Endocannabinoid Deficiency and Cannabis Use Disorder

an opinion piece written by staff writer Alexandra Arnett @calyx.alex

It is my opinion that psychiatrists and psychologists may be misdiagnosing some people who use cannabis with Cannabis Use Disorder (CUD). Now, my argument is not that people cannot misuse cannabis or cannot be addicted to it. Instead, I want to focus on how some symptoms of endocannabinoid deficiency can fit in with the diagnostic profile of Cannabis Use Disorder. It wasn’t until recently that cannabis education for medical and mental health professionals became more common, and maybe even more desirable to those professionals. Let’s start with some basics. Cannabis Use Disorder is defined as having 2 or more of the following symptoms; 

  1. Cannabis is often taken in larger amounts over a longer period than was intended.
  2. There is a persistent desire or insignificant effort to cut down or control cannabis use.
  3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis or recover from its effects.
  4. Craving or a strong desire or urge to use cannabis.
  5. Recurrent cannabis use resulting in failure to fulfill major role obligations at work, school or home.
  6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  7. Important social, occupational or recreational activities are given up or reduced because of cannabis use.
  8. Recurrent cannabis use in situations which is physically hazardous.
  9. Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are unlikely to have been caused or exacerbated by cannabis.
  10. Tolerance, as defined by either:
    1. A need for markedly increased amounts of cannabis to achieve intoxication and desired effect, or
    2. A markedly diminished effect with continued use of the same amount of cannabis.
  11. Withdrawal, as manifested by either:
    1. The characteristic withdrawal symptoms for cannabis, or
    2. A closer related substance is taken to relieve or avoid withdrawal symptoms.

Again, I am not saying that cannabis is not addicting or that people don’t misuse it. It is very understandable for criteria such as failing to fulfill major obligations due to your use of cannabis to be cause for a CUD diagnosis. I generally agree with criteria 2, 3, 5, 6, 7 and 9. The reasons I didn’t include 1, 4, and 8 are because I think that they can be easily misinterpreted in sessions, however, they do have standing when paired with other criteria and situations. For criteria 10 and 11, this is where I think endocannabinoid deficiency can provide a different explanation.

Cannabis tolerance is still a new research topic. It is very dependent on one’s own endocannabinoid system, for example, some people have developed a high tolerance in order to function on their dosage of medication. Some doctors may misinterpret this high dosage use of cannabis to indicate the cannabis tolerance is negative. One withdrawal symptom of cannabis is stated to be a lack of appetite, but what if that is the reason you choose to medicate with cannabis? Other withdrawal symptoms include anxiety, insomnia, depression and irritability, several of the many reasons why people choose to medicate with cannabis in the first place. Therefore, it would make sense that these symptoms would occur when cannabis use is stopped. However, therapists and other mental health professionals often stigmatized the use of cannabis and may misdiagnose their patients, creating a problem that does not exist.

Humans have two major endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG). Research has found that the endocannabinoid system in humans plays a large role in several bodily processes and functions, including ones that occur in the above-mentioned conditions. The purpose of the endocannabinoid system is to maintain homeostasis. When someone is deficient in certain endocannabinoids, this can cause dysregulation of that homeostasis, which in turn may be the possible cause of several conditions and symptoms. Endocannabinoid deficiency has been suggested to be the cause of several types of disorders that before have not been found to have a specific cause. Conditions such as fibromyalgia, irritable bowel syndrome, migraines, glaucoma, bipolar disorder, and more have all been suggested to be linked to endocannabinoid deficiency. 

As an example, let us take a brief look at migraines and the endocannabinoid system. From 1843 to 1943 when cannabis was put on Schedule I, cannabis was one of the main treatments for someone suffering from a migraine. While there are limited human clinical trials, the case studies and survey research that have been conducted have shown that cannabis use may help to treat migraines. From the research that has been done, individuals who suffer migraines show decreased anandamide and 2-AG levels. CBD acts via the TRPV1, a specific cannabinoid receptor, and also limits the production of the enzyme fatty acid amidohydrolase (FAAH) which is responsible for the breakdown of anandamide. THC on the other hand activates the CB1 receptors which may help treat migraines by potentially inhibiting the trigeminovascular system which plays a huge role in migraines and headaches. Supplementing with cannabis, THC and CBD can help bring the endocannabinoid system back into homeostasis. 

In addition to phytocannabinoids, there are things that an individual can do to naturally boost the body’s endocannabinoid system. We call these “cannabimimetic agents” and they include activities such as exercising, eating foods, or taking supplements high in Omega-3 fatty acids. 

Activities such as these help to boost your body’s endocannabinoid system without using any part of the cannabis plant. While you may be able to boost your endocannabinoid system without cannabis, there are still many unknowns when it comes to treating things like migraines, fibromyalgia, bipolar disorder, irritable bowel syndrome, and more. If using cannabis helps mediate symptoms than your standard pharmaceuticals, then the concern needs to be focused on researching why cannabis is working to treat that disorder instead of stigmatizing and misdiagnosing patients.

References

Russo E. B. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis and cannabinoid research, 1(1), 154–165. https://doi.org/10.1089/can.2016.0009 

Cannabis and The Climate

written and photographed by Alexandra Arnett @calyx.alex

If anyone has ever grown a cannabis plant or two, you know that they require a lot of love and can be a lot of work. There are both genetic and environmental factors that influence how a plant will develop and what it will look like. It is commonly known that the difference between “indica” and “sativa” varieties is the morphology, but somewhere down the line, it became misconstrued into describing the effects.  

Cannabis has two main subspecies, Cannabis sativa subsp. Sativa and Cannabis sativa subsp. indica. The domesticated varieties of these subspecies include: Cannabis sativa subsp. sativa var. sativa (Broad-leaf hemp or BLH), Cannabis sativa subsp. sativa var. chinesis (Narrow-leaf hemp or NLH), Cannabis sativa subsp. indica var. indica (Narrow-leaf drug or NLD), Cannabis sativa subsp. indica var. afghanica (Broad-leaf drug or BLD). If you’d like to read more about the indica vs sativa debate, you can do so here, but today we’re going to focus on Cannabis sativa subsp. indica var. indica (Narrow-leaf drug or NLD) and Cannabis sativa subsp. indica var. afghanica (Broad-leaf drug or BLD). These are the “drug varieties” of cannabis with moderate to high levels of THC. Plants within the narrow-leaf drug category are what some consider to be the standard morphology of a “Sativa” and plants within the broad-leaf drug category would be considered to have the morphology of an “Indica.”

Cannabis morphology is largely based on the genetic origins of the plant. Certain plant adaptations occur in cannabis due to certain climates that they develop in. This is why many Afghani/Hindu Kush strains can have purple shades to them—because they evolved in colder mountain climates, they genetically adapted to their climate by producing more anthocyanins. These plants are also shorter and bushier than other varieties due to their adaptations to colder climates. Through selective breeding of these purple genetics, we have strains today like Sirius Black from Oregon Breeders Group. In the case of your “sativa” narrow-leaf drug varieties, the plants are typically taller and the leaves less dense due to the hotter climates they developed in and adapted to. Next to genetics, the weather is one of the most important factors. The colder the weather, the more stressed the plant can become if it is not native or adapted to the climate. If the climate is too hot, the plant can get burnt by the heat. 

The cannabis plant comes in many shades, such as greens, reds, and purples. Much like chlorophylls give plants and leaves their green color, flavonoids like anthocyanins give plants their orange, red, pink, purple, blue, and even black colors. To begin, flavonoids are consumed by humans through fruits, vegetables, and other plant-based foods and drinks. Anthocyanins are a specific group of flavonoids. This group of flavonoids includes over 400 different kinds of anthocyanins. Just a small fraction of the anthocyanins you may see expressed in the cannabis plant include cyanidin, delphinidin, malvidin, pelargonidin, peonidin, and petunidin.

In addition to providing color to the plants, flavonoids and anthocyanins have shown to have both neuroprotective and anti-inflammatory properties (Weston-Green, 2019). This is among the many reasons that people recommend using whole-plant extracts and concentrates like RSO and tinctures to aid in certain medical conditions. In particular, the cannabis plant also contains two specific flavonoids, Cannflavin A and Cannflavin B. Most recently, researchers have looked at their potential to help fight pancreatic cancer. Although the research is still new, it is something to keep an eye on in the future (Moreau et al., 2019).

References

McPartland, J. M. (2018). CannabisSystematics at the Levels of Family, Genus, and Species. Cannabis and Cannabinoid Research, 3(1), 203–212. https://doi.org/10.1089/can.2018.0039  

Moreau, M., Ibeh, U., Decosmo, K., Bih, N., Yasmin-Karim, S., Toyang, N., Lowe, H., & Ngwa, W. (2019). Flavonoid Derivative of Cannabis Demonstrates Therapeutic Potential in Preclinical Models of Metastatic Pancreatic Cancer. Frontiers in oncology, 9, 660. https://doi.org/10.3389/fonc.2019.00660

Weston-Green, K. (2019). The United Chemicals of Cannabis: Beneficial Effects of Cannabis Phytochemicals on the Brain and Cognition. Recent Advances in Cannabinoid Research, 83–100. https://doi.org/10.5772/intechopen.79266  

Cannabis, COVID-19, and our Lungs

Written By Alexandra Arnett, photographed by Danny Avina

Shortly before the world was hit with the COVID-19 pandemic, the US was suffering another lung crisis. Vape pens were all over the news in 2019 for reports of illnesses and deaths related to smoking them. The most recent update by the CDC was on February 18th, 2020. It showed that there have been 2,807 cases of illnesses related to nicotine or cannabis vapes, with 68 deaths. Among these patients, 2,022 of them reported which substance was being vaped, with 82% reported using THC containing products, while 33% reporting the use of exclusive THC containing products. Of the affected, 50% reported where their product was sourced, with 16% having obtained them from retail businesses and 78% obtaining them from friends, online, or other dealers. Overall, since the last article in February, there has not been a large rise in cases. However, it’s possible that the pandemic took front row for CDC priorities and it simply was not viable to keep reporting vaping illnesses, especially with what we know about the virus.

As a recap from the last Cannabis & The Lungs piece, we know that cannabis, specifically the terpene pinene and the cannabinoid THC, are both bronchodilators. As a bronchodilator, they help open up the airways to the lungs and may even help with conditions such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. However, there are several ingredients that companies have been found to use in vape cartridges that have not shown to be safe for vaping—or have not been tested for inhalation safety at all. These ingredients include MCT oil, natural and artificial flavorings and non-cannabis derived terpenes.

So far, the vaping crisis seems to have been subdued and the focus has been shifted. Other than Colorado, no other states pursued permanent bans on anything other than Vitamin E acetate. Currently, in Oregon, the OLCC is in the process of putting together a cannabis vape-additive ban which would ban all additives other than natural cannabis-derived terpenes. This means no more natural and artificial flavoring, no non-cannabis-derived terpenes, and no MCT oil or other additives. California has similar pending legislation but it would allow for botanically derived terpenes and other natural flavors. 

More recently, COVID-19 and cannabis have been in the news as researchers have been scrambling to find some sort of medicine that can help ease symptoms and/or treat the effects of the virus. As mentioned in the paragraphs above, we know that THC and pinene are bronchodilators. Currently, researchers have been analyzing CBD and specific terpene formulations for potential to help fight against the virus. 

CBD has been found to be an ACE2 inhibitor and it reduces inflammatory cytokine production. The inhibition of ACE2 expression plays an important role in how COVID-19 enters host cells. When ACE2 expression is inhibited, the virus has a more difficult time entering a host cell. In relation to cytokine production, COVID-19 creates what is called a “cytokine storm.” This cytokine storm is the release of so many cytokines that they become harmful to the host cells. Researchers in Israel are currently looking at CBD in combination with a terpene formulation. This terpene formulation is a blend of 30 various terpenes that have shown to have anti-inflammatory properties. While the research has not gone through any clinical trials, the results the research has produced is promising information. 

Neither the author nor Green Eugene endorses anything in this article as medical advice for treating or curing COVID-19. If you are having symptoms please get tested and speak with your doctor. Remember to wear a mask, practice social distancing out in public spaces, and avoid large crowds.

Runner’s High

words by Josh Delzell
photos by Connor Cox

Lazy, dull and careless; all stereotypes to describe stoners.  While it can be nice to give in to couch lock and watch a movie, not all “potheads” are lazy, despite what cultural stigmas may have you believe. Many stay active, and while the science is still murky on whether or not cannabis is beneficial to an active lifestyle, many swear by it. Active runners have said that it helps them push through the pain of a workout because of the high. Former NBA player, Matt Barnes, swears by cannabis use. Barnes said “All my best games I was medicated,” in an interview by Bleacher Report for their B/R x 4/20 piece. While most professional athletes are still hesitant to discuss their cannabis use, recreational athletes can talk more candidly about their consumption. Take Ruben Estrada for instance.

Estrada, a senior at the University of Oregon, has been active for most of his life. “Running has been a hobby of mine for a while,” he said. “I’ve played soccer since I was kid.” Estrada tries to get in a strenuous workout at least three days a week, and he does this all while utilizing cannabis.  He declared that he smokes every day,— following up with a clarification that he typically doesn’t smoke before classes, but occasionally indulges in the classic wake and bake on weekends.

Estrada even used to actively run after a smoke sesh. “It depends on the strain,” he said. “But with a sativa, a two hour plus run, even when the high was coming down, I still felt a little boost to add onto the runner’s high.” Estrada reflected on competing in the last Eugene Marathon. “My parents kind of made me do it. They didn’t force me or anything, but they started to really get into fitness by the end of my high school career.” Estrada felt as if he was getting ‘lazy’ while his parents were whipping themselves into shape. “My dad ran the Portland marathon, and my mom ran the half. I was like ‘dang, they’re in their 40’s, I can do this too!’” Estrada also wanted to challenge the ‘pothead’ stereotype in a way. “It was fun taking a bong rip and following up with a two and half hour run, and thinking, ‘most people won’t do this.’”

Estrada wanted to push back against the stigma of cannabis being detrimental to an active lifestyle, when in reality, it’s more common than you’d think.  “There are so many people that use it, that are professionals and are active on a daily basis.” Despite connotations, some people use cannabis and still go for a run or hit the gym. “I ran a marathon, and there are a lot of people who don’t smoke cannabis that didn’t. So, you can laugh your way to the bank knowing you’re doing stuff others aren’t even when they doubt your lifestyle.”

Estrada unfortunately suffered a knee injury during the marathon. “It was the classic, ‘mile 22 will get ya’,” he said. He suffered an LCL injury, and is currently doing rehabilitation for his knee, but unfortunately doesn’t run as much as he used to. However, Estrada continues to use cannabis as a pain reliever for his knee. “It’s a great pain reliever, it relaxes the pain.” THC and CBD have many anti-inflammatory properties, which makes it an effective pain reliever for active lifestyles. THC also relaxes the nervous system which can help with muscle spasms.  “I work for UO Concessions, so I worked all the football games, and I would end up running around 10 to 12 miles a game,” he said. “So at the end of the day, my knee was pretty sore… cannabis made it easier to go to sleep without a nagging injury keeping me up.” Estrada uses cannabis infused topical cream for his knee. He likens these topicals to Icy Hot. “You can slap it on your knee, back, shoulders or anything. It’s a great soother and relaxer,” he said.

Despite the benefits that cannabis provides to athletic lifestyles, it is still banned in most high profile athletic events. The Olympics and the U.S. Anti-Doping Agency (USADA) lists cannabis as a performance enhancing drug, due to “having the potential to enhance sport performance” and “representing an actual or potential health risk to the athlete,” according to the USADA Marijuana FAQ page. However, according to a study done by the Clinical Journal of Sports Medicine, no evidence was found of cannabis being a performance enhancing drug. They even touched on the potential cannabis could have to help with traumatic brain injury after further research. “There is no science that says it’s a performance enhancing substance in the context that it gives you an unfair advantage,” said Estrada. “There are ex-NBA players that have come out saying they used it, and it was their saving grace [for their injuries]. I would like to see a time where people  start to understand and empathize with the medical benefits from it, because I see it as a really therapeutic substance.”

With evidence that indicates cannabis can help athletes, it remains banned by high level athletic competitions. Many stigmas about cannabis come from a lack of knowledge and experience. People like Estrada challenge old stigmas and show that cannabis doesn’t make one lazy; how you use cannabis is up to you and your personal lifestyle. While reflecting on his experience in the Eugene Marathon, Estrada left with an anecdote that sums up what it’s like being an athlete that uses cannabis: “At the marathon I was wearing a t-shirt that had a pot leaf on it, and at mile 20 when I was feeling it a little, there was a group of people and one of the guys yells ‘Yeah! Powered by weed!’ and that was a motivator!”