What are cannabinoids and why are they revolutionizing medicine?

Cannabinoids are made in tiny external plant glands called trichomes. Above hundreds of trichomes under magnification. | Photo David Downs

Cannabinoids are made in tiny external plant glands called trichomes that look like crystals. Above hundreds of trichomes on a cannabis flower under magnification. | Photo David Downs

Illustration courtesy pf Hebrew University of Jerusalem

Illustration courtesy pf Hebrew University of Jerusalem

Cannabinoids are made in tiny external plant glands called trichomes. Above hundreds of trichomes under magnification. | Photo David Downs

Cannabinoids are made in tiny external plant glands called trichomes. Above hundreds of trichomes under magnification. | Photo David Downs

As the cannabis movement continues to gain ground, it is becoming clear that cannabis can help with dozens of conditions and symptoms. This variety of uses is all because of the plant’s medically active ingredients, called the “cannabinoids”.

Unlike alcohol and other drugs where there is usually one medically active ingredient (ethanol in alcohol, acetaminophen in Tylenol, ibuprofen in Advil), there are dozens of such cannabinoids in cannabis and each has their own array of medicinal benefits.

Some like THC cause a lift in mood or “high”. Others like CBD can treat seizures without any high. Others are targets for next blockbuster diet drug. What are these fascinating compounds, and could they help you? Read on to learn more.  

What are cannabinoids, like THC and CBD?

Cannabinoids, like THC, CBD or dozens of others, are the active chemical ingredients that are found in cannabis. These small molecules provide many of cannabis’ important medicinal effects. Understanding which cannabinoids do what can make a huge difference when it comes to finding the right types of cannabis for you.

What are the main cannabinoids I should care about?

You should definitely learn about tetrahydrocannabinol (THC), the most common active ingredient in cannabis. THC is responsible for street cannabis’ “high”, but it has a number of medical applications as well, including managing pain and nausea.

The second most popular cannabinoid is cannabidiol (CBD), which can offer powerful medical benefits without psychoactive effects. Other cannabinoids to get familiar with are cannabinol (CBN), cannabigerol (CBG), cannabichromene (CBC), tetrahydrocannabinol-acid (THC-A), and tetrahydrocannabivarin (THC-V).

Marijuana molecule THC

Marijuana molecule THC

Will cannabinoids make me feel ‘high’?

It depends. Some cannabinoids, such as THC or THC-V can cause a lift on mood or “high”. Others, like CBD or THC-A are non-psychoactive and can provide medical benefits without any disorienting effects.

What are cannabinoids being used for?

Cannabinoids are used for a wide variety of symptoms and condition. Studies show that THC can help manage pain, depression and anxiety, nausea, spasms, and sleep disorders, along with other conditions. The World Health Organization recently reported that CBD could help manage epilepsy, Alzheimer’s disease, cancer, psychosis, Parkinson’s disease, and other serious conditions. Each cannabinoid has its own benefits and potential uses. Learn about each to find out what might work best for you.

CBN is being used a sleep aid. It is an oxidized version of THC that’s known to be much more sedative.

THC-V is researched being by pharmaceutical companies as a diet drug. While THC can stimulate appetite (cause ‘the munchies’), THC-V suppresses appetite.

Are there side effects to using cannabinoids?

Yes, like every other drug, there can be side effects, depending on the particular cannabinoid in question. Most often, people take THC, which can cause short-term dizziness, dry mouth, low blood pressure, high heart rate, confusion, and impact coordination and memory. THC can be habit-forming in some individuals. You cannot fatally overdose on cannabinoids, because there are no cannabinoid receptors in the brain stem — which regulates heart rate and breathing.

Side effects of CBD can include loss of appetite, dry mouth, nausea, dizziness, and sedation.

Where is the science on cannabinoids coming from?

The science of cannabinoids comes from lab studies on cells, animals, and humans, along with limited clinical trials of main cannabinoids like THC and CBD. The U.S. has institutional barriers to studying cannabinoids, but other countries do not and have conducted much more research on humans. A search of the medical literature index PubMed.com located 15,073 studies with the word “cannabinoid” in them.

Where do cannabinoids come from?

Cannabinoids usually come from cannabis, but there are also synthetic cannabinoids, such as the drug Marinol. Unlike cannabis, Marinol is approved by the FDA, but it has drawbacks compared to natural cannabinoids. Patients report that natural cannabinoids (especially blends of cannabinoids) simply work better for them than the synthetic alternatives.

The cannabinoids in cannabis come from tiny external plant glands called “trichomes”. Cannabinoids are synthesized in the trichome using precursor chemicals the plant makes, along with the energy from sunlight.

Cannabinoids can be made through chemical synthesis in a lab, and new techniques involve editing the genes of yeast bacteria to produce cannabinoids.

What are synthetic cannabinoids?

Synthetic cannabinoids are extremely dangerous and have been implicated in countless deaths, injuries and other health issues. Do not take synthetic cannabinoids under any circumstance unless recommended by a physician. Synthetic cannabinoids are chemicals that are man-made and interact with the endocannabinoid system in your body.

Often made in China where they are sprayed on plant matter and sold as “synthetic marijuana” or “Spice” or “K2”, synthetic cannabinoid compounds can be hundreds or thousands of times stronger than natural THC or other cannabinoids. That makes them very dangerous, and they can cause psychosis, heart damage, and other permanent health problems. People take synthetic cannabinoids because they want the “high” of marijuana, but they do not want to fail routine drug tests that are often given in the military, workplace, on sports teams or elsewhere.

How do I find natural cannabinoids?

You can find cannabinoids in most states with recreational or medical cannabis laws. California, Washington, Colorado and Oregon are all examples of places where you can purchase cannabinoid products without first getting a doctor’s recommendation.

How do I take cannabinoids?

Cannabinoids can be inhaled, taken sublingually, eaten or used as a topical. Be aware that when you eat the cannabinoid THC it converts into delta 11-THC. This is a different molecule which can last longer and can affect you differently.

What are endocannabinoids?

Endocannabinoids are a type of cannabinoid found naturally in the human body and include anandamide and 2AG. Your body makes these cannabinoids to interact with receptors in the body’s endocannabinoid system to maintain the body’s internal balance.

What is the endocannabinoid system?

The endocannabinoid system is a fundamental electrochemical signaling system found in all animals. This biochemical control system is made up of receptors throughout the body (CB1 and CB2), which are activated by both plant cannabinoids (THC, etc.) and our bodies’ own endocannabinoids, like anandamide and 2AG. This system regulates a broad range of biological functions, such as sleep, body temperature, the immune system, appetite, thirst, heart-rate and blood pressure.

A diagram of the endocannabinoid system of receptors (cb1) and endocannabinoids (2AG). From the journal Metabolites 2017.

A diagram of the endocannabinoid system of receptors (CB1, CB2, etc) and endocannabinoids (Anandamide, 2AG). From the journal Metabolites 2017.

What is endocannabinoid deficiency syndrome?

Dr. Ethan Russo posits some people lack enough endocannabinoids to keep up this internal balance. This condition, known as endocannabinoid deficiency syndrome, can lead to a variety of different symptoms or diseases. Plant cannabinoids may reverse these problems by supplying the additional cannabinoids needed.

How do I learn more about cannabinoids?

To learn more about cannabinoids and their uses, check out these leading books on the topic:

Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential

by Dr. Ethan Russo

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

by National Academies of Sciences, Engineering, and Medicine

Marijuana and the Cannabinoids (Forensic Science and Medicine)

by Mahmoud A. ElSohly

Got any more questions about cannabinoids or other medical cannabis modalities? Email GreenState editor ddowns@sfchronicle.com or message us on Facebook.

Emily Earlenbaugh, PhD is a cannabis writer and educator. She holds a doctorate in the philosophy of science from UC Davis.