What is CBD or Cannabidiol in medical cannabis?
CBD or Cannabidiol is one of the major cannabinoids in medicinal cannabis (marijuana medicine). CBD is the non-intoxicating, non-addictive part of cannabis. CBD does not cause you to be "high". CBD in cannabis is similar to 2-AG or 2-arachidonoylglycerol which our bodies produce naturally. Receptors for CBD exist in various organ systems in the body and this is the reason it can help with so many medical conditions.
What do we mean by CBD oil?
CBD oils have little or no THC and are mainly CBD. Different strengths of CBD oils exist. THC: Tetrahydrocannabinol is the psychoactive part of cannabis and also helps with pain and sleep. This is the part of medicinal cannabis that can make you "high". Don't discount THC for medical use and we will feature THC in another article later on. Most CBD oils have no THC or less than 1mg THC per ml of oil. CBD oils with THC of more than 1mg are another story and the information below does not apply to those CBD oils.
Pros of CBD oil in Medicinal Cannabis
Patients use CBD oils for many reasons and chronic pain is the most common reason for taking CBD oils. Patients don't want to get "high", they just want relief without any side effects. Patients don't want to be addicted or dependent on anything they are using for pain. Weaning off prescription medications that are ineffective, causing side effects or have harms like opiates are the main reasons for seeking out CBD oils.
Does CBD oil really help with Pain?
CBD provides 3 main benefits.
Decrease inflammation and pain
Decrease muscle spasms or stiffness
Reduce anxiety
CBD helps with chronic pain for many patients but it does not work for everyone. Whether it is related to individual metabolism and tolerance is not clear. Research is still limited in cannabis medicine. The single benefit that is important in CBD is that it reduces inflammation throughout various parts of the body. Arthritis patients get relief with CBD oil. Taking CBD oil before an activity helps function better, like taking it before gardening or playing golf. Rheumatoid and other inflammatory arthritis get more benefits with regular use of CBD oils. Chronic back pain is the most common reason to take CBD oil.
CBD oil benefits are not limited to joints or muscles. It can reduce inflammation in various organ systems in the body. Inflammation is reduced such as related to GI or digestion, like Crohn's disease, reflux, irritable bowel syndrome etc. It can reduce inflammation in endometriosis and helps with pelvic pain. It can reduce hot flashes like in menopause. In some patients, sinus pain is reduced. Trigeminal neuralgia, jaw pain, and TMJ all benefit from CBD for the same reason.
Any condition with muscle spasms will have benefits from CBD. Multiple Sclerosis patients get significant benefits from CBD. Fibromyalgia patients get relief due to a reduction in muscle stiffness. Discomfort from muscle spasms in the legs at night is treated with CBD.
CBD helps prevent migraines rather than help with the acute management of migraines. CBD is even more effective on tension muscle headaches.
CBD does help neuropathic pain in some patients and there is some research in this area. Neuropathic pain is difficult to manage and response varies among individuals. However, neuropathic pain may need CBD in combination with THC as well. This limits the use of these oils to night only since THC can interfere with function during the day. Neuropathic pain is complicated and needs a separate post to explain this fully.
CBD reduces anxiety depending on the strain, cannabis has other cannabinoids and terpenes that all impact mood. Most people would describe the main benefit of CBD oil for decreasing anxiety as that they are able to cope better. The racing thoughts diminish. CBD is not like prescription medications, it is not a "hammer", it is more subtle and usually has little or no side effects if the correct strain/dosing is selected. CBD can be taken as needed or regularly and does not need to be weaned off. CBD is not intoxicating, nor addictive and dependence is not an issue.
What are the side effects of CBD in Medical Marijuana?
CBD generally does not have side effects for most people and is well tolerated with little or no cognitive effects. Although CBD is considered not intoxicating, it can affect mood. Minor side effects can be fatigue, diarrhea, and dry mouth but these are not common.
Cons of CBD oil in Medical Cannabis
Who is at risk for the side effects of CBD?
Like any medication, CBD is not without risks.
People who generally have drug sensitivities to prescription medications can also have side effects from CBD. These side effects occur because CBD is metabolized in the liver in similar pathways as many prescription medications.
People with mental health conditions can have side effects from CBD depending on which CBD strain is selected, for example: depression symptoms can worsen with some strains of CBD. Patients with bipolar, major depression, and previous hospitalizations for mental health issues are at higher risk. These risks are also due to interaction risks with specific prescription medications in this group of patients. Some CBD strains can worsen anxiety so choosing the best CBD strains for anxiety is necessary. Choosing cannabis strains is based on feedback from a large number of previous patients and data collection. Anxiety and depression should be treated by an experienced clinician in cannabis medicine due to the risk of harm.
Seniors at are higher risk with CBD. Side effects for people 70 years or older can vary depending on which CBD oil/capsule is selected. Due to this variation in strains, the quality of oils, selection of the best CBD strain and dosing are needed to avoid these side effects. But we must add that seniors also seem to get more benefits from pain relief from CBD than younger patient groups. CBD poses fewer risks than most prescription medications for pain. As we get older, the risks of side effects to prescription medications increase, along with polypharmacy. CBD also helps reduce some prescription medications.
If you work in a job that requires more focus and decision-making that would impact other's lives, such as professionals. For example a financial consultant. Then choosing the correct CBD strain is essential. Some CBD strains are less likely to impact cognition. However, in some cases, like if you have anxiety and CBD is helping with anxiety. You will feel better and you can do your job. Suppose you are taking CBD for pain and have no anxiety or depression, CBD could impact focus in some cases and impact your decision-making at work. In safety-sensitive jobs, CBD is not recommended at all. In some jobs, you cannot take CBD at work but can take it when you get home but you need to check your workplace policies.
CBD in dementia can have a negative impact on cognition in some cases. It's vital to choose the CBD strain that has been used by similar patients over the years. CBD strains that have a history of good feedback from previous patients and their care providers are important. In this case, the quality of the CBD strain is much more important. Please note: CBD oil does not help dementia. However, since CBD can help with anxiety and pain, a person with dementia can function better. CBD is worth trying since it can improve the quality of life for the person and their care providers.
Interaction with other prescription medications may occur but the clinical impact of this is not known to any large degree due to limitations in large randomized control trials.. Metabolism of CBD is in the liver similar to many prescription medications. Some medications pose higher risks than others and CBD may not be recommended at all. Medical history and polypharmacy also contribute to side effects that may occur. This is best discussed with a medical doctor.
Final Note: Does CBD help with sleep? Even though this article is on the pros and cons of CBD, this question gets asked so often so is worth a mention.
CBD helps some people sleep since it reduces anxiety and pain. If you don't sleep due to anxiety or pain then CBD may help. However, if you truly have insomnia or significant sleep issue despite multiple sleep medications. Then, CBD oil may not be enough. In cannabis medicine, it is micro-dosing THC (the psychoactive part of cannabis) in various ways or in combination with CBD that helps with sleep. The easiest medical condition to treat in cannabis medicine is sleep and many people are able to wean off their prescription medications with the help of the doctor in our clinic. Will discuss Sleep in another article later on.
Watch video on Cannabis Helps Sleep below:
If you would like to see Dr. Jagmeet Sethi (internal medicine specialist) at our clinic or by telemedicine, book a free video appointment anywhere in Ontario, Canada. Dr. Sethi has seen over 15,000 patients in cannabis medicine in the last 5 years.
Dr. Jagmeet Sethi MD
Sethi Cannabis Clinic
Website: sclinic.ca
Email: staff@sclinic.ca
Phone: (905) 681-7676
Research and data on cannabis are limited. The above information is for educational purposes only and should not be used to treat and diagnose medical conditions. Book a video appointment with the doctor today to talk about which CBD strain is best for your medical condition.