Cannabis 101 for Nurses
Cannabis is a general term used to refer to all products of the Cannabis sativa plant. According to the National Center for Contemporary and Integrative Health (NCCIH, n.d.), the Cannabis sativa plant contains about 540 chemical substances. However, only a few are known, including marijuana.
Also, few substances are known to have been included in medicinal products. These products include cannabinoids. More than 100 cannabinoids have been identified, but the most common ones are CBD and THC. This paper discusses how cannabis works in the body and the different and four delivery routes when patients use cannabis.
The Endocannabinoid System and How Cannabis Works in the Body
The FDA does not approve individual cannabis and cannabinoid products for medicinal use. However, some drugs containing cannabinoids have been approved, including Epidiolex for treating rare forms of epilepsy, Drabinol for treating appetite loss and weight loss in people with HIV, and Marinol and Syndros for treating nausea and vomiting caused by cancer chemotherapy. Cannabinoids and other cannabis products interact with the endocannabinoid system; thus, it is crucial to understand it first.
The endocannabinoid system comprises endogenous cannabinoids (endocannabinoids), cannabinoid receptors, and the proteins that transport, synthesize and degrade endocannabinoids. It encompasses a vast network of chemical signals and cellular receptors evenly distributed throughout the brain and the body.
The system regulates and controls critical body functions such as pain control, inflammatory and immune responses, and learning and memory. Cannabinoid receptors in the brain regulate the mentioned functions by controlling the level of activity from the neurotransmitters, thus, adjusting the system that needs to be adjusted, for example, alertness or pain control (Lu & Mackie, 2020). To stimulate cannabinoid receptors, the body produces endocannabinoid molecules, which are similar to molecules in the cannabis plant.
Cannabis and cannabis products are stimulants that people misuse, just like other stimulants. Cannabis works in the body by stimulating neurons in the reward system to produce and release the signaling chemical dopamine to levels higher than the typical levels in response to naturally rewarding stimuli. When cannabis products enter the bloodstream, they travel to the brain and alter communication with other body parts and the central nervous system.
The alteration is only possible since the THC chemical structure is similar to the Anandamide chemical structure. Anandamide is an endogenous cannabinoid. Cannabis, therefore, affects the brain areas responsible for influencing thinking, pleasure, concentration, memory, coordination, movement, time, and sensory perception. Due to the need to satisfy the urge of repeated rewarding behavior with dopamine, individuals who use cannabis products end up addicted.
Endocannabinoid deficiency syndrome is a clinical theory that proposes that a clinical endocannabinoid deficiency causes various discomforts in the body. The theory further stipulates that humans have an underlying endocannabinoid tone which reflects the level of cannabinoids, the state of cannabinoid receptors, and how the endocannabinoid system functions. When the endocannabinoid tone becomes deficient, the individual is said to have endocannabinoid deficiency syndrome.
The syndrome makes the individual’s body prone to disorders affecting body functions. Research shows that the syndrome is present in migraines, irritable bowel syndrome, and fibromyalgia (Brierly et al., 2022). Additionally, a disrupted endocannabinoid system makes the individual experience a lower pain threshold and disrupted sleep, mood, and digestion, among others.
Delivery Routes for Patients who may Use Cannabis
There are different delivery routes in which patients may use cannabis. Each route differs in the onset of actions and has different advantages and disadvantages. According to Russel et al. (2018), different routes of administration of cannabis use result in different health outcomes. THC and CBD are cannabis products that are primarily used in medicinal drugs.
One of the most used for patients when using cannabis products is vaporization. Vaporization in cannabis administration is a process whereby cannabis is heated to prevent the effects of combustion, and the vapor is inhaled. The onset of vaporization takes 5-10 minutes, and the duration of the chemical reaction may take 2-4 hours. One of the advantages of using vaporization is that it reduces the harm caused to the body by cannabis products through smoking, such as pulmonary problems.
Additionally, it alleviates symptoms such as nausea and pain fast due to its rapid reaction. A significant disadvantage of administering cannabis medicinal products through vaporization is that vaporizers are expensive, and not all are portable.
Oral administration is the other delivery route that patients can use with cannabis products. Oral administration includes oral mucosal spray, capsules, other P.O. medications, and edibles (Vinette et al., 2022). The onset of action in oral administration takes about 60-80 minutes, and the action lasts about 6-8 hours.
One of the most significant advantages of cannabis oral administration is the convenience in dosage since it is easier to have accurate dosages in oral medications. However, the delivery route may be disadvantageous when the medication requires to be titrated due to the slow onset of action. It can, therefore, not be used when the alleviation of symptoms is required within a short time.
Topical administration is also a method of drug administration using drugs that have cannabis constituents. Topical cannabinoids are delivered to localized areas and are ideal for localized symptoms such as dermatological conditions. Despite the limited research evidence on the effectiveness of this delivery route, it is widely used. The onset and duration of action in the topical administration of cannabis products are variable.
One of the advantages is that it is non-intoxicating and has been found effective for localized symptoms. A significant drawback of this delivery route is that it only has local effects and cannot be used to alleviate symptoms of conditions involving the entire body.
The other delivery route of cannabis products that patients can use is the suppository administration route. Suppository is a medical preparation and administration method in which the medication is designed to be inserted in the rectum or vagina for it to dissolve. However, suppositories of cannabis medical products are indicated for specific populations, for example, cancer patients, although there is limited research on the same.
According to Vinette et al. (2022), the onset of action for this delivery route is variable since different populations and conditions may allow faster absorption of the drug than others. One advantage of using this delivery route is preventing harmful effects caused by other routes, such as smoking. The limitation is that the method may not be effective for members of all populations.
The use of cannabis for medical purposes is an issue that is currently under research, with various controversies and issues arising. Very few cannabinoid products are FDA-approved and only as constituents of other drugs. Cannabis and cannabinoid products have various effects on the human body, as discussed above. Nurses should know how the products work in the body and the different delivery routes patients can use. There are various cannabis routes of administration identified, but they lack sufficient evidence-based research for backup.
- Brierley, S. M., Greenwood-Van Meerveld, B., Sarnelli, G., Sharkey, K. A., Storr, M., & Tack, J. (2022). Targeting the endocannabinoid system for the treatment of abdominal pain in irritable bowel syndrome. Nature reviews. Gastroenterology & Hepatology, 10.1038/s41575-022-00682-y. https://doi.org/10.1038/s41575-022-00682-y
- Lu, H.-C., & Mackie, K. (2020). Review of the Endocannabinoid System. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. https://doi.org/10.1016/j.bpsc.2020.07.016
- Russell, C., Rueda, S., Room, R., Tyndall, M., & Fischer, B. (2018). Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. The International Journal on Drug Policy, 52, 87–96. https://doi.org/10.1016/j.drugpo.2017.11.008
- The National Center for Contemporary and Integrative Health. (n.d.). Cannabis (Marijuana) and Cannabinoids: What You Need to Know. https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know
- Vinette, B., Côté, J., El-Akhras, A., Mrad, H., Chicoine, G., & Bilodeau, K. (2022). Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer, 22(1), 319. https://doi.org/10.1186/s12885-022-09378-7