Constituyentes psicoactivos del cannabis y sus implicaciones clínicas: una revisión sistemática Psychoactive constituents of cannabis and their clinical implications: a systematic review

Autores/as

  • Cristina Casajuana Köguel Institut d’Investigacions Biomèdiques August Pi i Sunyer / Hospital Clínic of Barcelona
  • Hugo López-Pelayo Fundació Clínic per la Recerca Biomèdica / Hospital Clínic of Barcelona
  • Mª Mercedes Balcells-Olivero Hospital Clínic of Barcelona
  • Joan Colom Public Health Agency of Catalonia
  • Antoni Gual Institut d’Investigacions Biomèdiques August Pi i Sunyer / Hospital Clínic of Barcelona

DOI:

https://doi.org/10.20882/adicciones.858

Palabras clave:

Delta(9)-Tetrahidrocannabinol, Cannabinol, Cannabis, Cannabinoides, Drogas psicoactivas Delta(9)-Tetrahydrocannabinol, Cannabinol, Cannabis, Cannabinoids, Psychotropic drugs

Resumen

Objetivo Esta revisión sistemática pretende resumir la actual evidencia sobre qué cannabinoides naturalmente presentes contribuyen a la psicoactividad final del cannabis, considerando sus concentraciones registradas y su farmacodinamia en humanos. Metodología Siguiendo las guías PRISMA, se revisaron artículos científicos publicados antes de marzo 2016 en Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge y COCHRANE, que cumplieran unos criterios establecidos a-priori. Resultados En 40 artículos científicos, se identificaron tres cannabinoides naturalmente presentes (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol y cannabinol) y un metabolito humano (11-OH-THC) con relevancia clínica. De éstos, el metabolito produce los efectos psicoactivos más potentes. El cannabidiol (CBD) no es psicoactivo, pero sí ejerce un efecto modulador sobre los efectos psicoactivos del cannabis. La concentración 9-THC en derivados cannábicos (hasta 40%) supera en gran medida la de otros cannabinoides (hasta 9%). La farmacodinamia descrita varía, dada la heterogeneidad en aspectos clave de la metodología (dosis, rutas de administración y experiencia previa con cannabis de los participantes). Conclusiones Los resultados evidencian que el 9-THC es el cannabinoide que más contribuye al efecto psicoactivo del cannabis. Otros cannabinoides psicoactivos contribuirían mínimamente, dada su menor potencia psicoactiva y su baja concentración en los derivados cannábicos. La falta de estándares metodológicos dificulta el avance en los conocimientos sobre los efectos del cannabis en la salud. Establecer una unidad estándar de cannabis basada en 9-THC ayudaría a superar estas limitaciones.
Objective This systematic review aims to summarize current evidence on which naturally present cannabinoids contribute to cannabis psychoactivity, considering their reported concentrations and pharmacodynamics in humans. Design Following PRISMA guidelines, papers published before March 2016 in Medline, Scopus-Elsevier, Scopus, ISI-Web of Knowledge and COCHRANE, and fulfilling established a-priori selection criteria have been included. Results In 40 original papers, three naturally present cannabinoids (∆-9-Tetrahydrocannabinol, ∆-8-Tetrahydrocannabinol and Cannabinol) and one human metabolite (11-OH-THC) had clinical relevance. Of these, the metabolite produces the greatest psychoactive effects. Cannabidiol (CBD) is not psychoactive but plays a modulating role on cannabis psychoactive effects. The proportion of 9-THC in plant material is higher (up to 40%) than in other cannabinoids (up to 9%). Pharmacodynamic reports vary due to differences in methodological aspects (doses, administration route and volunteers’ previous experience with cannabis). Conclusions Findings reveal that 9-THC contributes the most to cannabis psychoactivity. Due to lower psychoactive potency and smaller proportions in plant material, other psychoactive cannabinoids have a weak influence on cannabis final effects. Current lack of standard methodology hinders homogenized research on cannabis health effects. Working on a standard cannabis unit considering 9-THC is recommended.

Biografía del autor/a

Cristina Casajuana Köguel, Institut d’Investigacions Biomèdiques August Pi i Sunyer / Hospital Clínic of Barcelona

Institut d’Investigacions Biomèdiques August Pi i Sunyer / GRAC Addiction Unit Hospital Clínic of Barcelona. Red de Trastornos Adictivos (RTA). Universitat de Barcelona

Hugo López-Pelayo, Fundació Clínic per la Recerca Biomèdica / Hospital Clínic of Barcelona

Fundació Clínic per la Recerca Biomèdica / GRAC Addiction Unit Hospital Clínic of Barcelona. Red de Trastornos Adictivos (RTA). Universitat de Barcelona

Mª Mercedes Balcells-Olivero, Hospital Clínic of Barcelona

GRAC Addiction Unit Hospital Clínic of Barcelona. Red de Trastornos Adictivos (RTA). Universitat de Barcelona

Joan Colom, Public Health Agency of Catalonia

Public Health Agency of Catalonia

Antoni Gual, Institut d’Investigacions Biomèdiques August Pi i Sunyer / Hospital Clínic of Barcelona

Institut d’Investigacions Biomèdiques August Pi i Sunyer / GRAC Addiction Unit Hospital Clínic of Barcelona. Red de Trastornos Adictivos (RTA). Universitat de Barcelona.

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2018-04-15

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Vol. 30 Núm. 2 (2018)

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