Cannabis or marijuana, Cannabis sativa and Cannabis indica, as a botanical medicine has increased in popularity as more governments recognize it has therapeutic benefits beyond its status as a recreational drug and are legalizing use and sale of cannabis products. Research has shown it to be beneficial for anorexia due to cancer or AIDS/HIV, chronic pain, epilepsy, insomnia, multiple sclerosis, neuropathy, and more.

Cannabis has two primary bioactive cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD), and different strains of cannabis have been bred to have varying amounts of these chemicals. Currently only CBD oils from strains of hemp without THC are available on the open market in the US; though the FDA has declared CBD oil an illegal drug, currently no companies have been prosecuted for selling them as dietary supplements. Some states have legalized cannabis products for medical and/or recreational use, but most have limited sales to licensed dispensaries. Sativex standardized cannabis spray has been approved as a prescription medication for multiple sclerosis (MS) in the UK, Canada, Australia, and Spain. Epidiolex, a CBD oil based prescription medication, is available in the US for children over the age of 2 with uncontrolled seizures from two rare forms of epilepsy, Darvet syndrome and refractory Lennox-Gastaut syndrome.

Cannabis exhibits analgesic activity due to type 1 cannabinoid receptor (CB1) agonistic effects of delta-9-THC. It also exerts antiemetic properties due to inhibition of neurotransmitter release from CB1 and CB2 receptors. Cannabis suppresses immune function by increasing IL-10, IL-4, and other cytokines that inhibit immune function and decreasing IFN-gamma and IL-12 cytokines that stimulate immune function. Cannabis also inhibits platelet aggregation and may increase the risk of bleeding. In general THC increases anxiety and psychotic-like symptoms whereas CBD reduces anxiety and psychotic-like symptoms.

Side-effects of inhalation or oral cannabis extracts include bronchodilation, cough, decreased blood flow to optic nerves, dissociation, dizziness, drowsiness, dry mouth, fatigue, headache, increased appetite, nausea, and paranoid thinking. Side-effects of CBD oil include decreased appetite, diarrhea, dry mouth, drowsiness, elevated liver enzymes, fatigue, vomiting, and weight loss. Low doses of CBD oil (15mg) may act as a stimulate, while moderate to high doses are sedating. Intoxicating doses of cannabis may impair reaction time, motor coordination, and visual perceptions, and can cause depression, flashbacks, hallucinations, panic reactions, and other emotional problems. Long-term use of cannabis products may cause cognitive impairment, decreased memory, hyperemesis (cyclic vomiting), psychotic symptoms or psychosis. Smoking may cause cardiovascular issues including acute coronary syndrome, arteritis, hypotension or hypertension, myocardial infarction, palpitations, syncope, tachycardia, and vasodilation. Smoking cannabis also increases risk of developing lung cancer by 8% for every year of smoking. Contraindications for use of cannabis products include bipolar disorder, cardiovascular disease, compromised immune system, depression, pregnancy and lactation, respiratory diseases, schizophrenia, stroke, surgery, alcohol, acetaminophen, anesthetics, anticoagulant and anti-platelet drugs, antifungals, antipyrine, barbiturates, calcium channel blockers, chemotherapy drugs, chlorzoxazone, clarithromycin, central nervous system depressants, corticosteroids, cyclosporine, digoxin, disulfiram, estrogens, fexofenadine, fluoxetine, H2 antagonists, loperamide, lovastatin, protease inhibitors, theophylline, and others. Hypokalemia, dangerously low potassium levels, have been reported when combining high doses of THC with drugs that effect potassium equilibrium including antifungals, beta 2 receptor agonists, calcium channel blockers, corticoid steroids, diuretics, insulin, laxatives, and xanthines such as caffeine and theophylline.

Medicinal cannabis extracts and oils should be standardized based on THC and/or CBD content and labeled accordingly. Oral preparations are best taken with a high fat meal or snack for best absorption. Currently there are no standard dosing recommendations, but clinical trials can help guide dosing decisions. In clinical trials 1-5 capsules twice daily of standardized extract containing 2.5mg THC and 0.8-1.8mg CBD oil has been used for MS for up to 12 weeks. Another clinical trial for MS used a standardized extract containing 27mg/mL delta-9-THC and 25mg/mL CBD daily for up to 2 years. For neuropathy an inhaled cannabis product containing 25mg (9.4%) THC three times daily has been used in clinical trials. To improve sleep quality in those with rheumatoid arthritis a standardized extract spray containing 2.7mg delta-9-THC and 2.5mg CBD per spray in doses up to 6 sprays daily 30 minutes before bed has been used for 5 weeks. A small clinical trial on those with insomnia reported longer sleep duration when taking 160mg CBD oil 30 minutes prior to bedtime compared to placebo; lower doses (40mg and 80mg) had no effect on sleep duration. Epidiolex is standardized to contain 100 mg/mL CBD oil and the most effective dose is titrated up to 5mg/kg of body weight twice daily, with a maximum dose of 10mg/kg of body weight twice daily, in children with rare forms of intractable epilepsy. Clinical trials on commercially available CBD oil for children with intractable epilepsy found that 3mg/kg of body weight of CBD oil was as effective as the anti seizure medication clobazam without the sedative side-effects of the prescription drug; as an add-on therapy along with clobazam, CBD oil was even more effective at reducing seizures.

Disclaimer: The content herein is not intended to be a substitute for professional medical advice. It is not meant to diagnosis, cure, or treat any medical condition. Always consult a physician or other qualified healthcare provider with questions regarding a medical condition and before starting new diets and dietary supplements. Not all diets or supplements are appropriate for all people or all health conditions.

 

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