Is THC really just the recreational cannabinoid? And what about CBD..is it really all its cracked up to be?
So now that you know all about our Endocannabinoid System let’s talk about the cannabinoids found in cannabis, which are called phytocannabinoids.
Did you know the cannabis plant contains over 700 chemicals including over 100 cannabinoids (such as THC and CBD), terpenes (taste, smell – potential biochemical effect) and flavonoids (phytonutrients found in cannabis and other plants)? As you probably know, the most well studied and abundant cannabinoids found in cannabis are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol).
Other cannabinoids such as CBG, CBC, THCA, CBDA, CBCV, CBGV, CBDV, THCV etc. may also play a role in the medical use of cannabis, however, THC and CBD are the two that we know the most about.
THC and CBD interact with the body’s endocannabinoid system, along with other regulatory systems, modulating various neurotransmitters. The ratio of THC:CBD in cannabis varies from strain to strain (or product to product) and leads to different therapeutic effects.
What can THC be used for?
THC is the primary psychoactive phytocannabinoid in cannabis, meaning that THC can cause euphoria, and that the intoxicating effects of cannabis are mainly associated with THC. For medical purposes, the goal is not to cause intoxication or euphoria by controlling the amount of THC administered in a prescription medicine, since negative side effects are mainly dose dependant. This is why it is important for patients to be monitored by a registered medical practitioner.
Most of the side effects of THC (including euphoria, dizziness, dry mouth) are short-term, are usually dose dependant and can be mitigated in most patients through slow titration and by building their THC tolerance over time. Patients can be prescribed cannabinoid-based medicines that have small amounts of THC, or by using a technique called “microdosing”. Long-term effects of THC are still being studied, but we do know that certain molecules in cannabis can affect basic motor coordination and complex executive function tasks, such as the ability to plan, organise, solve problems, make decisions, remember, and control emotions and behaviour. These deficits differ in severity depending on the quantity, frequency, age of onset and duration of use. You can read more about the acute and long term effects of cannabis use here.
What can CBD be used for?
CBD is another major cannabinoid found in the cannabis plant. Unlike THC, CBD is non-intoxicating and the WHO has stated that it has no dependence potential. This means, that in general, it does not produce euphoria or loss of cognition and motor control, although, individual responses may vary and drowsiness can occur in large doses. CBD may increase levels of the body’s own natural cannabinoids (endocannabinoids) and affect levels of other neurotransmitters. CBD is thought to counteract some of the “negative” side effects of THC, although more research is required to support this theory.
There is evidence to suggest that for some conditions THC and CBD can exert their effects more effectively when they are administered together and can act in synergy with each other; this is referred to as the “Entourage Effect”. Some clinical studies have shown that full plant extracts, which contain a mixture of cannabinoids and terpenes, are more effective than individual cannabinoids for some conditions.
Side Effects of THC and CBD
In general, cannabis is a well-tolerated drug, but as is the case with most drugs, it still carries the risk of side effects. Side effects are usually dose-dependent and occur during the first few weeks of the dose titration period. However, when compared to other drugs, cannabis has been shown to have a superior safety profile, with no reported deaths, most likely due to the lack of cannabinoid 1 (CB1) receptors in the brainstem cardiorespiratory centres.
The Department of Health states, “…because of the large effective to lethal dose ratio in humans (in excess of 1:1000 in non-tolerant users) the risk of experiencing severe toxic effects of cannabis is limited to the euphoric / psychotropic effects of high doses – which would lead to cessation of use before the onset of any dangerous physical consequences.” This means that although you might experience unwanted side effects, it would be very difficult to take a lethal dose of cannabis.
A typical therapeutic dose of THC can be as low as 2.5 mg per day, depending on the medical condition and the patient. However, it is important to note that variations of your cannabis dose (sometimes by just 0.1 mL) can produce opposite effects for some patients. For example, low doses of THC can help alleviate anxiety; high doses can exacerbate it. Low doses of CBD can cause alertness; high doses can cause drowsiness. Side effects can vary greatly from patient to patient.
MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med 2018; 49: 12-19 2012.
It’s important to remember that cannabis is still deemed as an experimental drug in Australia and caution must be taken before considering treatment. This is particularly important for cannabis naïve users, the elderly, or those who have multiple conditions are are taking other medications. Treatment is unique for each of our patients, and requires a medical opinion and medical supervision to ensure patient safety and best outcomes.
Toxicity and Risk of Dependence
The TGA has stated that cannabis has a low-to-moderate risk of dependence, and a report by the USA National Academies of Science, Engineering and Medicine published in 2017 found that cannabis has a lower risk of dependence than coffee, alcohol, nicotine and morphine.
In studies conducted in animals, the reported overall acute toxicity of THC is low. The median lethal dose (that which kills 50% of treated animals in a study ) of oral THC in rats is 800 to 1900 mg/kg. In contrast, the LD50 of some opioids in rats is 0.9 to 70 mg/kg. Thus, cannabis-based medicines have a better safety profile when administered under appropriate medical supervision.
A healthcare professional will consider a number of different criteria when deciding whether cannabis is an appropriate treatment option for you. Remember, cannabis can interact with a number of different drugs and cause adverse side effects which must be monitored, there are contraindications to its use, and many different types of cannabis-based medications to choose from.
Talk to a medical professional at Tetra Health to discuss all options prior to starting any potential treatment.
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