• Eric I Mitchell MD MA FAC

You don’t know what you don’t know: The Endocannabinoid System

You don’t know what you don’t know! My desire to become a surgeon started long before I got to medical school at the Perelman School of Medicine of the University of Pennsylvania. I operated on my sisters’ dolls early on and moved to building projects with tinker toys. I graduated to getting my own hammer and saw as I worked with my Father in building my aunt’s house at age nine. Then, I progressed to having my own home improvement business as I went to college and medical school. Being one of seven children, with 4 of us in college, you didn’t write home for money or attempt collect phone calls home.

I got to medical school and converted all those early skills of dexterity into good sterile surgical techniques that were taught to me. I soon joined a surgical society to promote this interest. That society was the D Hayes Agnew Society at Penn. The society’s formulation dated back to the 1890s when sterile techniques were first being introduced into America’s surgical suites and operating rooms. You don’t know what you don’t know!

I tell you this story to take you back in time when doctors didn’t know what they didn’t know about sterile technique. Until the discovery of the microscope, germs and bacteria could not be seen with the naked eye. So out of sight, out of mind! It’s the famous Thomas Eakins painting of the Agnew Clinic that hangs in the Perelman School of Medicine which changed everything. Surgeons started washing their instruments and their hands before and after surgery because of these bacteria that they could now see with this thing called a microscope.

Now, I am going to tell you about a human biological neurotransmitter system that 87% of allopathic doctors don’t know what they don’t know. Amongst global experts, it is believed that the Endocannabinoid System (ECS) is the regulatory system for all other biological systems. A recent study suggested less than 13.3% of our medical schools even mention the words “Endocannabinoid System”. And, the majority of physicians and other medical professionals have no idea this biological system exists because it’s not taught in medical schools because of its Schedule 1 classification under the Controlled Substances Act of 1970.

However, the U.S. repository for medical literature is not short on this subject matter, and you’ll find over 28,400 studies published on cannabis. Tylenol, a well-known over the counter medicine, brings in about 22,000 results. Ritalin, another brand of medicine known to the public, will pull up 8,680 results.

The endocannabinoid system is a biological system composed of endocannabinoids, which are endogenous lipid-based retrograde neurotransmitters that bind to cannabinoid receptors and cannabinoid receptor proteins that are expressed throughout the vertebrate central nervous system and peripheral nervous system. So why don’t we know what we should know.

The DEA has been one of the major obstructions to meaningful research due to the federally restrictive scheduling of cannabis over the last 48 years as Schedule 1. The political wishes of the powers that be have expressed their wishes over medical societies like the AMA in both 1937 and 1970. The passage of the 2018 Farm Bill will now allow for this political conundrum to be lifted with nothing now stopping allopathic medical schools from teaching future MDs “what we do know” about the endocannabinoid system but fear itself.

However, give credit where credit is due! Osteopathic and naturopathic medical schools have already begun putting future DOs & NDs at a clear advantage over their allopathic (MD) counterparts. It’s way past the time to optimize cannabinoid therapy for patients by integrating the endocannabinoid system and cannabis education into the medical curriculum, as well as those in other sectors of healthcare (e.g. nurses, nurse practitioners and physician assistants).

Sad but true, there is also a public persona in the general public because of the books we read. National Geographic’s, Guide to Medicinal Herbs –The World’s Most Effective Healing Plants, written by a group of allopathic doctors, doesn’t have Cannabis sativa L included anywhere in this book. The book was published in 2010. Sad but true!

The endocannabinoid system (ECS) plays an important role in our body well beyond the process it's named for, which is interacting with Cannabis sativa L which includes hemp with less than 0.3% THC and hemp with greater than 0.3% THC. The Endocannabinoid System is a crucial system for “homeostasis”.

To understand the ECS, it first helps to understand what homeostasis is. Basically, homeostasis is your body's efforts to keep everything in the right zone. Its job is to keep your internal environment stable and optimal no matter what's going on in the environment around you. Think of all the gauges in the dashboard of a car or airplane. Those dials and gauges all tell the operator whether things are—or aren't—operating in the proper zone.

When a bodily system is operating outside of its right range, your body activates the ECS to help correct it. So, when you're really hot and begin to sweat, thank your ECS for working to cool you down. Stomach growling? That's your ECS helping to remind you to eat because you need fuel. The ECS does this via cannabinoid receptors found in select tissues. We have (at least) two types of cannabinoid receptors:

CB1 receptors are in the central nervous system (brain and nerves of the spinal cord). CB2 receptors are in the peripheral nervous system (nerves and bones in your extremities), the skeletal system, the digestive system, and specialized cells in the immune system. These cannabinoid receptors are believed to be among the most plentiful in our central nervous system.

The federal government has gone out of its way to discourage the discussion of even the neuroanatomy and neurophysiology of the ECS. Strangely, the government has been particularly active in its efforts to falsely debunk the medical utility of cannabis and cannabinoids—even though the Department of Health and Human Services has a patent on the second most common cannabinoid, Cannabidiol (CBD).

If the physician doesn’t know of the ECS, its constituents such as the neurotransmitters anandamide, 2AG and dopamine and/or the role of dopamine in retrograde inhibition, how will doctors ever understand how and why cannabis treats migraines, seizure disorders, Crohn’s disease, arthritis, and the myriad of other conditions cannabis has been shown to treat?

You now know “what you should know” about the Endocannabinoid System so go challenge your physicians, nurses, nurse practitioners and physician assistants, in a retrograde fashion to discover the pathology and physiology of the ECS, so that they can know about this magnificent age-old botanical- based biological system of the human body as it works to improve our lives and lifestyles.

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