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Why isn’t the endocannabinoid system taught in medical schools?

January 10, 2020
endocannabinoid system, what doctors are taught about cannabis, brain chemistry and marijuana
(enisaksoy/iStock)
I am currently dependent on medical cannabis, and despite loving the plant, I’m kinda bitter about this fact. And it’s not the usual lamenting of “Why me?” that so often goes with illness; it’s because the medical professionals I encounter have little to offer about the origin and treatment of my disease, fibromyalgia. A major reason that they’re at a loss with it—and so many chronic illnesses like it—is because it may be sourced in the endocannabinoid system (ECS).

As a Leafly reader, you might already know that the ECS is a bodily system made of receptors located throughout the body and that it works with all other systems to maintain homeostasis, or optimal functionality.

But did you know that this vital system isn’t covered in medical school despite the fact that studies worldwide have been articulating its prowess since 1992?

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Medical schools are “too full” for additional information

And do you know what their primary reason is? Because they say they “don’t have time to teach it.” That’s right—med schools are apparently no longer open to integrating new science into their curriculums. We reached out to many medical schools for comment, but repeated emails went without response.

“The typical response is, ‘What will we eliminate?’ However, that ignores the importance of this system and its fundamental role in regulating physiology in every aspect.”
Dr. Ethan Russo, pharmacologist and neurologist

According to Dr. Ethan Russo, board-certified neurologist and psychopharmacology researcher, the common response is that they’d have to remove something else from the curriculum to make room for it.

According to Dr. Russo, “The medical curriculum is just jam-packed. I went to med school back in the ‘70s, and even at that point there was just no slack in the schedule. What one has to cram into particularly the first couple years of basic science, is rather astounding. And now there’s been an additional 40 years of scientific discovery that also has to be incorporated. Administrators are always going to be defensive about that. The typical response is, ‘What will we eliminate?’ However, that ignores the scientific importance of this system and its fundamental role in regulating physiology in every aspect.”

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One would hope that the response to realizing there is a vital bodily system missing from medical school curriculum would be something thoughtful, like, “This system works with all of the other bodily systems and is essential to maintaining health in the body—maybe it’s time to reassess and reorganize.”

But, alas, the party-line solution is actually to just not teach another piece of medicine, which would remove it from practice. It’s as if medicine goes into a tool belt, and rather than reconfiguring a more suitable tool belt when full—they’d instead just toss aside an irreplaceable tool.

The ECS is integral to the function of all the “major” systems

Dr. Russo says that the idea of not educating doctors on the ECS is incomprehensible because it is fundamental to how our bodies work.“A prime example is that there are more cannabinoid receptors in the brain than there are for all of the neurotransmitters put together,” he said.

“One could easily argue that you can’t understand how neurotransmitters in the brain work without knowledge of the endocannabinoid system.”
Dr. Ethan Russo

As you’ve probably ascertained, this is a fact with significant implications. He continues, “One could easily argue that you can’t understand how neurotransmitters in the brain work without knowledge of the ECS.” Additionally, he confirmed this could also imply that there are more opportunities for cannabis to work with the body than pharmaceuticals.

The ECS is also responsible for maintaining the homeostasis of all of the other bodily systems—which is a fancy way of saying that it keeps balance in the other systems, ensuring that they are functioning optimally. It’s also often described simply as the way the brain communicates with the body. Or, as Russo put it in our interview, “Everything in the body is connected, and this is the glue.”

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Because the ECS appears to regulate actually recognized bodily systems, many things go awry when it doesn’t function correctly. Endocannabinoids have been observed to directly and indirectly influence a variety of physiological systems that control appetite, pain, inflammation, thermoregulation, intraocular pressure, sensation, muscle control, energy balance, metabolism, sleep health, stress responses, motivation/reward, mood, and memory.

These functions are not minor details—if you were to lose even a single one of these abilities, it could significantly alter your daily life. Chronic illnesses, which last three months or longer and are generally considered “incurable,” affect 40% of Americans. Why is it that so many of our bodies are afflicted with conditions that modern medicine cannot do anything to absolve?

Could it be that we’re missing a crucial piece of the puzzle? Surely, there must be something else going on.

What do cannabis and pharmaceuticals have to do with it?

When asked why the ECS isn’t being taught in medical schools, another common response was that there are presently very few medications that interact with it—but how will there ever be if the medical community doesn’t even regard it in the first place? And why does it matter, anyways—do doctors only need to know about bodily systems that can be treated via the pharmaceutical industry? (And even the answer there is a plutocratic ‘yes,’ then do the available synthetic cannabinoids not count?)

These are apparently not questions that are often discussed in the medical community. The basic consensus seems to be that though medical students ought to be taught about all illnesses—not just those that there are presently pharmaceuticals for—that’s simply not how it works.

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Another factor is, of course, the federally-illegal status of the plant that works so adeptly with the ECS; still holding its ancient and never-been-true title of ”Schedule I–Drug with no currently accepted medical use.” But since the ECS generally functions without the help of cannabis (thanks to our naturally occurring endogenous cannabinoids), one wonders why this is show-stoppingly relevant—again, shouldn’t doctors need to know about bodily systems that don’t already have viable medications? Isn’t that all the more reason they should be trained in what we do know about the ECS, so they may help patients keep the vulnerable system unharmed?

This next revelation will not surprise you: According to Russo, stigma around cannabis and a lack of funding as a result also appear to play a role in this reckless and willful knowledge gap, “One has to imagine that a prejudice against cannabis, fear of cannabis, and lack of funding is spilling over into a pejorative effect on education about the endocannabinoid system.”

Hope and change

Even though Russo says that grad students rarely want him as a mentor, some colleges are hedging their bets that tomorrow’s generation will have a different take. The University of Maryland School of Pharmacy is one such school, now offering a Master of Science (MS) in Medical Cannabis Science and Therapeutics. Leafly talked with Andrew Coop, PhD, their Professor and Associate Dean for Academic Affairs, who seems hopeful that logical changes in this area are on the way.

“The reason we started the program was because so few programs focus on the health benefits of marijuana,” Coop said, “the pluses, the minuses, the strengths, where further research needs to go, where the indications have good strong evidence, where there is no strong evidence. We are teaching 150 students at the master’s level to understand all aspects—but also to be able to critically assess what the current state of the art says and doesn’t say, and what further studies need to be formed so that we can move forward in a systematic manner.”

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Their twelve courses cover a comprehensive range of topics, from an introduction to the history and culture of cannabis, to the highly technical “Genomics and Pharmacognosy,” to “Expert Seminars and Case Studies” where students identify knowledge gaps in the science and design an educational intervention.

Coop is looking forward to more sweeping changes in policy and legislation. “To me, the bottom line is that we need change at the federal level, such as the MORE Act, before we’ll see more med schools include it in their curriculum,” he said. “Once we get things such as the decriminalization of marjiuana, I predict more schools will include it. There is a want and a need for education in all aspects of marijuana.”

Until that day, those of us with diseases suspected to be sourced in ECS malfunction must wait. One day, researchers like Dr. Russo will have the resources to provide necessities like a diagnostic test for fibromyalgia, something he’s waiting on funding to get rolling on—a development that could change the lives of millions.

As Dr. Russo told us, “This failure to address ECS education appropriately is in unforgivable breach of scientific trust and a major disservice to the public health.” 

Meg Hartley's Bio Image

Meg Hartley

Meg Hartley is an Alaska-grown cannabis writer and advocate who now lives and loves in Long Beach, California.

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  • PatrickMonkRn

    Because it threatens the Pharmaceutical Industry, and the entire Medical/Industrial Complex.