Nurses treat patients who consume or are considering the use of cannabis as a medicine. Researching and validating information can be hard, but good and timely research can inform clinical nursing practice. Cannabis has a vast history for recreational use, in spiritual use, and as a medicine. Since cannabis science is not taught in many nursing schools, nurses should research information about cannabis. This essay will focus on the endocannabinoid system and routes of administration by patients.
Endocannabinoid System (ECS)
ECS is a complex cell signaling system realized by researchers exploring THC, a conventional cannabinoid. Cannabinoids are amalgamations constituted in cannabis (Kasperkiewicz, 2020). The endocannabinoid system controls a range of processes and functions, including appetite, sleep, memory, moods, fertility, and reproduction. Endocannabinoids exists and is functional in the human body even if they do not take cannabis. The endocannabinoid system is made up three main components, which include; endocannabinoids, receptors, and enzymes.
Endocannabinoids are molecules formed by the body. Endocannabinoids are also known as endogenous cannabinoids. 2-arachidonoylglyerol (2-AG) and anandamide (AEA) are two critical endocannabinoids identified so far. AEA and 2-AG help internal functions run smoothly. Endocannabinoids receptors are found in the body. Endocannabinoids tie up to them to inform that endocannabinoids systems need to take measures. Endocannabinoid receptors are made up of two major parts: CB2 receptors, which are commonly found in the peripheral nervous system, primary immune cells, and CB1, which are basically established in the central nervous system. Endocannabinoids can tie up to any receptor. The resultant effect depends on which endocannabinoid binds to and where the receptor is located. For an instant, endocannabinoids might tie up to a CB2 receptor in the immune cell to pass information that the body is experiencing inflammation, a basic autoimmune mess. Endocannabinoids can also bind with CB1 receptors in a spinal nerve to mitigate pain.
Enzymes break down endocannabinoids after they have finished carrying out their functions. Monoacylglycerol acid lipase and fatty acid amide hydrolase are two main enzymes that break down endocannabinoids. Monoacylglycerol typically breaks down 2-AG, and fatty acid amide hydrolase breaks down AEA.
The endocannabinoid system is complicated, and researchers have not yet known how it functions, however, research has connected the ECS to some of the following functions; chronic pain, metabolism, moods, inflammation, sleep, liver function, stress, reproductive system function, appetite, and digestion, muscle formation, and bone remodeling and growth. These functions contribute to homeostasis. Homeostasis is the stability of the internal parts of the body. Tetrahydrocannabinol (THC) is among the essential cannabinoids found in cannabis. THC is the component that makes one feel “high.” When THC enters the body, it interacts with ECS by binding to receptors. However, THC is partly potent because it can tie up with both CB1 and CB2 receptors. These make it have a broad scope of effects on the mind and body. Some of the results are more advantageous than others. For instance, THC restorative appetite helps lessen pain, but it can also cause anxiety and paranoia. Cannabidiol (CBD) is another main cannabinoid found in cannabis. CBD typically does not cause any negative effects. CBD does not tie up with CB1 and CB2 receptors as THC does. CBD prevents endocannabinoids from being broken, hence allowing endocannabinoids have more effects on the body.
Most of the specialists maintain a theory known as clinical endocannabinoid deficiency (CECD). CECD theory suggests that ECS dysfunction or low endocannabinoid levels can read to the evolution of definite conditions (Concierge, Farmacann, & Blog, 2021). This theory explains why some people develop irritable bowel syndrome, migraines, and fibromyalgia. These conditions do not have a clear underlying cause. They are also frequently resistant to treatment. If clinical endocannabinoid deficiency does not take part in this condition, targeting endocannabinoid production could be the missing key to treatment.
Delivery routes of cannabis products
Inhalation: The use of cannabis in cigarettes is widespread among Leisure users and is one of the most approved among therapeutic users (DeFilippis et al., 2020). However, this method of consumption is associated with effects such as bronchitis, chronic cough, and inhalation of toxic products such as ammonia or tar and carbon monoxide. Another similar way of consuming cannabis is inhalation through the use of vaporizers. Vaporizers heat the cannabis at which the cannabinoids decarboxylate but without reaching the point of combustion. In this way, cannabinoids attain their maximum concentration in the brain and blood quickly after consumption.
This represents two significant advantages of this way compared to other routes of administration: One, the therapeutic benefit is immediate, this is very important during acute crises in specific pathologies, the other advantage is the speed of the effects helps avoid overdose episodes. However, inhalation of cannabis through vaporizers has some drawbacks. For example, the amount of cannabinoids absorbed in the body is inconsistent and relies on frameworks such as; temperature and rate of the vaporization, duration, and effectiveness of every inhalation, and type and amount of cannabis placed in the vaporizers.
Topical administration: Although topical ointments and creams are increasingly more extended, there are no controlled studies conducted on the bioavailability and distribution of this route. Few preclinical pieces of research have been carried out with dermal patches and argue that absorption is slow, not too high, and are long-lasting. This route of administration could be fascinating for the treatment of localized or pain and superficial inflammations and skin problems such as wounds, psoriasis, and acne.
Rectal administration: Thorough clinical trials or studies or preclinical trials have not been carried out on the pharmacokinetics of cannabis in this method. However, this route is spreading among patients at a high rate. Its approval is found in the testimonies of many of the users as they claim to consume maximum amounts of THC every day without experiencing any form of psychotropic effects. However, lack of psychoactivity is the cause of the low absorption of THC through rectal mucosa. Rectal mucosa does not capture cannabinoids and hydrophobic compounds well. These pro-forms of tetrahydrocannabinol have greater bioavailability as compared to the oral route.
Oral administration: Most of the cannabis products used by patients are taken oromucosally, orally, or sublingually. The effects take more time to occur, last longer and intense are minimal through this route compared to inhalation. This method of administration is commonly used by patients with a persistent illness who requires a maximum level of cannabinoids in their body. The effects of edible things are very hard to regulate in terms of the time they take to occur and their intensity. This is the reason why oral administration is linked with overdose episodes.
Cannabis is used in different ways, such as medicinal, recreational, and spiritual use. Cannabis has both positive and negative effects on the patients. Some of the functions of cannabis include; sleep, moods, chronic pain and muscle formation, and bone remodeling and growth. Patients use different routes such as inhalation, oral and rectal routes to administer cannabis.
Concierge, Y. C., Farmacann, M., & Blog, F. (2021). Medical Cannabis Research Medical Cannabis Research.
DeFilippis, E. M., Bajaj, N. S., Singh, A., Malloy, R., Givertz, M. M., Blankstein, R., … & Vaduganathan, M. (2020). Marijuana use in patients with cardiovascular disease: JACC review topic of the week. Journal of the American College of Cardiology, 75(3), 320-332.
Kasperkiewicz, A. (2020). Exploration of the suitability of coated blade spray for rapid analysis of pesticides in agricultural commodities and byproducts (Master’s thesis, University of Waterloo).
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