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Medicamentos, preparações e substâncias à base da planta da canábis: aspetos farmacológicos e toxicológicos
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Abstract(s)
A Cannabis sativa L. e os produtos dela obtidos têm uma longa história de uso, tanto terapêutico como recreativo. Considerada como a substância ilícita mais consumida no mundo, a canábis tem sido, contudo, foco de uma intensa investigação nas últimas décadas, centrada sobretudo no estudo das propriedades medicinais e aplicações clínicas da planta e dos fitocanabinoides, o que contribuiu para as recentes alterações na legislação de vários países, incluindo Portugal. Atualmente são conhecidos mais de 100 canabinoides na planta da canábis, dos quais o Δ9-tetrahidrocanabinol (Δ9-THC) e o canabidiol (CBD) são os mais abundantes e estudados do ponto de vista científico. O Δ9-THC é o principal canabinoide psicoativo, responsável pelos efeitos inebriantes da canábis, enquanto o CBD tem sido associado a benefícios para a saúde. Evidências científicas do valor terapêutico da canábis/canabinoides conduziram à aprovação de medicamentos contendo canabinoides como substâncias ativas e, mais recentemente, de preparações de canábis para fins medicinais nos casos de doentes não responsivos aos tratamentos convencionais. Contudo, o consumo de canabinoides para fins terapêuticos ou recreativos pode estar associado a uma panóplia de efeitos adversos agudos e crónicos. Assim, a determinação dos fitocanabinóides e dos seus metabolitos em diferentes matrizes biológicas assume grande interesse em Toxicologia Clínica e Forense. O presente trabalho pretendeu promover o conhecimento dos efeitos fisiológicos, farmacológicos e toxicológicos dos fitocanabinoides e destacar as implicações legais, clínicas e médico-legais do seu uso. Para o desenvolvimento do trabalho, foi realizada primeiramente uma revisão da literatura sobre as características principais da canábis e dos principais fitocanabinoides, incluindo formas de administração, aspetos farmacocinéticos e farmacodinâmicos, efeitos fisiológicos e toxicidade aguda e a longo prazo. Posteriormente, é referida a importância da canábis e potenciais áreas de aplicação das análises toxicológicas em contexto clínico e forense.
Cannabis sativa L. and its products have a long history of use, both therapeutic and recreational. Considered to be the most widely consumed illicit substance in the world, cannabis has, however, been the focus of intense research in recent decades, mainly focused on the study of the medicinal properties and clinical applications of the plant and phytocannabinoids, which has contributed to the recent changes in legislation in several countries, including Portugal. Currently, more than 100 cannabinoids are known in the cannabis plant, of which Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are the most abundant and scientifically studied. Δ9-THC is the most important psychoactive cannabinoid, responsible for the intoxicating effects of cannabis, while CBD has been associated with health benefits. Scientific evidence of the therapeutic value of cannabis/cannabinoids has led to the approval of cannabinoid-containing drugs as active substances and, more recently, of medicinal cannabis preparations in cases of patients not responding to conventional treatments. However, the use of cannabinoids for therapeutic or recreational purposes may be associated with a range of acute and chronic adverse effects. Thus, the determination of phytocannabinoids and their metabolites in different biological matrices is of great interest in Clinical and Forensic Toxicology. This study aimed to promote the knowledge of the physiological, pharmacological and toxicological effects of phytocannabinoids and highlight the legal, clinical and medico-legal implications of their use. For the development of the work, a literature review on the main characteristics of cannabis and the main phytocanabinoids, including forms of administration, pharmacokinetic and pharmacodynamic aspects, physiological effects and acute and long-term toxicity was first performed. Subsequently, the importance of cannabis and potential areas of application of toxicological analyses in clinical and forensic settings are also mentioned.
Cannabis sativa L. and its products have a long history of use, both therapeutic and recreational. Considered to be the most widely consumed illicit substance in the world, cannabis has, however, been the focus of intense research in recent decades, mainly focused on the study of the medicinal properties and clinical applications of the plant and phytocannabinoids, which has contributed to the recent changes in legislation in several countries, including Portugal. Currently, more than 100 cannabinoids are known in the cannabis plant, of which Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are the most abundant and scientifically studied. Δ9-THC is the most important psychoactive cannabinoid, responsible for the intoxicating effects of cannabis, while CBD has been associated with health benefits. Scientific evidence of the therapeutic value of cannabis/cannabinoids has led to the approval of cannabinoid-containing drugs as active substances and, more recently, of medicinal cannabis preparations in cases of patients not responding to conventional treatments. However, the use of cannabinoids for therapeutic or recreational purposes may be associated with a range of acute and chronic adverse effects. Thus, the determination of phytocannabinoids and their metabolites in different biological matrices is of great interest in Clinical and Forensic Toxicology. This study aimed to promote the knowledge of the physiological, pharmacological and toxicological effects of phytocannabinoids and highlight the legal, clinical and medico-legal implications of their use. For the development of the work, a literature review on the main characteristics of cannabis and the main phytocanabinoids, including forms of administration, pharmacokinetic and pharmacodynamic aspects, physiological effects and acute and long-term toxicity was first performed. Subsequently, the importance of cannabis and potential areas of application of toxicological analyses in clinical and forensic settings are also mentioned.
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Keywords
Cannabis sativa Canabinoides Farmacocinética Farmacodinâmica Uso terapêutico Toxicidade Forense Cannabis sativa Cannabinoids Pharmacokinetics Pharmacodynamics Therapeutic use Toxicity Forensics