Danisha Kumar ( 1st Year MBBS Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. )
Taimur Faheem Usmani ( 1st Year MBBS Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. )
Moeez Tariq ( 4th Year MBBS Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. )
May 2023, Volume 73, Issue 5
Student's Corner
Abstract
DOI: 10.47391/JPMA.7805
Madam, Marijuana, also known as cannabis, is a plant-based illicit drug notorious for its recreational purposes. However, in recent years its extracts are being extensively studied for their overall therapeutic effects. Active substances found in marijuana that interact with the endocannabinoid system are known as cannabinoids, the primary examples being 9-tetrahydrocannabinol (9-THC) and Cannabidiol (CBD). These cannabinoids ligand to receptors such as CB1 (found in CNS) and CB2 (found in immune system cells) to prevent the release of neurotransmitters and modulate immune cell migration as well as cytokine release, respectively1. In recent years, there has been a surge of interest in the neuroprotective potential of marijuana; however, investigators could not make firm conclusions about the effectiveness of these treatments. A comprehensive review by Bahji A et al. (2022)2 found an evident link between cannabidiol-based products and relief from the motor as well as behavioural and psychological symptoms spanning Alzheimer's disease (AD), Huntington's disease (HD), and Parkinson's disease (PD)2. Here we discuss the effects of marijuana and its derivatives on the treating significant neurodegenerative disorders.
Dronabinol (2.5 mg) seemed to lessen the disordered behaviours as assessed by the Cohen-Mansfield Agitation Inventory in 12 patients of AD (p=0.05)3. Sherman et al. (2018) reported the association of cannabis administration with weight and pain management in AD patients. The adverse effects are typically well tolerated at the levels supplied, even though cannabis is linked to an increased risk of euphoria, sleepiness and psychosis1. On the other hand, for HD, nabilone (1 or 2 mg) had a substantial therapeutic benefit in a different 10-week placebo-controlled crossover experiment as determined by the overall motor and chorea score on the Unified Huntington's Disease Rating Scale (UHDRS)4. Available reviews revealed variable evidence suggesting the clinical benefits of cannabis in treating motor symptoms in patients with PD. A randomized trial found that compared to a placebo, giving a single dosage of 300 mg of CBD successfully decreased tremor amplitude5.
Neurological diseases, including the neurodegenerative diseases, comprise 8.7% of the disease burden in lower- middle- income countries (such as Pakistan)6. Currently, there is no real cure for neurodegenerative disorders, only symptomatic management, such as dopamine treatment for PD or cholinesterase inhibitors for dementia. Cannabinoids might be the lifeline all neurodegenerative disorder patients have been waiting for. However, for it to be viable hurdles like the legality of its use must be crossed, as possession, selling and growing of cannabis are all banned in Pakistan with punishments of up to a life sentence under certain conditions7. To overcome this further research and increasing awareness are suggested.
Submission completion date: 20-09-2022
Acceptance date: 23-12-2022
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Sources: None to declare.
References
1. Sherman C, Ruthirakuhan M, Vieira D, Lanctot KL, Herrmann N. Cannabinoids for the treatment of neuropsychiatric symptoms, pain and weight loss in dementia. Curr Opin Psychiatry. 2018; 31:140-6. doi: 10.1097/YCO.0000000000000399.
2. Bahji A, Breward N, Duff W, Absher N, Patten SB, Alcorn J, et al. Cannabinoids in the management of behavioral, psychological, and motor symptoms of neurocognitive disorders: a mixed studies systematic review. J Cannabis Res. 2022; 4:11. doi: 10.1186/s42238-022-00119-y.
3. Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ. Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 1997; 12:913-9.
4. Lim K, See YM, Lee J. A systematic review of the effectiveness of medical cannabis for psychiatric, movement and neurodegenerative disorders. Clin Psychopharmacol Neurosci. 2017; 15:301-12. doi: 10.9758/cpn.2017.15.4.301.
5. de Faria SM, de Morais Fabricio D, Tumas V, Castro PC, Ponti MA, Hallak JE, et al. Effects of acute cannabidiol administration on anxiety and tremors induced by a Simulated Public Speaking Test in patients with Parkinson's disease. J Psychopharmacol. 2020; 34:189-96. doi: 10.1177/0269881119895536.
6. Organization WH. Neurological disorders: public health challenges: World Health Organization; 2006. [Online] [Cited 2022 August 12]. Available from: URL: https://www.who.int/ publications-detail-redirect/9789241563369
7. The Control of Narcotic Substances Act. [Online] [Cited 2022 August 7]. Available from: URL: https://khalidzafar.com/laws-ofpakistan/control-of-narcotics-substances-act1997/#:~:text=The%20Control%20of%20Narcotics%20Substance ,to%20the%20whole%20of%20Pakistan..
Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees:
