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A Scientific Look at Cannabis and CBD Oil

Ryan Perkins, M.D.

March 21, 2019

I get asked weekly about using cannabis and CBD oil.  Questions relating to amount of THC and whether you should take it orally or by smoking usually trail in the conversation.  So I thought it was time to address this topic more scientifically.

Marijuana has been around for a long time.  I remember my Grandfather telling me that people used to sneak into his alfalfa fields and plant marijuana so it was camouflaged from legal officials – they just had to harvest it sooner than Grandpa had his first cutting of hay, otherwise, the cows enjoyed the harvest.

The endocannabinoid system is a network of receptors, and signaling molecules that are designed to help the body manage anxiety and inflammation when placed under stress.  There are two types of cannabinoid receptors: CB1 and CB2. CB1 receptors are mainly found in the brain and central nervous system, CB1 receptor activation leads to feelings of euphoria. CB2 receptors are found in the rest of the body, like the muscles, skin, and heart and on the white blood cells, and their activation affects the regulation of inflammation chemicals.

THC (tetrahydrocannabinol) is the main psychoactive component of marijuana and activates both CB1 and CB2 receptors.  It is also found in different concentrations in cannabis oil, and hemp oil.  CBD (Cannibidiol) lacks the THC component and thus doesn’t produce the intoxicating properties one associates with marijuana use.  CBD has a weak affinity for CB1 and CB2 receptors and would have some anti-inflammatory effects without the “high”.

THC has been synthesized and has been prescribed clinically for nausea, vomiting, appetite stimulation, pain reduction and spasticity over the last 20 plus years.   The more common names of Dronabinol are Marinol and Syndros.  In my experience for patients, Marinol works moderately well, but has not been my first or second choices in my cancer patients.

Most states allow CBD oil to be used for certain conditions including, Alzheimer’s, AML (amyotrophic lateral sclerosis), cancer, Crohn’s disease, seizures, HIV, multiple sclerosis with spasticity, chronic pain, and nausea.

Unfortunately, most of the data that shows efficacy was collected using the smoked form of cannabis.  Blended amounts of CBD oil with differing concentrations of THC have suggested improved benefit for pain compared with CBD alone.  Thus, dispensing pharmacies will often graduate patients to higher concentrations of THC with the CBD preparation if the lower concentrations are ineffective.

The health risks from cannabis smoking are associated with motor vehicle accidents, lower birth weight babies, psychosis, and respiratory disease.  The risks of CBD are not well established and will take many more years before they are known.

And lastly, cannabis is illegal under federal law.  Thus, physicians cannot prescribe these products and pharmacies cannot dispense them.  Currently, some states are regulating the dispensing of medical cannabis through state licensed dispensaries.  These centers will sell preparations or products in compliance with state regulations.  However, since the FDA does not regulate these products, the manufacturing of these products has no national standards.  Health care professionals in the corresponding states have to be registered and they in turn will certify patients for cannabis use using state generated guidelines.

The physicians at the Ackerman Cancer Center do not certify patients for cannabis use nor do we dispense the products.   However, some patients have reported marked improvement in their symptoms of pain, nausea, appetite stimulation and abdominal discomfort.  There are no documented uses of cannabis for treatment of cancer.  As with most cancer care recommendations, be sure to communicate with your physicians to coordinate your care, which may use cannabis as another tool to manage hard to control symptoms.

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