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CBD or THC – The New BUZZ? As many states begin legalizing marijuana, more and more consumers are getting curious. This has resulted in an increased curiosity and sales of CBD in non-legalized states.  As of now, 33 states and Washington, DC have laws permitting the MEDICAL use of cannabis. And 10 of these have legalized recreational use. (PLEASE NOTE: this is a fairly technical article.)

Especially in children, Cannabidiol (CBD) has been best known for its potential to reduce the frequency and severity of seizures. CBD is also gaining a significant amount of attention for its wide variety of other therapeutic and lifestyle benefits. So, the question is: what exactly is CBD and how does it work?

What is CBD?

There are more than 400 different compounds that exist within the cannabis plant. Cannabinoids is one of the more important compounds. In addition, within this group, there are more than 60 individual compounds, and counting. The two main compounds found in the cannabis plant are CBD and THC. Both can have health benefits.

Produced by the cannabis plant, Cannabinoids are specific compounds that interact with the endocannabinoid system (ECS) of the body. Then, these bind to endocannabinoid system receptors giving a variety of effects.

The endocannabinoid system (ECS) is part of the nervous system. The ECS is responsible for regulating a number of different functions including appetite, mood, pain, memory and much more.

As a matter of fact, Cannabinoids aren’t just ingested from outside of the body. Actually, they are naturally produced in the human body in a different form. That being said, these cannabinoids shouldn’t really be looked at as a foreign substance at all.

So, Where can CBD be Found?

CBD is a naturally occurring compound found in the seeds, stalk and flowers of the cannabis plants. But, because CBD is present in high quantities in the plant, it can be easily extracted using various techniques. In reality, CBD is among the more prevalent cannabinoids in the cannabis plant in addition to THC.

Hemp and marijuana cannabis plants both contain CBD. The difference between the two is the level of THC in each. Marijuana contains high levels of THC, while hemp only has trace amounts of the psychoactive cannabinoid. By the same token, the CBD that is naturally found in hemp is legal in the U.S., while CBD from marijuana is illegal, .

CBD Derived from Hemp vs. Marijuana

Equally important, not all CBD is created equal, in regards to strength. That being said, confusion exists between CBD that is derived from hemp versus CBD that is derived from marijuana. Consumers considering buying CBD need to understand the difference between the two in terms of its legality and efficacy before making that purchase.

So, to distinguish between the two, it helps to have an understanding of hemp and marijuana. Both come from the cannabis sativa L plant species. Hemp plants have been around for decades. The most common commercial product widely available is rope. Of course, this is a legal product that is readily available on store shelves most everywhere. Mostly grown for its durable fiber, it is usually tall and thin.

Marijuana

On the other hand, mainly grown for its flowers and buds, Marijuana, is a shorter and wider plant. These flowers and buds are cultivated specifically to smoke for recreational purposes or for cannabinoid extraction.

The concentration in CBD oils and other products on the market vary widely. Not just from product to product, but also from bottle to bottle of the same brand. Of course, foods and dietary supplements can not include CBD from marijuana legally. Use in cosmetics is allowed, but only if it contains <0.3% THC. Approximately 70% of CBD products on the market are mislabeled, containing more or less CBD than listed. So, how are we seeing all these products for sale if it is illegal? It all comes back to the source of the CBD. If it is from marijuana, it is ILLEGAL, however, if it is from HEMP it is LEGAL. Correspondingly, by ferdeal law, medical claims can NOT be made on the label of any product.

Furthermore, there are only a few legal (RX only) products on the market containing cannabinoids. Dronabinol* capsules, Nobilone capsules, Nabiximols (combines THC and CBD) oromucosal spray, and Epidiolex* (for certain severe epilepsy).

Differences Between CBD and THC

It goes without saying that THC is the compound responsible for the recreational “high” users have come to know, the psychotropic effect. It wasn’t until recently that more information has been discovered on the effects of CBD.

As a matter of fact, The biggest difference between these 2 compounds is their psychological effects on the brain.  THC’s euphoric effects are a result of the cannabinoid binding to receptors CB1 and CB2, mostly located in the brain.

POSSIBLE HEALTH BENEFITS OF CBD

Equally important, the large variety of health benefits of CBD has been the reason it has gained popularity in the recent past.  Scientific studies have shown some of the following benefits.

Relieves Pain: Many people use NSAIDs (Non steroidal anti-inflammatory drugs) for all kinds of injuries or ailments. CBD oil offers pain relief the natural way.  They work by slowing down the transmission of neurons along the pain pathways. Additionally, CBD oil can help inhibit inflammation in joints that is the culprit of the pain with arthritis and other degenerative diseases.

Reduces Anxiety: When taken in the proper dose, CBD oil can have a calming effect. Anxiety can have a debilitating effect on a person and is a common mental health disorder. The drugs typically used to treat this condition come with several side effects, including agitation and drowsiness. Some can even be addictive.

Helps Combat Cancer: This is a huge one. Simple and natural! CBD oil may be able to slow the growth of cancerous tumors and may stop them completely.

More possible uses

Help with Addiction: Studies have shown a decrease in heroin-seeking behaviors.

Improve Insomnia: This occurs due to the reduction of anxiety and increase in drowsiness.

Muscle relaxation: may be related to the decreased anxiety and pain.

Relieves Nausea: For a long time, Cannabis has been used to treat this condition. For centuries, actually. But, more recent studies show that low doses of cannabinoids like CBD oil can suppress toxin-induced nausea and vomiting.

And, Even More possible uses

Treats Seizures: This is one that has been in the news in recent years. Many people that suffer from epilepsy and other seizure-related disorders can benefit from the ability of CBD oil to reduce the frequency and severity of seizures. Many children have already experienced the benefit.

Reduces the Incidence of Diabetes: CBD oil studies have shown the ability to drastically lower the incidence of diabetes due to its impact on insulin, glucose, and insulin resistance. It also found an association between smaller waist circumferences and CBD, which is an important factor in developing diabetes.

Improves Cardiovascular Health: Some studies have linked CBD with a number of CV and circulatory system benefits including lowering BP, an important factor in strokes and heart attacks. This could become a natural and effective treatment protocol for HBP.

Minimizes Acne: Acne affects over 9% of the American population. A common skin condition that can be exacerbated by genetics, poor diet, bacteria, and an overproduction of sebum.

Lack of Studies

We see a wide variety of products touting their healing products. At this time, there are not enough studies to support or refute the benefits and safety of using medical cannabis to manage these various chronic conditions. 

The study parameter does not allow Participants to drive AT ALL during the study. This results in a lack of study data. Moreover, this has been the biggest obstacle for the studies to even begin. There are not enough participants willing to forgo this freedom.

For medical history purposes, it is important that patients reveal their use to all practitioners. However, the question remains, “Where do you put it in their chart?”

Is it a Supplement?

Without knowing the exact product they use, CBD vs THC, you do not know whether to list it as a supplement or if it is illicit. The problem is, with many government programs, the patient’s ability to qualify will be eliminated with the admission of illicit use.

As a matter of fact, until the DEA makes a decision on HOW to classify these products and makes it UNIFORM across the US, many patients will continue to omit this from their medication and supplement lists. The label of “illegal drug” prohibits patients from admitting it’s use due to fear of reprisal and fear of treatment refusal. Being turned into the authorities is another fear. But, not knowing of their use can lead to deadly drug interactions and improper dosing.

HOME TO HOSPITAL TRANSITION and Vice-a-Versa:

For Patients that are going into the hospital that are currently being treated with CBD or THC (where allowed) at home, it can pose a problem. Most hospitals do NOT allow the use of CBD or THC in their facilities due to government regulations. The reasons hospitals do not allow it vary, but some include the implications to the medical professionals and employees. Some states may require physicians to be registered with local programs to authorize these therapies. so they cannot be prescribed. Because of this, you may see patients maintained on cannabinoids at home get worse in the hospital.

Equally important, when an authorized professional has authorized your patient to be given cannabinoids in the hospital, transitioning to home may be an issue. When they transition back to home, their care is handed over to a different medical professional. This medical professional may NOT have the authority to continue the treatment. Again, the patient may decline or worsen.

There is a movement to permit hospitals as facilities to dispense and control cannabis use. In Minnesota, this regulation has already been passed (2017). Other states are passing legislation to protect nurses from criminal, civil or disciplinary actions when administering medical cannabis to qualified patients. Connecticut and Maine are 2 of those states (2017).

DOSING:

Patients will use these products with the intent of possibly improving their health, even though it is not recommended without medical advice . Of course, with CBD being widely available, many will try it on their own.

So, how do we dose it? There are no set dosing schedules with the lack of proper studies. The best dosing we can give is this: Go low and slow, buy as reputable as possible (NOT at a gas station!), go through the legal market and buy from a licensed dispensary.

CHOOSING PRODUCTS:

Patients should look for products that have been tested by a 3^rd party lab for purity and concentration. A third party means that the business selling the product has NO connection in ANY WAY with the lab. There are no FDA regulations for purity or concentration, however, an unaffiliated company doing the testing shows that the manufacturer is trying to follow protocols that exist for other products.

To buy products, Just remember FLOW:

Possible NEGATIVE effects of CBD:

• Decreased appetite and weight loss
• Diarrhea
• Dizziness, drowsiness, and fatigue
• Liver injury at high doses or with certain drugs
• May give a positive result for urinary THC content

WHEN to AVOID CBD USE:

• Pregnancy, planning to become pregnant, or breast feeding
• Prior negative result/ reaction

DRUG INTERACTIONS:

Of course, the downside to any supplement, herbal or drug is the interactions it may have with other medications the patient is taking.

Here are a few KNOWN interactions with CBD or THC, however, nothing is certain without more studies. Equally importnat, we need reports from patients using CBD that they had a problem with any combinations.

• Blood thinners (any) –increase drug levels and thereby increase the risk of bleeding
• Ketoconazole – increase serum levels of CBD and THC
• Rifampin – decrease serum levels of CBD and THC
• Sedatives (benzodiazepines), alcohol, antihistamines – get additive effect
• TCA’s (i.e., amitriptyline), stimulants, sympathomimetics – Increase tachycardia
• Macrolide antibiotics (erythromycin, clarithromycin, nitrofurantoin) – increase drug effects
• Valproate – causes liver toxicity
• Calcium channel blockers, beta blockers – increase serum levels of the drug
• Smoking form – Increase theophylline metabolism

Known CBD and THC actions

• Nearly 60 percent of the medications on the market are metabolized through a set of liver enzymes. These enzymes are cytochrome P450, or CYP450. These are the same enzymes , coincidentally, that break down CBD.
• CBD is an inhibitor of these enzymes (CYP540) that will cause the medication to yield increased potency (just like grapefruit juice).
• Of these, CYP3A4 is the most prevalent CYP enzyme in the liver. And this is the one responsible for metabolizing an estimated 50% of prescription medications used today.
• However, these CYP enzymes are known to cause many clinically relevant drug-drug interactions. Some drugs induce the enzymes’ metabolic activity while others will inhibit drug metabolism, which changes the concentrations of drugs present in the body as well as their pharmacokinetic profiles.
• For example, a drug that inhibits CYP3A4 will slow the metabolic process, yielding an accumulation of drug concentrations and leading to an increased risk for side effects and possible drug toxicity. Both of these compounds, THC and CBD, are metabolized by CYP3A4.
• THC is also metabolized by CYP2C9, and CBD by CYP2C19. When cannabis, (THC or CBD) is taken along with certain prescription drugs, THC and CBD can inhibit or induce the metabolic process.
• For example, CBD is a potent inhibitor of CYP3A4 and CYP2D6 enzymes, while THC is an inducer of CYP1A2.

Drug interaction database

Of course, there are online databases available to check for drug interactions. However, the good ones are NOT free. The free ones tend to be less reliable, unfortunately. In the same manner, that’s why it is important to discuss all medications a patient is taking, including herbal (CBD), supplements, vitamins, legal or illegal.

In addition to your local pharmacy, there is one reliable source available to patients to check for possible drug interactions with medications. It is drugs.com. Here, you can plug in  cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and enter the other medications to see the interactions.

Patient Perspective

Which health professionals need to know I’m trying CBD?

• First, Tell any and all of your health care professionals and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD to avoid side effects.
• Second, Fill all of your medications at the same pharmacy, so your pharmacist will be able to assess for drug interactions for ALL of them, regardless of who prescribed them.
• Third, Of course, You should also tell the pharmacist about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. Bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains
• Lastly, Patients may be wary of stigma surrounding CBD products, but most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief

WHAT PATIENTS NEED TO KNOW:

• Even though it is a relatively safe drug compared to so many other drugs out there, CBD is not a benign or safe option.
• It still has bioactive effects and can jeopardize your medical treatment.
• Just like anything else you put in or on your body, it’s best to err on the side of caution and know, to the best of your ability, exactly what the potential side effects are.
• If you insist on trying it, keep track of the product name, strength listed, dose you used, times you took it and other medications, all other medications/supplements you take, and any side effects you experienced.

Is CBD or THC not legal in your state? Well, if you are like me, you want some options that ARE legal! Browse through my site on Health and Fitness! There are some great products there!

Resources

Resources for Nurses •Cannabis Nurse Network    https://www.cannabisnursesnetwork.com •Medical Cannabis Handbook for Healthcare Professionals by Christine Nazarenus  (around $45, available on Amazon)

Education •Certificate program: Pacific College of Oriental Medicine •CME, CPE, CNE and dispensary certification : Medical Marijuana 411 https://medicalmarijuana411.comindicates

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