The production, processing, and oversight of medical Cannabis currently straddles a line between pharmaceutical and food product. Although Cannabis is used to treat a myriad of medical conditions, it is produced in a manner closer to growing strawberries than to producing medication.
What makes Cannabis Medicine?
The Cannabis plant has dozens of active ingredients called cannabinoids which are found in a wide range of concentrations within the flower, leaf, and stem. The Cannabis plant produces cannabinoids in varying levels throughout the plant, a majority of which can be found in the flowers of the female plant and are concentrated in a viscous resin that is produced in glandular structures known as trichomes. In addition to cannabinoids, the resin is rich in terpenes, which are largely responsible for the odor and many nuanced physiological differences within the plant and from strain-to-strain.
Cannabinoids are delivered to the body by several different routes, including smoking the raw plant material, a variety of concentrates, ingesting the plant material in a variety of forms, or even by applying topically. Researchers have identified over 100 unique cannabinoids within the Cannabis plant. Many of these cannabinoids interact with the human endocannabinoid system using the cannabinoid receptors found throughout our bodies.
Although there are newly recognized endocannabinoid receptors currently being identified and studied, the two main known subtypes of endocannabinoid receptors are termed CB1 and CB2. The CB1 receptor is expressed mainly in the brain and central nervous system, but also in the lungs, liver and kidneys. The CB2 receptor is mainly expressed in the immune system, hematopoietic cells and throughout the gut. The affinity of an individual cannabinoid to each receptor determines the effect of that cannabinoid. Cannabinoids that bind more selectively to certain receptors are more desirable for medical usage.
The following chart is adapted from Figure 1 in Raphael Mechoulam, et al., “Nonphyschotropic Plan Cannabinoids: New therapeutic opportunties from an ancient herb”, Trends in Pharmacological Science, 1-13 (2009).
Due to the unique nature of the distribution network, regulation, and legal status, Cannabis poses several questions for regulators, producers, retailers, and consumers alike. One of these questions must be: “How will this medicine be provided to patients in an acceptably safe form and with a consistent and known dosage?” As state and local governments begin providing a more comprehensive regulatory environment for the production and distribution of Cannabis, solving that problem must rank as a high priority.