Introduction
The use of cannabis has to be properly understood and discussed by nurses and other healthcare providers. This substance has many advantages and disadvantages, and people should recognize when this choice is the only appropriate way of treatment or alleviating symptoms. Cannabidiol (CBD), one of the major compounds of cannabis, is a pleiotropic drug characterized by more than 65 molecular targets (Lee, 2011). CBD and tetrahydrocannabinol (THC), another cannabis compound, interact with the human body and imitate endogenous cannabinoids, becoming a part of the endocannabinoid system (ECS) and provoking endocannabinoid deficiency syndrome. Four routes of cannabis administration exist, namely oral, inhalation, rectal, and topical. All these characteristics and processes will be discussed to prove the effectiveness of cannabis work in the human body.
How Cannabis Works in the Body: The Endocannabinoid System (ECS) and Endocannabinoid Deficiency Syndrome
Cannabis consists of multiple compounds, and CBD and THC are the most common elements that interact with receptors in the body’s nervous system, where neurotransmission allows the exchanging of messages between the body and the brain. As soon as the first findings about cannabis’s benefits for health were reported, the investigation was improved to reveal that the body was able to make its own cannabinoids, known as endogenous cannabinoids or endocannabinoids, that performed transmitting functions (Project CBD, 2018). Due to a similar structure of endocannabinoids and cannabinoids, the brain cannot distinguish them, and this makes it possible for cannabis to affect human behaviors and emotions. Thus, endocannabinoids, receptors, and enzymes create the endocannabinoid system that regulates various physiological processes (Project CBD, 2018). The work of cannabis depends on the receptors involved in the process and their level of impact.
The ECS has several types of receptors that are bound by endogenous ligands and enzymes. The work of the system is based on homeostasis, an ability to adjust to changes in the external environment. CB1R and CB2R are G-protein-couple receptors that play a crucial role in regulating several functions, including cognition, mood, appetite, and memory (Chye et al., 2019). Endocannabinoids perform the role of neuromodulators released by post-synaptic neurons to control the release of other neurotransmitters (Chye et al., 2019). However, when the required balance between all elements of the ECS is not maintained, poor functioning is observed, provoking chronic deficiencies known as endocannabinoid deficiency syndrome (EDS) (Project CBD, 2018). This condition can be explained as a limited number of cannabinoids in the body and impaired homeostasis that weakens the body system and makes it vulnerable to frequent inflammations. Other signs of EDS include low pain threshold, uncontrolled mood, poor sleep, headache, migraine, depression, anxiety, and gastrointestinal problems.
Four Different Delivery Routes Patients May Use Cannabis: Onset of Action, a Pro, and a Con
If cannabis use for medical purposes is legal in the state, nurses should recognize the most appropriate route of administration for the chosen drug. Currently, oral, rectal, topical, and inhalation delivery methods exist. For example, an oral route of administration is possible through ingesting edible products, drinks, and spays (Subbaraman & Kerr, 2021). It is one of the most common forms of administration among patients of different ages. Its onset of action is within 1-2 hours and lasts about 6-8 hours, and this type is defined as an ideal approach for medical use (MacCallum et al., 2022). Its main advantage is the possibility of controlling drug dosing and managing safe prescriptions for patients either in hospitals or at home. However, the risk of potential delayed impairment should not be ignored, and healthcare providers need to observe patients or contact them regularly to report changes.
Inhalation of fresh or dried cannabis leaves is another way to take the drug and alleviate acute symptoms among critically ill patients. Compared to the previous route of administration, inhalation’s onset of action is short, about 5-10 minutes, and it is in effect for about 1-4 hours (MacCallum et al., 2022). Smoking or vaporizing cannabis is popular among people who use it for recreational purposes (Subbaraman & Kerr, 2021). Still, its medical benefit is its high concentration in the blood and immediate effect, e.g., reducing pain. At the same time, nurses admit difficulties with choosing accurate dosing and the depth of inhalation processes (MacCallum et al., 2022). Unintentional impairment is not as high as in oral use, but it has to be recognized in healthcare facilities to educate patients and their families about possible adverse effects of cognitive and emotional changes.
Suppository or rectal routes of administration for cannabis have already gained popularity in health care. Not many studies discuss the peculiarities of this form of cannabis because 2-8% of oncological patients prefer to use it (Vinette et al., 2022). Its rapid onset of action, which is about 15 minutes, attracts attention because of the necessity to manage symptoms (Vinette et al., 2022). Its pro is the access to high doses of cannabis being taken at the same time and provoking no severe psychotropic effects. CBD and THC have a hydrophobic nature, which does not give them a chance to pass through a rectal mucosa. Talking about its con, one should understand that the effects of rectal administration are unpredictable, and it is not recommended to try this method at home without counseling and professional supervision.
Finally, local application of topical cannabis may be offered to patients, while not many controlled studies have been developed during the last several decades. This form is introduced by placing CBD creams, lotions, ointments, patches, and gels on body parts (MacCallum et al., 2022). The main characteristics of this route include its slow absorption and the onset of action, which is about 48 hours (Vinette et al., 2022). On the one hand, its effect on local areas like wounds and acne is great, and some healthcare providers define it as a solid second-line treatment option. On the other hand, researchers underline that this method is poorly understood, and the benefits of pain localization do not prevail over unknown reactions and the growth of complications. These controversies put topical CBD under question in modern healthcare practice.
Conclusion
In general, it is wrong to stick to one particular opinion about cannabis and its impact on human health. On the one hand, the way how cannabis works and remains invisible within the body system provokes concerns and additional investigations. On the other hand, when the body is not able to protect itself, some extra help should be offered, and the similarities between endogenous receptors and cannabinoids play an important role. Nurses have to learn the main routes of administration for cannabis to ensure its best outcomes for patients with specific needs and health. Either oral, rectal, topical, or inhalation administration has its pros and cons, and it is the choice of a patient or a nurse which decision to make. Still, cannabis for medical purposes cannot be rejected in the modern system of health care.
References
Chye, Y., Christensen, E., Solowij, N., & Yücel, M. (2019). The endocannabinoid system and cannabidiol’s promise for the treatment of substance use disorder. Frontiers in Psychiatry, 10. Web.
Lee, M. A. (2011). How CBD works. Project CBD. Web.
MacCallum, C. A., Lo, L. A., Pistawka, C. A., Christiansen, A., Boivin, M., & Snider-Adler, M. (2022). A clinical framework for assessing cannabis-related impairment risk. Frontiers in Psychiatry, 13. Web.
Project CBD. (2018). What is CBD? Project CBD. Web.
Subbaraman, M. S., & Kerr, W. C. (2021). Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state. Journal of Cannabis Research, 3(1). Web.
Vinette, B., Côté, J., El-Akhras, A., Mrad, H., Chicoine, G., & Bilodeau, K. (2022). Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: A scoping review. BMC Cancer, 22(1). Web.