Cannabis Pharmacogenetics: What to Know and How to Use It to Make Marijuana Work for You
Posted by Marijuana Doctors on 04/06/2018 in Medical Marijuana
Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
We’re all unique. Or, at least, our genes sure are.
Science in the 21st century has shed revolutionary light on why we think and act the way we do. From sleep cycles to sociability to how long we wait to file our taxes, we now know what makes us “us” is a complex dance of environment, upbringing and genetic code.
Yet medical research in the past decade has revealed some surprising details about the latter. Our genes, it seems, may hold the secret to untangling some of medicine’s trickiest health concerns and complications. Few gene-based movements have made more waves in recent memory than the burgeoning science of pharmacogenetics. And when those waves ripple out to cannabis, it begins to turn heads.
What Is Cannabis Pharmacogenetics?
Pharmacogenetics is a broad branch of pharmacology focused on how genes shape the way we metabolize drugs.
It studies a number of variables on the individual gene level, using DNA samples to “unlock” your body’s — and only your body’s — response to and processing of drugs. By offering its pinpointed, hyper-personalized insights, doctors can understand why certain treatments might work for you and which won’t — a feat previously unimaginable outside of sci-fi movies.
Many medical practitioners believe pharmacogenetics is the wave of the future. Already, it’s been incorporated as standard practice alongside certain clinical treatments, with wider use likely to emerge as pharmacogenetics testing, training and result counseling gain traction.
Cannabis pharmacogenetics, then, is the application of these tests to understand how a patient metabolizes marijuana based on their genes. Like other pharmacogenetics tests, it separates and identifies reactions to dozens of marijuana strain types and cannabinoid compounds. It places extra emphasis on the doses and types of medical marijuana recipients should take, as well as how those doses interact with other common medications or prescriptions.
In other words, marijuana pharmacogenetics is the science of making cannabis work safely and effectively for you.
Why Research Marijuana Pharmacogenetics?
The medicinal uses for cannabis are hardly new. Yet in today’s world, studying marijuana through a pharmacogenetics lens shakes its stigma and roots the practice in science-first principles, hard data and a cutting-edge look into the future of the entire medical field.
Ancient Cannabis Uses
References to medicinal marijuana date back nearly 3,000 years. Ancient Chinese medical practitioners ground up cannabis “achenes,” or seeds, and brewed them with tea as a pain-relieving and fever-lowering remedy. The treatment is believed to have spread with trade, reaching India, the Middle East, East Africa and the Mediterranean. Texts reference its cultivation, usage and application widely, from depression diagnoses and stress relief to joint pain, inflamed skin and reducing the pain of childbirth.
Contemporary Medical Understanding
Today’s views on medicinal cannabis are dramatically different than these ancient origins. Expanding on its pain-relieving history, the movement reinforces the legitimacy of cannabis as medicine through research, monitored medical studies and 21st -century technology and regulation.
Cannabis and pharmacogenetics began to gain serious traction in the early 1990s, when researchers discovered and named marijuana-specific receptor genes. While these receptors are universally responsible in signaling our bodies to metabolize marijuana, researchers began to note differences in metabolic reactions and rates across demographics.
During this time, science also made serious strides in mapping the unique chemical composition of cannabis, known as cannabinoids. Today, marijuana has hundreds of strains — and the count is growing. Each of these cannabis strains consists of a rich and complex mix of cannabinoid compounds. Yet amid these vast arrangements, cannabinoids themselves break down into one of two primary categories.
- Tetrahydrocannabinol (THC): The colloquial “high” feeling associated with marijuana comes from THC. Symptoms often include states of bliss, euphoria and overall well-being or happiness. THC is also the series of cannabinoids responsible for the psychoactive effects of marijuana, as well as the source of much controversy in the ethics of wide-scale distribution.
- Cannabidiol (CBD): While CBD doesn’t induce the same potent “high” states and sensations as THC, it does offer unique calming properties. Not only that, but isolated CBD tinctures contain a range of proven pain-reducing properties, migraine and nausea relief, nerve relaxation and more. CBD even accompanies traditional cancer treatments, particularly to curb the lack of appetite, nausea and vomiting side effects correlated with chemotherapy.
With its in-depth investigation of an individual’s reactions to drugs, marijuana pharmacogenetics opens the door for a whole new understanding of THC, CBD and overall cannabinoid chemistry — one as promising as it is profitable.
Today’s Marijuana Pharmacogenetics Applications
Marijuana pharmacogenetics blends the best of both worlds. It takes the ancient understanding that marijuana and the human body have a compatible and positive relationship, while applying that relationship safety and scientifically.
As marijuana continues to become legalized and its usage more accepted, pharmacogenetics will allow physicians to treat their patients in a more holistic and personalized manner.
There are numerous reasons to study marijuana pharmacogenetics today.
- Cannabis safety: Assigning proper dosages, as well as what strains and cannabis varieties to recommend, are just some of the safety measures pharmacogenetics improves. It ushers in a more methodic and monitored approach to tailored patient treatments, while reducing the stigma around marijuana use.
- Cannabinoid specialty: Much of today’s medical-cannabis research aims to better isolate and alter certain THC and CBD traces. By lowering or increasing one of these two, you will produce your desired medicinal effects in simpler and more accurate prescriptions. In tangent with this, the pharmacogenetics of cannabinoids allows doctors and researchers to be able to match ideal THC and CBD variations with your body. You gain the clearest and healthiest picture of your exact cannabinoid processing, what works and what doesn’t.
- Improved psychoactive vs. medicinal-marijuana familiarity: While we’ve long grasped the difference in effects THC and CBD elicit, we’ve never understood to meaningful degrees why. The boom in marijuana pharmacogenetics allows for a better understanding of cannabinoids’ hundreds of chemical compounds, expressions, molecules and metabolites. Today’s pharmacogenetics interest lets us dive deeply into these processes like never before — with discoveries only beginning.
- Improved health outcomes and patient trust:While most of today’s standard, Western medicines only treat symptoms, marijuana pharmacogenetics gets to the core of a patient’s genetic makeup. This ability to understand a patient inside and out — literally — is the true goal of medicine, one cannabis pharmacogenetics captures.
What Is the Endocannabinoid System?
To fully grasp the potential of cannabis pharmacogenetics, you must understand another important note about our bodies: the endocannabinoid system (ECS).
The ECS is a molecular and cell network that keeps our bodies in homeostasis. It maintains optimal internal conditions for our body’s cells to talk to one another, receive messages and run in tip-top shape. Think of it like cell-to-cell walkie-talkies. Without it, your cells wouldn’t be able to communicate with one another as building blocks to so many bodily functions. The ECS is a big player across these critical mental and physical relationships.
- The ECS helps our immune system’s inflammation signals keep from over-firing. Inflammation occurs when our body recognizes a damaged or infected area, reacting by swelling and isolating that tissue. If the system is always saying something is wrong, though, you’ll experience chronic inflammation. If unaddressed, this inflammation can lead to serious health concerns, like auto-immune diseases and cardiovascular damage.
- The ECS aids in regular brain cell firings. Overactive brain neurons firing signals left and right can cause serious neurological chaos. On the other hand, underperforming neuron pathways aren’t ideal, either. The ECS helps regulate these neuron firings and synapse connections.
- The ECS plays a part in motor function and reward. Known by many as “runner’s high,” the euphoric feeling you get after an intense physical workout is no placebo. Rather, it’s a part of a brain-body reaction the ECS produces. Certain endocannabinoid plasmas increase during exercise, and are one of the few messages that can seep through our selective brain-blood barrier to make our brains release rewarding dopamine.
- And, yes, the ECS allows our bodies to interact with marijuana the way it does. Our ECS contains and maintains all the cell receptors necessary to bind with cannabinoids. During that cell binding and metabolizing, we feel the same effects we do from consuming marijuana.
Marijuana and the ECS
Marijuana has the effects it does due to gene-determined, cell-to-cell cannabinoid interactions. When those cannabinoids make their way through us post-ingestion, they inevitably come into contact with and get processed by our ECS.
Your ECS is made up of hundreds of unique cell receptors. These receptors are the reason you respond the way you do to various cannabinoids. When a receptor meets a cannabinoid compound, it receives a nerve message and cell direction. This results in all the singular states and side effects marijuana can have — whether that feeling is hungry, sleepy, calm or more pain-tolerant.
There are two primary ECS cell receptors in our bodies.
- CB1 receptors: CB1 receptors have a higher concentration in the brain and nervous system and lower concentrations spread throughout bodily organs. Therefore, CB1 receptors process the headier, psychoactive reactions to cannabinoids.
- CB2 receptors. Complementary to CB1s, CB2 receptors are located more in the immune system and GI tract, but are not uncommon in certain brain cells, as well. They’re tasked with immune inflammation functioning and messaging in the digestive tract. As such, medical marijuana with CB2-targeting properties shows a lot of promise for many common auto-immune digestive diseases, such as Crohn’s disease and IBS.
Pharmacogenetics and the Endocannabinoid System
By unlocking the singularly unique way your body’s ECS reacts to and processes cannabinoids, you can know what works best for you — and what doesn’t. This knowledge is only possible because of pharmacogenetics.
It’s an exciting time for the field. Pharmacogenetics’ technological developments in the past decade, as well as the growing interest from scientists and consumers alike for access and usage, has paved the way for its highest research rates ever.
Already, pharmacogenetics has uncovered several key health findings.
The Binding Affinity
Certain cannabinoids are drawn to certain cells, spread throughout various parts of the body. Think cells in the immune system, memory cells in the brain or cells located in inflamed joints — all of which have their own message receptors. Cannabinoids are drawn to these particular cells in an act known as the binding affinity.
With pharmacogenetics, researchers can target these bindings for medical purposes. They can do so with acute detail and accuracy, given the genetic roadmap they now have access to.
- Following ingestion, hyper-specialized enzymes and proteins located primarily in our GI tract and liver get to work metabolizing cannabinoids. It’s a metabolic reaction as old as our species. These enzymes are responsible for chemically altering cannabinoids into larger compounds we can eventually eliminate, called metabolites.
- THC and CBD each have their own special enzymes and metabolic “elimination” steps.
- Those enzyme populations and their activity level differ between people. That means not only will the “high” you feel from strains be different than, say, your spouse’s, neighbor’s or your coworker’s, but the actual rate at which your body is converting and eliminating cannabinoids will also vary.
- THC and CBD do nothing to us in their raw forms. They don’t activate until they get heated, causing their unique range of side effects.
- We now recognize that, as certain cannabinoid metabolites are processed, they can actually spike in potency before turning inactive.
- ECS-regulated drug transporters act as gatekeepers for your brain, determining how intensely psychoactive substances, like THC, affect it.
- These drug transporters are also genetically coded and controlled, varying across demographics.
CB1 and CB2 Variations
- Pharmacogenetics can tell us a lot about our individual CB1 and CB2 receptors. In particular, people can be overexpressed in one of the two, meaning they’re more likely to feel the effects of psychoactive THC if they have overexpressed CB1 receptors, or have above-average, positive results from CBD-targeting treatments through overexpressed CB2 receptors.
- Likewise, those low in CB2 receptors may not respond quickly to CBD tinctures. Those wishing for THC-necessary relief, like patients with anxiety or depression, may not see their desired results if low in CB1s.
Fields That Can Benefit From Cannabis Pharmacogenetics and ECS Research
The rapidly growing interest in pharmacogenetics creates many exciting cannabis genotyping opportunities for medical practitioners. They stand to help doctors and researchers provide enhanced treatments for their patients with these conditions, across medical fields.
- Cancer/oncology: The most widespread and accepted clinical use for medical marijuana is for patients undergoing chemotherapy, who often experience a collection of negative side effects. These include, but are not limited to, dizziness, vertigo, nausea, lack of appetite and indigestion. Medical marijuana is already a common remedy to alleviate many of these symptoms, but cannabis pharmacogenetics would sharpen doses and prescriptions to aid in overall recovery, and — hopefully — remission.
- Rheumatism/arthritis/inflammation: With medical marijuana legalized in more than half the country, one of its current thriving applications centers on chronic-pain relief. While disease-modifying anti-rheumatic drugs are still the standard and advised treatment, many patients could see extra relief through THC-isolated supplements. Enhanced by individual genetic testing, supplementary treatments developed by expert practitioners will add buffer relief for patients, such as THC-tailored patches or tinctures.
- Cardiovascular health:With their anti-inflammatory properties, both primary cannabinoid types show promise for immune function, blood vessel, artery and heart medication. Yet isolated compounds extracted from pure Indica breeds, with their CBD-only calming effects and no hallucinatory THC properties, show the most potential. Pharmacogenetics can recognize patients low in CBD-metabolizing enzymes, the kind necessary to make such medicines work.
- GI conditions: Chronic, auto-immune diseases disrupting the GI tract are on the rise. With no known cure and a medical battle to explain this rise, marijuana pharmacogenetics stands to help researchers use binding affinity-related treatments for a patient’s damaged immune and digestive systems. Since a large part of the ECS functions in our immune systems and GI tracts, there is a world of medical research that could be done to better link the two. As with arthritis and other chronic pain conditions, tailored treatments could be the way of the future.
- Mental health: With the majority of CB1 receptors located in the brain and nervous system, there is an active interest from the medical and psychiatry communities on marijuana’s clinical and therapeutic uses for conditions that directly disrupt these areas. Studies show marijuana-based, ECS-targeting medicines as displaying a range of positive results for brain-based conditions like bipolar disorder, PTSD, anxiety, depression, Parkinson’s and Huntington’s disease, epilepsy and multiple sclerosis. Plus, when looping in pharmacogenetics, we can identify people with certain gene variants that will adversely respond to these neurological-targeting treatments — ensuring the reputation and safety of medical marijuana as a whole.
- Obesity/metabolism disorders: Another emerging theory highlights certain ECS regulations in the digestive tract, which physicians can explore as alternative treatments for obesity, insulin and metabolic disorders. Since the ECS plays a part in fat and glucose metabolism, regulatory food intake, intestinal inflammation and hunger signals, some believe targeting these signals could be an attractive treatment for patients struggling with their weight. In addition, the factors that go into a person’s weight and natural metabolism are highly gene-based — meaning cannabis pharmacogenetics could be the key to unlocking a healthier ECS and digestion relationship.
Note that this list is not exhaustive. Cannabis pharmacogenetics is still in its early stages. As clinical and public interest continue to grow, research opportunities, funding, access to tests, insurance coverage, market-friendly pricing and wider usage and applications are only set to expand.
Cannabis Pharmacogenetic Tests
The best way to see how marijuana works for you is by taking a cannabis pharmacogenetic test. These tests are in-depth and extensive, usually only requiring a simple cheek swab. They profile a range of metrics and gene relationships, helping you know your THC and CBD metabolism profiles and related drug responses.
What Do Pharmacogenetic Test Results Include?
- Methodology:An explanation of the test’s overall functions and uses.
- Disclaimer:Your test results are private and should not be shared with anyone without your consent. Disclaimers will also recommend you follow up with any and all doctors you see to ensure they include your test results in official medical files, as well as discuss current medications in light of findings.
- Potential response index:The “meat and potatoes” of your test results, this section will list major cell-receptor types in your body, their amount and how they handle THC and CBH compounds. They will give insight into your metabolic rates compared to the average, as well as give recommended dose adjustments you may need.
- Drug interactions: Cannabis pharmacogenetic tests will usually include a pharmaceutical section. These can be anywhere from a few pages to a few dozen, depending on your test package. Drug-interaction sections will break down medications potentially impacted by your personal results, ranging from standard precautionary usage to advising you to find an alternative. Note: No credible pharmacogenetic test should recommend outright stopping a medication immediately, before consulting a doctor. Always discuss your results with a trained medical professional before changing any prescription routine.
- Summary cards:Summary cards show the major findings of your personal test. They’re similar in appearance and size to a medical marijuana recipient card. You can cut or clip them from your multi-page results and carry it around with you for easy access and review.
Interested in Learning More About Marijuana Pharmacogenetics and Testing?
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