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New York State Practitioner Education Medical Use of Marijuana 2-hr Required Course
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Section 1.0: The Endocannabinoid System and Phytocannabinoids
Part 1
The Endocannabinoid System (ECS):
"Changes in marijuana policies across states legalizing marijuana for medical and/or recreational use suggest that marijuana is gaining greater acceptance in our society. Thus, it is particularly important for people to understand what is known about both the adverse health effects and the potential therapeutic benefits linked to marijuana" (1). ~Nora D. Volkow, M.D., Director National Institute on Drug Abuse
In order to fully appreciate the health effects of cannabis, it is essential that one has knowledge of the endocannabinoid system. Therefore, we begin this comprehensive cannabis curriculum with a discussion of the endocannabinoid system, the cannabis plant, and how the components of the cannabis plant interact with the endocannabinoid system.
The endocannabinoid system (ECS) is an internal homeostatic system that plays a critical role in the nervous system and regulates multiple physiological processes, including appetite, digestion, mood, seizure threshold, coordination, and other processes (1, 2). The ECS also influences immunomodulation, cardiovascular functions, sensory integration, tumor surveillance, fertility, bone physiology, the hypothalamic-pituitary-adrenal axis, neural development, and intraocular pressure (1-5).
This homeostatic system was only discovered within the last three decades and was referred to as the endocannabinoid system because it is an endogenous system whose components interact with or resemble delta-9-tetrahydrocannabinol (THC), a compound derived from the cannabis plant.
The endocannabinoid system is comprised of three main components: endocannabinoids, receptors and regulatory enzymes.
Endocannabinoids(also called endogenous cannabinoids) – These compounds are endogenous agonists of the receptors to which delta-9- tetrahydrocannabinol (THC) also binds. Two of the most well studied endocannabinoids are derivatives of arachidonic acid:
N-arachidonoylethanolamine (also called anandamide or AEA)
2-arachidonoylglycerol (2-AG)
Receptors– There are two well-known cannabinoid receptors: cannabinoid receptor-1 (CB1) and cannabinoid receptor-2 (CB2). Some endocannabinoids and some cannabis-derived compounds bind to receptors other than CB1 and CB2. For example, anandamide and cannabidiol (a compound derived from the cannabis plant) are partial agonists of the TRPV1 receptor (Transient Receptor Potential Vanilloid type-1) (6). Also, evidence indicates that GPR55 is an endocannabinoid receptor, and this receptor has been referred to as CB3. All four receptors are G-protein coupled receptors (GPCRs).
Regulatory enzymes– Some endogenous regulatory enzymes synthesize endocannabinoids, while others catabolize endocannabinoids. For example, fatty acid amidohydrolase (FAAH) is an enzyme that breaks down the endocannabinoid anandamide.
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