Reefer Madness
Reefer Madness was a film made originally in 1936 to try and dissuade kids from using marijuana and then rediscovered in the 1970's and used as a satire of the paranoia of uptight parents and to advocate for marijuana as an ostensibly safe recreation. Marijuana has a colorful history. The name marijuana seems to be Mexican Spanish but the true etymology is contentious. (1) The cannabis plant, another one of many names for marijuana, is originally native to South Asia and has been in use for centuries.
People of a certain age know that besides hurting your short term memory - if you remember the 60's you weren't there - getting stoned also gives you the munchies. Although marijuana doesn't appear to increase weight in potheads or help much with the weight loss of AIDS and cancer (2) somebody got the idea that maybe a drug that could block the munchies effect of marijuana would help treat obesity. Possibly fueled by this potentially lucrative idea, a lot of research has been done on marijuana's effect on appetite. It turns out that animals have receptors called cannabinoid receptor types 1 and 2 (CB1,CB2) in the brain and lots of other places. So our bodies make endocannabinoids, molecules that bind to those receptors and do all kinds of interesting stuff in us. An early beneficiary of this knowledge is dranobinol a cannabinoid drug effective for relieving the nausea and vomiting of cancer chemotherapy. The cannabis-marijuana plant delivers a cocktail of different cannabinoids and can itself also be used to treat nausea and vomiting.
On June 25, 2018, the U.S. Food & Drug Administration (FDA) approved EPIDIOLEX® (cannabidiol, CBD) oral solution for the treatment of seizures associated with two rare and devastating epilepsy syndromes - Lennox-Gastaut syndrome and Dravet syndrome. It turns out to be the first and only FDA approved medication to treat seizures in Dravet syndrome.
Rimonabant
But to treat obesity there was rimonabant, a selective CB1 receptor blocker that was discovered and developed by Sanofi-Aventis. It did cause some weight loss and had an even greater effect on waist circumference and other cardiometabolic risk factors than could be accounted for by the weight loss. (4,5) It gained approval for treatment of obesity in Europe and Brazil but never in the US. Alas, within 2 years it was found to have too many serious psychiatric side affects and withdrawn in 2008.
The cannabinoid hyperemesis syndrome
A new twist in the madness of reefer is the cannabinoid hyperemesis syndrome that we have been seeing a lot of in my small town pediatric practice. Contrary to the anti nausea reputation of marijuana, these teenagers, mostly girls in our experience, have recurrent nausea, vomiting, cramping abdominal pain, weight loss and dehydration that is due to prolonged, high-dose marijuana use. An interesting observation is that really hot showers help alleviate the symptoms of cannabinoid hyperemesis syndrome. The mechanism is not understood. The fact that this is a new phenomenon might indicate that modern marijuana is more potent cannabinoidfully than it used to be.
Since fat science is about everything, marijuana is also interesting to fat scientists.
1. https://en.wikipedia.org/wiki/Marijuana_(word)
2. Sansone RA, Sansone LA. Marijuana and Body Weight. Innov Clin Neurosci. 2014 Jul-Aug; 11(7-8): 50–54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204468/
3. https://www.epilepsy.com/treatment/alternative-therapies/medical-marijuana
4. Despres J-P et al. Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. N Engl J Med 2005;353:2121-34.
5. Pi-Sunyer FX et al. Effect of rimonabant on weight and cardiometabolic risk factors in overweight or obese patients. JAMA,2006;295:761-75.