Cannabinoids are flooding the market every day with more research and benefits. These cannabinoids come with many benefits for the body. Even though diseases like cancer are showing promising results as CBD is being used as a possible treatment for it. This has led to questions on the effects of cannabinoids. Just like other drugs, people tend to find the cannabinoid intoxicating and addictive. This article will examine the possibilities of the intoxication of cannabinoids.
What are Cannabinoids?
Cannabinoids are chemical compounds in cannabis and are produced by the human body. Endocannabinoids are an essential component of our bodies’ endocannabinoid system (ECS). It is mostly responsible for maintaining internal balance. Phytocannabinoids produced by the cannabis plant, mimic the functions of our endocannabinoids. They are responsible for the euphoric effects associated with THC.
The ECS helps the body maintain functional balance through its three main components. They are “messenger” molecules that our bodies synthesize. The receptors these molecules bind to. And the enzymes that break them down.
Pain, stress, appetite, energy metabolism, cardiovascular function, reward and motivation, reproduction, and sleep. These are a few of the body’s functions that cannabinoids impact by acting on the ECS. The potential health benefits of cannabinoids are numerous and include inflammation reduction and nausea control.
Types of Cannabinoids.
1. Endogenous cannabinoids
Endogenous cannabinoids are cannabinoids that the body produces. Cannabinoid receptors fall into one of two categories: CB1 and CB2. Anandamide and 2-arachidonoylglycerol (2-AG) are the body’s two most well-known endogenous cannabinoids. They seek out both CB1 and CB2 receptors. They also activate several other receptor proteins. These are those that are sensitive to heat (TRPV receptors).
2. Exogenous cannabinoids (Phytocannabinoids)
Exogenous cannabinoids, more known as Phytocannabinoids, are plant-derived types of cannabinoids. In cannabis, they are from granular trichomes covering the plant’s surface. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are not only the most well-known. They are also the most prevalent cannabis compounds.
As an activator of the CB1 receptor, THC is the main intoxicating component of cannabis. The cannabinoid, THC shows intoxication to increase blood flow to the prefrontal cortex. It also includes the region of the brain responsible for decision-making, attention. It also has motor skills and other executive functions. The exact nature of THC’s effects on these functions will vary from person to person. THC cannabinoids bind to CB1 receptors. It also triggers feelings of euphoria from the brain’s reward system.
CBD is the second most abundant cannabinoid found in the cannabis plant. Though non-intoxicating, CBD cannabinoids do exhibit psychoactive effects. But they are often calming rather than intoxicating. They contribute to CBD’s potential to treat anxiety, chronic pain, and seizures.
Other major cannabinoids include cannabinol (CBN), tetrahydrocannabinol acid (THCA), and cannabidiol acid (CBDA). CBN is a degrading form of THC, often in old or aging cannabis plant matter. THCA is a non-psychoactive cannabinoid that turns into THC. This is when decarboxylated, or exposed to heat. Similarly, CBD is a product of decarboxylated CBDA. More than 100 other cannabinoids have been successfully isolated from the cannabis plant. Though there is little research on their effects.
How does Cannabinoid Intoxication occur?
Cannabinoid intoxication occurs most frequently through inhalation, whether you use it recreationally or medicinally. Cannabinoid toxicity usually occurs due to overuse and abuse of cannabis. Accidental overuse can occur with marijuana edibles due to excessive ingestion. This is during the extended, unanticipated time it can take for peak action. Inadvertent ingestions most often occur in children due to exploratory behavior. And ingesting what may otherwise look like a normal food product. Greater availability due to legalization has led to novel preparations of cannabis. This is including baked goods, various candies, hash, and oils. Most cannabinoid toxicity is likely due to the abuse of synthetic cannabinoids. This has more adverse effects.
CLINICAL PRESENTATION OF THC INTOXICATION
A mild intoxication, often the desired effect of use, produces euphoria, hypersensitivity. And also altered time perception, silliness, motivation, increased appetite, and conjunctival injection. More serious intoxications can show lethargy, obtundation, stupor, dysphoria, depersonalization. anxiety or panic, postural hypotension, tachycardia, hypotonia, incoordination, ataxia, slurred speech, and nystagmus. Seizures may come in patients with a seizure disorder.
Children in particular are easily poisoned by edibles. They may also develop respiratory depression that requires intervention.
Patients who use marijuana over a long period may develop a clinical condition. This condition is Cannabinoid Hyperemesis Syndrome.
TREATMENT
There is no specific antidote for cannabinoid toxicity. Treatment is symptomatic and supportive. Liberal use of benzodiazepines may be beneficial for significant agitation or hallucinations.
Get routine labs in those suspected of a non-recreational degree of marijuana intoxication. A routine urine drug screen presumptively identifies marijuana/THC. But a positive result correlates only with recent use. It does not diagnose active drug effects.
A FOCUS ON CANNABINOID HYPEREMESIS SYNDROME
This syndrome presents as repetitive cycles of nausea, vomiting, and abdominal pain. It persists for 2 to 7 days. Often, one carries out an extensive and fruitless GI workup. This is due to many presentations of the patient with these symptoms. A clue in history is a report that relief can come from a very hot shower.
The proposed mechanism is the desensitization of the CB1 receptors. The ones that are in the central vomiting center. Of note, the responsible neural network also involves the sensory TRPV1 receptor. The same one that hot peppers and hot water stimulates.
Treatment of hyperemesis syndrome
Correct dehydration and electrolyte imbalances that result from excessive vomiting. Complete cessation of marijuana use will resolve symptoms. But there are strategies for short-term intervention.
You can use conventional antiemetics such as ondansetron, promethazine, and metoclopramide. But they usually have a poor response. As 1st line therapy, apply capsaicin 0.075% cream (OTC product) to the abdomen, back or arms. Or anywhere the patient indicates that hot water contact gives relief. It may create burning pain, without damaging the skin, but will provide relief of emesis in 1-2 hours. Repeat application in 2 to 4 hours as needed.
Adjunctive therapy includes sedation with benzodiazepines, antipsychotics, or diphenhydramine. Opioid analgesics are generally discouraged due to a lack of efficacy.
