In order to use cannabis as medicine successfully, there are a number of concepts that you should understand. These include:
THC is the most prominent cannabinoid in the cannabis plant and is responsible for the psychoactive “high” effects. Many think THC is just for getting high, but it is quite medicinal in its effects for thousands of patients. The claim that THC is recreational only and has no medicinal value is bogus.
I often read in medical journals that psychoactive effects are “unwanted,” and although that may be true for some people, many of my patients report significant and life-changing relief with THC-rich cannabis. This does not make these patients “potheads.” Remember that people with chronic and serious illnesses often suffer with endocannabinoid deficiency or dysregulation, meaning their endocannabinoid system is not working properly. THC can and does correct this imbalance for many patients. A person with an endocannabinoid dysfunction who finds THC-rich cannabis to be helpful should have access to this medicine, just as someone with diabetes or asthma should have access to the medications that benefit them. After talking with thousands of patients who have found excellent results with THC-rich cannabis medicine, I can definitively state that it is a safe and effective medication when used responsibly. As with all medicines, there are a few circumstances where THC use should be avoided (see Chapter 5).
THC works directly by binding to the cannabinoid receptor similarly to the way endocannabinoids bind to these receptors. Remember that your endocannabinoid system works to maintain homeostasis of your cells. When there is a trigger such as illness, injury or inflammation, if your endocannabinoid system functions properly, you will make endocannabinoids that will balance the cells’ messages. As discussed in Chapter 3, certain medical conditions are associated with an endocannabinoid deficiency and those suffering with this deficiency cannot respond to cellular imbalance as they do not have enough endocannabinoids to respond to the trigger. THC can replace the missing endocannabinoids and natural balance can be restored.
A good example of this is neuropathic pain, also called neuropathy, a painful condition that is notoriously difficult to treat with conventional pharmaceuticals. In neuropathy, often associated with diabetes, HIV/AIDS, multiple sclerosis or chemotherapy toxicity, an excitatory neurotransmitter called glutamate can accumulate and cause cell damage and death, worsening the pain. We know endocannabinoids are released in response to these insults, but sometimes these compounds cannot fully correct the imbalance, especially in cases of endocannabinoid deficiency. THC, which binds to the cannabinoid receptor, decreases the transmission of glutamate, resulting in cellular protection and diminished pain.
In my clinical experience, THC-rich cannabis medicine is used for chronic pain, anxiety, depression, insomnia, appetite stimulation, gastrointestinal ailments and nausea and vomiting, especially when induced by chemotherapy. Studies prove that THC works as a neuroprotectant and as an anti-inflammatory, anticonvulsant, antispasmodic, antitumor and antioxidant agent. Some patients have such significant relief of their conditions, especially arthritis, insomnia, intestinal distress and migraine headaches, that they think they are cured. They also often find that once they are improved, low and intermittent doses of cannabis keep their conditions under control. Some patients will feel so well that they will stop using cannabis completely and may find that the medical condition does not return. Others find that continued use of cannabis maintains balance and that the medical condition is managed easily.
One particular patient came to me with a long history of migraine headaches that started when he was a young teenager. His mother, grandmother and three siblings all suffered with migraines as well. He had complete resolution of his migraines for one year with the use of THC-rich cannabis. Thinking he was cured and no longer needed treatment, he stopped using it. Three months later he came back to see me, reporting that the migraines had returned. He resumed his use of cannabis medicine and remains migraine free. He reports that low doses of vaporized THC a few nights per week keep the headaches away, with the beneficial side effects of less anxiety, better sleep and no adverse side effects. This patient likely suffers from a genetic endocannabinoid deficiency that causes his migraine condition. The use of THC allows his brain to maintain balanced neurotransmitter messages, resulting in resolution of his condition.
Potency of the cannabis plant is usually measured by the content of THC, which can range from 5% up to 30%. Concentrated forms of THC-rich cannabis can have potencies up to 90%. The average potency of cannabis in the 1970s was 1-3% and now ranges between 10-20% in states with medical cannabis laws. I have not seen issues with this increase as patients using cannabis for medical purposes rarely over-medicate. They use trial and error to find the dose that alleviates the medical condition, and if they use more, they find that the higher dose can be uncomfortable or with the development of tolerance over time, the beneficial medicinal effects may be lessened or lost. Most of my patients using THC-rich cannabis report that they don’t need much to get the results they are seeking. When a patient reports using large amounts of THC, tolerance has usually developed. Abstaining for a few days to a week will diminish the tolerance and allow the patient to lessen the amount of cannabis being used while likely improving the medicinal effects.
There are a few things to keep in mind when using THC-rich cannabis medicine:
Cannabidiol is the second most prominent cannabinoid in the plant. As research into the amazing medicinal properties of CBD continues to increase, more CBD chemovars and products are becoming available and more medical cannabis patients are including CBD in their regimens. Whereas THC binds directly to the cannabinoid receptor, CBD does not bind directly to the receptors. Recently CBD was found to be an allosteric modulator of the receptor, meaning it influences the compounds that bind to the receptor. It also works at multiple other targets. These include non-cannabinoid receptors and ion channels where calcium, potassium and sodium pass in and out of cells. This is why CBD has no psychoactive effects and does not cause tolerance with repeated use. CBD is well documented to be extremely safe for human use. CBD is often alerting in low to moderate doses and can be sedating in higher doses. Occasionally, new CBD users may experience sedation initially, which usually resolves in the first few weeks of use.
CBD has multiple properties and can act as an anti-inflammatory, antioxidant, anticonvulsant, antianxiety, antidepressant, anti-psychotic, antibacterial and antitumor agent. It also works as a pain reliever and muscle-relaxant. Research shows that the brain’s endocannabinoid activity is enhanced by CBD, as CBD blocks the breakdown of these compounds, allowing them to last longer. Additionally, CBD blocks the breakdown of THC to its metabolite 11-OH-THC, thereby decreasing some of the psychoactivity and sedation associated with this metabolite. Due to the entourage effect, CBD’s properties are enhanced when other cannabinoids and terpenoids are present.
In my clinical experience, patients who benefit the most from CBD-rich chemovars are those who want to minimize the psychoactivity of cannabis use and who have inflammatory illnesses, autoimmune disease, epilepsy, cancer, gastrointestinal disorders, anxiety and/or depression and psychosis. Because all CBD-rich cannabis plants (not hemp) contain some THC, knowing how much CBD and THC that are in the plant or product is important so that the CBD:THC ratio can be calculated. Knowing this ratio allows patients to determine potential psychoactivity.
Many patients use CBD-rich cannabis on a daily basis, one to three or more times per day, to keep inflammation or seizures under control. Others who feel they do not need daily medication may use CBD-rich cannabis on an as-needed basis to help mitigate the symptoms of migraines, mood disorders, episodic anxiety or pain conditions.
One particular patient that has had great success with CBD-rich medicine is an 18-year-old with rheumatoid arthritis, Crohn’s disease and a concurrent seizure disorder. She began using CBD-rich oil, taken by mouth every 8 hours, with the goal of treating her seizure disorder. She became seizure free within weeks of starting the oil and, within about three months, her blood tests for the inflammatory disorders showed significant improvement. She was able to stop taking all other medications, which included anticonvulsants and biologics (medications that are injected to stop inflammatory conditions), both of which were not effective for her.
Another patient who reports excellent results with CBD-rich cannabis is an older woman who had severe traumatic injuries, including significant head trauma, after a car accident. It took her two years to rehabilitate and she continued to suffer from chronic pain and intermittent depression that was not responding to conventional pharmaceuticals. She began using THC-rich medicine that eased her physical pain, but she did not find relief of her depressive symptoms. I encouraged her to add CBD-rich cannabis to her regimen and she found tremendous improvement in her mood. She only uses cannabis as needed and has been able to stay off of pharmaceuticals for over five years.
Important things to know about CBD:
Remember that analytical testing of the cannabinoids is the only way to know the accurate content of any particular plant!
Cannabinol (CBN) is the third most prominent phytocannabinoid after THC and CBD. CBN is found in only trace amounts in the freshly cut cannabis flower. Unheated raw cannabis contains THCA (Delta-9-Tetrahydrocannabinolic acid) which, when heated up, converts to THC. CBN results from the oxidation of THC as it degrades.
CBN is weakly psychoactive. It has pain relieving and antibacterial properties. It also promotes bone growth and reduced eye pressure. CBN is thought to be sedating, however this effect is due to the loss of certain terpenoids which occurs when cannabis ages. The terpenoids that remain in the aging plant material are responsible for the sedating effect.