As a rural physician making house calls to palliative care patients, Dr. Danial Schecter learned first-hand the power of the cannabis plant. It was on his rounds of the homes along the quiet shores of Georgian Bay that he first discovered that many of his patients were self-medicating with cannabis, a drug he then knew little about. Since, he’s spent time under the tutorship of Dr. Mark Ware and helped hundreds of patients transition from illegal channels to the MMAR, then the MMPR and now the ACMPR. We connected with Dr. Schecter, co-founder of the Cannabinoid Medical Clinic, to discuss the young science of the endocannabinoid system and find out what developments on the topic could mean to the medical cannabis community.
The endocannabinoid system (ECS) is known as “the body’s own cannabis system.” Can you explain that categorization?
One of the reasons is because the molecule that really controls the endocannabinoid system is called a cannabinoid, and this molecule is actually produced in the body. It’s interesting that this molecule is also the main molecule that is present in the cannabis plant, and the effects of our own body’s cannabinoid, or endocannabinoid, parallels the effect that the cannabinoids that are found in the cannabis plant have. So, in a way, we have our own cannabis system within the body that is controlled by the very same molecules that are in existence in nature, so our body and nature work really hand in hand.
What is the system primarily responsible for?
The endocannabinoid system plays a function in an incredibly wide range of conditions. So it’s actually more pertinent to say not ‘what is the endocannabinoid system responsible for?’ but more so, ‘where have we not found the endocannabinoid system to play a role?’ The endocannabinoid system is really a signaling system that is in part responsible for controlling things and keeping things in balance, specifically with regard to our sensation of pain, our anxiety, our sleep-and-wake cycles, our digestion, our reproductive system and fertility. It plays an incredibly wide range of functions across an incredibly vast number of systems within the human body.
Where in the body is the ECS located?
The ECS is pretty much located in every single tissue, but the two areas that have provided the most amount of research interest is in the central and peripheral nervous system, as well as the nervous system that’s found in the GI tract. The other area is in the immune system. It’s really interesting that the endocannabinoid system has such an effect on our nervous system – not only our brain, not only the nerve that goes throughout the body, but the gut, which has its own nervous system. There are actually as many neurons in our gut as in our brain.
The ECS is known as the largest receptor system in the human body. What endocannabinoid receptors have been identified?
We basically have two main cannabinoids that have been identified, CB1 and CB2, and a few more that are under active investigation. These two receptors are located in very different parts of the body. The cannabinoid receptor 1s are located in the central, peripheral nervous system, and the GI system, and cannabinoid receptor 2s are found within the immune system.
Why are they significant?
Cannabinoid receptors are actually not found in this one little area of the brain called the brain stem. And that’s where we have what is called a respiratory drive; that’s what controls breathing. We have very few receptors, so no matter how many cannabinoids you flood your central nervous system [with], it will never cause you to overstimulate the cardio-respiratory sector, or the brain stem. So cannabis, or cannabinoids, are a very safe drug. It would take about 1,500 pounds of marijuana consumed in a 15-minute period to cause death. So I don’t even think Snoop Dogg could consume that amount. That said, cannabis isn't suited for certain people, especially those with unstable cardiac, respiratory or psychiatric illness. It should also be used in caution in other individuals including those who are younger than 25, pregnant or breastfeeding.
In the context of medical cannabis, why is the endocannabinoid system an important area of research?
The endocannabinoid system represents a completely new avenue for us to be able to develop therapeutic treatment. Right now, we have an incredibly high proportion of our population that is living with chronic disease, and this chronic disease has caused the quality of life to be incredibly poor for a large number of people. And the medications that we currently have to treat these chronic diseases – whether it be pain, epilepsy, PTSP, gastro-intestinal problems – are simply not always effective. If they are, often they provide very negative side-effects. Manipulating, or finding medication derived from medical cannabis, offers a brand-new and unique class of medication that we can now provide to patients that is incredibly safe and has few interactions with other medications. It’s a fertile area of study and I think it really represents a hope for many, many people who aren’t able to tolerate medications or therapies that are currently offered.
Research on the system is still developing. In what areas do we have the strongest evidence for the system?
In the greater context of things, the endocannabinoid system is in the developing stage of trying to understand why it works, how it works and how we can manipulate it to get the best effects. It has been identified for 30 years and there’s an exponential interest in research that has to with basic science and pre-clinical science, and there’s been a lot of research to suggest many different areas where the endocannabinoid system may be useful. But from a clinical perspective, the highest degree of evidence that we have has to do with neuropathic pain.
Do you think clinical trials with compounds that modulate the ECS will lead to novel approaches to treat disease?
There’s an incredible amount of research and thought that suggests in future we will be able to more precisely modulate the endocannabinoid system in order to treat more specific symptoms or diseases. I absolutely agree that within five, 10, 20 years, there will be a good number of medications that are available on the market that have gone through high-quality randomized controlled trials that do modulate the endocannabinoid system. And I have no doubt that some of these medications will be used in the treatment of patients with cancer, patients with treatment-resistant epilepsy, various types of chronic pain and likely anxiety and gastro-intestinal disorders.
Why is the ECS not yet taught in medical schools and what will it take to make that happen?
When I give presentations to other physicians about cannabis 101, I always talk about the endocannabinoid system, because that’s at the very heart of understanding why cannabinoids can be considered a viable therapeutic alternative. I ask for a show of hands for who has learned about the endocannabinoid system in school or residency, and there might be one or two hands that shoot up. And this is because the endocannabinoid system, although it’s been identified, is still relatively poorly understood. We still don’t have medications that can modulate the endocannabinoid system in a precise way in order to affect single changes in the body. With time, as we develop more medication that can precisely modulate the endocannabinoid system, we’re going to be learning about this a lot more within medical schools.
What is the function of the endocannabinoid anandamide?
Anandamide is one of the body’s own naturally-producing endocannabinoids. It basically emulates the endocannabinoid system and plays an incredibly important role in modulation of pain states, anxiety, sleep, appetite and it also mimics the actions of THC, which most commonly makes someone feel happy, hungry and sleepy. The word anandamide comes from the Sanskrit word meaning Ananda, which means bliss. And that derives from the sensation that Ananda, or THC, or the endocannabinoid system, can make you feel.
Do you believe there is such a thing as an endocannabinoid deficiency? If so, what symptoms and conditions could that deficiency cause?
Many people ask about whether the endocannabinoid deficiency syndrome exists and we truly don’t know. I have a strong suspicion that we will find evidence to support that certain people have a low functioning endocannabinoid system, and that could be why they feel lethargic, tired, low energy and it could be the reason why they have increased pain or higher states of anxiety. It could by why, even though they don’t have a specific diagnosis, they do respond well to cannabis. The body is such a complex phenomenon, biology is so incredibly complex and the endocannabinoid system plays such an important role in so many different aspects of human functioning, that it must have some way of being downregulated through a genetic component that we haven’t yet identified. I’m almost positive that with enough time and enough research, that we will be able to identify such a thing as a cannabinoid deficiency syndrome.
We want to thank Dr. Schecter for his answers and insight!