The Role of Cannabis and Cannabinoids in Diabetes
The Role of Cannabis and Cannabinoids in Diabetes
This paper reviews the role of cannabis in diabetes. Cannabis is by far the most commonly used illicit drug in Britain, though its use may be declining. There are an estimated 50,000–100,000 people with diabetes using cannabis, with an unknown number using the drug for self-medication. The evidence of the effects of cannabis on diabetes is complex, ranging from anecdotal reports of benefits and harms to experimental research on cannabinoids. The endocannabinoid system appears to have a role in the regulation of body weight and food intake, and the development of hyperglycaemia, insulin resistance and dyslipidaemia. In experimental models, the main psychoactive constituent of herbal cannabis, Δ9-tetrahydrocannabinol, has been shown to interfere with both the action of insulin and its release. The paper also considers the effects of cannabis on complications of diabetes. Experimental work has suggested a mechanism to reduce neuropathy but the only double-blind clinical trial to date of a cannabis-based drug found no difference in the ability of the cannabis-based product to relieve neuropathic pain when compared with placebo. In conclusion, new insights into the role of cannabis and cannabinoids in diabetes are emerging from this developing field of research.
There have been claims that cannabis and its derivative compounds have medicinal use including use for diabetes. However, cannabis (with some limited exceptions discussed below) has no current status as a medicine since it became illegal in theUK under the Dangerous Drugs Act 1925. Cannabis is now classified as a 'class B' drug under the Misuse of Drugs Act 1971. The aim of this paper is to review the literature onthe relationship between cannabis and diabetes. The paper is divided into three sections: (1) epidemiology of cannabis and diabetes, (2) the effects of cannabis on diabetes and (3) the effects of cannabis on diabetic complications.
Although cannabis is by far the most commonly used illicit drug in the UK, the term 'cannabis' applies to a wide range of substances. Cannabis refers to a genus of flowering plants that includes three species: cannabis sativa, cannabis indica and cannabis ruderalis. The taxonomy of cannabis is somewhat in dispute, however most now regard the genus cannabis to belong to the Hemp family, Cannabacea. These plants that have grown wild throughout the world for centuries and have had various uses, such as to make rope and textiles, as a medicinal herb and asa recreational drug. Cannabis plants produce cannabinoids, although there are also synthetic cannabinoids which are not found in cannabis plants. To date, over 60 cannabinoids have been isolated, of which THC is considered to be the primary psychoactive component of the plant. The amount of THC ingredient in herbal cannabis varies from 1% up to 15%, while skunk, can have up to 20% (skunk refers to a range of stronger types of cannabis, grown either under artificial lights or in a greenhouse, often using hydroponic techniques). Despite concerns about increased potency, the evidence is mixed, with recent studies indicating broadly similar ranges of potency over the last 10 years.
The only cannabinoids available as medicines in the UK are nabilone (a synthetic cannabinoid) and Sativex (cannabis plant extract containing THC and CBD) but neither are licensed for use in diabetes. Nabilone® is licensed for nausea and vomiting caused by cytotoxic chemotherapy that is unresponsive to conventional antiemetics, while Sativex® was granted a product licence in June 2010 as an add-on treatment for symptom improvement inmultiple sclerosis patients with moderate to severe spasticity. Rimonabant (an inverse agonist for the cannabinoid receptor CB), which had been licensed as an appetite suppressant, was withdrawn from the market in 2009 over concerns about psychiatric side effects (particularly depression and suicidal ideation).
Abstract and Introduction
Abstract
This paper reviews the role of cannabis in diabetes. Cannabis is by far the most commonly used illicit drug in Britain, though its use may be declining. There are an estimated 50,000–100,000 people with diabetes using cannabis, with an unknown number using the drug for self-medication. The evidence of the effects of cannabis on diabetes is complex, ranging from anecdotal reports of benefits and harms to experimental research on cannabinoids. The endocannabinoid system appears to have a role in the regulation of body weight and food intake, and the development of hyperglycaemia, insulin resistance and dyslipidaemia. In experimental models, the main psychoactive constituent of herbal cannabis, Δ9-tetrahydrocannabinol, has been shown to interfere with both the action of insulin and its release. The paper also considers the effects of cannabis on complications of diabetes. Experimental work has suggested a mechanism to reduce neuropathy but the only double-blind clinical trial to date of a cannabis-based drug found no difference in the ability of the cannabis-based product to relieve neuropathic pain when compared with placebo. In conclusion, new insights into the role of cannabis and cannabinoids in diabetes are emerging from this developing field of research.
Introduction
There have been claims that cannabis and its derivative compounds have medicinal use including use for diabetes. However, cannabis (with some limited exceptions discussed below) has no current status as a medicine since it became illegal in theUK under the Dangerous Drugs Act 1925. Cannabis is now classified as a 'class B' drug under the Misuse of Drugs Act 1971. The aim of this paper is to review the literature onthe relationship between cannabis and diabetes. The paper is divided into three sections: (1) epidemiology of cannabis and diabetes, (2) the effects of cannabis on diabetes and (3) the effects of cannabis on diabetic complications.
Although cannabis is by far the most commonly used illicit drug in the UK, the term 'cannabis' applies to a wide range of substances. Cannabis refers to a genus of flowering plants that includes three species: cannabis sativa, cannabis indica and cannabis ruderalis. The taxonomy of cannabis is somewhat in dispute, however most now regard the genus cannabis to belong to the Hemp family, Cannabacea. These plants that have grown wild throughout the world for centuries and have had various uses, such as to make rope and textiles, as a medicinal herb and asa recreational drug. Cannabis plants produce cannabinoids, although there are also synthetic cannabinoids which are not found in cannabis plants. To date, over 60 cannabinoids have been isolated, of which THC is considered to be the primary psychoactive component of the plant. The amount of THC ingredient in herbal cannabis varies from 1% up to 15%, while skunk, can have up to 20% (skunk refers to a range of stronger types of cannabis, grown either under artificial lights or in a greenhouse, often using hydroponic techniques). Despite concerns about increased potency, the evidence is mixed, with recent studies indicating broadly similar ranges of potency over the last 10 years.
The only cannabinoids available as medicines in the UK are nabilone (a synthetic cannabinoid) and Sativex (cannabis plant extract containing THC and CBD) but neither are licensed for use in diabetes. Nabilone® is licensed for nausea and vomiting caused by cytotoxic chemotherapy that is unresponsive to conventional antiemetics, while Sativex® was granted a product licence in June 2010 as an add-on treatment for symptom improvement inmultiple sclerosis patients with moderate to severe spasticity. Rimonabant (an inverse agonist for the cannabinoid receptor CB), which had been licensed as an appetite suppressant, was withdrawn from the market in 2009 over concerns about psychiatric side effects (particularly depression and suicidal ideation).
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