Medical Cannabis: The Health Effects of THC and CBD Specialization

Start Date: 10/13/2019

Course Type: Specialization Course

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About Course

The legalization of cannabis (i.e., marijuana) and the recent federal legalization of cannabidiol (CBD) has led to unprecedented access to cannabinoids (e.g. THC and CBD), a projected 60 billion dollar industry (cannabis and hemp) by 2025, and the fastest growing jobs sector in the economy according to recent reports in the media. Despite all of this, there is very little evidence-based information about the health effects of cannabis or about how to maximize the potential benefits while minimizing harm. Parents of children with seizure disorders, veterans with PTSD and chronic pain, cancer patients, and our aging parents deserve better. People WANT evidence-based information about the potential risks and benefits of cannabis products so that they can weigh the pros and cons of cannabis versus other options. They also want to know how to maximize the positive effects of cannabis while minimizing the side effects. This specialization is designed to provide that information. The specialization is useful to a range of learners. It is intended for patients and their loved ones who have questions about cannabis and CBD products as well as for health care providers and others who work in public health who want to provide helpful information to patients. Most importantly, it is intended for people who want to work in the cannabis industry. For all of these groups, understanding the evidence base is critical in terms of communicating the risks and potential benefits.

Course Syllabus

History of Medical Cannabis
Cannabis, Chronic Pain, and Related Disorders
Cannabis, Mental Health, and Brain Disorders
Healthy Aging and the Future of Cannabis Research

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Course Introduction

Learn About the Health Effects of Cannabis and CBD. You will learn how communicate about the potential benefits and risks of cannabis.

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Article Example
Long-term effects of cannabis Cannabis with a high THC to CBD ratio produces a higher incidence of psychological effects. CBD may show antipsychotic and neuroprotective properties, acting as an antagonist to some of the effects of THC. Studies examining this effect have used high ratios of CBD to THC, and it is unclear to what extent these laboratory studies translate to the types of cannabis used by real life users. Research has shown that CBD can safely prevent psychosis in general.
Medical cannabis The most psychoactive cannabinoid found in the cannabis plant is tetrahydrocannabinol (or delta-9-tetrahydrocannabinol, commonly known as THC). Other cannabinoids include delta-8-tetrahydrocannabinol, cannabidiol (CBD), cannabinol (CBN), cannabicyclol (CBL), cannabichromene (CBC) and cannabigerol (CBG); they have less psychotropic effects than THC, but may play a role in the overall effect of cannabis. The most studied are THC, CBD and CBN.
Medical cannabis A 2014 review stated that the variations in ratio of CBD-to-THC in botanical and pharmaceutical preparations determines the therapeutic vs psychoactive effects (CBD attenuates THC's psychoactive effects) of cannabis products.
Effects of cannabis Acute effects while under the influence can include euphoria and anxiety. Cannabidiol (CBD), another cannabinoid found in cannabis in varying amounts, has been shown to alleviate the adverse effects of THC that some consumers' experience. With very high doses, THC can induce auditory and visual hallucinations.
Cannabis (drug) CBD is a 5-HT receptor agonist, which may also contribute to an anxiolytic effect. This likely means the high concentrations of CBD found in "Cannabis indica" mitigate the anxiogenic effect of THC significantly. The effects of sativa are well known for their cerebral high, hence its daytime use as medical cannabis, while indica is well known for its sedative effects and preferred night time use as medical cannabis.
Effects of cannabis There are also similar compounds contained in cannabis that do not exhibit any psychoactive response but are obligatory for functionality: cannabidiol (CBD), an isomer of THC; cannabivarin (CBV), an analog of cannabinol (CBN) with a different side chain, cannabidivarin (CBDV), an analog of CBD with a different side chain, and cannabinolic acid. How these other compounds interact with THC is not fully understood. Some clinical studies have proposed that CBD acts as a balancing force to regulate the strength of the psychoactive agent THC. CBD is also believed to regulate the body’s metabolism of THC by inactivating cytochrome P450, an important class of enzymes that metabolize drugs. Experiments in which mice were treated with CBD followed by THC showed that CBD treatment was associated with a substantial increase in brain concentrations of THC and its major metabolites, most likely because it decreased the rate of clearance of THC from the body. Cannabis cofactor compounds have also been linked to lowering body temperature, modulating immune functioning, and cell protection. The essential oil of cannabis contains many fragrant terpenoids which may synergize with the cannabinoids to produce their unique effects. THC is converted rapidly to 11-hydroxy-THC, which is also pharmacologically active, so the drug effect outlasts measurable THC levels in blood.
Cannabis indica In the recent era of cannabis breeding higher-ratio CBD strains are being developed from Indica origins that may test out as 1:1 (CBD-THC balanced) or even as high as a 22:1 (CBD dominant). The medical interests in Cannabis are taking this further and we will see increasing cultivation trends for more strains developed with CBD-dominant ratios. In California, cities such as Coachella and Desert Hot Springs are re-zoning areas for cannabis cultivation. Even though Californians may legalize recreational use of cannabis in late 2016, the LA Times reported an entrepreneurial focus on CBD-dominant medical hemp crops, "The demand for medical products was so high, this [380,000-square-foot cultivation expansion] was just to fill the need for that." Low anxiety and hallucinogenic properties (psychoactive effects of THC reduced by CBD) make these "high-CBD strains" very desirable for chronic treatment programs.
Effects of cannabis While many psychoactive drugs clearly fall into the category of either stimulant, depressant, or hallucinogen, cannabis exhibits a mix of all properties, perhaps leaning the most towards hallucinogenic or psychedelic properties, though with other effects quite pronounced as well. THC is typically considered the primary active component of the cannabis plant; various scientific studies have suggested that certain other cannabinoids like CBD may also play a significant role in its psychoactive effects.
Cannabis indica On average, "Cannabis indica" has higher levels of THC compared to CBD, whereas "Cannabis sativa" has lower levels of THC to CBD. However, huge variability exists within either species. A 2015 study shows the average THC content of the most popular herbal cannabis products in the Netherlands has decreased slightly since 2005.
Tikun Olam (cannabis) As of 2014 Tikun Olam grows 12 different strains, including two species of medical cannabis containing 1% THC and 17% CBD (cannabidiol).
Effects of cannabis The primary effects of cannabis are caused by the chemical compounds in the plant, including cannabinoids, such as tetrahydrocannabinol (THC), which is only one of more than 100 different cannabinoids present in the plant. Cannabis has various psychological and physiological effects on the human body.
Cannabis in South Carolina Cannabis in South Carolina, United States, is illegal for recreational and medical purposes, but use of low-THC CBD oil is allowed for certain conditions.
Cannabis sativa Some studies indicate that, on average, "Cannabis sativa" has higher levels of THC to CBD, whereas "Cannabis indica" has higher levels of CBD compared to THC. However, huge variability exists within either species, and there is an increasing discussion whether the existing paradigm of the difference between species adequately represents the variability found within the "Cannabis" genus. There are five chemotaxonomic types of "Cannabis": one with high levels of THC, one which is more fibrous and has higher levels of CBD, one that is an intermediate between the two, another one with high levels of cannabigerol (CBG), and the last one almost without cannabinoids.
Cannabis "Cannabis" plants produce a unique family of terpeno-phenolic compounds called cannabinoids, some of which produce the "high" which may be experienced from consuming marijuana. There are 483 identifiable chemical constituents known to exist in the cannabis plant, and at least 85 different cannabinoids have been isolated from the plant. The two cannabinoids usually produced in greatest abundance are cannabidiol (CBD) and/or Δ-tetrahydrocannabinol (THC), but only THC is psychoactive. Since the early 1970s, "Cannabis" plants have been categorized by their chemical phenotype or "chemotype", based on the overall amount of THC produced, and on the ratio of THC to CBD. Although overall cannabinoid production is influenced by environmental factors, the THC/CBD ratio is genetically determined and remains fixed throughout the life of a plant. Non-drug plants produce relatively low levels of THC and high levels of CBD, while drug plants produce high levels of THC and low levels of CBD. When plants of these two chemotypes cross-pollinate, the plants in the first filial (F) generation have an intermediate chemotype and produce intermedite amounts of CBD and THC. Female plants of this chemotype may produce enough THC to be utilized for drug production.
Effects of cannabis When THC enters the blood stream and reaches the brain, it binds to cannabinoid receptors. The endogenous ligand of these receptors is anandamide, the effects of which THC emulates. This agonism of the cannabinoid receptors results in changes in the levels of various neurotransmitters, especially dopamine and norepinephrine; neurotransmitters which are closely associated with the acute effects of cannabis ingestion, such as euphoria and anxiety.
Cannabis (drug) Marijuana or marihuana (herbal cannabis), consists of the dried flowers and subtending leaves and stems of the female "Cannabis" plant. This is the most widely consumed form, containing 3% to 20% THC, with reports of up-to 33% THC. This is the stock material from which all other preparations are derived. Although herbal cannabis and industrial hemp derive from the same species and contain the psychoactive component (THC), they are distinct strains with unique biochemical compositions and uses. Hemp has lower concentrations of THC and higher concentrations of cannabidiol (CBD), which decreases the psychoactive effects
Effects of legalized cannabis Cannabis is a legal recreational and medical drug in several countries and US states and there have been several effects of the drug being legalized.
Cannabis Cup All cannabis products are additionally tested for THC content and CBD content by independent cannabis testing laboratories.
Medical cannabis Albert Lockhart and Manley West began studying in 1964 the health effects of traditional cannabis use in Jamaican communities. They developed, and in 1987 gained permission to market, the pharmaceutical "Canasol", one of the first cannabis extracts.
Cannabis and psychosis There is evidence that the brains of people with psychosis who previously used cannabis differ from those of healthy individuals with respect to areas such as the cingulate and prefrontal cortex. Research has consistently found that people with psychosis have higher rates of cannabis use, and that there exists an association between cannabis use and schizophrenia and other forms of psychosis. Some studies have also concluded that cannabis use is associated with an earlier age at onset of schizophrenia. However, it is less clear whether this association is a result of the specific effects of cannabis use. Proposed mechanisms by which this possible link could occur include the effects of dronabinol, a pure isomer of THC, and its ability to induce "acute psychotic states," which, in turn, have been called "the early signs of schizophrenia and related disorders." Further complicating the establishment of causation, another cannabinoid found in cannabis, cannabidiol (CBD), is thought to have antipsychotic properties. CBD has been shown to have anxiolytic properties and inhibit the psychotomimetic effects of THC, yet CBD content varies widely and has rarely been accounted for in epidemiological studies. It is believed that cannabis' effects on the risk of schizophrenia is especially pronounced among those who begin using the drug early.