Update: 27 April 2024

Medical Cannabis & CBD

Author: Julie Casper, C. Ac.

Medical cannabis promises new hope for those suffering from physical pain and emotional distress, and other conditions. Cannabinoids are both miraculous and mysterious. Understanding the complexities will help you develop and manage a therapeutic protocol that works best for you.

Contents

1. Self-Medication
2. Cannabis TEQ (Self-assessment download)
3. CBD & Terpenes

Self-Medication

Currently, determining your most effective medicinal cannabis protocol is relegated to the grey zone of self-medicating. Yet despite the low-risk associated with cannabis, relying on a ‘best guess’ approach can reduce the therapeutic benefit and increase treatment cost.

More than 50% did not know how much CBD (or THC) they were consuming. Project CBD Survey (3,500+ participants)

Self-medication is a common aspect of self-care that often can be very effective, but can be tricky also. Apart from the prescribed medicines we get from our doctors, at one time or another most everyone ‘self-medicates.’ We take over-the-counter medicines, nutritional supplements and medicinal herbs. We use natural or traditional remedies that have been handed down to us. And some of us use ‘alternative or complementary’ services to help manage health problems or to improve and maintain health. There are a lot of reasons why we may choose self-care. Including:

• We feel the problem doesn't justify a visit to a healthcare professional.
• We may have been harmed by providers or the conventional healthcare systems.
• Self-care may be easier, save time or be more cost efficient.
• Self-care may be safer and work better.
• Because of our location or financial status there may be few (if any) options.

The best outcome from our interest in self-care might be the cultivation of self-awareness. When people begin paying closer attention to how and why they feel the way they do, they begin to make better choices. When we make choices that help us heal rather than harm us — everyone benefits.

Statistically, aging populations exhibit growing interest in self-care. The Internet provides new access to health information (both good, and bad). In the USA:

• 65% of us visited health-related websites in a 12-month period.
• 59% say they are more likely to treat their condition today, compared to a year ago.
• 73% would rather treat themselves than see a doctor.
• 6 in 10 say they would like to do more self-care.

Dosage Questions

When medicine is intended to help us heal, feel better or recover, its best used for the minimum amount of time needed to prevent downregulation and dependence. When there are too many cannabinoids in your system, the response is a need for fewer receptor sites in the brain. Thus, frequent intake of cannabis, or intake of high-potency cannabis, will desensitize or down-regulate corresponding neuronal receptors. Then there is a need to increase intake to enjoy the same level of effects. Having to dose up to get the same affect is a probable sign of endocannabinoid receptor down-regulation.

When cannabis is used to reduce anxiety for instance, over time, protocol variables will change. A patient may benefit from therapies which reinforce their progress, such as physical activity, nutritional support and counseling, thus reducing the need for additional support. Treatment protocols usually require adjustment because the causes and levels of anxiety are dynamic, and because our intelligent biology is highly responsive to perceived changes. Psychiatric pharmacology is acutely aware of this problem. Inevitably, finding the right therapy protocol will require personal experience and (informed) adaptation.

There are new dangers to consider with cannabis use as well. To increase profitability, some producers resort to toxic growing and processing methods, and may add harmful ‘enhancement’ ingredients.

For parents with a sick child, improper dosing is a serious concern. Today it is the patient's difficult responsibility to determine both the correct dosage and what type of cannabis to use. Because cannabis is proven to be generally safe, this is not necessarily a bad thing. Self-medication does have a long history of success. However, cannabis is still a potent psychotropic drug on which one can develop dependence.

Without having a proper medical background to inform therapy decisions, you are left to rely mainly on personal experience, self-education, and advice from close friends, maybe even dispensary budtenders. And of course the internet. With its contradictory, sometimes confusing and often times (but not always) incorrect information.

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CBD & Terpenes

Unfortunately for the patient who is simply seeking relief, the CBD marketplace is overwhelmed with unqualified vendors selling unregulated products. Many are ineffective and possibly harmful. Labeling inaccuracies are common. Some do not contain the amount of CBD claimed, others no CBD at all.

Researchers report of the more than 80 CBD products tested, less than one-third (%31) were labeled accurately. 43% had higher concentrations of CBD than listed on their labels, and 26% had less CBD than claimed. Jennifer Chesak

Cannabinoids can have a lasting positive effects on health and wellbeing. The therapeutic benefit from the cannabinoids is scientifically verified to impact a wide range of symptoms and disorders. The medicinal use of cannabis actually pre-dates recorded history.

Cannabidiol (CBD) in Cannabis

The canabinoid cannabidiol, commonly referred to as CBD, is an active ingredient in cannabis, and the second most researched constituent after THC.

THC and CBD are only two cannabinoid molecules found within the cannabis sativa plant. We know there are at least 500 natural components, about 100 of which have been classified as ‘cannabinoids’ (i.e., chemicals unique to the plant).

Alone, CBD provides a range of beneficial medical effects. In addition, it acts as a mediator of potentially undesirable effects of THC. However, reports of how the constituents of cannabis have changed over the first decade of the 21st century are concerning. Early cannabis researchers discovered the amounts of THC and CDB in cannabis to be balanced, approximately 4% of each substance. In contrast, today's much higher potency strains contain 16-22% THC, and less than 0.1% CBD. Research suggests that this THC/CBD imbalance in itself could explain an increase in cannabis-related cases of psychosis. Evidence indicates that using certain forms of cannabis can trigger psychosis among people with a genetic vulnerability to schizophrenia (e.g., Sherif et al., 2016). Various environmental factors likely interact with one another, as well as with genetic vulnerabilities, in complex ways to increase the likelihood of developing the condition. The psychotic-like effects of marijuana may relate to an individual's preexisting level of risk for psychotic disorders.

The CBD molecule has multiple therapeutic effects and properties, it is anticonvulsive, sedative, hypnotic, antipsychotic, and neuroprotective. CBD also has an anti-inflammatory effect several hundred times stronger than aspirin. And, CBD does not cause psychotropic effects (like THC does) so it has excellent potential for use in medicinal applications.

Cannabidiol (CBD) has antipsychotic effects in humans, but how these are mediated in the brain remains unclear. Cannabidiol may partially normalize alterations in parahippocampal, striatal, and midbrain function associated with the CHR state. As these regions are critical to the pathophysiology of psychosis, the influence of CBD at these sites could underlie its therapeutic effects on psychotic symptoms. Sagnik Bhattacharyya, MBBS, MD, PhD; Robin Wilson, MBBS, MRCPsych; Elizabeth Appiah-Kusi, MSc; et al

When studies compared cannabis with conventional pain medications, they found cannabis is less harmful to the liver, kidneys and other organs. Researchers also discovered that the individual cannabinoids within the cannabis plant provide distinct benefits from one another, and that some act synergistically to improve the therapeutic effect. In light of this understanding, the therapeutic application of cannabis should be in its natural form as a whole-plant medicine (complete with its complex of synergistic compounds). If taken as a pharmaceutical isolate, the therapeutic value could be diminished or eliminated.

• Marijuana and Cannabinoids: A Neuroscience Research Summit Presentations from the MJ Neuro Summit focusing on the neurological and psychiatric effects of marijuana and the endocannabinoid system. Expert presentations discuss adverse effects and potential therapeutic value of the cannabinoid system.
• Reading a CBD Label: How to Find a Quality Product Jennifer Chesak
• Diet: High Fat Foods Increase CBD Absorption University of Minnesota

Terpenes

Terpenes are a large group of volatile unsaturated hydrocarbons found in the essential oils of plants, such as herbs, conifers and citrus trees. Their aromatic compounds give cannabis varieties distinctive smell and flavor. More than 120 different terpenes have been identified in cannabis so far. All the major terpenes found in cannabis can be found in nature (e.g. myrcene, alpha-pinene, and betacaryophyllene).

Terpenes seem to be involved in different interactions with cannabinoids. They may work synergistically, to modify or enhance their therapeutic effects. Research on the potential interactions between terpenes and cannabinoids is ongoing, but its been shown that terpenes produce pharmacological effects: anti-inflammatory (myrcene), neuroprotective (myrcene) and analgesic (beta-caryophyllene).

Due to the variety and types of terpenes, many different combinations can be present in a cannabis plant. So each distinct strain has its own unique composition of cannabinoids and terpenes.

• Cannabis Terpenes, What are They, What Do They Do? Bailey Rahn

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