Cannabis, or marijuana, is a drug derived from the cannabis plant that is used for recreational use, medicinal purposes and religious or spiritual rites.

Cannabis plants produce a unique family of compounds called cannabinoids. Of these, the major psychoactive (brain function-affecting) compound is tetrahydrocannabinol (THC).

Marijuana contains high levels of THC, as well as other psychoactive chemicals, which produce the ‘high’ users feel when inhaling or ingesting it.

Two other compounds, tetrahydrocannabivarin (THCV) and cannabidiol (CBD) have been shown to have benefits for blood sugar control and metabolism in diabetes studies.

Legalisation on the NHS

On 1 November 2018 medical cannabis products were made available on the NHS for some people in the UK.

Treatments can only be prescribed by specialist doctors in a limited number of circumstances and not by GPs.

The treatments will contain varying quantities of THC and CBD. Treatments will include pills, capsules and oils but smoking cannabis will not be prescribed.

People who stand to benefit will be children with rare, severe forms of epilepsy, adults with vomiting or nausea caused by chemotherapy, and adults with muscle stiffness caused by multiple sclerosis.

History of cannabis

Cannabis has been used by humans for thousands of years, with the earliest record of its use dating back to the 3rd millennium BC.

It is indigenous to Central and South Asia, and is believed to of been used by many ancient civilizations, particularly as a form of medicine or herbal therapy.

Cannabis and its effect on diabetes

There is growing research investigating cannabis use and the effects on diabetes.

Possible benefits of cannabis

A number of animal-based studies and some human studies have highlighted a number of potential health benefits of cannabis for diabetes.

Research by the American Alliance for Medical Cannabis (AAMC) has suggested that cannabis can help:

• Stabilise blood sugars – a large body of anecdotal evidence is building among people with diabetes to support this.
• Suppress some of the arterial inflammation commonly experienced by people with diabetes, which can lead to cardiovascular disease
• Prevent nerve inflammation and
  
  ease the pain of neuropathy
  
  – the most common complication of diabetes – by stimulating receptors in the body and brain.
• Lower blood pressure over time, which can help reduce the risk of heart disease and other
  
  diabetes complications
  
• Keep blood vessels open and improve circulation.
• Relieve muscle cramps and the pain of gastrointestinal (GI) disorders
• Be used to make topical creams to relieve neuropathic pain and tingling in hands and feet

Cannabis compounds have also been shown to reduce intra-ocular pressure (the fluid pressure within the eye) considerably in

people with glaucoma

– a type of eye disease that is caused by conditions that severely restrict blood flow to the eye, such as severe

diabetic retinopathy

Insulin benefits

THCV and CBD have been shown to improve metabolism and blood glucose in human and animal models of diabetes.

A 2016 study found that THCV and CBD decreased blood glucose levels and increased insulin production in people with type 2 diabetes, indicating a “new therapeutic agent for glycemic control”.


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Previously, tests in mice have shown the compounds boosted metabolism, leading to lower levels of cholesterol in the blood and fat in the liver.

UK-based company GW Pharmaceuticals is currently in the process of developing a cannabis spray called Sativex, a prescription medication used to treat muscle spasms in multiple sclerosis. GW is aiming to utilise the CBD and THCV compounds in the product to help with blood sugar regulation in people with type 2 diabetes.

Meanwhile, a separate 2017 study found that cannabis use was linked with lower insulin resistance in a cohort of people with and without diabetes.


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Treatment for inflammation

CBD has long been known to possess anti-inflammatory properties, and because chronic inflammation is known to play a role in the development of insulin resistance and type 2 diabetes, research is investigating its efficacy in reducing inflammation in diabetes.

A 2017 study by the Medical College of Georgia revealed that CBD treatment reduced inflammation in animal models of diabetes, concluding “the nonpsychotropic CBD is a promising candidate for anti-inflammatory and neuroprotective therapeutics”.


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In 2015, Israeli researchers at the Hebrew University of Jerusalem reported that the anti-inflammatory properties of CBD,

could treat different illnesses such as diabetes

, atherosclerosis and cardiovascular disease.

In August 2015, cannabis pills containing only CBD, and not THC, were sold legally in Europe for the first time.

Treatment for peripheral neuropathy

Peripheral neuropathy is another complication reported to be eased by cannabis.

The Medical College of Georgia Study in 2017 also revealed that CBD treatment reduced the severity of diabetic retinopathy in diabetic animal models.

Another study in 2015 saw University of California researchers gave 16 patients with painful diabetic

peripheral neuropathy

either placebo, or single doses of cannabis, which varied in dose strength.

Tests were first performed on baseline spontaneous pain, evoked pain and cognitive function. The higher the content of THC participants inhaled,

the less pain they felt

Treatment for obesity

Furthermore, GW Pharmaceuticals research has revealed that cannabis could be used to treat obesity-related diseases such as type 2 diabetes by

increasing the amount of energy the body burns

In December 2014, cannabis was linked to a lower likelihood of obesity, lower BMI and reduced risk of type 2 diabetes in an Inuit population.

Cannabis drug class

Laws regarding the production, possession, use and sale of cannabis came into effect in the early 20th century.

But despite being illegal in most countries, including the UK, its use as a recreational drug is still very common.

In fact it is the most used

illicit drug

in the world, according to the United Nations, with approximately 22.5 million adults across the globe estimated to use marijuana on a daily basis.

Legal status

In the UK, cannabis is categorized as a Class B drug under the UK Misuse of Drugs Act.

Individuals caught in possession of marijuana are therefore given more lenient punishment – often confiscation and a ‘cannabis warning’ for small amounts.

Effects of cannabis

Cannabis causes a number of noticeable but mild (in comparison with other recreational drugs) physical and mental effects. These include:

• Increased pulse rate
• 
  Dry mouth
  
• 
  Increased appetite
  
• Bloodshot eyes
• Light-headiness
• Occasional dizzy spells
• Problems with memory, concentration, perception and coordinated movement

Pro-cannabis groups and campaigners often highlight its pain relief benefits and stress the fact that not one cannabis-related death has ever been recorded.

Treatment for peripheral neuropathy

Another study in 2015 saw University of California researchers gave 16 patients with painful diabetic

peripheral neuropathy

either placebo, or single doses of cannabis, which varied in dose strength.

Tests were first performed on baseline spontaneous pain, evoked pain and cognitive function. The higher the content of THC participants inhaled,

the less pain they felt

Negative effects of cannabis

Studies that have investigated this subject suggest that cannabis can have a number of effects on blood glucose control, depending on dosage. These include:

• Memory and concentration-related problems which may affect glycemic control.
• Raised appetite, or ‘munchies’ – a craving for sweet/fatty food, which can subsequently lead to
  
  hyperglycemia
  
  (abnormally high blood sugar levels)
• 
  Impaired glucose tolerance
  
  and hyperglycemia when heavily used.

Experts from Diabetes New Zealand, a national non-profit organization, also claim that cannabis indirectly affects blood glucose levels due to the drugs’ effect on the brain, which they say can lead to users not recognizing symptoms of

hypoglycemia

(low blood sugar) or confusing such symptoms with the effects of the drug.

Cocaine is a powerful, harmful and addictive drug that is derived from the leaves of the coca shrub.

It usually comes as a white crystalline powder (coke), but is also commonly supplied as ‘freebase’ cocaine (powder cocaine that’s been prepared for smoking) and ‘crack’ (a small rock-like form of cocaine that makes a cracking noise when burnt), which are both usually smoked in a glass tube, plastic bottle or in foil.

Each of these forms has a potent, short-lived impact on both the mind and

body

However, both freebase and crack tend to have a stronger effect and be more addictive as they

affect the brain

much quicker than snorted powder cocaine.

Drug class

Cocaine in all its forms is categorised as a Class A drug in the UK. If caught in possession of the drug by the police, you could be arrested, taken to court and given a prison sentence of up to seven years.

If caught supplying the drug, you could face life in jail and receive an unlimited fine.

In addition, it is illegal and very dangerous to drive whilst high on cocaine (as with all

recreational drugs

) or allow other people use cocaine in your house or any other premises.

Effects on the body

People who take cocaine generally report feeling very confident, wide-awake and on top of the world.

However, some people can easily become over-confident, arrogant and aggressive towards others, including their friends. Like all stimulants (or ‘uppers’), cocaine also:

• Reduces appetite
• Increases body temperature
• Makes the
  
  heart
  
  beat faster
• Can cause
  
  dehydration
  , especially if used when partying or clubbing

The effects of cocaine tend to only last for around 20-30 minutes (10 minutes for crack or freebase), and once they begin to wear off, users suffer a long ‘comedown’ which can make them feel tired, bad-tempered and depressed.

In addition to the short-term effects, there are also many serious longer-term risks of cocaine use. For example, high doses or frequent use can:

• Cause
  
  anxiety
  , paranoia and panic attacks.
• Damage or destroy the cartilage in between your nostrils.
• Increase the body’s temperature, cause convulsions and heart failure
• Trigger underlying
  
  mental health
  
  problems.
• Lead to chest pains and breathing problems (if smoked in the form of crack or freebase).
• Damage veins, cause ulcers and increase the risk of HIV and hepatitis infections, if injected (powdered cocaine and crack can also be prepared into an injectable solution).
• Cause heart attack or stroke, particularly if used by people with high blood pressure or heart-related problems.
• Increase the risk of death by overdosing, especially if mixed with
  
  alcohol
  
  and/or other drugs.

Additionally, coke and especially crack cocaine is highly addictive and often leads to cravings, which can be difficult to resist.

Possible effect on diabetes

For people with diabetes, taking cocaine in any of its forms can have a huge impact on blood glucose control and diabetes management.

Cocaine can:

• Suppress the feeling of hunger and disturb sleep patterns, which can cause
  
  hypoglycemia
  
  (abnormally low blood sugar levels).
• 
  Indirectly affect blood glucose
  
  levels due to its effect on the brain – e.g. users might not recognise signs of hypoglycemia or mistake such symptoms for the effects of the drug.
• Cause people to forget or
  
  avoid* taking their insulin
  
  (cocaine users have a tendency to omit insulin for extended periods of time). This can lead to high blood sugar levels (
  
  hyperglycemia
  
  ), dehydration and exhaustion, especially if used in a hot environment, like a club.

*Cocaine users have a tendency to omit insulin doses for extended periods of time, which also puts them at increased risk of

diabetic ketoacidosis

, a serious condition that usually affects people with

type 1 diabetes
.

Ecstasy is the street name for the chemical MDMA. Ecstasy is an oral drug best known for its energy boosting stimulant effects, becoming infamous in the early 1990s.

In fact, it’s seen as the original designer drug due to its well documented connection to dance music culture, which took off in the late 80s and early 90s.

Ecstasy is usually sold as a tablet, although it can also be found in its natural powder form (MDMA).

Ecstasy tablets, also known as ‘E’ pills or Es, often come in various colours and often feature designs or logos (usually a smiley face, made popular in the 1990s).

Drug class

In the UK, ecstasy is a Class A drug. Possession of the drug can range from a formal caution to an unlimited fine, arrest/prosecution and up to seven years in jail – extending to possible life imprisonment if convicted of supplying the drug to other people.

In addition, people caught driving whilst under the influence of drugs such as ecstasy are likely to receive a heavy fine plus a lengthy driving ba, and could also face time in jail.

Effects on the body

The main effect of ecstasy is that it produces seemingly boundless energy, which makes users feel alert, alive and “in tune” with their surroundings.

Music and colours seem more intense, and users often become chattier and affectionate with those around them, including both friends and strangers.

However, the drug can cause a number of physical side effects, including:

• Increased heartbeat
• Dilated pupils
• Tightened jaw muscles
• Reduced appetite
• Raised body temperature

Raised body temperature can also lead to overheating and dehydration (especially if used in a hot atmosphere, such as a club).

The mental effects can be just as worrying, with users often becoming:

• Anxious
• Panicky
• Confused
• Paranoid

The comedown following an E experience can also make people feel:

• Lethargic
• Irritable
• Depressed

Long-term use of ecstasy has also been linked to memory problems, depression and

liver

, kidney and

heart problems

In addition, ecstasy is rarely pure MDMA, and so users may experience other side effects from other drugs and ingredients added to the E.

Possible effects on diabetes

As a stimulant, or an ‘upper’ drug, ecstasy can suppress appetite and cause the user to not feel the need for rest.

For people with diabetes, this is particularly concerning. Being unaware of whether you need a rest or not can result in

hypoglycemia

or low blood sugar, especially if the drug is taken whilst dancing.

This could ultimately lead to a hypo.

In addition, those who have diabetes and take ecstasy may make the mistake of omitting their

insulin intake

, which can lead to severe dehydration and exhaustion, if combined with dancing or raving.

Skipping insulin doses may also cause a dangerous diabetes complication known as

diabetic ketoacidosis

(DKA).

LSD is a psychoactive hallucinogenic drug that is manufactured from lysergic acid (LCD is short for lysergic acid diethylamide).

This substance is found in ergot, a type of fungus that grows on rye and other grains.

LSD is usually distributed on sheets of blotting paper that have been dipped in the substance, dried and perforated into small paper squares or ‘tabs’ (these often bear psychedelic symbols or designs.

It can also be found in several others forms, including powder, thin gelatin squares or as a clear, odourless liquid. It is usually taken orally but can also be rubbed against the skin.

It is not considered to be an addicting drug as it does not produce compulsive drug-seeking behavior like other recreational drugs such as cocaine, heroin alcohol and nicotine

LSD: drug class

In the UK, LSD (or Acid) is categorised as a Class A drug under the UK Misuse of Drugs Act.

People caught in possession of this extremely potent drug can face an unlimited fine and up to seven years in prison. This can extend to life imprisonment for those caught supplying or dealing the drug.

Effects on the body

The impact of LSD

on the body

varies greatly depending on the amount take, the user’s environment and mood.

Physical symptoms can include:

• Increased heart rate
• Increased blood pressure
• Dilated pupils
• Higher body temperature
• Sweating
• Loss of appetite
• Sleeplessness
• Tremors
• 
  Dry mouth
  

In terms of feelings and sensations, large doses of the drug often lead to delusions, altered sense of time and space, and extreme visual hallucinations (also known as trips), which can last up to 12 hours.

LSD can also cause a ‘crossover’ of the senses, including sound and vision – for example, users often report seeing sounds or hearing colours.

As with the physical symptoms, these psychedelic effects can be unpleasant or even frightening.

Bad ‘trips’ can result in total panic,

severe depression

or fear of death. Even after coming off the drug, users can have sudden flashbacks of certain aspects of their LSD experience.

These flashbacks can occur within a few days or more than a year after LSD use.

Research also suggests that regular use of LSD can trigger mental disorders in individuals who have no history of mental health problems.

Possible effect on diabetes

LSD can affect control and management of diabetes as it distorts perception of reality and time. This could cause a person with type 1 or

type 2 diabetes

to forget their

diabetes medication

or insulin.

Users may also forget to check their blood sugar levels and could go long periods without eating or resting, increasing their risk of both

hyperglycemia

(high blood sugar) and hypoglycemia (dangerously low blood sugar levels).

Recreational drugs are mind-altering chemical substances that are used for non-medicinal, leisure purposes (i.e. taking a substance for the sole purpose of getting ‘high’).

These are split into 3 main categories:

• 
  Hallucinogenics
  
  – these affect the mind and what you see, feel or hear
• 
  Downers
  
  – these affect thought, heart rate and breathing
• 
  Uppers
  
  – which make the body faster in terms of speech, reaction and heart rate

Recreational drugs are also known as psychoactive drugs, due to their effects on one’s consciousness, cognitio, mood and behaviour.

This may lead to addiction or substance abuse which, in turn, can have a detrimental effect on the user’s physical and mental health.

However, the consequences of recreational drug use can be a lot more severe for people whose health is already affected by conditions such as

diabetes

What types of recreational drugs are there?

There are many types of recreational drugs. Some people are often surprised to realise that caffeine is a drug.

The most commonly used drugs are:

• 
  Alcohol
• Alkyl Nitrite (Poppers)
• Amphetamines (Speed)
• Anabolic steroids
• Caffeine – found in
  
  tea
  and
  
  coffee
• 
  Cannabis
  (or marijuana)
• 
  Cocaine
• Crack
• 
  Ecstasy
• Glue and solvents
• Heroin (opium)
• 
  LSD
• Methamphetamine
• 
  Tobacco
  (Nicotine)

What effects do these drugs have?

Recreational drugs affect both the mind and body, causing a wide range of feelings and emotions.

Some such as amphetamines and ecstasy are stimulants which act on the

central nervous system, causing an increase in heart rate and a rush of blood through the

heart
and

brain

Users often report increased confidence and energy levels combined with a physiological arousal, but as the body’s energy levels reduce they become prone to feelings of:

• Anxiety
• Irritability
• Restlessness
• Dizziness

The mental and physical effects of drugs such as cannabis are noticeable but usually milder, while others such as crack and LSD are much more intense and extreme in their effects, with users often experiencing hallucinations and paranoia.

There are also differences between each drug in terms of how quickly the effects are experienced, the length of time they last and the after-effects (withdrawal symptoms).

How are recreational drugs administered?

There are a number of ways in which these substances can be taken:

• Orally, as a liquid or solid
• Inhaled as a vapour
• Insufflatio, or snorted into the nose
• Injected either intramuscular or intravenously.

Effects of recreational drugs on diabetes

Many of the physical effects of recreational drugs can affect

blood glucose control, which for people with diabetes can lead to serious

health complications

While the effects of legal drugs like alcohol and nicotine (smoking) on diabetes are well documented, the role of marijuana, cocaine and other illicit substances remains less clear because of their illegal status in the UK and many other countries.

Research into illegal substances

However, the research that is available on the general effects of illegal substances suggests that while they all affect diabetes control in one way or another, cannabis could also be used to help treat the disease.

Previous studies have linked cannabis use to

hyperglycemia
(high blood glucose levels) – a common problem for people with diabetes.

However, some researchers have shown that cannabis, which is already used in the treatment of some medical conditions, could also have a number of anti-diabetes benefits.