Cannabis is an extraordinary plant that contains a wide variety of active principles known generally as cannabinoids. The two most studied for their importance are CBD, cannabidiol, and THC, delta 9-tetrahydrocannabinol. Both act on specific receptors located on cell membranes. Specifically, they are called CB1 and CB2 cannabinoid receptors, which are related to the neurological and anti-inflammatory effects of THC.

CBD binds with lower affinity to the same receptors but exerts a significant influence on anti-inflammatory and anticonvulsant action, as well as mitigating some of the unwanted neurological effects produced by THC.

With that said, it is not our intention to proclaim therapeutic cannabis as the definitive solution, but there is sufficient scientific evidence, together with the testimony of hundreds of thousands of patients who do recognise its beneficial pharmacological properties for the symptomatic treatment of some ailments, such as various forms of chronic pain, motor disorders associated with multiple sclerosis, convulsions in childhood epilepsy, nausea caused by chemotherapy, lack of appetite, etc.

Therapeutic use of cannabis

The administration and therapeutic use of cannabis is only possible by two different methods:

Inhalation: This is the most direct method; the active ingredients are absorbed directly into the blood in the pulmonary alveoli. This can be done by using vaporisers that volatilise the active ingredients without combustion. This option is recommended over smoking the typical cigarette, as it avoids certain carcinogens and respiratory tract irritants.

Infusion: As cannabinoids are fat-soluble and not very soluble in water, it is recommended to add a little oil, milk or butter to the water. Bring the mixture to boiling point. The effects are felt as digestion occurs and can last from 2 to 6 hours.

Since it is a substance that is susceptible to great variability in the concentration of cannabinoids from one plant to another, therapeutic doses are difficult to determine with any accuracy. It is best to start with low doses and work your way up until you feel that the effect is satisfactory.

With infusions it is more difficult to get the dosage right, as the time it takes to take effect is longer. Whereas inhalation increases the likelihood of undesirable psychological effects.

In any case, the results must be observed after one or two weeks and, as much as possible, have a controlled starting material with information on the content of active principles. Even so, it is important to be very careful with the dosage. The same amount will not be the same in different people, as the effect will not be the same depending on the patient’s previous relationship with cannabis.

Therapeutic cannabis in Spain

On the other hand, according to the latest survey by the National Plan on Drugs, 11% of the Spanish population aged between 15 and 64 consumed cannabis for recreational purposes in the past year, and around 35.5% admit to having consumed it at some point in their lives.

But with no legal distinction between medicinal and recreational use of cannabis, any patient is liable to an administrative fine of varying amount for unlawful possession.

Among patients, there is some misunderstanding in regard to this situation, as they do not understand why they are being denied the right to improve their health. According to Carola Perez, a medical cannabis user and president of the OECM, “it is irresponsible for the government not to regulate the use of cannabis when the reality is that patients are self-medicating with a substance that is not harmless, without any type of health control, quality certifications or dose prescription.”

The situation has been exacerbated by pandemic restrictions. With the closure of cannabis clubs and the lack of access to the black market, for patients it is as if pharmacies have closed; they are helpless and unprotected, unable to alleviate their ailments.

However, not everything has been negative in the last year for those who advocate regulating medical cannabis. The UN Commission on Narcotic Drugs has decided to remove cannabis from Schedule IV of the Drug Convention, which lists the most dangerous drugs such as heroin and cocaine.

This is good news at least for the area of cannabinoid research. Until now, it has been very difficult to obtain the necessary licences to carry out their research. For the same reason, the lack of investment has always been greater in the cannabis sector compared to other much more toxic but non-Schedule IV substances.

The UN resolution provides some hope that it will be possible to carry out more clinical trials without the administrative difficulties that so far make it impossible to advance the knowledge and effectiveness of medical cannabis.