properties by modern researchers as early as 1947.
An early study conducted at the University of Sydney in 1974 demonstrated that delta-9-THC given in high doses had an anticonvulsant effect on mice that were induced to experience seizures via administration of chemical and electrical shocks. It was noted that CBD increased this effect of delta-9-THC, although the researchers did not find that CBD was effective in its own right.
Since then, various studies have found that CBD does in fact possess remarkable anticonvulsant properties in its own right, as well as potentiating the effects of delta-9-THC. A 2001 study demonstrated that delta-9-THC and the synthetic delta-9-THC analogue WIN 55,212-2 exerted their effect by agonising the CB1-receptors; CBD exerts its effects via a different means, as it does not agonise the CB1-receptor but instead acts as a weak antagonist.
Due to its effect on the CB1-receptors of the central nervous system, delta-9-THC can actually cause convulsions in rare cases, while CBD does not appear to have this side-effect due to its independent mechanism of action.
The precise mechanism utilised by CBD when working to control convulsions has still not been established, but it is proving highly effective in treating various types of epilepsy including Dravet syndrome in young children, and has gained ground rapidly as a potential treatment due to its lack of psychoactivity.
2. Neuroprotective Benefits of Cannabis for epilepsy
As research into the endocannabinoid system advances, it is becoming clear that it plays an important role in regulating the duration and frequency of seizures—in fact, some researchers believe that epilepsy could occur as a result of an inherent imbalance of the endocannabinoid system (a condition speculatively known as clinical endocannabinoid deficiency), which could arise due to brain injury, infection or genetic predisposition.
In 2008, a study published in Nature indicated that patients suffering from temporal lobe epilepsy appeared to have dysfunctional endocannabinoid systems. As the name suggests, temporal lobe epilepsy affects the temporal lobe of the brain, and typically produces non-convulsive seizures that involve some degree of sensory (visual, auditory, olfactory or even gustatory) disturbance—although it may also produce tonic-clonic seizures in severe cases.
The common cause of convulsive and non-convulsive seizures is excessive excitation of the neurons of the brain, with the affected region of the brain varying according to the type of epilepsy. In healthy patients, the endogenous cannabinoids anandamide and 2-AG are thought to play a fundamental role in regulating the level of neuronal excitation and thereby reducing the likelihood that a seizure is triggered.
Thus, in patients who possess a dysfunctional endocannabinoid system, cannabis and cannabis-based therapies can actually target the cause of epilepsy and provide a neuroprotective effect that reduces the severity and frequency of symptoms.
3. Status epilepticus
In extremely severe cases of epilepsy, a condition known as status epilepticus may occur. Status epilepticus may involve convulsive or non-convulsive seizures, which either last for a duration of over five minutes each, or occur at a frequency of more than one seizure per five minutes with no return to full consciousness in between.
If the patient is not provided immediate medical care during an episode of status epilepticus, the prolonged loss of normal brain function may result in brain damage or even death. If adequate medical care is provided, epileptic patients usually survive an episode of status epilepticus without major complications.
Status epilepticus is typically treated with benzodiazepines or barbiturates; both classes of drugs are well-known for their often debilitating side-effects, and are far from effective across the board.
However, there is evidence that cannabinoids—specifically CB1-receptor agonists like anandamide, delta-9-THC, and the synthetic analogue WIN 55,212-2—may provide stronger protection against status epilepticus. In a 2006 study published in the Journal of Pharmacology, WIN 55,212-2 demonstrated the ability to totally suppress all seizure activity, including the prolonged episodes associated with status epilepticus.
The study also noted that WIN 55,212-2 significantly outperformed phenytoin and phenobarbital in suppressing status epilepticus.
From this and various related studies conducted over the last decade or so, it has been well-established that agonists of the CB1-receptors are fundamentally important to terminating seizures and preventing the onset of status epilepticus, and that in epileptic patients, an imbalance in the endocannabinoid system increases the frequency and severity of seizures. A 2007 paper noted that if epileptic neurons were administered CB1-receptor antagonists, it would cause continuous epileptic activityas seen in patients with status epilepticus. If then treated with CB1-receptor agonists, the excessive activity would stop. Conversely, when non-epileptic neurons were treated with CB1-receptor antagonists, the excessive activity resembling status epilepticus did not occur.
Thus, it is clear that both delta-9-THC and CBD have an important role to play in the management of seizures in epilepsy. However, the respective mechanisms of action are not fully understood, particularly in the case of CBD, which exerts its effect through means that are independent of the main cannabinoid receptors. CBD products have however seen a rise in popularity lately, with research backing up its therapeutic benefits.