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Medical Marijuana and CBD: Miracles or Menace? (Part 2)

What is CBD?

Cannabidiol (CBD) is an essential component of medical marijuana but is just one of the over 100 active components found in the plant. (Of note, tetrahydrocannabinol or THC is one of the main chemicals that causes the “high” that goes along with marijuana use. It is fat-soluble after ingestion and is quickly distributed to fat tissue, the spleen, liver, and lungs.) CBD by itself does not cause intoxication and doesn’t have addictive potential, according to reports from the World Health Organization.

CBD can be extracted from the marijuana or hemp plant. The vast majority of CBD on the market is derived from the hemp plant, which is a cousin of marijuana. (They are both in the Cannabis family.) It is interesting to note that the two plants are produced very differently. Marijuana is bred for high concentrations of psychoactive content (THC) and grown in different ways to selectively maximize these qualities. Hemp is grown to generate fiber and seeds and other common items while containing only traces of psychoactive compounds. Industrial hemp is versatile, durable and sustainable. It grows quickly, in various environments, and doesn’t require pesticides. In fact, hemp actually benefits the soil by removing toxins.

What is it used for?

CBD is typically used by people suffering from anxiety, insomnia, certain types of chronic pain and spasticity. CBD may help decrease pain and inflammation from arthritis and may help treat neuropathic pain. It has been shown to be effective in treating certain types of epilepsy in children.

Is it legal?

The federal government still considers CBD in the same class as marijuana, although the DEA enforcement efforts tend to target criminal activity. Each state has its own laws regarding CBD with varying degrees of restriction.

Is it Safe?

A review of the literature, which is a thorough summary of previous research on the topic of CBD was done. The purpose of this review was to summarize, objectively evaluate and clarify previous research related to the safety and side effects of CBD. Overall, they found that CBD is safe. The authors of the review acknowledged that the European Industrial Hemp Association commissioned and paid them to do this comprehensive review. Most of the studies had some limitations that should be noted. Some studies were only carried out for a few weeks or contained only a small number of participants, hence extracting the safety of long term use or generalizing results to the population as a whole is difficult to do. The studies in the review had minimal data looking at the effect CBD has on the immune system or hormones. CBD has been shown to increase the level of Coumadin in the bloodstream and blocks the ability of certain enzymes to break down medications for proper elimination (using the same mechanism that grapefruit juice does to alter the metabolism of certain medications). This may cause the level of the medication in the bloodstream to rise, leading to potential side effects or toxicity.

CBD is typically used orally or topically. The most common side effects when CBD is taken by mouth are nausea, fatigue, and irritability.

The biggest concern is that CBD is marketed and sold as a supplement, therefore the FDA doesn’t have the ability to regulate and ensure the purity or safety of the supplement you may be taking. There is no guarantee that the product you buy has any of the active ingredients listed on the label or in the dose they say it is. A supplement may contain various unknown elements, which could have unfavorable effects, also.  

Without proper studies, we don’t know the therapeutic dose of CBD for specific medical conditions nor the upper limit in order to prevent or minimize side effects.

Summary

CBD may be an effective way to help manage insomnia, anxiety and chronic pain but more high-quality studies are necessary.  Be thoughtful and steer away from companies that claim it is the cure-all for almost everything. You should discuss over-the-counter medications and supplements you are taking with your provider to avoid drug interactions, potential side effects or toxicity.  

Conclusion

It is understandable that many patients are embarrassed to bring up the topic of medical marijuana or CBD with their health care provider.  Many physicians and clinicians have not embraced the concept of medical marijuana or CBD because there aren’t rigorous studies and proof of the benefits and risks.  There are side effects and potential drug interactions. However, individual providers are learning and doing their own research to understand the applications of its use.  Be open and honest with your provider. Be willing to discuss all types of therapy and medications and cooperatively make the best decision regarding the treatment of your symptoms or condition.

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

https://www.health.harvard.edu/blog/medical-marijuana-2018011513085

Gillespie, B. (2019) Marijuana: Ancient Medicine, the Devil’s Playground, or Medical Miracle? Elite Healthcare Nursing Continuing Education, 50-62.

https://www.healthline.com/nutrition/cbd-oil-benefits#section1

https://www.medicalnewstoday.com/articles/320984.php#1

Medical Marijuana and CBD: Miracles or Menace? (Part 1)

I recently underwent orthopedic surgery from an injury sustained in my teenage years as a cheerleader. After years of discomfort, limping, limited range of motion, and several scopes I finally succumbed to the inevitable and had a partial knee replacement. I am very thankful for modern technology and medical interventions and treatments that make this possible but was quickly reminded of how much I appreciate crutches, the polar ice machine, and pain medication.

As a healthcare provider, I am acutely aware of the significant benefits that pain medications provide but also keenly understand that if these medications are used inappropriately, they can lead to catastrophic damage in one’s life; physically, mentally, emotionally, socially, and spiritually. As a patient, it is sometimes difficult to find a balance between using enough medication to alleviate the pain so physical therapy exercises can be done in order to get back to “normal” life versus using too much. One thing is for sure, if medications are used inappropriately, your life may never be “normal” again.

* It is important to note that neither medical marijuana nor CBD oil is indicated for this type of post-operative pain. This will be explained as you continue reading.

With so many people in this world suffering from physical discomforts, emotional pain, chronic insomnia, or personal dissatisfaction, it is no wonder that substances have been used to ease multiple kinds of pain. One particular substance, marijuana, has been considered illegal until recently. Few topics bring up stronger emotions than medical marijuana. It captures the attention of all; not only doctors and lawyers, researchers and scientists, public officials, and policymakers, but even the general population.

Many people have questions about marijuana and a couple of particular substances extracted from the plant, namely cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). The purpose of this article is to briefly discuss some of the similarities and differences, indications for use, legality, and identify safety precautions by using any of these substances. Part I will talk about medical marijuana while part II will review CBD. THC has specific and limited medical indications and not the focus of these articles. 

A BRIEF HISTORY

Variations of the cannabis plant have been around for thousands of years, with evidence of its existence found in a small village in China, dating back to approximately 8000 BCE. The Chinese emperor, Shen Nung, in 2737 BCE described the powerful impact it had on treating patients that were described to have inflammatory disorders (rheumatism, gout, and malaria). The psychoactive response was noted, but at the time it was felt that the benefits outweighed the risks. This ancient medicine gradually spread to India, Africa, and then Europe. In fact, during Colonial times in the United States, hemp was a major commercial crop in the South. It was mainly a source of fiber used for textiles at the time. It wasn’t until 1890, that cotton became the major cash crop of the South.

By 1850, the United States Pharmacopeia described the practice of using marijuana for labor pains, nausea, and rheumatism. Again, the intoxicating effects of the plant were noted among patients and caught the eye of the U.S. Federal Bureau of Narcotics in the 1930s. At that time, the addictive potential of marijuana frightened the government and parents alike. Marijuana became symbolically associated with those who rebelled against authority in the 1950’s and just 20 years later, was classified (alongside heroin and LSD) as a Schedule I drug, having no medicinal use and the highest potential for abuse.

With this colorful history and longevity of marijuana, it’s easy to see why medical marijuana in the 21st century creates all sorts of questions. Is it safe? Is it addictive? How do we keep it out of the hands of teenagers? Has it been proven to be effective? What conditions can it treat? In what form and what dose?
Here are some main points to help improve understanding of medical marijuana, CBD, and what THC is.

MEDICAL MARIJUANA

What is it?

Traditionally, marijuana is smoked via hand-rolled cigarettes or pipes, can be vaped, or eaten in cookies or tea. Some users smoke or eat the concentrated resins or extracts, which contain higher amounts of marijuana’s active ingredients.

Marijuana contains more than 400 distinct chemicals that bind to various receptors throughout the body generating a multitude of effects. Marijuana has a combination of properties that decreases anxiety, produces a mild sedative effect, creates an expansion of consciousness, decreases the perception of pain, stimulates appetite, and creates a desire for more of the drug. Even though it is used to achieve feelings of happiness and relaxation, it may also cause anxiety or paranoia, forgetfulness, depression, scattered thought processes, and distortions in time.
We have abundant research analyzing the components of tobacco smoke but minimal data on the composition of marijuana smoke. We know that tobacco smoke contains more than 4,000 chemicals, with at least 50 of these compounds known to cause cancer. Smoking marijuana generates more than 2,000 compounds. It’s logical that the smoke components between the two will have many similarities, but are likely to have some striking differences. Until more research is done, it should be assumed that smoking marijuana increases the risk of developing multiple types of cancer.

Medical marijuana means different things in different states. In Utah, a summary of the current status of medical marijuana (or medical cannabis program) can be found at https://health.utah.gov/wp-content/uploads/MedCanFactSheet4-8-19.pdf

The medical cannabis program should be operational by March of 2020. It requires individuals seeking this treatment to apply for a medical cannabis card with their qualified medical provider (QMP) in the office through an electronic verification system. Qualified medical providers must complete certain education requirements in order to be allowed to prescribe medical cannabis. Providers are limited as to the number of patients they can have in the medical cannabis program and this form of treatment is only approved for specific conditions. Prescriptions must be filled at a central state pharmacy or a retail pharmacy that has applied for this privilege (the number of pharmacies allowed to apply is currently seven). Only certain dosages and devices will be available. Smoking and edibles are prohibited. The law limits who is allowed to possess or purchase medical cannabis (based on proximity to the pharmacy) and allows for a specific amount to be dispensed at one time.

What is it used for?

Since marijuana appears to impact almost every body system, it is used for a variety of conditions. It is typically used to help control chronic pain (although it is not strong enough for severe pain, ie: pain associated with kidney stones or post-operative). Marijuana appears to ease episodes of nerve pain associated with multiple sclerosis (MS), lessen tremors in Parkinson’s disease and may have potential benefits with people suffering from fibromyalgia, endometriosis, and interstitial cystitis. It has been used to manage nausea, weight loss, PTSD, glaucoma, irritable bowel syndrome, Crohn’s disease and wasting syndrome associated with HIV. Marketing claims in advertisements and on labels regarding its effectiveness should be viewed cautiously. Evidence of marijuana’s effectiveness in all these applications is waning.

Is it legal?

Medical marijuana is now legal in more than half the states throughout the country and in Washington DC. It is still illegal from the federal government’s perspective.
It is important to note that compliance with the Utah Medical Cannabis Act may not protect patients from liability for violations under federal law or the laws of other states.

Is it safe?

Probably, as it has been used for thousands of years, but it also obviously has some side effects and downfalls that need to be understood. It does affect the perception of space and time. It causes a decline in cognition, a delayed response time, impairs memory, and the ability to plan, focus, and carry out multiple tasks. Marijuana negatively affects coordination, judgment, and reaction time. The exact form and dose that should be used and for what condition is still not clearly understood. When looking at the addictive and overdose potential compared to narcotics, it is safer than opiates.

Summary

Medical marijuana does have therapeutic benefits and may carry less risk than traditional medications currently used. Inherently, it has some negative effects also, and the risks and benefits will need to be discussed on an individual basis with your healthcare provider. It will be legal to use in Utah, when specific conditions are met by the Spring of 2020, but is still considered illegal by the federal government. There is still a lack of rigorous scientific testing and research is ongoing.
Look for part II next week, to learn how CBD is related to marijuana and how it is used.

The National Academies of Sciences, Engineering, and Medicine has released a review of the evidence for the use of medical cannabis. You can download a FREE copy at
https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

https://www.health.harvard.edu/blog/medical-marijuana-2018011513085

Gillespie, B. (2019) Marijuana: Ancient Medicine, the Devil’s Playground, or Medical Miracle? Elite Healthcare Nursing Continuing Education, 50-62.

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