Newly available Cannabinoids title

Newly available Cannabinoids – The good the fad and the ugly

By Q2 Clinic Chief Medical Director, Dr Peter Grinspoon M.D.

In the span of a few years, the second most abundant component of cannabis called CBD (cannabidiol) went from being relatively obscure molecule to a healthcare fad that has swept the world. It is estimated that currently one in seven Americans use CBD in one form or another, including billions in sales, millions of users, CBD workout clothing, pillowcases, hamburgers, ice cream and – you name it. But, some are concerned that the enthusiasm for this molecule is flying high above the actual science that justifies its use. Are the safety concerns, such as potentially dangerous drug interactions, being given short shrift in the enthusiasm to treat chronic pain, insomnia, anxiety, and many of the other conditions that CBD is believed to help alleviate?

Cannabis, however, is composed of up to six hundred different molecules. Some one hundred and forty of these molecules are called “cannabinoids” because they work on our body’s Endocannabinoid System, which a vast system of chemical messengers and receptors that help control many of our most critical bodily functions such as appetite, inflammation, learning temperature, emotional processing and memory. It was only a matter of time until these other cannabinoids were discovered, researched and commercialized. 

What are some of these newly available cannabinoids that are popping up in news articles and in advertisements? What are their claimed benefits, and what should we be concerned about? 

CBN

The non-intoxicating cannabinoid CBN (cannabinol) is present in trace amounts in the cannabis plant but is mainly a byproduct of the degradation of THC – the main compound in cannabis that causes the “high” that people either avoid or seek out.  Marijuana that has been sitting around for too long in the closet has a reputation for becoming “sleepy old marijuana” – most likely because of the higher CBN concentrations in it. CBN is widely marketed for its sleep-inducing qualities, but if you review the literature, it is interesting to note that there isn’t much scientific evidence that CBD actually makes you sleepy– except for one study of rats that were already on barbiturates, and who slept longer when given CBN. However, many people claim that CBD does make them sleepy, so this claim needs to be studied more thoroughly. We certainly can use more and safer sleep-inducing medications.

CBN does, however, have potential, at least in animal studies, to act as an appetite stimulant and an anti-inflammatory agent – both extremely important medical uses. There is a recent study that has come out of Israel which demonstrated that strains of cannabis higher in CBN were associated with better symptom control of ADHD in humans. (https://pubmed.ncbi.nlm.nih.gov/32017685/)

CBG

CBG or cannabigerol is another non-intoxicating cannabinoid of hazy legality in the United States because, technically, if you derive CBG from cannabis it is illegal, but if you derive it from hemp, it is legal — even though it is the exact same molecule. It has a wide variety of potential medical uses, but most of the studies that have been done on it have been done in animals, so it is difficult to fully extrapolate to humans. Experiments in mice has shown that it can decrease inflammation associated with inflammatory bowel disease (https://pubmed.ncbi.nlm.nih.gov/29562280/) and that it can slow the growth of colorectal cancer. It has also been shown – in mice – to protect neurons in Huntington’s Disease, to act as an anti-microbial against many different agents, including the difficult to treat MRSA bug which causes so many hospital-acquired infections. CBG also act as an appetite stimulant, and to treat bladder contractions. CBG is thought to be a relatively non-toxic substance with the main danger in its use lying in the lack of regulation and standardization that accompanies the entire supplement industry in this country. A recent survey-like study (in humans of course…) demonstrated efficacy in treating pain, depression, anxiety and insomnia. (https://www.liebertpub.com/doi/abs/10.1089/can.2021.0058?journalCode=can#.YWMiq2QOBoY.linkedin)

THCV

If I had to pick a favorite non-intoxicating cannabinoid, it would be THCV, or tetrahydrocannabivarin, because it has vast potential to help alleviate our related epidemics of obesity and diabetes.  There is robust animal data that it lowers fasting insulin levels, facilitates weight loss and improves control of blood sugar. In a 2016 human study in Diabetes Care (https://pubmed.ncbi.nlm.nih.gov/27573936/) THCV was shown to significantly improve fasting glucose, pancreatic beta cell function (i.e. the cells that make insulin and which ultimately fail in diabetes), as well as several other hormones associated with diabetes. It was well-tolerated without significant side effects. In places like Israel, where the study of cannabinoids are far more advanced than the United States, due to less restrictive laws, cannabinoids such as THCV are being bred up to therapeutic levels and are being aggressively studied.

Exciting to see what the future holds

Acceptance of medical cannabis is growing – currently 94% of Americans support legal access to medical cannabis, and the rest of the world heading in a similar direction. The one thing that virtually everyone agrees upon is the need for further research into cannabis and cannabinoids – their benefits, their harms, and the ways we can safely develop and exploit them to improve human health. We are in the midst of an incredibly exciting time with new discoveries occurring daily in cannabinoid science, with old cannabinoids like CBG, CBN and THCV newly available, and I, for one, can’t wait to see what the future holds.

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