Posted by Vi Hughes on Oct 10, 2019
This Tuesday we heard from one of our members, family physician Stephan Jansen van Vuuren and his associate, Kristen Stefanec, an LPN and Cannaboid Therapist and Educator from Canada House Clinics. Stephan gave us some background on the use of cannabis, which has been used for medical purposes in China for many thousands of years. He said that the first of many active chemical compounds to be discovered was THC (delta 9 tetra hydro cannabinol). It was first described in 1964 by medicinal chemist, Raphael Mechoulam. Since then over one hundred and fifty different compounds have been found in this plant, many of which have physiological effects. He was also instrumental in the discovery of the endogenous (naturally found in the human body) compound anandamide and it’s receptors in the human body in the 1990’s.  It was found to have receptors on cells both in the brain and in various locations throughout the body. This and related compounds have effects on things like pain relief, sleep patterns, anxiety and the immune system. Only two of the compounds found in cannabis cross the blood brain barrier, THC and CBD (cannabidiol). The others all have their effects in other parts of the body.
Stephan first became interested in these compounds about ten years ago when he encountered patients who suffered from PTSD (post traumatic stress disorder) and who had found that cannabis greatly relieved their symptoms. Families and friends of these people said that cannabis had given them back their loved one.  At that time very little was known about the medical uses of cannabis and in his words it was ‘the wild west’ of cannabis use, prescriptions were only very loosely controlled. He thought that caution was called for, so he decided that he first needed to learn as much as possible about this new treatment. Since then he has learned a lot about the medical uses of cannabis, and the interactions it can have with other medications. He cautioned that it is not considered a first line therapy and that it should only be used when the first line treatments have failed. He said that there are a lot of preconceived notions about cannabis and these can be hard to dispel.  
Stephan said that the cannabis currently in use is a raw mixture of at least one hundred and fifty different compounds, each with their own effects, some of which amplify or reduce the other’s effects. Some are hallucinogenic while others are calming. Some are sedating, others energize. The amounts of each present in a particular batch of plants can vary greatly depending on the genetic strain and the conditions it was grown under. The amount of air (oxygen and carbon dioxide levels) water, nutrients and light, even the wavelength of light can affect their relative amounts.  The use of pure compounds has not been found to be effective, so it is some as yet unknown combination of compounds that gives the best effects. Cannabis is not the best treatment for any specific symptom, but the fact that it affects so many different systems makes it useful in the treatment of sleeping problems, anxiety, nausea, pain, inflammatory diseases and many other hard to treat conditions. It can also have some nasty side effects (rapid heart beat, dizziness, low blood pressure, depression, hallucinations and paranoia) and can interact with other medications. All of this means that treatment can be very complex.
Stephan is now treating patients through Canada House Clinics. He has set up a team approach to treatment that also involves the patient’s general physician and any other specialists as needed.  The patients that they treat have already been fully evaluated and diagnosed by other physicians and have failed first line treatment. Prescribing is very carefully controlled and it’s effectiveness is followed by the team. The initial prescription is only for three months and a full evaluation is done at that point.  Future legalisation will bring the use of both oral and topical preparations, which will add to their choices of treatment. The cannabis they prescribe is not the same as what you can buy in the store. It has been specially grown, carefully selected and tested for the desired compounds. Any batches that fail are sent for general consumption instead.  Treatment with cannabis is rapidly evolving and keeping up with it will be a challenge, but it is definitely one worth pursuing. We would like to thank both Stephan and Kristen for their very informative and interesting presentation.