Cannabis is derived from two main plant species: Cannabis Sativa and Cannabis Indiga. Interestingly, cannabis is not a single drug but rather a complex compound comprising hundreds of different chemicals including cannabinoid and non-cannabinoid compounds1-5. The most well-known and active cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) which have greatly differing effects on the human body.
To add to complexity, there are hundreds of different strains of cannabis with varying ratios of CBD: THC and therefore differing clinical effects. Furthermore, the effects of the other non-cannabinoid compounds such as terpenes, flavonoids are less known.
Abundant data exists supporting the clinical benefits of cannabis on pain 6,7, chemotherapy related nausea and vomiting 8,9, anorexia 10,11 , muscle spasms 5,12-16 seizures 5,12-17 and inflammation 5,12-16 however, the optimal strains for each symptom have yet to be elucidated to maximize clinical benefits. In other words, there exists an optimal strain that works best for pain, anorexia, inflammation, etc.
To facilitate research on tailored cannabis therapy we need to determine the content of CBD and THC of each strain. The hallmark example of successful tailored therapy is the “Charlotte’s Web” strain which is used in refractory epileptic patients17. The success of this strain is owed to it’s very high CBD content and minimal THC content which has been shown to have antiepileptic properties5,17.
Conversely, determining the CBD: THC content of each strain is important in gauging potential side effects for each patient. For example, strains with high THC content should be avoided in patients with cardiac history to avoid tachycardia and hypotension 5,18.
Cannabis displays various potential clinical benefits but a “One size fits all” approach is suboptimal. Recognition of cannabis as a complex, heterogenous entity, with varying ratios of CBD: THC is crucial. Also, an understanding of the clinical effects of non-cannabinoid compounds should be defined. Once the chemical properties of each strain are determined further randomized controlled research on the clinical effects of each strain should be carried out to optimize clinical effects and to tailor therapy for patients.
Damien Hansra MD
7