Leading cannabis researcher, Dr Gabriella Gobbi, believes there needs to be separation between recreational and medicinal cannabis, as an increasing number of countries adopt drug reforms.
It is claimed that cannabis can be used to treat everything from pain and insomnia to anxiety and depression. Although there is a growing body of research exploring the use of cannabis as a potential treatment, the data to back these claims remains incomplete.
Dr Gabriella Gobbi, a leading cannabis researcher and professor at McGill University in Montreal, believes there is a danger in painting cannabis as a “magic drug”, and if used incorrectly, can have a detrimental effect on people’s mental health.
A recent report from Health Canada revealed that there has been an increase in self-medication amongst Canadians who are suffering from mental health issues like anxiety and stress.
As a psychiatrist and neuroscientist, Dr Gobbi sees the potential for the use of synthetic cannabinoids to treat mental health conditions through the regulation of the endocannabinoid system, however she believes that using THC or cannabis flower as a treatment is an “illusion”.
Cannabis Health spoke to Dr Gobbi to learn more about her research and why she believes it is vital to keep medicinal and recreational cannabis separate.
Cannabis Health: You first started studying cannabis in 2002. What were those early years of research like?
Dr Gabriella Gobbi: At that time, Canada had the highest rate of cannabis consumption in the world, among adolescents in particular. I met a lot of patients that had depression who were smoking cannabis, so I started to think that there must be a link between mood and cannabis.
This was the big question at the time. There was a lot of research about cannabis and psychosis, but there was [none] about the link between cannabis and mood disorders.
For this reason, we started to [study] if the endocannabinoid system was affecting mood. First, we demonstrated that a molecule called URB597, which increases endocannabinoids, has an antidepressant effect. We also found that CB1 agonists and THC both have antidepressant effects in the short term, but after a long time of consumption produce depression.
Over the years, we were really able to dissect the effect of cannabinoids on depression.
CH: People claim that cannabis can treat or help manage a long list of different conditions. What is your opinion on these claims?
GG: The problem today is that people use cannabis, both THC and CBD, for all kinds of diseases; for pain, for nausea, as antibiotics, for COVID-19, for increased immunity, the list goes on. It is not possible that THC and CBD will be a magic drug for everything. It is important to understand what is best for specific diseases and to understand the mechanism of action.
With pain, for example, it is very important that science can target one or two indications precisely, to know the doses of THC that should be used, and to understand which subtype of pain it can treat.
CH: Is there potential for cannabis as a treatment for mental health issues?
GG: This is a difficult question. It is very complex because in the short term it produces a euphoric effect, so it’s an antidepressant, an anxiolytic and it increases the capacity to socialise.
But, in the long term, after one or two years of high consumption, it has a [negative effect] on mental health.
You increase the risk of psychosis, you increase the risk of depression. I think it is only an illusion to think that cannabis can be used for mental health.
Having said that, we know that there are synthetic drugs that block the degradation of cannabinoids and increase the endogenous endocannabinoids which have sustained antidepressant, anxiolytic effects.
The way to go for mental health is not to use THC but to enhance the endocannabinoid system, so as to have a good effect on mental health.
CH: How does the effect of cannabis on the endocannabinoid system impact mental health?
GG: We must distinguish what THC does in the endocannabinoid system and how the endocannabinoid system can be used as a target for mental health.
There are a few studies saying that if adolescents consume a lot of THC, they actually create a down-regulation of the endocannabinoid system. This is very bad because it decreases 2AG [an important endocannabinoid] and causes the suppression of CB1 receptors.
We can find other pharmacological strategies to increase the natural endocannabinoids in the brain and this eventually can be a new target for mental health. But the illusion to use just THC to treat mental health is not viable and will not be a good strategy.
CH: The global push for the development of new cannabis-based medicines runs parallel with campaigns for the legalisation of recreational cannabis. Do you think the interconnection between the two poses any issues?
GG: The problem with cannabis is that since the beginning, 20 or 30 years ago, our society has mixed together the medical and the recreational. I don’t know why; for other plants it didn’t happen like that. This problem creates misunderstanding because people think that, since it’s a plant, it can only be good.
This is a big misconception that we have in our society. In my opinion, it is very important for medical cannabis to be distinct from recreational cannabis. We should keep medical cannabis and recreational cannabis separate.
It is also important not to use recreational cannabis at the same doses as medical cannabis. For example, the dose of medical cannabis for pain is about one gram a day, but for recreational cannabis, the dose should be much less.
When we have recreational cannabis with 25 percent THC, such as in Canada, this is a problem. This is not recreational cannabis; this is pharmacological cannabis with a lot of side effects.
CH: Canada legalised cannabis in 2018. What is your opinion on the country’s approach to legalisation?
GG: Canada included medical and recreational cannabis in the same law, but interestingly, the people that were against the legalisation were patients using cannabis because they didn’t want to be associated with recreational [users].
Canada does not have a maximum concentration of THC, so you can go into a shop and buy cannabis with 25 to 30 percent concentrations of THC, and buy up to 150 grams a month.
When I worked at the emergency ward, we saw people with psychosis that consumed up to five grams of cannabis per day. Before, we did not see these patients. When I asked where they bought it, they said SDQC [the sole retailer of legal recreational cannabis in Québec].
Before legalisation, it was mostly adolescents and people under the age of 25 consuming. Now, we have the elderly, a completely new population, consuming a lot of cannabis.
A good thing in Canada, however, is that it seems the consumption of cannabis in adolescents is slowing down.
CH: What are the risks of using cannabis as a teenager?
GG: We have demonstrated by doing a meta-analysis of studies from around the world, that if you smoke cannabis during adolescence, you increase the risk of developing depression later in your 20s – even in the absence of a predisposition. Cannabis is a trigger for depression later in life.
If you consume cannabis as an adolescent, you also have a greater chance of [developing] psychosis, even if you don’t have a predisposition. The same applies for schizophrenia and bipolar disorder.
If you have a predisposition for schizophrenia or bipolar disorder and you smoke cannabis, then your symptoms will be much worse, meaning the psychosis or bipolar disorder will start earlier.
There is a lot of evidence for this. There are so many epidemiological studies from around the world and we can’t just ignore the long term effect of cannabis in adolescence.
CH: Are you in favour of recreational cannabis?
GG: I’m not against it. I believe in good law and good legislation. We know that prohibition does not work, and we know that complete legalisation does not work either.
For recreational cannabis, I think it is very important to control the concentration of THC and the quantity that people can smoke. We have a lot of evidence-based data [suggesting] that high concentration cannabis is bad for people’s mental health.
I think we can do legalisation in a better way.
We need more campaigns warning people that cannabis is just temporary relief from anxiety and depression and not a treatment. Secondly, in my opinion, we need to control the percentage of THC in the cannabis that we sell and introduce a maximum recommended dose.
CH: What is your current research focusing on?
GG: What we are really interested in now is understanding a little bit more about CBD and its medical function. A lot of people use CBD oil, but we still don’t have the proof of concept for which diseases CBD can be used for.
We have to better understand CBD in pain and whether CBD can be used after opioid dependence. One of our studies in animals is to see if THC or CBD can help people recover from opioid dependence.
Another area of interest for us is to understand the co-administration of psychedelics and cannabis. We know that in the illicit market, a lot of people mix the two together and we want to understand what happens in the brain when the two meet.
Emigration: “I tried cannabis again and I noticed that I was in less pain when I took it.”
In a new series, we speak to Irish cannabis patients about their decision to emigrate in search of easier, safer cannabis access.
In a new series, Cannabis Health News talks to people who have experienced emigration in search of safe, legal cannabis access.
Our previous stories have focused on the difficulty of packing your entire life into boxes and emigrating with your family to a new country for access. However, there is another side to emigration: the potential for return.
What happens once you are a medical cannabis patient in another country and need to travel home?
The returning Irish from emigration in the past few years has hit record numbers. As people settle into life away from home, it gets harder to return. Travel options have never been easier with several flights to and from Ireland daily from all over the country, ferry options and failing that, zoom calls are a vast improvement on Skype.
COVID lockdowns meant that it’s been a difficult year for travel. Families who have experienced emigration may not have seen in their families since the beginning of the crisis. Now thanks to vaccines, travel is starting to become a possibility again.
This leaves medical cannabis patients in a confusing situation. What do you do if you have a prescription in one country yet need to go to another?
This is the situation *Joe is in. This is not his real name but he has asked to remain anonymous due to the persisting negative attitudes towards cannabis which he is prescribed for debilitating arthritis.
“I have since the age of 14 suffered from debilitating rheumatoid arthritis. I also suffer from sciatica. I played rugby six days a week for my school, worked on the family farm and lived a full and normal life. My body then changed and while initially my shoulders were affected but then my knees. It felt like someone was trying to tear my arms from their sockets and that I had broken glass in my knees. That was 36 years ago.”
Arthritis is a common condition that causes pain and inflammation in a person’s joints. Osteoarthritis and rheumatoid arthritis are the two most common forms of the condition. It can start when a person is between 40 and 50 years old although it also affects children and teenagers.
In rheumatoid arthritis, the body’s immune system targets affected joints causing pain and swelling. The outer covering of the joint is the first place to be affected before it spreads across the joint leading to further swelling and a change in shape. This may cause the bone and cartilage to break down. People with rheumatoid arthritis may also develop problems with other tissues and organs.
The Irish Children’s Arthritis Network (iCAN) estimates there are over one thousand children and teenagers currently diagnosed with juvenile arthritis.
Emigration in Ireland soared in the 1980s as a result of a harsh recession and lack of jobs. It is estimated that during the ten years of the 1980s, 206,000 more people left Ireland. Like a lot of Irish teenagers unable to find work and looking to leave home, Joe decided to leave Ireland for the UK. While working on a building site, he encountered other workers using cannabis.
“Although I had my condition to contend with it, my symptoms were at their worst in autumn and winter and I went to the UK in the summer to work on building sites (I had no idea my short visit would last 33 years and counting.”
“I was brought up in Ireland with typical conservative social values. Many fellow workers on site were smoking cannabis but I had no interest and indeed felt it was both inherently morally wrong as well as being illegal.”
“For months my fellow workers would say to try some. I relented when we were out together one night as I had a few drinks so my guard was down. I smoked some cannabis. I was violently ill. I did not know that smoking cannabis with drink would have such an immediate and obvious effect.”
Emigration, cannabis and pain
Joe began to feel more pain as winter began and his joints reacted to the cold. Despite his illness the first time, he tried cannabis again and noticed an effect on his pain levels. His quality of life began to improve and he started to make positive changes.
“I tried cannabis again a few weeks later and by this time the winter was in full flow and my bones were aching. I noticed that I was in less pain when I took it. I prayed for guidance on the issue and felt it was not a sin for me to use cannabis because it was helping to alleviate my symptoms.”
“I then started to use cannabis more frequently. When I reached 19, I no longer needed to take my prescription and I was able to cancel an appointment for injections. As my condition had relented I was able to reengage with my passion for sport and would swim a mile per day, cycle to and from work and work as a scaffolder during the day.”
“I studied A levels at night school. I returned to studies as I felt if my condition worsened I would not be able to engage in physical labour and I also had a calling to be a lawyer. Anyone who has handled scaffolding tube on a cold winters day will also understand why I felt a move indoors could be a welcome change.”
Joe did well enough in his A levels to gain a place to study law at university. He qualified as a solicitor and worked at one of the top regional practices in the country. He had the honour of meeting Irish President Mary McAleese on one of her trips to Manchester. He credits being able to live such a full life to the benefits of cannabis.
Breaking the law
However, he was starting to worry about what could happen if his use was to become public knowledge. Especially as someone working in law.
“Cannabis had managed my condition so effectively that I was able to play football for the corporate team and had no outwards signs which could not be dismissed as being down to simple stiffness. I was concerned however that should my use of cannabis become public knowledge my career would be brought to an abrupt end.
“I was leading a double life – cannabis at the time was dismissed as having no medical use and I was afraid no-one would believe me if I said I was taking it for my arthritis.”
Joe stopped using cannabis for three years as he became fed up with breaking the law. He had also noticed attempts to change the law in regards to medical cannabis and wanted to see if he could access it legally. But his symptoms flared up as a result of him stopping his treatment.
“During my cannabis break however my arthritis flared up with a vengeance. Although now prescribed methotrexate, sulfasalazine and naproxen. During my near 30 year use of cannabis prior to this point, I needed no other drugs. Significant bone erosion occurred in this 3 year period.”
“My hands and feet were badly affected and I was unable to form a fist with either hand for about 2 years. I had to stop playing classic guitar. In addition to studying law, I also studied music and played guitar in ensembles and gave performances with others in my spare time so losing the ability to play was quite hard to take”
Joe was delighted when his prescription for cannabis was approved. After taking it for about a year, he found his condition far more under control and began to come off some of the drugs he had been prescribed. He was also able to play the guitar again.
One of the biggest things, he notes, is the feeling of being able to access his medication responsibly and not break the law.
“Cannabis, for me, does have limitations. Once I take it, I won’t drive for the rest of the day. It can give me mood swings although nothing too extreme. I can be grumpier in the mornings. I am mindful that all drugs have their side effect. I am losing my hair due to methotrexate which gives me a number of bladder issues as well as nausea.”
Emigration and settling
Although Joe is happily settled in the UK with no plans to move home, he still has family in Ireland who he would like to visit. This presents him with an issue, how to pack his prescription?
Going without cannabis while abroad can result in a lot of pain as Joe discovered when he stopped taking it. However, bringing it with him can result in having to again break the law. The other alternative is accessing the black market which is not safe for patients.
“My elderly parents live in Ireland and I would love to visit them. Ireland’s policy on drugs is different to that of the UK. There is nothing unusual about this as individuals states have their own laws. The UN passed the psychoactive Substances Convention in 1971. The Convention enables international travellers to bring their medication with them to other jurisdictions, even though they have different drug policies. Ireland is a signatory to this convention. The Irish State also supplies details of who to write to seek prior approval for the carriage of controlled drugs.”
Joe has started an email and letter campaign of writing for help. He is not the only Irish person in the UK who has experienced emigration and wants to travel home. He encourages others to get involved.
“I have on many occasions asked both the relevant Secretary for Health and the Minister for Health for permission to travel to Ireland with my cannabis prescription and for clarification of Ireland’s drug policy for tourists and have pointed out the large numbers of people who could be affected. It’s not just persons prescribed cannabis if Customs is going to seize all controlled drugs.”
“Although nearly 6 months have passed, I am yet to receive either a formal approval or rejection of my request to travel home. In the meantime, my parents are of course getting older as indeed am I.”
There are also other concerns about using cannabis medicine while in another country besides emigrating.
Joe cautions: “To anyone who is thinking of just leaving their cannabis medication at home in the UK and then driving in Ireland, please bear in mind that in addition to dealing with withdrawal symptoms you may also fail a roadside drugs test.”
“It’s not at all clear that you will have a medical defence to a drug driving charge in Ireland. Thus if you want to travel lawfully with a car, consider not taking your cannabis prescription for sufficient time to pass a drug driving test, but obviously, this is impractical for sick people who are only granted a prescription for cannabis where other medicines haven’t worked.”
Joe advises that those thinking of travelling to Ireland with their prescriptions for CBMP should seek approval for their medication. This can be done by writing to the Controlled Drugs Unit in Dublin.
CBD and gaming: Could CBD help you level up?
When it comes to gaming, could CBD give you a competitive edge? Always Pure Organics’ Sally Dempster explores the benefits.
Always Pure Organics’ Sally Dempster explores the CBD trend within gaming.
The gaming community is growing exponentially, from people playing casually with friends to professional esports competitors, all of whom are contributing to the phenomenal 1.8 billion (US) dollar industry. Especially with the lockdown conditions of Covid-19, the gaming industry has seen a huge surge in revenue and time spent video gaming- increasing by double digits in all regions. The increased amount of time spent gaming can sometimes lead to health problems; frequent players often report physical aches and pains, altered sleep cycles, stress and anxiety. Many of these health problems can be caused by the prolonged periods of time spent at a console or in front of a screen.
Physical aches and pains from gaming can manifest themselves in a variety of forms including carpal tunnel syndrome, gamer’s thumb, and tennis elbow. Avid gamers can sometimes fall prone to these problems which cause inflamed muscles, nerves, or tendons due to overuse.
Whilst cannabidiol (CBD) cannot cure the underlying damage caused by carpal tunnel syndrome, gamer’s thumb or tennis elbow, it may help to reduce overall swelling and it has been shown in studies to relieve inflammation. Research on CBD has also shown that the Cannabis sativa extract may, in some cases, be beneficial as a method of pain relief. Using CBD as a form of pain management could help to relieve pain from gaming conditions, enabling players to be more stress-free and relaxed throughout the natural healing process. It is important to note that using CBD as a method of pain management for acute pain will not result in instant healing; users should be aware that any decrease in pain does not equate to a fully healed injury.
Gaming and scientific debates
There are ongoing scientific debates as to whether video games induce stress or whether they help to manage and reduce it. The answer to this debate perhaps depends on the level of investment that the player has in the game. Players who spend less time gaming or who only play for recreational and social purposes, for example, are less likely to get stressed during play compared to high stakes players or career gamers.
Evidence points towards CBD having a calming effect on the central nervous system. Taking CBD before gaming may help pre-emptively mitigate stressful feelings, this is due to the fact that CBD is a neurotransmitter that will bind to receptors in the brain. These bindings displace any anxiety-inducing neurotransmitters and stop them from binding to the receptor, which helps to restore equilibrium in the brain.
A recent study determined that video games do affect the stress system, in addition to the cognitive system of humans depending on the game style. Fear inciting games, which feature genres such as, survival, action, and psychological horror is more prone to elicit feelings of stress and tension. The research also demonstrated that the type and level of stress triggered in the players depend on the game style (Aliyari et al., 2021).
Esport competitions have closely monitored regulations regarding doping. Competitions adhere to the World Anti-Doping Agency (WADA) list of prohibited substances; players found breaking these regulations could find themselves (and their teammates) banned from competing. Cannabidiol is the only cannabinoid compound found in cannabis permitted in esport competitions.
Although WADA has removed CBD from its list of prohibited substances it is still advised that competitors using the extract choose CBD products carefully as some broad-spectrum products contain low levels of THC which is still a banned substance in esports competitions.
As the number of gamers increases and the industry grows, player gaming injuries will become more prevalent; extracts such as CBD may prove useful in mitigating these issues. Cannabidiol could, in some cases, also aid with the reduction of stress created when playing video games. Especially at high levels of competitive esports, there is an intense amount of pressure on the players to perform; now that WADA has approved CBD for use in competitions it may be able to minimise players’ feelings of stress and anxiety while gaming.
CBD may reduce side effects associated with anti-seizure medications.
Could CBD help with the side effects of anti-seizure medications for people with epilepsy?
A study published in the journal, Epilepsy and Behaviour examined CBD’s potential impact on anti-seizure medications for people with epilepsy.
There are 600,0000 people living with Epilepsy in the UK. It’s one of the most common nervous system disorders affecting people of all ages. It’s a neurological condition that can result in seizures. Treatment for epilepsy can include anti-seizure medication, diet therapy such as the ketogenic diet and surgery.
The side effects of medication can include dizziness, nausea, headaches, fatigue, vertigo and blurred vision.
There are medications such as Epidolex prescribed for rare seizure disorders such as Dravet syndrome or Lennox-Gastaut syndrome. However, it is not approved for other forms of epilepsy. There are around 60 different types of seizures and it is possible to have more than one type. Seizures can vary depending on where in the brain they are happening.
They analysed data collected between April 2016 and July 2020 from 418 patients. The participants included 71 adults with epilepsy who used artisanal CBD products for medicinal purposes and 209 who were caregivers of children or adults who also used artisanal CBD. The control group of 29 adults with epilepsy who were considering CBD and 109 caregivers who were interested in it for dependent children or adults.
Participants were asked to fill in a survey and answer questions about their quality of life, anxiety, depression and sleep. They were also given follow up surveys every three months for over a year.
In comparison with the control group, artisanal CBD users reported 13 percent lower epilepsy medication-related adverse effects. They also had 21 percent greater psychological health satisfaction at the beginning of the study.
Their anxiety was recorded as being 19 percent lower and depression was 17 percent. Both the adult and youth groups reported better quality sleep than the control group.
The caregivers of patients currently using CBD reported 13 percent less stress and burden in comparison with the control group. Patients in the control group who started using artisanal CBD reported improvements in their physical and psychological health. They also self-recorded reductions in anxiety and depression.
Participants were asked to record possible adverse effects related to their CBD use. Among all of the participants, 79 percent did not report any effects.
Of the remaining participants, 11 percent reported potential drowsiness, 4 percent said their symptoms may have gotten worse, 3 percent had concerns about the legality and 4 percent worried about the cost of the profits.
The researchers reported that further research is needed to understand how the findings could be applied to patients. They also stated that patients should consult with their doctor before trying CBD products.
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