Module 5 Assignment
Cannabis in Nursing
Pharmacotherapeutic management of different conditions in hospitals has undergone several developments over the decades. Conditions that were for instance resulting from inadequate secretion of hormones have been treated by administering such hormone replacement. This has been the case with insulin therapy in diabetes management or even hormone replacement therapy in postmenopausal women who may develop complications such as osteoporosis, atrophic changes, and mood disturbances. The use of cannabis use in healthcare is another evidence of the advancement of pharmacotherapy. Although the application is still controversial with only a few states legalizing medical cannabinol use, the therapy manipulates an existing endocannabinoid system in the body to exert its effects (Pratt et al., 2019). As such, the effects of the exogenous cannabis administered are almost the same as that of endogenous components that exist in the body. Understanding how cannabis works in the body would be necessary for the nurses including the routes of administration of the substances to promote the justified application of the therapy in practice. The objective of this assignment is to discuss cannabis use in healthcare by describing the endocannabinoid system (ECS), discussing the endocannabinoid deficiency syndrome, and highlighting its routes of administration.
How Cannabis Works in the Body
Endocannabinoid System (ECS)
The ECS encompasses the body components that interact with the administered cannabis to exert its effects. The components are usually naturally existing in the body to interact with the endogenous cannabinoids, which is a cannabis-like substances in the body (Miller et al., 2020). ECS exists in both humans and animals where the actions and functions are the same. Some of the components of the system include endocannabinoids, enzymes, transporter proteins, and receptors. Endocannabinoids that is naturally secreted in the body include 2-arachidonoylglyerol (2-AG), anandamide (AEA), palmitoylethanolamide (PEA), and oleoylethanolamide (OEA). These substances interact differently with the cannabinoid receptor 1 (CB1) in the brain and cannabinoid receptor 2 (CB2) in the other parts of the body including the liver, muscles, and even gastrointestinal system. Regulation of their action is thereafter achieved when they are broken down by the endocannabinoid enzymes which include monoacylglycerol acid lipase, which typically breaks down 2-AG, and fatty acid amide hydrolase which breaks down AEA (Pratt et al., 2019). This breakdown terminates the interaction of the endocannabinoids and the receptors and therefore modulates their actions and effects. It also breaks down the naturally occurring anandamide, a cannabinoid, to prevent the continuous cannabinoid effects.
In addition to the enzymes that regulate the endocannabinoid function, there are the endocannabinoid transporters as components of the ECS. These transporter proteins conduct the endocannabinoid into and out of calls thus regulating their action on the intracellular receptors. Some of these transporters include Hsp70 and fatty acid amide hydrolase (FAAH) (Miller et al., 2020). Their involvement in transport can be employed during treatment with exogenous cannabis.
Effects of Cannabis within the Body
The effects of cannabis are realized after the interaction of its active component tetrahydrocannabinol (THC) on the aforementioned cannabinoid receptors. When the cannabis that is obtained through its different forms is taken, its active component THC for instance binds to the CB1 or CB2 to exert their functions which include neurogenesis and neuroprotection, regulation of appetite, inflammation, nociception, cell growth, mood, and metabolism of lipids and glucose (Cohen et al., 2019). It may also promote smooth muscle contractility, motivation, and mood, and enhance cognitive functions. In the brain, through the CB1 interaction, they may act as neurotransmitters as opposed to spinal nerves where they bind to CB2 to regulate pain modulation, therefore, achieving pain relief (Pratt et al., 2019). The THC’s action is however short-lived due to metabolism by the FAAH enzyme that breaks it down and prevents its exaggerated action and body response.
Endocannabinoid Deficiency Syndrome (ECD)
The ECS functions that were described are important for hemostasis. Its action in individuals, however, varies with some having a relatively abundant state with optimum action while others have a deficient state with suboptimal action (Meccariello, 2020). The deficient action of ECS presents with a myriad of manifestations that are commonly referred to as clinical endocannabinoid deficiency syndrome (CECD). Patients who present with different chronic conditions such as chronic migraine, fibromyalgia, and irritable bowel syndrome have been postulated to have endocannabinoid deficiency that informs the disease presentation.
Chronic Migraine
Migraine is characterized by recurrent headaches and is thought to arise from abnormal processing and modulation of pain sensations. Activation of the trigeminovascular system with the release of the vasoactive substances from its nerve ending is thought to be the initiator. The vasoactive substances that include serotonin trigger an inflammatory response that would also include the increased permeability of the vessels and inflammation of surrounding brain tissue which then presents with visual disturbances, dizziness, and numbness (Greco et al., 2018). Due to the involvement of trigeminal nerves, severe throbbing pain is also reported. The condition is reportedly worse in CECD (Meccariello, 2020). In these individuals, the AEA that is usually produced in response to inflammation to reduce the inflammation and minimize nociception is inadequate thus exaggerating inflammatory response and symptoms (Greco et al., 2018). As such, activation of ECS may be attempted by the administration of cannabis in these patients to attempt to reduce the inflammation and reported pain.
Fibromyalgia
Fibromyalgia presents as chronic musculoskeletal pain and has a prevalence of between 2-8% in the US (Bourke et al., 2022). The reported pain is exaggerated and may be associated with stiffness, chronic fatigue, and non-restorative sleep. Genetic abnormalities that alter the endocannabinoid system including single nucleotide polymorphisms that affect the endocannabinoid receptors have been identified in individuals with fibromyalgia leading to high circulating levels of endocannabinoids with a relatively low response (Cohen et al., 2019). In these individuals therefore pain modulation effects of the endocannabinoids are decreased and pain sensation is heightened. Therapy with endocannabinoids may be employed to address the patient’s symptoms.
Irritable Bowel Syndrome (IBS)
This gastrointestinal disease which presents with abdominal pain with associated changes in bowel emptying frequencies is reported to have a prevalence of 7-16% (Pandey et al., 2020). Although its pathology is unclear, the deficiencies of the endocannabinoid system have also been implicated. Given activation of CB1 and CB2 usually regulate intestinal motility, secretion, and hypersensitivity in addition to anti-inflammatory action, it is proposed that the patients with IBS have an alteration of ECS that leads to their symptoms (Pratt et al., 2019). Therapy with cannabinoids can therefore be attempted especially in individuals whose symptoms do not respond to contemporary therapies so that the alteration of ECS is addressed and patient symptoms relieved.
Cannabis Delivery Routes
Cannabis has different forms that affect the delivery routes. Such delivery routes vary in the quantity of drug delivered, the onset of action, and the effect of therapy. Their advantages and disadvantages also vary.
Oral/oromucosal/sublingual administration
The cannabis products that are consumed through this route include cannabis embedded in food such as weed cookies, beverages, chocolate, and oils or Sativex® which is an oromucosal spray (Russell et al., 2018). After administration, the substances cross the mucosal barrier and move into the blood and through the liver into the site of action. In the liver, it might be metabolized to reduce the blood concentration of the drug which decreases drug bioavailability due to the first pass metabolism. This biodegradation may reduce the concentration of cannabis by up to 15% thus should influence the higher dosing for edible therapeutic cannabis (Subbaraman & Kerr, 2021). Its onset of action would be between 0.5-6hours although the duration of action may be as long as 24 hours. This route of administration is convenient for the condition being treated with some capsules designed to act in specific parts of the digestive tract after their enzymatic activation thus helping in achieving site specificity (Russell et al., 2018). However, the aforementioned first pass metabolism reduces the bioavailability and might interfere with the effectiveness of administered drugs if the dosage is not adjusted.
Rectal Administration
Cannabis suppositories may be administered either rectally or through the vagina to exert their action. Such suppositories penetrate the mucosa into the bloodstream and are then transported to the site of action. Given the facilitated mucosal penetration, its onset of action is within 10-15minutes but the duration of action is relatively short as it is only up to 8 hours (Cohen et al., 2019). The advantage of this route of administration is the rapid onset of action that may help in emergency treatment as well as increased bioavailability due to the elimination of first-pass metabolism. However, the cons include the route which may be uncomfortable for some patients and less discrete thus interfering with adherence to medication (Subbaraman & Kerr, 2021). Further, the suppository drugs require storage in the refrigerator thus interfering with their transport.
Topical Administration
Topical products such as creams and lotions are administered topical especially where a localized effect of the drug is desired. This route however has a slow rate of absorption with its peak concentration at 2 hours and sustained absorption and response up to 48hours (Bruni et al., 2018). The prolonged absorption has an advantage as it can be applied to provide extended therapy when such is desired. It might however have limited value for patients with skin hypersensitivity, especially to the components of creams or lotion (Russell et al., 2018).
Inhalation Route
Widespread use of cannabis has been in form of cigarette that is smoked. Although it is majorly used by recreational users, the route can be employed for therapeutic use (Bruni et al., 2018). Vaporizing form is another effective alternative to smoking for inhalation of cannabis. This route has the most rapid onset of action within 2 minutes after inhalation although the duration of action is up to 24 hours (Subbaraman & Kerr, 2021). Its rapid onset of action is an advantage that may help it to be used in emergencies (Bruni et al., 2018). The route, however, poses health risks including chronic bronchitis and even lung cancer which limits its applicability in practice.
Conclusion
The use of ECS includes endogenous cannabinoids, receptors, and enzymes that function together to influence the function of the system. In states where there is an alteration in either component of this system, the CECD results in its various forms including chronic migraine, fibromyalgia, and irritable bowel syndrome. Management of these conditions would require the administration of exogenous medical cannabis in its different forms via different routes which include inhalation, oral, rectal, and topical administrations. These routes however have varying onset of actions and duration of actions that must be considered before either is chosen.
References
Bourke, S., Schlag, A., O’Sullivan, S., Nutt, D., & Finn, D. (2022). Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research. Pharmacology &Amp; Therapeutics, 240, 108216. https://doi.org/10.1016/j.pharmthera.2022.108216
Bruni, N., Della Pepa, C., Oliaro-Bosso, S., Pessione, E., Gastaldi, D., & Dosio, F. (2018). Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Molecules, 23(10), 2478. https://doi.org/10.3390/molecules23102478
Cohen, K., Weizman, A., & Weinstein, A. (2019). Positive and Negative Effects of Cannabis and Cannabinoids on Health. Clinical Pharmacology &Amp; Therapeutics, 105(5), 1139-1147. https://doi.org/10.1002/cpt.1381
Greco, R., Demartini, C., Zanaboni, A., Piomelli, D., & Tassorelli, C. (2018). Endocannabinoid System and Migraine Pain: An Update. Frontiers In Neuroscience, 12. https://doi.org/10.3389/fnins.2018.00172
Meccariello, R. (2020). Endocannabinoid System in Health and Disease: Current Situation and Future Perspectives. International Journal Of Molecular Sciences, 21(10), 3549. https://doi.org/10.3390/ijms21103549
Miller, S., Daily, L., Dharla, V., Gertsch, J., Malamas, M., & Ojima, I. et al. (2020). Endocannabinoid metabolism and transport as targets to regulate intraocular pressure. Experimental Eye Research, 201, 108266. https://doi.org/10.1016/j.exer.2020.108266
Pandey, S., Kashif, S., Youssef, M., Sarwal, S., Zraik, H., Singh, R., & Rutkofsky, I. (2020). Endocannabinoid system in irritable bowel syndrome and cannabis as a therapy. Complementary Therapies In Medicine, 48, 102242. https://doi.org/10.1016/j.ctim.2019.102242
Pratt, M., Stevens, A., Thuku, M., Butler, C., Skidmore, B., & Wieland, L. et al. (2019). Benefits and harms of medical cannabis: a scoping review of systematic reviews. Systematic Reviews, 8(1). https://doi.org/10.1186/s13643-019-1243-x
Russell, C., Rueda, S., Room, R., Tyndall, M., & Fischer, B. (2018). Routes of administration for cannabis use – basic prevalence and related health outcomes: A scoping review and synthesis. International Journal Of Drug Policy, 52, 87-96. https://doi.org/10.1016/j.drugpo.2017.11.008
Subbaraman, M., & Kerr, W. (2021). Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state. Journal Of Cannabis Research, 3(1). https://doi.org/10.1186/s42238-021-00071-3
Assignment: Cannabis 101 for Nurses
Write a 1000-1500 word essay addressing each of the following points. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.
Explain how cannabis works in the body by including information regarding the endocannabinoid system (ECS) and endocannabinoid deficiency syndrome.
Describe four different delivery routes patients may use cannabis, the onset of action for each, and one pro and one con of each route.
