(Pharmacist’s Letter, September 2018)
While CBD and THC are known to be derived from the cannabis family of plants, these two compounds have distinct differences in their benefits, therapeutic uses, negative effects, and risk of dependence. There are more than 400 compounds found in Cannabis sativa, but only some of these compounds are specific to the cannabis plant. Two cannabinoids that have generated much interest in the media as having potential therapeutic effects are cannabidiol (CBD) and delta-9-tetraydrocannabinol (THC).
Does the specific plant source of cannabinoids matter? Due to the fact that THC can give you a high, but CBD does not elucidates the importance of knowing where these cannabinoids are derived. THC is mainly found in marijuana, and because it gives off that “high,” it is the subject of many legal discussions surrounding the medicinal and recreational use of this specific compound. On the other hand, CBD can be found in marijuana as well, but it is the hemp plant that contains only CBD. For that reason, hemp is a legal source for CBD in the United States. Because of the legality of hemp, CBD has been gaining momentum in the complementary and alternative medicine arena. And since the market for CBD is now becoming increasingly ample, it’s important to note that these products are unregulated by the FDA. The actual quality and amount of CBD in a given product may be different than what is being claimed on packaging. However, some sellers may provide a product analysis and details on their methods of production to help consumers make the right selection.
Here, we break down the differences in potential benefits, uses, and other characteristics between CBD and THC.
Potential beneficial effects
The potential benefits of both CBD and THC may differ in intensity based on the specific amount and concentration of the actual product. Both these cannabinoids may be used in different forms such as oils, capsules, topicals, inhalants, or solutions, and this also leads to varying beneficial effects.
It has been shown that CBD may have the following beneficial effects:
- Analgesia and pain control
- Decreasing number of seizures in epileptic patients
- Management of psychosis and mood disorders
- Muscle relaxant
- Recovery of nervous system damage
THC may provide the following benefits:
- Analgesia and pain control
- Preventing nausea and vomiting
- Appetite stimulation
- Muscle relaxant
Potential negative effects
Again, negative effects of both CBD and THC are dependent on the specific product and formulation that is being used.
CBD’s potential negative effects:
- Decreased appetite and weight loss
- Dizziness, drowsiness, and fatigue
- Liver injury
Potential negative effects of THC:
- Increased nausea and vomiting
- Psychoactive effects such as feeling drunk, impaired cognition, dizziness, disorientation, and paranoia
What’s the current evidence for the use of CBD and THC as therapeutic compounds?
There is evidence for the use of CBD in decreasing the number of seizures in patients with Dravet and Lennox-Gastaut syndromes, two types of severe epilepsy. There is also evidence that shows CBD may reduce psychotic episodes in Parkinson’s disease patients. In anxiety associated with public speaking, there is limited evidence showing that CBD helps in this regard.
As for THC, evidence supports the use of this cannabinoid for chronic pain, especially pain associated with cancer, multiple sclerosis, rheumatoid arthritis, and neuropathic pain. As mentioned above, THC may also help with nausea and vomiting, specifically the type that is associated with chemotherapy side effects. Patients with HIV/AIDS who experience appetite loss may find improvement with THC. Finally, there is limited evidence that THC may help with dementia and PTSD.
Some patients may even use a combination of CBD and THC, technically referred to as nabiximol, for pain or spasticity from multiple sclerosis. Nabiximols may also help patients suffering from obstructive sleep apnea, fibromyalgia, and chronic pain.
Are there any drug or food interactions with cannabinoids?
Both CBD and THC are metabolized by liver enzymes that are commonly found in many medications used to treat major diseases such as heart disease and epilepsy as well as some antibiotics. Care must be taken when complementing current medication regimens with CBD or THC, making sure the cannabinoids do not increase or decrease certain drug levels to a harmful degree. There has been some evidence that high-calorie and high-fat foods may increase the absorption of CBD leading to increased effects of this cannabinoid. The same can be said of using THC with alcohol.
What about dependence on these substances and their impact on urine drug screens?
As mentioned earlier, CBD does not lead to a high, whereas THC does. Because of this, THC can lead to both physical and psychological dependence and associated withdrawal symptoms. On the contrary, pure CBD has a low probability of leading to dependence. Again, since these products are unregulated, consumers must be careful of the quality when purchasing CBD products.
As for urine drug screens, many tests screen for only THC and its metabolites. Positive results may show after about a week to ten days of use and up to six weeks of heavy use. Most CBD products and hemp oil do not contain detectable amounts of THC.
The use of cannabidiol shows positive evidence for controlling epilepsy, mood disorders, and pain without giving the “high” that comes with THC. It’s important to be aware of the quality of CBD products, interactions CBD may have with other medications, and potential negative effects when selecting a product. It is exciting to see the development of the CBD industry as ongoing research drives the future of CBD as a potential and effective therapeutic product.