CBD: A useful stopgap?

Drs. Khalsa and Rad – Canna Therapy, MD

The state will begin accepting applications for medical cannabis user cards on July 4th, but the law doesn’t allow for dispensaries to open until January 2020, at the earliest. In the meantime, health food stores, convenience stores, gas stations—seemingly everywhere—are selling CBD oils, tinctures, rubs, and other products.

We ask Drs. Hari Khalsa and Radhika Ratnabalasuriar of Canna Therapy MD about CBD and its utility as a stopgap until the dispensaries open.

There’s quite a bit of time between the first issuance of med cards, and when the dispensaries open in 2020. Is CBD a good option for treatment for those who qualify for medical marijuana?

Patients can try hemp-based CBD oil, however it should be under the care and guidance of a physician trained specifically in cannabis-based medicine. This will help patients take correct dosages, at correct frequencies for their needs, and allow patients to experience maximum benefit in a safer environment.

Ultimately, we tend to see the most effective results with medical grade cannabis provided by a licensed state dispensary.

What’s the difference between the CBD oil sold everywhere now, and the THC- containing cannabis and cannabis-derived products that will be available exclusively from dispensaries?

CBD refers to cannabidiol, the most prevalent phytocannabinoid compound found in cannabis plants. It’s not psychoactive, meaning that it doesn’t get a patient “high” like THC. CBD binds to some of the cannabinoid receptors throughout the body, which gives it medicinal potential, but it does not function the same as, or the same without, tetrahydrocannabinol (THC).

CBD is not specifically a federally scheduled substance. It is found in hemp, as well as in conjunction with THC in cannabis plants that are more commonly referred to as “marijuana.” Hemp has been cultivated for industrial uses such as rope, textiles, and paper, where THC content is irrelevant. Medicinal cannabis plants have been bred specifically to enhance their THC content for its medicinal and psychoactive properties. Both varieties fall within the “cannabis” genus, while their difference in species is hotly debated.

Currently available CBD is derived from hemp plants, and contains under 0.3% THC content, whereas medical cannabis contains between 5% and 30% THC content in flower form and greater concentrations in refined form. CBD certainly can have a medically significant, and therapeutically useful, effect on the body, but the best-studied and most useful potential cannabis therapy comes from a combination of CBD and THC, which will only be available from dispensaries.

The different results between CBD and THC are attributable to the different bioavailable chemicals present in hemp plants versus medicinal cannabis plants grown for and sold in dispensaries. Medical cannabis plants are cultivated to contain resin with a high THC concentration. That resin also contains some CBD. Both of these compounds are metabolized into their active forms before they become bioavailable, the term meaning “useable by the body.”

Terpenes are additional components of cannabis that significantly influence the effects of medical cannabis on patients. Terpenes are considerably less present in hemp. Continued research will hopefully shed more light on the medical usefulness of terpenes and their interactions with CBD, THC, and other medications.

Which is better: CBD oil derived from hemp, which is common in the market, or CBD oil derived from THC-containing medical cannabis, which is available from dispensaries?

The best source of CBD oil is organically grown, high-resin, CBD-rich cannabis from medical cannabis plants. This is because low-resin industrial hemp contains far less CBD by volume. This requires more raw material to extract a useful amount of CBD, which increases the risk of other contaminants and toxins entering the production process and contaminating the CBD product.Also, industrial hemp is less chemically diverse than medical grade cannabis, and therefore lacks the therapeutic mixture of terpenes and other secondary cannabinoids found in high-resin medical cannabis.

The more we learn about medical cannabis, the more we find that CBD and THC create what is called an “entourage effect.” In other words, patients increasingly find they get significantly better results when both THC and CBD are present in the source plant.

New research continuously identifies additional organic components, including terpenes, that are present in medical cannabis and its derivatives. These additional organic compounds play a role in achieving the desired medicinal effect of cannabis.

When considering CBD for treatment, what can a patient expect?

The biggest challenge for patients wanting to try hemp-based CBD is finding organic and pure CBD concentrates that effectively limit toxic additives. Also, the significant differences between hemp-based CBD and cannabis-derived CBD remain.

We remind patients that if one form of medication does not work well for them, that does not mean all forms will not work well. There is a wide variety of cannabis-based therapies, some involving CBD and THC blends, others favoring medicinal cannabis derived CBD. Finding the right combination takes teamwork between a patient and physicians specifically trained in cannabis medicine.

The process of using medical cannabis shifts some responsibility to the patient to experiment within physicians’ recommended guidelines with dosing, ingestion, and strains that may work best for them. As physicians trained in cannabis medicine, our goal is to guide and educate our patients on how to do this safely.

How does a patient know if they’re using it right, or using enough?

Our advice to patients is to start “low-and-slow.” In the medical cannabis field, we call this microdosing. Typically we have patients start at 1-2mg of CBD/THC and increase slowly until they reach therapeutic levels. Specifics about microdosing regimens are beyond the depth of this article but we do discuss this with our patients during their office visit.

If at any point a patient experiences negative side effects (dry mouth, vomiting, lightheadedness) we recommend they stop using medical cannabis. While these side effects are exceedingly rare, each patient’s body reacts differently to the organic compounds used in cannabis-based therapy. Once they return to normal and their symptoms have resolved, they generally restart their regimen at the last dose that was tolerated well.

Their physician may additionally guide them toward a different cannabis strain or method of ingestion. It’s very common for patients and physicians to work together to find the right combinations for their symptoms, physiology, and needs. As with adjusting any medication, this can be an ongoing process, and is nothing to fear.

How does CBD work?

Cannabidiol (CBD) is a naturally occurring compound found in hemp or the resinous flower of medical cannabis. It has various therapeutic properties, including anti- inflammation and neuroprotective benefits. It is closely related to THC. It appears to work best when paired with THC and terpenes from medicinal grade cannabis.

Should a patient consider CBD after they receive their patient care card?

If a patient has a Qualifying Condition (i.e., a medical condition recognized by the state of Missouri as treatable by medicinal cannabis) and they are approved for a medical cannabis card, they most likely will benefit from medical grade cannabis that is sold in state-licensed dispensaries.

However, if a patient would like to try hemp-derived CBD for additional benefit, we encourage them to do so. This is because every person is different, and treatment will look different for each patient. Medical cannabis is an individualized medication. Patients should feel empowered to work with their physician to find the right combination of treatments for their specific medical conditions and individual needs.

The content herein is provided for informational purposes only. If you would like to discuss the particulars of your unique medical symptomology and condition, please consult with a trained medicinal cannabis physician.