Therapeutic Cannabis and Endocannabinoid Signaling System Modulator Use in Otolaryngology Patients

Abstract

Objectives1) review benefits and risks of cannabis use, with emphasis on otolaryngic disease processes; 2) define and review the endocannabinoid signaling system (ESS); and 3) review state and federal regulations for the use and research of cannabis and ESS modulators.MethodsThis manuscript is a review of the current literature relevant to the stated objectives.ResultsCannabis (marijuana) use is increasing. It is the most widely used illicit substance in the world. There is increasing interest in its therapeutic potential due to changing perceptions, new research, and legislation changes controlling its use. The legal classification of cannabis is complicated due to varied and conflicting state and federal laws. There are currently two synthetic cannabinoid drugs that are FDA approved. Current indications for use include chemotherapy‐related nausea and vomiting, cachexia, and appetite loss. Research has demonstrated potential benefit for use in many other pathologies including pain, inflammatory states, and malignancy. Data exists demonstrating potential antineoplastic benefit in oral, thyroid, and skin cancers.ConclusionsESS modulators may play both a causal and therapeutic role in several disorders seen in otolaryngology patients. The use of cannabis and cannabinoids is not without risk. There is a need for further research to better understand both the adverse and therapeutic effects of cannabis use. With increasing rates of consumption, elevated public awareness, and rapidly changing legislation, it is helpful for the otolaryngologist to be aware of both the adverse manifestations of use and the potential therapeutic benefits when talking with patients.

Assessment of quality and consistency of monoclonal antibodies for CB1 and CB2 in head and neck squamous cell carcinoma

“…Cannabinoids are being studied as potential modulators for pain, inflammation, and malignancy . In the field of head and neck cancers specifically, the role of the ESS has been largely unexplored, with the limited current literature drawing disjointed and incomplete conclusions from isolated studies.…”

“…Different geographic portions of the brain demonstrated increased or decreased expression with cannabinoid exposure; these dichotomous effects leave much to be understood about how chronic marijuana use can impact different tissues with different functions. Furthermore, the CB1 g‐protein‐coupled receptors (GPCRs) are thought to interact with vast intracellular processes through downstream second messenger systems, including calcium transport related to neuronal action potentials, and thus marijuana use over time is hypothesized to impact the functioning of a broad range of critical neural processes . In immune tissues, a study used reverse transcription polymerase chain reaction to quantify CB1 and CB2 expression in peripheral blood cells of marijuana smokers vs non‐marijuana smokers and found that there were 1.5 to 2× the quantity of receptor proteins in smokers compared with controls .…”

“…Furthermore, the CB1 g-protein-coupled receptors (GPCRs) are thought to interact with vast intracellular processes through downstream second messenger systems, including calcium transport related to neuronal action potentials, and thus marijuana use over time is hypothesized to impact the functioning of a broad range of critical neural processes. 3,7 In immune tissues, a study used reverse transcription polymerase chain reaction to quantify CB1 and CB2 expression in peripheral blood cells of marijuana smokers vs non-marijuana smokers and found that there were 1.5 to 2× the quantity of receptor proteins in smokers compared with controls. 8 Further in vivo studies to build on these early results and better characterize receptor modulation in human neural and immune tissues are now becoming possible with the changing research environment surrounding marijuana.…”

“…1,2 Cannabinoids are being studied as potential modulators for pain, inflammation, and malignancy. 3 In the field of head and neck cancers specifically, the role of the ESS has been largely unexplored, with the limited current literature drawing disjointed and incomplete conclusions from isolated studies. In one study, endogenous cannabinoids were found to facilitate the formation of reactive oxygen species yielding anticancer effects via the receptor-independent 5-lipoxygenase pathway.…”

Cannabis Use and Sinonasal Symptoms in US Adults

“…26 In patients with newly diagnosed head and neck cancer, cannabis use has been shown to be associated with improved pain scores and over-all well-being. 27,28 Therefore, it is unclear if the association between cannabis use and sinonasal symptoms is similar to tobacco use.…”