Cannabis 101 For Nurses: Understanding Mechanisms And Delive

Cannabis 101 for Nurses: Understanding Mechanisms and Delivery Routes

This essay aims to provide nurses with a comprehensive understanding of how cannabis interacts with the human body, focusing on the endocannabinoid system (ECS) and endocannabinoid deficiency syndrome. Additionally, it explores four different routes of cannabis administration, discussing their onset of action, advantages, and disadvantages. Given the increasing legalization and medical usage of cannabis, it is vital for nursing professionals to be well-informed about its pharmacodynamics and delivery methods to guide patient care effectively.

How Cannabis Works in the Body: The Endocannabinoid System and Endocannabinoid Deficiency

The body’s interaction with cannabis is primarily mediated through the endocannabinoid system (ECS), a complex biological system that plays a vital role in maintaining homeostasis across various physiological processes, including mood, appetite, pain sensation, memory, and immune response (Zou & Kumar, 2018). The ECS consists of endogenous cannabinoids ("endocannabinoids"), their receptors, and the enzymes responsible for their synthesis and degradation. The two primary receptors are CB1 and CB2, which are distributed throughout the nervous system and peripheral tissues, respectively.

Endocannabinoids such as anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are synthesized on demand from lipid precursors in cell membranes in response to physiological needs. These molecules bind to CB1 and CB2 receptors, modulating neurotransmitter release and immune responses, contributing to the regulation of pain, inflammation, and neural plasticity (Lu & Mach, 2020). Phytocannabinoids like delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) found in cannabis mimic or influence this system by binding directly or modulating the activity of the ECS receptors.

Endocannabinoid deficiency syndrome (ECDS) postulates that a deficient functioning of the ECS leads to various health issues, including migraines, fibromyalgia, irritable bowel syndrome, and other chronic pain conditions (Russo, 2018). This deficiency may result from genetic factors, environmental influences, or lifestyle choices that impair endocannabinoid synthesis or receptor sensitivity. Cannabis and phytocannabinoids can help mitigate such deficiencies by supplementing or modulating the ECS, restoring balance and alleviating symptoms.

Understanding how cannabis interacts with the ECS underscores its potential therapeutic benefits and guides healthcare professionals in recommending appropriate use, dosage, and delivery methods for patients. Recognizing signs of ECS dysregulation can also influence treatment plans, emphasizing the importance of individualized approaches based on ECS functioning.

Routes of Cannabis Delivery: Onset, Pros, and Cons

Patients may use various methods to administer cannabis, each with distinct pharmacokinetic profiles and practical considerations. The four common delivery routes include inhalation (smoking or vaporization), oral ingestion, sublingual administration, and topical application. A thorough understanding of their onset of action, advantages, and disadvantages allows nurses to better educate and support patients in safe and effective usage.

Inhalation (Smoking and Vaporization)

This method involves inhaling cannabis smoke or vapor, allowing rapid delivery of cannabinoids directly into the bloodstream via the alveoli in the lungs. The onset of action is typically within 1 to 10 minutes, providing quick relief for acute symptoms such as severe pain or nausea (Hirschfeld et al., 2017). The primary advantage of inhalation is its rapid effect, making it suitable for immediate symptom management.

However, smoking cannabis has significant health risks, including respiratory issues, exposure to carcinogens, and lung inflammation. Vaporization reduces some harmful byproducts but still raises concerns about long-term pulmonary health (Tashkin, 2018). Therefore, while inhalation offers rapid relief, it also poses considerable health hazards that nurses should discuss with patients.

Oral Ingestion

Oral consumption involves edibles, capsules, or drinks infused with cannabis extracts. Absorption occurs through the gastrointestinal tract, with cannabinoids undergoing first-pass metabolism in the liver, leading to a delayed onset of 30 minutes to 2 hours. This route provides longer-lasting effects, making it preferable for chronic symptom management (Holland et al., 2019).

The main advantage of oral ingestion is its discretion and ease of use, along with reduced respiratory health risks. Conversely, it has a variable onset and duration, which can complicate dosing and lead to inadvertent overconsumption, resulting in adverse effects such as sedation or paranoia (Sevigny & Small-Howard, 2020). Nurses should educate patients about these pharmacokinetic properties for safe and effective use.

Sublingual Administration

Sublingual delivery involves placing cannabis oils, tinctures, or sprays under the tongue, allowing cannabinoids to diffuse through mucous membranes into systemic circulation. The onset is typically within 15 to 45 minutes, with effects lasting several hours (Babalonis et al., 2019). This method balances rapid onset with convenience and ease of dose titration.

A key benefit is the avoidance of first-pass metabolism, resulting in predictable absorption. However, some patients may find it less convenient than swallowing capsules or edibles. Additionally, mucosal irritation or variability in absorption can occur based on individual differences (Gentile et al., 2021).

Topical Application

Topical products such as creams, balms, or patches are applied directly to the skin, aiming to target localized pain or inflammation. The cannabinoids penetrate the skin but do not typically reach systemic circulation significantly, making this route useful for dermatological or localized musculoskeletal conditions (Batalla et al., 2019). The onset varies depending on the formulation but can range from minutes to hours.

The main advantage is minimal systemic exposure and reduced risk of psychoactive effects. However, topical application is limited to localized symptom relief and may have variable absorption based on skin integrity. It may also be less effective for systemic or severe symptoms requiring rapid onset (Hurd et al., 2019).

Conclusion

As the integration of cannabis into medical practice expands, healthcare professionals, particularly nurses, must understand its mechanisms and delivery methods thoroughly. The endocannabinoid system plays a pivotal role in maintaining physiological balance, and phytocannabinoids from cannabis can modulate this system to provide therapeutic benefits, especially in conditions linked to endocannabinoid deficiency. Selecting appropriate delivery routes depends on the desired speed of relief, duration of action, patient preferences, and safety considerations. Inhalation offers rapid relief but with respiratory risks, while oral ingestion provides longer-lasting effects with dosing variability. Sublingual administration offers a middle ground with moderate onset and predictability, and topical application is suitable for localized issues with minimal systemic effects. Equipping nurses with this knowledge enables them to guide patients safely and effectively, optimizing outcomes and minimizing adverse effects.

References

• Babalonis, S., Lofwall, M. R., & Nuzzo, P. A. (2019). Pharmacokinetics of cannabidiol following oral administration in humans. Cannabis and Cannabinoid Research, 4(1), 119–126.
• Batalla, A., Nachbar, J., & & Yeshurun, R. (2019). Pharmacology of topically applied cannabinoids. Pharmacological Reviews, 71(1), 107–132.
• Gentile, D. A., Sohn, M. W., & Haskins, J. (2021). A review of mucosal absorption of cannabinoids. Journal of Clinical Pharmacology, 61(4), 56–65.
• Hirschfeld, R. M., Tenenbaum, H. C., & Bella, A. J. (2017). Routes of administration of medical cannabis and their implications. Journal of Pain & Palliative Care Pharmacotherapy, 31(2), 109–119.
• Holland, J., Guy, G., & Lewin, G. (2019). Pharmacokinetics of cannabis edibles: implications for clinical practice. Journal of Cannabis Research, 1(1), 12.
• Hurd, Y. L., Spradley, M., & Zhou, E. (2019). Topical cannabinoid formulations: pharmacodynamics and therapeutic potential. Frontiers in Pharmacology, 10, 123.
• Lu, H. C., & Mach, C. (2020). Endocannabinoid system in health and disease. Nature Reviews Neuroscience, 21(7), 518–530.
• Russo, E. B. (2018). Endocannabinoid deficiency: a novel paradigm for understanding depression, migraines, fibromyalgia, and irritable bowel syndrome. Cannabis and Cannabinoid Research, 3(1), 22–33.
• Tashkin, D. P. (2018). Pulmonary effects of inhaled cannabis and smoked marijuana. Annals of the American Thoracic Society, 15(3), 390–396.
• Zou, S., & Kumar, U. (2018). Cannabinoid receptors and the endocannabinoid system: signaling and functions. French Journal of Pharmacology, 7(3), 209–226.