Post by Admin on Feb 11, 2019 21:34:10 GMT
Clinical Implications for Cannabinoid Use in the Rheumatic Diseases
Introduction
Cannabinoids as therapeutic agents in traditional medicine are both lauded and maligned. The ubiquitous use in years gone by once made cannabinoids a mainstay of the physician's dispensary, yet the understanding of the pharmacology of these drugs is relatively recent. The physiologic and psychoactive effects of the cannabis, or hemp, plant, cultivated in ancient times for the production of textiles, led to ceremonial, therapeutic, and eventual recreational use, beginning in the Himalayan region of central Asia and with the first recorded medicinal use in China in 2700 BC (1).
In the Western world, 2 paths of scientific study of cannabinoids have been followed. In the earliest studies, 19th century French psychiatrists focused on the effects on mood, whereas British physicians explored the sedative, analgesic, hypnotic, and anticonvulsive properties (1). In the early 20th century, interest in cannabis as a therapeutic agent waned following the introduction of drugs with a more reliable therapeutic profile, such as opiates. With increasing global concerns about narcotic addiction, cannabis was misclassified as a narcotic, similar to heroin, opium, and cocaine, at the Geneva International Convention on Narcotics Control in 1925, which resulted in a ban on cannabis for recreational use in the UK in 1928 and criminalization in the US in 1937 (1, 2). Renewed interest in the therapeutic effects of cannabinoids emerged following the identification and cloning of cannabinoid receptors in the late 1980s and 1990 (3-5).
The endocannabinoid system, found throughout the animal kingdom, comprises endogenous ligands, termed endocannabinoids, and receptors. This system has effects on pain mechanisms, immune function, inflammation, and bone health, as has been noted in the laboratory setting. However, formal clinical study has been limited. Therefore, the true efficacy and risk/benefit ratio with regard to the therapeutic effects of cannabinoids, whether derived from the hemp plant Cannabis sativa or synthesized from cannabis derivatives, remain controversial (6). The use of cannabinoids as therapeutic agents has mostly remained outside mainstream medicine in modern times and is further prejudiced by the recreational use of marijuana, a drug associated with abuse with a reported usage rate of 4% of the global population (2, 3). Because more than 60 alkaloids are present in the plant form, and because there has been increasing identification of endocannabinoids in the animal world and an explosion in the development of synthetocannabinoids, the specific molecules offering clinical benefit require elucidation.
Almost 10% of patients with chronic pain in the US are taking cannabinoids for self‐medication purposes, but the purpose of their use in more than one‐half of patients has not been disclosed (7). Physicians must therefore be knowledgeable of the physiologic mechanisms, current clinical evidence, and risks associated with cannabinoid use to be able to provide balanced counsel to patients. Because cannabis is illegal in most countries, any recommendation for medicinal use should be made within the law, usually regulated by a “medical exemption authorization.” In this selected literature review, we provide an overview of the current status and understanding of cannabinoids and the endocannabinoid system as it pertains to rheumatology practice.
Source: onlinelibrary.wiley.com/doi/full/10.1002/art.34522
Introduction
Cannabinoids as therapeutic agents in traditional medicine are both lauded and maligned. The ubiquitous use in years gone by once made cannabinoids a mainstay of the physician's dispensary, yet the understanding of the pharmacology of these drugs is relatively recent. The physiologic and psychoactive effects of the cannabis, or hemp, plant, cultivated in ancient times for the production of textiles, led to ceremonial, therapeutic, and eventual recreational use, beginning in the Himalayan region of central Asia and with the first recorded medicinal use in China in 2700 BC (1).
In the Western world, 2 paths of scientific study of cannabinoids have been followed. In the earliest studies, 19th century French psychiatrists focused on the effects on mood, whereas British physicians explored the sedative, analgesic, hypnotic, and anticonvulsive properties (1). In the early 20th century, interest in cannabis as a therapeutic agent waned following the introduction of drugs with a more reliable therapeutic profile, such as opiates. With increasing global concerns about narcotic addiction, cannabis was misclassified as a narcotic, similar to heroin, opium, and cocaine, at the Geneva International Convention on Narcotics Control in 1925, which resulted in a ban on cannabis for recreational use in the UK in 1928 and criminalization in the US in 1937 (1, 2). Renewed interest in the therapeutic effects of cannabinoids emerged following the identification and cloning of cannabinoid receptors in the late 1980s and 1990 (3-5).
The endocannabinoid system, found throughout the animal kingdom, comprises endogenous ligands, termed endocannabinoids, and receptors. This system has effects on pain mechanisms, immune function, inflammation, and bone health, as has been noted in the laboratory setting. However, formal clinical study has been limited. Therefore, the true efficacy and risk/benefit ratio with regard to the therapeutic effects of cannabinoids, whether derived from the hemp plant Cannabis sativa or synthesized from cannabis derivatives, remain controversial (6). The use of cannabinoids as therapeutic agents has mostly remained outside mainstream medicine in modern times and is further prejudiced by the recreational use of marijuana, a drug associated with abuse with a reported usage rate of 4% of the global population (2, 3). Because more than 60 alkaloids are present in the plant form, and because there has been increasing identification of endocannabinoids in the animal world and an explosion in the development of synthetocannabinoids, the specific molecules offering clinical benefit require elucidation.
Almost 10% of patients with chronic pain in the US are taking cannabinoids for self‐medication purposes, but the purpose of their use in more than one‐half of patients has not been disclosed (7). Physicians must therefore be knowledgeable of the physiologic mechanisms, current clinical evidence, and risks associated with cannabinoid use to be able to provide balanced counsel to patients. Because cannabis is illegal in most countries, any recommendation for medicinal use should be made within the law, usually regulated by a “medical exemption authorization.” In this selected literature review, we provide an overview of the current status and understanding of cannabinoids and the endocannabinoid system as it pertains to rheumatology practice.
Source: onlinelibrary.wiley.com/doi/full/10.1002/art.34522