A Tale of Two Cannabinoids

British cannabis

There wasn't much of a fanfare from Cannabis activists, or even outrage in the British media, when Cannabis started to be legally prescribed in the UK for the first time in June last year. A few years ago, getting Cannabis prescribed for MS sufferers was high on the Cannabis Activist's wish list (remember Mark and Lezlie Gibson getting busted in 2007 for providing MS sufferers with Cannabis chocolate?) so now we should be happy, right? Well, kind of... The fact is, rather than allowing the estimated third of MS patients in the UK who currently use illegal Cannabis to treat their symptoms, to possess and consume Cannabis without fear of prosecution, the Government have outsourced to the pharmaceutical industry - namely GW Pharmaceuticals (a division of Bayer), for the delivery of Cannabis as medicine. Unlike California and some other progressive states in America, the UK Government at present only recognizes Cannabis-based medicine as effective for the relief of spasticity related to MS, not for the whole host of conditions - from cancer to insomnia and depression - that some American doctors can prescribe it for. “Unlike California and some other progressive states in America, the UK Government at present only recognizes Cannabis-based medicine as effective for the relief of spasticity related to MS„

Doctors

As Americans, your prescription from the doctor allows you to buy a whole host of raw buds from specialist dispensaries where the ‘experts' will advise you on what variety will best treat your condition. Over here in the UK, the only way you're going get government sanctioned Cannabis is with a prescription from the doctor for relieving MS-related spasms, and even then it will come in the form of a spray called Sativex, and it won't actually get you high. So, it may be a good thing that the government finally recognizes some medicinal value in Cannabis. In that typically British way, they've had to admit that it is an effective and suitable treatment, but only once they'd sucked all the fun out of it. One positive to come from this development is that GW Pharmaceuticals - with all their facilities, laboratories, equipment and most importantly, money - have done some pretty interesting and long overdue research into cannabinoids and how they actually affect us.

Cannabis

From their perspective the more conditions they can prove their drug works for, the more money they make, which puts them as uneasy allies with the pro-Cannabis community. By proving some of the positive effects of Cannabis consumption the hope is that the image of Cannabis may improve in the eyes of the general population, having taking such a bashing in the media following the Lancet Journal's 2007 publication of the paper Cannabis Use and Risk of Psychotic or Affective Mental Health Outcomes, a systematic review that supposedly highlighted the causal link between Cannabis and psychosis. Ironically, high on GW Pharm's list of conditions that may be helped by Cannabis is psychosis. It was in 1988 that scientists first discovered the endocannabinoid system in the human body, that is, naturally occurring cannabinoid receptors (CB1 and CB2) in all human brains. This was followed a few years later by the discovery of the ligand that bonds with these receptors, named 'anandamide' after the Sanskrit word for ‘bliss'. This discovery that the human brain and Cannabis were linked through these receptors and naturally occurring 'endocannabinoids' opened up the study of Cannabis as medicine, as it showed the scientific community that Cannabis clearly does effect the many ways our brains and bodies operate, be it pain perception, mood, muscle control, sleep, anxiety, psychosis and so on.

All about the research

Research has so far identified two main cannabinoids that affect the human endocannabinoid system: Δ9-THC (Delta-9 Tetrahydrocannabinol) and CBD (Cannabidiol), and it is these two that make up Sativex. In their own words: "THC has analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-emetic properties, whilst CBD has anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory effects." Another study involving Cannabis and sleep found that "fifteen milligrams THC would appear to be sedative, while fifteen milligrams CBD appears to have alerting properties as it increased waking activity during sleep and counteracted the residual sedative activity of fifteen milligrams THC." Clearly these two cannabinoids interact in interesting ways that we are only just beginning to understand. Both are present in the vast majority of Cannabis plants but in different ratios, depending on the plant itself. Recent Cannabis breeding has had the aim of deliberately increasing THC levels and lowering CBD to achieve the most powerful and euphoric high, without the counter-effect of CBD. It is this same logic that has ultimately brought about the introduction of a suitable medical Cannabis product.

CBD

When taken together the CBD modulates the effects of the THC. For this reason GW include a fine balance of both in Sativex, all but eradicating any kind of 'high'. This was a major hurdle for GW in bringing their product to market because as a medicine it is not meant to actually get you high. Heaven forbid! As an aside, research also found that when CBD is separately administered first, then followed by THC (as was done under scientific trial conditions with human volunteers) it inhibits the breakdown of THC in the liver, therefore raising levels in the brain for a longer period. 'CBD before THC gets you higher', basically. So how exactly do they produce this Cannabis-based preparation? Sativex is an oromucosal spray, which means it is absorbed through the mucous membrane in the mouth. The label states that "each 100 microliter spray contains 2.7 mg delta-9-tetrahydrocannabinol and 2.5 mg cannabidiol from Cannabis sativa L." To make it, GW has been growing its own Cannabis plants at a secret location in the south of England. Primarily they have been using a high-THC strain with no CBD, and a high-CBD strain with no THC. They have grown the CBD chemovar outdoors which, along with the lack of THC, would suggest it is a hemp fiber or even ruderalis strain; whereas the THC chemovar has had to be grown indoors or under glass in the summer. [caption id="attachment_5811" align="alignnone" width="619"]

The greenhouses

Much time was wasted trying to grow a greenhouse crop in the winter before GW realized that high light levels played a crucial part in producing THC (is there anyone reading this that didn't already know that?) Then, they've effectively been making hash - they call it an Enriched Trichome Preparation or ETP - or more accurately, bubble hash, from the dried buds. They could have no doubt saved themselves a bit of effort if they had asked an experienced grower and hash maker for some tips. Still, it's nice to know that the men in white coats endorse the bubble hash process, but for their purposes only the six- or seven-screen process (like the Ice-o-Lator bags, Next Level BubbleSacs and the Canadian Bubble Bags with the 75-micron and 25-micron screens) are used for separating the useable gland. Their research showed that most of the plant's cannabinoids are in the upright gland heads (again, we could have told them that) which are roughly 75- to 100-microns in size and so are exclusively caught on the 75-micron screen. The THC hash (ETP!) and CBD hash are blended together, suspended in ethanol, creating Sativex. It's not original to observe how remarkable the Cannabis plant really is, but the more we learn through rigorous scientific research, the more the population as a whole will be able to see how much we have missed out on through prohibition. The fact that Cannabis can have so many medical applications for conditions where the best alternatives are either ineffective or cause horrific side effects, while being completely non-toxic and free from unpleasant side-effects, must be a dream for a pharmaceutical company - and is in itself pretty remarkable.

Facts

The fact that we humans have our own, naturally occurring cannabinoid (anandamide) in our bodies, and receptors in our brains to receive it - and that Cannabis is the only place outside of our own bodies where these compounds are found - must surely hint at a very long evolutionary history between us and the Cannabis plant. Indeed, it is well-documented that humans ate the seeds and used the fibers, but a recent archaeological dig in the Gobi desert (China) revealed the tomb of a blue-eyed man buried with 789 grams of bud that still had active THC in the glands, estimated to be 2,700 years old. Man has evolved alongside Cannabis, growing and selecting all the time. Undoubtedly it is a good thing that MS sufferers can have some much needed relief from Sativex. Getting any pharmaceutical drug to market takes a painfully long time for those waiting for it. GW is currently trying to get Sativex licensed for many more conditions, but research has to be done and reviewed before this can happen. What Sativex has done is drawn a distinct line between medical and recreational Cannabis. This is the major difference between medical Cannabis here, and in California or Holland, where it is accepted that Cannabis is beneficial and it is up to the patient as to how they administer it and in what form they buy it. Whether or not this is a good thing is debatable.

Cannabis expert

Already growers, breeders and Cannabis experts are responding to this new research - and particularly to the benefits of CBD. Jorge Cervantes, Howard Marks and Shantibaba have all put their names to the ‘CBD Crew'; while Jamie from Resin Seeds in Spain recently tested an individual plant with an even ratio of THC and CBD. This has kicked off a program to breed seeds that can offer this chemical profile every time, clear evidence that the Cannabis Community is responding in its own way to these new discoveries. The problem they have is that the only way to tell the chemical profile of a plant is by having it tested in a laboratory. Most Cannabis breeding is done by selecting plants on the basis of size, smell, yield and high, rather than their cannabinoid profile. This means that simultaneously we have the dedicated Cannabis experts and breeders - with limited resources but a wealth of knowledge and experience of Cannabis use - and GW Pharmaceuticals: with all its money, resources and scientific know-how, but clearly no direct experience striving for the same thing. Both ultimately have the same goal, producing effective Cannabis-based medicine, but both are being held back by their lack of the very thing the other party has. You can see where this is going; medicines take a notoriously long time to get to market, but as more and more conditions are recommended for Cannabis therapy, the harder it will be for the anti-Cannabis lobby to paint it as the devil's-weed of 1930s prohibition propaganda.

Medical Community

The medical community has well and truly started to take notice of Cannabis as a possible panacea. Public opinion in the US is quoted as being 70% in favor of the Federal legalization of Cannabis; Switzerland have just made growing a personal supply of Cannabis a non-prosecutable offense; Portugal has decriminalized all drugs; while all over Europe laws on personal use are increasingly being relaxed - except in Britain. We are sadly now a long way behind the rest of the Western world in our attitude towards Cannabis. Still, if you're an MS sufferer with spasms, congratulations! You can now get the first legal Cannabis this country has seen for a very long time. What is certain is that the issue is not likely to go away, especially now that the pharmaceutical industry's appetite is whetted. As this goes to press a challenge has been raised to the monopoly that GW has been granted by the government to produce medical Cannabis. Since GW holds the only license in the UK, they certainly do have a monopoly, which is indeed illegal, so it will be interesting to see how it plays out. This is just the beginning.