The Cannamanual - Free chapter

The Therapeutic Potential of The Endocannabinoid System(ECS)

What we are discovering in cannabinoid medicine is that the ECS responds differently when we are ill. As previously mentioned, the ECS can be highly variable between individuals and the elements of the ECS can be expressed in varying ratios. This can take theform of increased or decreased levels of endocannabinoids, altered levels of the synthesizing and degrading enzymes, or changes in the prevalence and distribution of receptors. We are realising that in disease states, this regulatory system suffers a loss of function and certain elements become exaggerated or degenerate. In diseases such as cancer, healthy cells and cancerous cells show very different ECS patterns (Chen et al.,2015). This altered fingerprint may present in several ways and may be caused by factors that we are slowly beginning to understand.
A strong example ofthis ECS alteration can be observed in epilepsy. Explorative studies investigating how the ECS may be altered in the epileptic brain have shown that elements of the ECS may be damaged or under-expressed. The CB1 receptor has been repeatedly observed to be deficient in epileptic people’s hippocampus (Ludányi et al.,2008). The significance of this is that THC, the most abundant compound in cannabis, targets and activates the CB1 receptor. The basic principle is that the binding of THC to CB1 initiates this anti-epileptic effect. The effect though is highly dependent on the fingerprint of the individual’s ECS. This points us in the direction of personalised cannabinoid medicine.

The CB1 distribution across the neuronal tissues is highly variable and, as a result, underlying alterations in the endocannabinoid system may vary case by case. There are many forms of epilepsy, each affecting different regions of the brain, depending specifically on the types of neurons in the brain and so the treatment strategy will need to be adjusted.
It is becoming clear that this same relationship is true for many diseases, ranging from cancer to arthritis. For this reason, we must discuss the ECS in greater detail when debating cannabis, medicines and policy. It is the ECS that offers the greatest therapeutic potential but our knowledge of it is still in its infancy. As this knowledge matures, so will the treatment potential of the ECS (Pertwee, 2005). Ignoring the ECS would be comparable to ignoring mechanics and engineers when making automotive policy or directing industry. The fundamentals cannot be ignored.

Although crude cannabis consumption works very well for some people, it is by no means the future of medicine and is still very much the equivalent of consuming raw opium. Cannabis lacks the specificity of conventional medicines but is arguably far safer than some treatments we administer legally. Cannabis has tremendous potential acrossthe board for general symptom management and relief.
In terms of what can beachieved medically, the ECS and its targeted manipulation hold truly revolutionary potential. Synthetic cannabinoids modulate the endocannabinoid with more precision, creating 21st century therapies to renew our cells and biology. Our rapid rate of technological advancement will help us process the overwhelming volumes of data, giving us the ability to reprogramme and re-coordinate this dysregulated cellular communication that is fundamental in most diseases. The endocannabinoid system is yet to be fully incorporated into the medical education system and the scale of its potential is only justbeing recognised by science.



Chen, L. et al. (2015) ‘Endocannabinoid andceramide levels are altered in patients with colorectal cancer’, OncologyReports. Spandidos Publications, 34(1), pp. 447–454. doi:10.3892/or.2015.3973.

Ludányi, A. et al. (2008) ‘Downregulation of the CB1 cannabinoidreceptor and related molecular elements of the endocannabinoid system inepileptic human hippocampus.’, The Journal of neuroscience : the officialjournal of the Society for Neuroscience. Society for Neuroscience, 28(12),pp. 2976–90. doi: 10.1523/JNEUROSCI.4465-07.2008.

Pertwee, R. G. (2005) ‘The therapeutic potential of drugs that targetcannabinoid receptors or modulate the tissue levels or actions ofendocannabinoids’, The AAPS Journal. Springer-Verlag, 7(3), pp. E625–E654.doi: 10.1208/aapsj070364.