Tag: Health

Is THCV Psychoactive?

It’s “the sports car of cannabinoids,” according to one California cannabis testing lab. That’s certainly a sexier way of referring to the THCV molecule than by its full name, tetrahydrocannabivarin. But the zippy tagline might be misleading. While some claim the little-known cannabinoid packs a punch—“a powerful high without the munchies,” one website promises—the science tells a different, much more complicated story.

THC is, of course, famous for its psychoactive properties. CBD, by contrast, is known for having next to none. As science dives deeper into the physiological effects of lesser-known compounds in cannabis, there’s always that voice calling from the sideline: “Yeah, but does it get you high?”

When it comes to THCV, the answer is… probably. We’re not 100% sure yet.

This is science, after all. It’s complicated.

RELATED STORY

What is THC (Tetrahydrocannabinol)?

Researchers haven’t been talking about THCV for long. In the 1960s, scientists were isolating and identifying all sorts of new cannabinoids: CBD, CBG, CBC, CBDV, and—in a seminal 1970 paper—THCV. The vast majority of study, understandably, focused on that intriguingly psychoactive molecule, THC.

Figure 1: (Amy Phung/Leafly)Figure 1: Enzymes in the cannabis plant convert cannabinoid precursors CBGA and CBGVA into a variety of cannabinoids. (Amy Phung/Leafly)

Like you might guess from those letters, THCV is a not-too-distant cousin of THC. A side-by-side diagram makes clear THCV is basically the THC molecule with the end snipped off, just a few carbon atoms shy of what emerged as the family favorite. Science calls this an analogue—it’s similar, but different in an important way.

THCV-vs-THC 3Figure 2: Molecularly speaking, the THC and THCV differ only by a few carbon atoms. (Amy Phung/Leafly)

THC is what’s called a CB1 receptor agonist—it activates CB1 receptors in the brain, and that activation is what allows for psychoactive effects.

Early studies suggested THCV was about a quarter as potent as THC in this regard—meaning it did seem to exhibit psychoactive effects. But later research suggested something interesting: The behavior of the molecule seems to change depending on the dose.

RELATED STORY

CBD vs. THC: Why Is CBD Not Psychoactive?

At lower doses, THCV acted as a CB1 antagonist—in very, very simple terms: does not get you high. At higher doses, however, it can switch, behaving as a CB1 agonist, much like THC. In other words, take a lot of THCV, and zoom—it’ll tickle that CB1 receptor and produce a psychoactive buzz.

(For a quick catch-up on how these receptors work, see Bruce Barcott’s explanation of why THC is psychoactive and CBD isn’t.)

The buzz associated with THCV, from what little science has studied it, appears to be clear-headed and stimulating. It’s said to intensify the euphoria of THC—although it doesn’t last as long. A THCV-induced high seems to set in quickly yet fade faster, demonstrating about half the duration of THC.

THCV seems to act a bit like CBD in that it modulates and dampens some traditional effects of THC.

There are good reasons beyond the buzz to study THCV. If you’ve read about the cannabinoid before, for example, you’ve probably read of lab tests that show the cannabinoid can suppress food consumption and even encourage weight loss. (Queue a parade of articles on “skinny pot.”)

Keep in mind, first, that THCV is a minor cannabinoid, found at trace levels in most strains. It’s found at slightly higher concentrations in certain strains of African descent, and in some cases plants “highly predominant in this agent have been produced,” leading cannabinoid researcher Dr. Ethan Russo wrote in 2011.

Most consumers will probably (for now) only encounter THCV in small amounts, for example in African landrace strains like Durban Poison. Even if you’re able to track down a higher-THCV strain, such as Doug’s Varin or Pineapple Purps, you’ll be consuming THCV alongside other cannabinoids—most notably THC.

RELATED STORY

CBD and the Brain: What Does It Do and What Is It Good For?

THCV seems to act a bit like CBD in that it modulates and dampens some traditional effects of THC, which normally bind easily to CB1 receptors in the brain. Take THCV’s effect’s on the munchies: In mice, the ingestion of THCV has led to decreases in both food consumption and body weight. (Decreased food consumption is a general effect of compounds that block CB1 receptors.)

The effect doesn’t seem to turn off hunger completely. Mice deprived of food—the ones that were truly hungry, in the nutritional sense of the word—ate roughly the same amount whether they’d received THCV or not. Nor did it decrease food intake or body weight of obese mice, though THCV did seem to improve insulin resistance in those animals. That’s likely one reason scientists have begun looking into the possible effects of THCV on diabetes.

Dosing may also play a role here. If THCV is blocking CB1 receptors at lower doses and reducing food intake, we might expect higher doses to activate those receptors and instead increase food intake. But that’s just speculation—such an experiment hasn’t been tried yet.

RELATED STORY

What Is THCV and What Are the Benefits of This Cannabinoid?

There are also indications THCV could reduce anxiety attacks in PTSD patients, improve tremors and motor control problems associated with Alzheimer’s disease, and stimulate the growth of bone cells. Research suggests it may also have anti-inflammatory effects.

For now, we still don’t know a ton about THCV. In cosmic terms, it’s a tiny satellite in a system that science has only recently pulled into view. We’ve long been dazzled by the sparkle of THC. We’re starting to understand the sway of CBD. But as we pull them into focus, THCV and other less obvious cannabinoids are proving to be captivating worlds of their own. What a universe a single plant can unlock.

References:
Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-64. PDF
Mcpartland JM, Duncan M, Di marzo V, Pertwee RG. Are cannabidiol and Δ(9) -tetrahydrocannabivarin negative modulators of the endocannabinoid system? A systematic review. Br J Pharmacol. 2015;172(3):737-53. PDF
Gill EW, Paton WD, Pertwee RG. Preliminary experiments on the chemistry and pharmacology of cannabis. Nature. 1970;228:134–136. PDF

Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

How Does Cannabis Interact With Other Drugs?

Virtually all chemical compounds, from over-the-counter drugs and prescription pharmaceuticals to illicit substances, interact with other compounds. There are, for example, 82 identified drug interactions with caffeine (of which 25 are classified as moderately severe to severe). Even seemingly benign substances, like grapefruit, are known to interact with many prescription drugs. When it comes to cannabis, most potential interactions that have been identified are relatively mild. And, in fact, some drugs seem to work together with cannabis favorably.

RELATED STORY

Does Cannabis Interact with Antidepressants?

But, before we dive deep on some of the most common drugs people combine with cannabis, it’s important to understand the difference between an “additive” and “synergistic” effect. Additive simply means the interaction between two chemicals equals the sum of their parts (e.g. 1+1 = 2). Synergistic means that when two chemicals interact, the effect is greater than the sum of their parts (e.g. 1+1 = 3. Sounds like “alternative math!”). Likewise, keep in mind that THC/CBD ratios and different strain profiles (with variable cannabinoid and terpene profiles) can influence effects.

Note: in some cases, cannabis may actually increase the effectiveness or potency of other drugs. But, even if the interaction is potentially beneficial, close monitoring by a medical professional, along with regular blood work, is important as a patient may need adjust their dosing accordingly.

Drugs That Affect Blood Sugar Levels

close up of hands making injection by insulin pen

Interestingly, there is evidence to suggest cannabis may decrease insulin resistance, improve the metabolic process, and improve blood sugar control. However, most evidence comes from large epidemiological studies that analyze general patterns, including the causes and effects of various health conditions within specific populations. (Several studies found that cannabis users had lower rates of obesity and diabetes when compared to non-users.) However, far fewer studies look specifically at how THC, CBD, or other cannabinoids interact with other drugs that have known effects on blood sugar (like insulin).

Although we don’t have conclusive evidence, it’s possible cannabis may work together with other drugs favorably. But, by the same token, there could be a risk that cannabis combined with other drugs could lower glucose levels too much. Clearly, patients should continually monitor the effects (under medical supervision) to mitigate potential risks and adjust medication appropriately.

Drugs That Lower Blood Pressure

Measuring blood pressure

One of the major features of THC is that it simultaneously activates the CB1 and CB2 cannabinoid receptors. Activating both receptors induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries. While reports of adverse events are relatively rare, patients who are taking blood pressure medication should be aware that cannabis may compound effects.

RELATED STORY

Cannabis and Its Impact on High Blood Pressure

Drugs That Increase Risk of Bleeding

Medication - Over the Counter, otc

Both THC and CBD may increase the effect of drugs used for blood thinning (e.g. warfarin or heparin), or drugs known to carry their own risk of blood thinning (e.g. ibuprofen, naproxen, etc.). How? By possibly slowing down the metabolism of these drugs. To a lesser extent, THC may displace warfarin from protein binding sites.

Opioids

Several Prescription Pill Bottles in a Pile

Most studies suggest there is a bidirectional modulatory relationship between the body’s natural opioid system and the body’s natural cannabinoid system (the endocannabinoid system). However, characterizing the specific mechanisms by which they interact proves challenging. Nonetheless, the pain-relieving properties of cannabis are well-established. And, many medical professionals have come forward to suggest cannabis (as an alternative pain medication) could play a role in stemming the overuse of prescription (and illicit) opioids.

RELATED STORY

How Cannabis Could Turn the Opioid Epidemic Around

There’s no question. From an abuse potential and toxicity perspective, cannabis as a substitute to narcotic pain medications would be a far better first-line drug for management of chronic pain.

However, what about as an adjunct to opioid therapy? How does cannabis measure up? Could cannabis reduce a patient’s reliance on opioids, or would combining the two elevate risk of concurrent dependency or abuse?

Examining the subjective effects of vaporized cannabis in conjunction with opioids, Dr. Donald Abrams, an oncologist from UC, San Francisco, and his team published a small study in 2011. They found no significant change in opioid blood level concentrations after exposure to cannabis. Moreover, patients reported a 27% decrease in pain following cannabis administration.

Abrams concluded that cannabis can, in fact, safely augment the pain-relieving effects of opioids. His team also found that combining opioids and cannabis may allow for treating patients with lower opioid doses while reducing risk of dependency and fewer side effects. Several other studies, which we’ll explore further in an upcoming series, support the findings from Abrams’ study.

RELATED STORY

What Are the Best Cannabis Strains for Pain?

Alcohol

Red wine

Mixing alcohol with virtually any drug is generally not a good idea. In fact, mixing it with some drugs (particularly opioids and central nervous system depressants like benzodiazepines, barbiturates, and sleep meds) can prove fatal. But, what about alcohol and cannabis? There’s no doubt: cannabis and alcohol is a popular combination. But what does the research say? Is mixing these two substances okay?

Overall, drawing a conclusion based on available research is subject to interpretation and personal biases. The same studies can be interpreted positively or negatively, depending on your perspective. On the one hand, studies have provided compelling evidence that alcohol increases blood THC levels (although no evidence suggests the converse–that THC increases blood alcohol levels). On the other hand, some research suggests people consume less alcohol when they use cannabis.

RELATED STORY

How Cannabis Can Help You Cut Back on Alcohol and Live Healthier

These two findings aren’t mutually exclusive. In fact, they make sense. If THC reacts to alcohol by potentiating the desired effects on mood, then one would need less alcohol.

After digging back to 1985, I did find one study published by the National Institute on Drug Abuse (NIDA), Alcohol and Marijuana: Concordance of Use by Men and Women, that examined consumption pattern differences in three different environments (only alcohol is available, only cannabis is available, both are available).

Here’s what they found:

  • 14 out 16 subjects drank significantly less alcohol when both alcohol and cannabis were available (compared to when only alcohol was available)
  • 12 of the 16 subjects consumed slightly more cannabis when both were available (compared to when only cannabis was available)

Basically, when people have access to both substances, their consumption patterns change: they smoke a little bit more, but they drink a lot less! It was a small study, so we can’t necessarily generalize the findings; however, they do seem consistent with most people’s experiences.

RELATED STORY

How Does Alcohol Affect THC Blood Concentration?

That being said, one still needs to be cautious. For one, alcohol and cannabis together pose even greater dangers driving than when using either one independently. Second, if someone has had too much to drink–to the point they need to vomit to expel the toxins–know that cannabis inhibits nausea and vomiting. By preventing yourself from vomiting, you’re putting yourself at greater risk of suffering from alcohol toxicity.

Sedatives

Pills

Many sedatives–such as alcohol, benzodiazepines (Ativan, Valium, etc.), some antidepressants, barbiturates such as phenobarbital, and narcotics such as codeine–influence GABA neurotransmitters in the central nervous system, producing a calming effect. Likewise, cannabinoids like CBD and THC as well as terpenes like myrcene and linalool, can produce sedative effects. (Although, each of these compounds produce effects differently, and sometimes paradoxically. For example, higher doses of THC can actually be stimulating and increase anxiety, while CBD can be both calming or wake-inducing.)

RELATED STORY

Cannabis and Sleep: 10 Things to Know About Your Herbal Nightcap

When combined with sedatives, cannabis produces an additive effect. Cannabis doesn’t seem to elevate blood levels or potentiate the sedative actions of other sedatives (as would be the case if it were synergistic effect). Therefore, while it’s not as risky as mixing alcohol with sedatives (which can prove deadly), the combination is still risky. Users should exercise extreme caution, or better yet, avoid the combination altogether.

CBD and Cytochrome P450

Neuron cell network

Cytochrome P450 isn’t a drug. It’s a class of essential enzymes known to play a significant role in drug interactions–not just with cannabis, but many drugs. Although evidence suggests CBD is largely safe, well-tolerated, and non-addictive (even anti-addictive), in some patients it can interact synergistically (beneficially or adversely) with other medications. How so?

Most notably, the interplay between CBD and cytochrome P450 seems be most prominent when it comes to epilepsy and anti-seizure medications. One small study published in 2015 found that CBD elevated blood concentrations of clobazam (an anticonvulsant) in children while elevating norclobazam (an active metabolite of clobazam).

The good news is the remedy seems fairly straightforward: reduce the dose of clobazam, which reduces side effects. Moreover, the study found that all but four of the subjects (out of 13) had a 50%+ reduction in seizures. The researchers concluded CBD (in combination with clobazam) is a “safe and effective treatment of refractory epilepsy.”

RELATED STORY

CBD and the Brain: What Does It Do and What Is It Good For?

There are a few other potential interactions that we’ll go into more depth in an upcoming series. But in short, CBD inhibits breakdown of warfarin (a blood thinner), thereby increasing its duration of action and effect. Patients taking CBD-rich products should pay close attention to changes in blood levels and adjust dosage accordingly as instructed by their doctor. Also, patients who are undergoing chemotherapy and taking CBD should be aware that the same dose of chemotherapy may produce higher blood concentrations.

In Summary

For most patients, cannabis is relatively safe, well-tolerated, and carries fewer risks of adverse drug interactions than many other commonly prescribed drugs. Nonetheless, cannabis is not a single drug; it’s a complex plant comprised of numerous compounds from cannabinoids to terpenes. Influenced by these cannabinoid and terpene profiles, potential interactions, both good and bad, can vary from strain to strain. Drawing broad conclusions on how this “pharmacological treasure chest” interacts with other drugs is inevitably imprecise.

Nonetheless, given its therapeutic versatility, one of the most compelling arguments for cannabis is that it can actually reduce the need to combine multiple medications that have a high risk potential of producing adverse interactions. Dr. Donald Abrams, chief of hematology-oncology at San Francisco General Hospital and a professor of clinical medicine at the University of California, San Francisco, echoes this important but often overlooked point: “Why would I write six different prescriptions, all of which may interact with each other, when I could just recommend one medicine?”


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Does Cannabis Use Lower Your IQ?

The manner in which cannabis affects IQ has long been a hotly debated topic. Policymakers, parents, researchers, and, of course, the media, passionately (and empathically) weigh in on the debate. The debate often plays out in the press.

How many times have you seen headlines like this?

Fox News writes: Pot Does Lower IQ, Study Finds

On, the other side of the spectrum, the Washington Post opines: No, Marijuana Use Doesn’t Lower Your IQ

So, who’s right?

“Yes, Cannabis Lowers IQ.”

library

Most of the reports that cannabis lowers IQ rely on one study: the seminal Dunedin Study led by Madeline Meier. In all fairness, it’s one of the best studies we have to date. Most research of this kind is retrospective (or captures a small period of time); the Dunedin Study, on the other hand, is a prospective cohort study.

In retrospective studies, individual outcomes of the participants are known from the outset, and the investigators look back in time to determine how various factors influenced the outcome. Prospective studies, on the other hand, don’t know the individual outcomes from the outset; they follow a group of people over time, identifying predicted outcomes and determining how various factors influence the outcomes.

RELATED STORY

How Does Cannabis Consumption Affect the Brain?

In the Dunedin Study, researchers followed 1,037 people born between 1972 and 1973 in Dunedin, New Zealand, from birth to age 38. In fact, their study pool represented 91% of all eligible births. The study—like all studies—had limitations. But, unlike far too many studies, the authors were candid in what their limitations were, and tried to minimize their influence by excluding many of the most common confounding factors that could provide alternative explanations for an IQ decline, including:

  • Acute or residual cannabis intoxication
  • Tobacco dependence
  • Hard-drug dependence (e.g., heroin, cocaine, amphetamines)
  • Alcohol dependence
  • Schizophrenia

There are other potentially unaccounted factors that could influence outcomes. For example, could it be people with unknown (or undefined) shared characteristics are more likely to misuse cannabis at a young age, and these shared characteristics are associated with a decline in IQ? We know nutrition, industrial toxins, stress, and exposure to trauma are a just few factors that can influence IQ (and possibly the risk of addiction).

RELATED STORY

Cannabis and Post-Traumatic Stress Disorder (PTSD)

However, it’s impractical to control for every possible confounding factor. What we expect is that the authors are forthcoming in their study’s limitations, and that they make their best effort to control what they can. The Dunedin team clearly did that. It was well designed, and the authors were nuanced in their conclusions.

The authors examined six hypotheses:

  • Cognitive decline: Persistent cannabis consumers demonstrate greater decline in test performance from childhood to adulthood than nonusers.
  • Specificity: Are impairments confined to specific neuropsychological domains or are they present across each of the five specific domains? The authors hypothesized that impairments aren’t limited to specific cognitive domains.
  • Education: Some evidence suggests staying in school can boost one’s intelligence. Could persistent cannabis consumers experience neuropsychological decline simply because they abandoned academics in favor of other opportunities?
  • Everyday Cognition: Does cannabis-induced neuropsychological impairment translate into functional problems in daily life? The authors posit that it would.
  • Developmental Vulnerability: Cannabis has heightened toxic effects on the developing brain, thus adolescents are particularly vulnerable to the effects of persistent cannabis use.
  • Recovery Hypothesis: Former persistent users who quit or reduce their cannabis use may be able to restore their neuropsychological health.

What were their conclusions?

  • Early initiation to cannabis correlates to a decline in IQ as adults, with more persistent use associated with a greater decline in IQ.
  • Predictably to some, surprisingly to others, they found no decline in IQ among individuals who waited until they were adults before using cannabis. This finding was consistent not only among casual users, but also among those with a use disorder.

RELATED STORY

Here’s Why Cannabis Legalization Doesn’t Lead to Higher Teen Use Rates

How did abstainers compare to users?

This is where it gets interesting.

Abstainers: Of the 1,037 study participants, 242 reported never having used cannabis. Those participants experienced a modest uptick in their IQ—from 99.84 to 100.64.

Casual Users: 479 participants reported prior cannabis use, but were never diagnosed with a use disorder. This group experienced a modest decline in IQ—from 102.32 to 101.25. Roughly one point.

Problematic Users: Among the 38 participants who met the criteria for cannabis use disorder at three out of five follow-up assessments (ages 18, 21, 26, 32, and 38), the IQ decline was far more profound. They experienced a decline nearly six points—from 99.68 to 93.93.

RELATED STORY

Is Cannabis Addictive?

What was particularly interesting is the IQ difference between those reporting being lifelong abstainers versus those who reported prior cannabis (but had never met the criteria for a use disorder). The average IQ for the latter was nearly 2.5 points higher than the abstinent group prior to induction into cannabis. At age 38, due to modest upticks in the “never used” group and the modest decline in the “used, never diagnosed” group, the IQ gap narrowed. But the “used, never diagnosed” group managed to maintain a 0.61 point IQ advantage. Perhaps that finding warrants a headline: “Study: Cannabis Abstainers Are Less Intelligent Than Casual Users.”

“No, Cannabis Doesn’t Lower IQ.”

Development Team Cooperating In Their Office.

Contrary to many assertions, the Dunedin Study was well designed and the authors attempted to control many of the most common confounding factors that could have tainted the results. Interestingly, many of those who initially criticized this study as biased later praised the authors’ follow-up study (analyzing the same populations) that found the only negative physical health effect associated with long-term cannabis use was an increased risk of gum disease.

Nonetheless, several notable critiques emerged:

Declines could be explained by socioeconomic factors. Norwegian research economist Ole Røgeberg suggested socioeconomic factors could account for the decline. The basis of his argument is that cannabis use is more common among those of lower socioeconomic status, and that education temporarily boosts the IQ of these children, creating a false impression that IQ declines later in life. However, even applying these potential factors, Meier’s findings (which are consistent with other studies) have found that socioeconomic background is a poor predictor of cannabis use. Cannabis is popular across all backgrounds. Likewise, Meier didn’t find any differences in adolescent IQ versus adult IQ among those who came from lower socioeconomic backgrounds.

Personality traits explain the decline. British behavioral scientist Dr. Michael Daly suggested personality traits could explain positive non-causal associations between cannabis use and cognitive functioning. High levels of openness to experience could lead people to seek out activities—including cannabis experimentation—that promote cognitive functioning. Daly analyzed data from 6,401 individuals who participated in the British study. His post hoc analysis found openness positively predicted cannabis use and an increase in neuropsychological functioning.

RELATED STORY

Female Interest in Cannabis is Growing, But by How Much?

Likewise, he challenged Meier’s findings, suggesting conscientiousness (one of the five defined personality traits) may explain the cannabis decline. However, Daly didn’t assess personality—his primary predictor—until well after cannabis initiation, at age 50. Early initiation to cannabis was a central feature of Meier’s study. Moreover, Meier applied the hypothesis to her data, and found that it didn’t alter the outcomes to a statistical significance.

Sample size is too small. Others have also weighed in. Columbia University’s Dr. Carl Hart noted that Meier’s study had a very small sample of heavy users—only 38 people. The small sample size, he claims, limits how generalizable the results could be. He’s right: 38 people is a small sample size. But it should be noted that Meier’s study included three other subsets of early onset users, all of which experienced declines proportional to how persistent their use was. However, there are still likely limits to how generalizable the studies are. Why, for example, do those with one use disorder diagnosis start with the lowest IQ (lower than even those diagnosed three times), while those diagnosed twice have the second highest starting IQ (102.14)—second only to the “tried, never diagnosed” group—of all groups?

Twin Studies on Cannabis and IQ

Marijuana bud close up

As I mentioned previously, it’s virtually impossible to eliminate every potential confounding variable. However, one way to eliminate most of them is by conducting a study on twins. And, at least one such study did just that. A multi-institutional study, “Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies,” compared IQ changes in twin siblings who either used or abstained from cannabis during a 10 year period. After accounting for potentially confounding familial factors, the scientists found no link between cannabis use and a decline in IQ. In twin sets where one twin used cannabis and the other didn’t, they found comparable declines in IQ, potentially validating their hypothesis—there were other familial confounds (such as genetics or home environment) that could account for a decline in IQ scores.

RELATED STORY

CBD and the Brain: What Does It Do and What Is It Good For?

This particular study provided the most convincing evidence to counter the Dunedin Study. However, it’s not without notable limitations. For one, the study contained little detail on frequency of use. Moreover, the study looked at two populations (Minnesota and Los Angeles), but used different surveys for each. The survey for Los Angeles posed questions with far less specificity than Minnesota. For example, if a youngster pulled a Bill Clinton and tried it but “didn’t inhale,” he or she would still be categorized as a “user.”

The Final Verdict

Life in Amsterdam

For adults, cannabis use doesn’t seem to impact IQ. However, chronic use is associated with adverse cognitive effects that seem to be reversible. For teens, the jury may be still out on how much of an impact cannabis use has. But we do know that the brain is particularly vulnerable while it still developing.

I suspect there’s truth to both sides of the debate. One, that early (and frequent) cannabis use can have persistent (and possibly irreversible) consequences. Two, it’s also likely that cannabis use is not the only factor contributing to a decline in IQ. If a kid is engaging in frequent cannabis use, chances are there are other things going on at home or in their life that may influence their addiction risk and potentially affect their IQ. However, in reviewing most of the research out there, Meier’s study thus far puts forth the most persuasive evidence that early onset cannabis use likely has a negative impact on IQ.

RELATED STORY

CDC Says Teen Cannabis Use Dropping as More States Legalize

The effect of cannabis exclusive of other factors may not be as profound as presented in the Dunedin Study. But the findings shouldn’t be discounted. How much does it really matter if cannabis causes a two point or six point decline? Both suggest adverse outcomes. Perception of risk—not the legality or illegality of cannabis—influences a teen’s decision to use or not. And, as the stigma around cannabis diminishes, it’s important that teens understand cannabis is not completely harmless. And that the use of it, particularly frequent use, carries risks.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Maximizing CBD’s Effects and Benefits: 5 Experts Weigh In

This article is sponsored by Firefly, a San Francisco-based technology company that specializes in the research, design, and manufacturing of vaporizer hardware.


Is CBD the magic cannabis molecule, or a misleading fad? There’s certainly a major trend toward CBD-only products on the cannabis market, and a push in some states leery of medical marijuana to legalize only one or two cannabinoids. Yet many are fighting back against this approach.  That’s because there’s an interactive synergy between cannabis compounds, known as the entourage effect, and many benefits attributed broadly to cannabis can only be unlocked through “whole plant medicine” – that is, with THC, CBD, terpenes, and other cannabinoids working together in sync.

RELATED STORY

5 Experts Weigh in on Cannabis Concentrates and How to Use Them

Whole plant medicine has been widely debated as many states consider limited legalization of cannabinoids like CBD, and the idea that the entourage effect is integral to using cannabis as medicine is increasingly accepted. In fact, some products are being designed specifically to maximize the value of whole plant medicine for the consumer. Take Firefly’s vaporizer technology, which sets out to capture all the myriad benefits of the entourage effect through dynamic convection technology. “[Firefly 2 was] truly designed around the plant…in order to deliver all the cannabinoids and terpenes in the most efficient way,” says Rachel Dugas of Firefly. Yet given the complexities of these chemical interactions, it’s still hard to pin down how exactly this maximizes the benefits of cannabis.

What the Experts Say About CBD’s Effects and Benefits

Neuron cell network

To shed some light on the subject, we assembled a panel of five experts in different areas of the cannabis space to weigh in:

Here’s what they had to say.

What effects does CBD have on its own?

Mary Lynn Mathre: “Many – anxiolytic, anti-inflammatory, anti-seizure, neuroprotective, bone stimulant, anti-spasmodic, and more.”

Jessica Peters: “Anti-inflammatory, anti-spasmodic, anti-proliferative, analgesic, anxiolytic (anti-anxiety), neuroprotective, anti-psychotic, anti-emetic (anti-nausea) … I can technically answer what are the properties of CBD, but these properties might not pop out if THC is not present. A potential new research category that I’ve seen evidence of anecdotally are addiction-fighting properties … CBD seems to reroute those neural pathways.”

Constance Finley: “Studies have shown CBD to have a positive effect on inflammation, pain, anxiety, psychosis and spasms, but it should be noted that most of these applications are not treated with just CBD alone and in fact do require some level of THC, whose role as a phytotherapeutic compound has already been established vis-à-vis many of the same conditions. CBD acts on different receptors than THC in the body.”

Perry Solomon: “It’s been found that CBD alone can cause a feeling of calm, relaxation. CBD’s other medicinal effects stem from completely separate pathways, such as the cannabinoid receptor 2 (CB2), mu and delta opioid receptors. Taken on its own, CBD has sedative, antioxidant, anti-anxiety, and antidepressant effects on the brain, but does not create any overtly psychoactive high like THC. It’s also been shown to have change gene expression and remove beta amyloid plaque, the hallmark of Alzheimer’s, from brain cells.”

RELATED STORY

Product Review: The Firefly 2 Portable Vaporizer

How are these effects augmented or altered by other compounds?

Peters: “Pretty significantly. CBD being cannabis-based is what’s most crucial for these properties to exist. The range of the volume of THC in relation to CBD will feature different properties. An equal amount of THC to CBD [for example] is often the best pain reliever. Many terpenes have relationships [and] the fact that those relationships exist is becoming clearer and clearer.”

Eloise Theisen: “CBD and THC seem to work better together. They lessen each other’s side effects.”

Solomon: “THC seems to potentiate all the effects of CBD and conversely, CBD affects THC. Dr. Ethan Russo further supports this theory by demonstrating that non-cannabinoid plant components such as terpenes serve as inhibitors to THC’s intoxicating effects, thereby increasing THC’s therapeutic index. This ‘phytocannabinoid-terpenoid synergy,’ as Russo calls it, increases the potential of cannabis-based medicinal extracts to treat pain, inflammation, fungal and bacterial infections, depression, anxiety, addiction, epilepsy, and even cancer … Terpenes act on receptors and neurotransmitters; they are prone to combine with or dissolve in lipids or fats; they act as serotonin uptake inhibitors (similar to antidepressants like Prozac); they enhance norepinephrine activity (similar to tricyclic antidepressants like Elavil); they increase dopamine activity; and they augment GABA (the “downer” neurotransmitter that counters glutamate, the “upper”). However, more specific research is needed.”

Mathre: “CBD has value, but its value can be enhanced with the whole plant and we can develop more individualized medicine (specific ratios depending upon the person and the need).”

RELATED STORY

Cannabis’s Entourage Effect: Why Whole Plant Medicine Matters

How much more effective would you say whole-plant medicine is than CBD-only?

Peters: “Radically. Not even close. It’s as though you’re working with different substances.”

Solomon: “I think that any whole plant medicine is more effective then any CBD-only product.”

Theisen: “Whole plant medicine is the only way to go.”

Mathre: “Safer and more effective, and tolerance will develop more slowly (if at all).”

Finley: “In almost all cases…I would say whole-plant therapeutics are 100% more effective than CBD-only.”

Thoughts on those who exclude THC or other cannabis components from the realm of medicinal cannabis?

Finley: “I believe everyone should have access to all types of treatment options that could potentially benefit them, and people need to be aware that not all cannabis is created equal. CBD from hemp does not have the medicinal properties that CBD from cannabis possesses, and is frankly an inferior product.”

Mathre: “We have lawyers and politicians practicing medicine without a license – they don’t know what they are talking about. Clearly there may be some patients who need little to no THC, but the vast majority will benefit from it. Patients should have all of the options open to them and research needs to continue to help determine how to best individualize cannabis medicine.”

Peters: “It’s so extraordinarily problematic that it feels criminal to me… The wall of bureaucracy is pushing up against the wall of science.”

RELATED STORY

Firefly 2: The Dynamic Convection Vaporizer Pushing the Industry Forward

What is the best way to consume cannabis to access its complete entourage of effects?

Finley: “Delivery methods vary greatly in terms of their efficiency and their effects. I heard a colleague say that smoking a joint for therapeutic effect is akin to opening your mouth in the rain to get a drink of water … Our preferred methods [are] buccal ingestion or sublingual ingestion, vaping from a vaporizer or vape pen whose hardware is safe to use with cannabis extracts, and topical for additional localized impact.”

Peters: “Certainly vaporizing flowers is one of the easiest options. I would [also] say tinctures … especially full plant and alcohol-extracted (with organic ethanol).”

Theisen: “Vaporization or tinctures of whole plants. Any sort of extraction method that isn’t going to deplete it.”

How Vaporizer Technology Can Maximize the Entourage Effect

firefly30 copy-web

In the vaporizer world, dynamic convection is the process by which vapes can capture a complete range of active ingredients and flavors in cannabis flowers and full-plant concentrates. This maximizes efficiency and optimizes the benefits of the entourage effect for the consumer. As vaporizer technology continues to advance in this direction, it will become easier and easier for patients to explore the benefits of whole plant medicine for themselves, and hone in on the cannabis strains best suited to their needs.

To learn more about dynamic convection technology in the Firefly 2, please visit the sponsor’s website.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Cannabis Drug Could Extend Lives of Brain Cancer Patients, Study Finds

UK drugmaker GW Pharmaceuticals announced Tuesday it has achieved positive results in the second phase of a clinical study on Glioma, a cannabinoid-based therapy aimed at treating an aggressive form of brain cancer.

The study looked at 21 patients with recurrent glioblastoma multiform, or GBM, and found that participants who were given the drug—a combination of THC and CBD—lived significantly longer than those who took a placebo.

“These promising results are of particular interest as the pharmacology of the THC:CBD product appears to be distinct from existing oncology medications and may offer a unique and possibly synergistic option for future glioma treatment,” the study’s principal investigator Susan Short, an oncology professor at the Leeds Institute of Cancer and Pathology at St. James University Hospital, said in a statement.

Study participants who received Glioma showed an 83 percent one-year survival rate, GW reported, compared to a 52 percent rate among those who took a placebo. The median survival rate was 550 days among those who took the drug and 369 days among those who did not.

While the company says the treatment was “generally well tolerated”  by patients, there were some observed side effects.  Most common were vomiting, dizziness, nausea, headache, and constipation.

GBM, one of the most common types of brain tumor, is an aggressive cancer that arises in the brain or spinal cord. It carries a poor prognosis, with only 28.4 percent of patients surviving longer than a year after diagnosis. Only 3.4 percent of patients survive to year five.

RELATED STORY

How GW Pharma Could Use U.S. Patents to Shape the Future of Medical Cannabis

CEO Justin Gover said in a statement that the latest results continue to validate the importance of researching cannabis as a treatment for cancer and other diseases.

“These data are a catalyst for the acceleration of GW’s oncology research interests,” he said, “and over the coming months, we expect to consult with external experts and regulatory agencies on a pivotal clinical development program for THC:CBD in GBM and to expand our research interests in other forms of cancer.”

GW Pharma is already known widely for its seizure drug Epidiolex, a cannabis-derived treatment that has shown promising results in reducing symptoms in children with a rare form of epilepsy. Beginning in 2007, the company has conducted research into cannabis as a treatment for various forms of cancer, including brain, lung, breast, pancreatic, melanoma, ovarian, gastric, renal, prostate, and bladder. It has also investigated the possible use of cannabis to treat diseases such as diabetes, schizophrenia, Alzheimer’s and Parkinson’s diseases, and multiple sclerosis.

The company’s research has resulted in a number of registered patents that could become increasingly important as medical cannabis expands both in the United States and globally.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Where Are the Medical Marijuana Doctors in Florida? We Mapped Them.

Medical marijuana in Florida is in a state of flux. The state’s voters overwhelmingly approved–by more than 70 percent–Amendment 2, the medical marijuana measure, in November 2016. But it will be many months before the full system of patient registration, growing licenses, and dispensaries is in place.

Here’s what’s legal as of early 2017.

The Compassionate Medical Cannabis Act of 2014 is still the law of the land. That measure allowed a severely limited number of patients to obtain and use high-CBD, low-THC cannabis. In 2015, Florida added a few conditions (very few–you basically have to be dying in the next 12 months) under which patients can receive higher-THC cannabis. Originally the Department of Health set up a system in which five growers would be licensed to grow, process, and sell to registered Florida patients. But the Department screwed up its judging of the grow-and-dispense license applications, and to fix the error the agency decided to issue two more licenses. So there are now seven licensed medical cannabis companies in Florida.

RELATED STORY

What’s the Deal with Florida’s ‘Dispensaries’?

Amendment 2 became effective on Jan. 3, 2017, but it currently offers vague and limited protections under the law. Right now, there’s no way to legally purchase higher-THC medical cannabis in Florida. Patients aren’t legally “qualified” until they receive a written recommendation from a physician, and possesses a valid patient ID card issued by the state. The state hasn’t started issuing those cards yet, so even if you have a physician’s recommendation, you are still operating in a legal gray area.

What is available right now? MMJ-qualified physicians and seven low-THC dispensary companies.

The Florida Department of Health requires physicians who recommend medical marijuana to complete an eight-hour training course before writing those recommendations. The DoH keeps a weekly-updated list of those physicians here, and we’ve turned that data into a handy map, below. The qualified physicians are the orange, smaller dots, the low-THC dispensaries are noted in teal, at a bigger size.

Click on the links below for more information about the 7 dispensaries listed:
Surterra Wellness
Trulieve – Clearwater
Modern Health Concepts
Knox Medical
CHT Medical
Trulieve – Tallahassee
Trulieve – Tampa 


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Cannabis and Epilepsy Treatment

Since medicinal cannabis has become a more commonplace alternative for a well-established list of ailments, patients are finding a place for it next to their Advil and Tums. But unlike many other chronic illnesses that can be managed with over-the-counter supplements, epilepsy requires a specific cocktail of chemicals not readily available at the local corner store.

This is why cannabis – specifically its chemical constituent CBD (cannabidiol) – has become so important for families struggling to treat their epileptic loved ones. Cannabis has demonstrated so much promise in the treatment of epilepsy that FDA-approved clinical trials are underway. But why is it that cannabis in particular is so effective at treating seizures, and why is it critical that clinical investigations continue?

RELATED STORY

Which Cannabis Strains are High in CBD?

What is Epilepsy and What Causes It?

EEG tests can help learn more about epilepsy causes

Epilepsy is characterized by recurring seizures of variable intensity and effect. These seizures are usually caused by disturbances in specific regions of the brain’s circuitry that create storms of extra electrical activity. Approximately 1 in every 26 Americans will develop epilepsy in their lifetime, and two-thirds of those diagnosed will have no specific origin for the disorder. But perhaps the most harrowing fact is that 34% of childhood deaths are due to epilepsy or accidents that occur during seizures. These figures illustrate the “hiding in plain sight” commonality of epilepsy and the incredible unmet need for the development of novel drugs to treat seizures.

RELATED STORY

CBD and the Brain: What Does It Do and What is It Good For?

While a seizure disorder can be a massive disruption to someone’s way of life and can even be deadly, most patients manage to acquire treatment and medicine while others simply grow out of it – though this is not always the case. Seizures and seizure disorders are as unique as the person afflicted by them, which can make seizures difficult to treat. Recently, epilepsy and cannabis have been highlighted in the news, especially success stories focusing on children with epilepsy who are trying medicinal cannabis. A few notable examples include Charlotte Figi and the high CBD Charlotte’s Web cannabis strain named after her, as well as Renee and Brandon Petro.

These cases and others have shone a spotlight on the medicinal uses of cannabis, regardless of its classification as a Schedule I narcotic (having no medicinal use in the eyes of the Federal government) and the generally accepted legal age of consumption for mind-altering substances (save caffeine and sugar).

The Current State of Cannabis and Epilepsy Research

cannabis and epilepsy clinical trial stages

These inspiring stories help illuminate the efficacy of medical cannabis while defining its range of treatment from the elderly to the young. While the capabilities of CBD and medical cannabis use seems to be self-evident, the DEA has only recently allowed academic institutions to explore the effects, side effects, and usefulness of cannabis as a medicinal plant. This seemingly innocuous change of face is an enormous leap forward for researchers, pharmaceutical companies, breeders, and the cannabis community at large as more scientific capital is put toward understanding this populous plant.

RELATED STORY

CBD vs. THC: Why is CBD Not Psychoactive?

“Based on these preclinical studies, one would be excited about the potential therapeutic potential of the cannabinoids,” wrote Dr. Francis M. Filloux in the journal Translational Pediatrics. “However, it is undeniable that the complex regulation that surrounds these Schedule I substances has impeded scientific investigation of their therapeutic potential.”

There has been no other drug in history that has been as widely consumed and applied for medicinal use without the institutional blessing symbolized by clinical human trials. But patients around the country currently have access to the “generic” versions of life-saving, CBD-rich cannabis products that are thriving beyond the regulatory reach of the FDA. So by conducting clinical trials with pure CBD, as GW Pharmaceuticals is with Epidiolex, concrete, tested scientific evidence can lay the first bricks in the road toward a variety of CBD/THC ratio products as well as synergistic cannabis cocktails targeted at other specific maladies.

RELATED STORY

High CBD Products for Medical Marijuana Patients

Clinical trials become more rigorous and far reaching as they progress through each stage. Currently GW Pharmaceuticals is undergoing Stage 3 clinical trials on Epidiolex, a nearly pure CBD preparation (98%+), to confirm the therapeutic value of this cannabinoid. This is also an astounding leap forward for cannabis and medicine, because, as noted by Dr. Filloux:

“Until the last few years, the published data was minimal and included [fewer] than 70 subjects. Very few of these were children. Furthermore, none of these studies would meet criteria as Class I-III clinical trials (50-53). However, this state of affairs is rapidly changing given the current climate.”

While this scientific success story isn’t a tear-jerker like Brandon’s or Charlotte’s, it does explain a necessary step toward proving the efficacy of cannabis-based therapies and its more egalitarian medicinal prescription.

Why Does Cannabis Work for Epilepsy and Seizures?

medical cannabis for epilepsy and seizures
The endogenous cannabinoid system is ubiquitous in our bodies, and is heavily regulated by cannabinoids found in cannabis.  With such potent biological usefulness throughout the human body, it’s obvious that the more scientific study that goes into the cannabis industry and the plurality of products it has created, the more the consumer will benefit. Time will be a better judge, but the future of medicinal cannabis as a treatment for disorders like epilepsy is here. Catherine Jacobson, Director of Clinical Research at Canadian licensed producer Tilray (note: Tilray is owned by Privateer Holdings, Leafly’s parent company), weighs in on the future of medicinal cannabis and the scientific progress that needs to be made:

“A pure CBD formula was the safest way to begin trials on epilepsy patients because of its lack of psychoactivity. The trouble with developing a single pure CBD formula is that epilepsy has never been a one-size fits all disorder. Of the 200,000 children living with treatment-resistant epilepsy, only a fraction has access to clinical trials investigating CBD. This leaves most parents and patients to acquire their own CBD-rich cannabis, which always contains some percentage of THC. It’s important to learn from these cases to understand which types of epilepsies might respond to a combination product, and to inform future clinical trials. Early results from clinical studies on GW’s Epidiolex clearly show a beneficial effect of CBD on some types of seizures, but more research is needed to fully understand whether a combination THC/CBD product can reduce the seizure burden in those patients who don’t respond to CBD alone.”

RELATED STORY

Here’s Why the DEA Will Never Reschedule Cannabis

This statement aligns well with conclusions drawn by Dr. Edward Maa, Chief of the Comprehensive Epilepsy Program at Denver Health and Hospitals. “It is possible that CBD and [THC] work synergistically to suppress seizures,” Dr. Maa write in Epilepsia. “In fact Ethan Russo, senior medical advisor to GW Pharma, recently reviewed the evidence for the ‘entourage effect’ of the phytocannabinoids and terpenoids, and he makes a strong case for their synergistic effects in a variety of disease states.”

Epilepsy is surprisingly common, exceptionally disruptive, and potentially deadly. But the uncertainty behind the effectiveness of cannabis and CBD in regards to epilepsy treatment is fading. This “controlled substance” is finally receiving its due diligence from the scientific community, and Dr. Jacobson is at the forefront of much of the forthcoming research.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Can Cannabis Chewing Gum Treat Irritable Bowel Syndrome?

A biotech firm has launched clinical trials in the Netherlands to test whether its CBD chewing gum could help treat irritable bowel syndrome.

Researchers will give a group of 40 adult patients CanChew Plus chewing gum, which contains 50 mg of hemp-derived cannabidiol per serving. Subjects will be able to take up to six servings per day under the study, which will record general relief of irritable bowel syndrome (IBS) symptoms—most often stomach cramps, bloating, and lower abdominal pain—along with any “change in stool frequency,” according to a press release.

The mint-flavored chewing gum was developed by Axim Biotechnologies, which has offices in New York and the Netherlands.

“IBS is the most common gastrointestinal disorder and affects up to 15 percent of the worldwide population,” Axim CEO Dr. George E. Anastassov said in a statement, “and It has no sustainable cure.”

RELATED STORY

Here’s What the National Academy’s Medical Cannabis Report Actually Says

The forthcoming IBS trials were developed by Axim and clinical investigators at the Wageningen University, a leading Dutch research institution and where the trials will be held.

“IBS is a very common and often painful disorder which is still difficult to manage,” Renger Witkamp, a nutrition and pharmacology professor at the school, said in a statement that accompanied the announcement. “People often experience sudden flare-ups and for many it has a negative impact on their quality of life. CBD has shown to have promising effects, but there has been a clear need for practical and effective formulations.”

While CBD is currently available in various forms, Witkamp claims that “providing it via a chewing gum results in sustained release of the compound and better bioavailability.”

RELATED STORY

CBD vs. THC: Why is CBD Not Psychoactive?

Axim also makes CanChew, a controlled-release CBD chewing gum, and a combination CBD/THC gum called MedChew Rx, which is currently undergoing clinical trials for the treatment of multiple sclerosis-related pain and spasticity. Standard CanChew gum is already available in all 50 US states, the company says, as it contains only hemp-based CBD.

If the IBS trial is successful, said Axim CEO Anastassov, “we will be ready to proceed immediately with further trials on our pharmaceutical grade CanChew Rx products to treat inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease.”

In a legal disclosure, the company says it “does not sell or distribute any products that are in violation of the United States Controlled Substances Act”—although the DEA might disagree.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Here’s What the National Academy’s Medical Cannabis Report Actually Says

The release of “The Health Effects of Cannabis and Cannabinoids,” a comprehensive report by the National Academy of Sciences, has sparked a flurry of reaction around the nation. Cannabis advocates have focused on the report’s conclusion that cannabis possesses therapeutic value for chronic pain patients, while others emphasized the report’s warnings about car crashes and memory problems. USA Today’s headline captured the report’s overall sense of caution: “Marijuana can help some patients, but doctors say more research needed.”

What is the report, what does it actually say, and why is it important? We’ve got you covered.

What is “The Health Effects of Cannabis and Cannabinoids” Report?

The National Academies of Science, Engineering, and Medicine is a private, nonprofit NGO established more than 150 years ago to advise the nation on scientific matters. It’s considered one of the gold standard institutions of science. In 1999, largely in reaction to California’s legalization of medical cannabis, the Institute of Medicine (the medical research arm of the National Academies) was tasked by the White House Office of National Drug Control Policy (ONDCP) to conduct a systematic review of the scientific evidence pertinent to the health risks and benefits of cannabis and cannabinoids. To the White House’s surprise, the institute came back with a report that cautiously supported the idea that cannabis could have beneficial medicinal effects.

RELATED STORY

CBD vs. THC: Why is CBD Not Psychoactive?

Almost two decades later, the National Academies put together this follow-up report to see what the science of the past 18 years has further revealed about cannabis and medicine.

What Kinds of Cannabis Research Did It Consider?

The committee reached nearly 100 research conclusions based on consideration of more than 10,000 research articles. They gave more weight to articles published since 1999 report. From this information, each specific research conclusion was assigned to one of five “levels of evidence”: conclusive, substantial, moderate, limited, and no/insufficient evidence. Importantly, the committee focused exclusively on the human literature, and did not consider basic research conducted using animal models.

You can read the full report, highlights, and public release slides here.

Female scientist in lab with hand detail

What Medical Applications Are Supported by Conclusive Evidence?

The committee found three medical applications for cannabis use supported by conclusive evidence (as opposed to substantial, moderate, limited, or insufficient evidence):

  • Nausea and vomiting associated with cancer chemotherapy
  • Chronic pain in adults
  • Spasticity in multiple sclerosis

There’s a lot more to dive into (see below), but let’s first consider some important caveats to the study’s conclusions.

RELATED STORY

Is Cannabis Better for Chronic Pain Than Opioids?

Barriers to Cannabis Research

One thing the report emphasizes is how much we don’t know—and why we don’t know it. It provides us with four conclusions about research barriers:

  • Specific regulatory barriers, especially the classification of cannabis as a Schedule I controlled substance, are an impediment to the advancement of research on cannabis and cannabinoids;
  • It is difficult for researchers to obtain access to the types of cannabis products necessary to address questions surrounding the health effects of human cannabis consumption;
  • A diverse network of funders is needed to help support the necessary research efforts;
  • Improvements and standardized set of research methodologies will be needed to develop conclusive evidence for the short- and long-term health effects of cannabis use.

This is a key take away point. If there’s one thing that everyone can agree on when it comes to cannabis, it should be that we need to do the research necessary to inform ourselves about its health effects. But this is very difficult to do in practice because of cannabis’ absurd designation as a Schedule I controlled substance. Because this report identifies multiple medical applications supported by conclusive evidence, it directly contradicts the Schedule I designation the federal government places on cannabis.

RELATED STORY

Here’s Why the DEA Will Never Reschedule Cannabis

Important Caveats

There are three big caveats I think we should keep in mind when reading this report:

Caveat 1: When reviewing human studies, members of the committee looked for statistical associations between cannabis use and health outcomes, but they did not attempt to evaluate whether significant associations were due to cannabis use causing a specific health outcome or whether cannabis use and that outcome were associated for some other reason, such as a common underlying cause. This is a key weakness when we only consider human studies involving a Schedule I substance: the findings are usually correlational and thus prevent us from drawing conclusions about cause-and-effect.

Caveat 2: Many human studies rely on self-reporting of cannabis usage. This is a huge caveat for many human studies, as any conclusions drawn about the effects of light, moderate, or heavy cannabis use rest on the assumption that subjects are accurately reporting their consumption.

RELATED STORY

How Scientists Debunked a Study About Medical Marijuana Laws and Underage Use

Caveat 3: The committee explicitly decided to not consider basic research studies. That helped simplify the gargantuan task of evaluating tens of thousands of research abstracts. There are many thousands of basic research studies out there (both test tube and animal studies), and considering these would have been incredibly time- and labor-intensive. While that basic research isn’t conducted in humans, it does allow us to dig deeper into mechanisms of action and establish cause-and-effect relationships. There’s a lot of interesting and compelling basic research out there that should inform the direction of human clinical research. This represents a huge knowledge gap in the report.

Below, I’ll walk us through the chapter highlights of the 11 chapters of the report. The basic conclusions reached by the committee are listed as bullet points, with my own commentary below them, including what we should take away and any important caveats we should keep in mind. Each heading below corresponds to one chapter of the report focused on a specific health concern.

woman's hands holding leafs of medicine marijuana

Therapeutic Effects of Cannabis

  • Oral cannabinoids are effective at treating chemotherapy-induced nausea and vomiting in adults.
  • Adults with chronic pain are more likely to experience clinically significant levels of pain reduction when treated with cannabis or cannabinoids.
  • Oral cannabinoids provide improvement for adults with MS-related spasticity.

Not much new here. These effects have been widely known for some time. Again, these are the areas supported by evidence deemed “conclusive” by the committee. There are many more things for which “substantial,” “moderate,” or less convincing levels of evidence exists.  For me, the second bullet point is arguably the most important, as it could have huge implications for the country’s ongoing opioid epidemic.

RELATED STORY

How Cannabis Could Turn the Opioid Epidemic Around

Cannabis and Cardiometabolic Risk

  • The evidence is unclear about the association of cannabis use with heart attack, stroke, and diabetes. 

Not a whole lot to add here. To be safe, people with cardiovascular issues should be extremely careful, as THC’s action through CB1 receptors in the brain can cause an acute (temporary) increase in pulse and blood pressure.

Cannabis and Cancer

  • Evidence suggests that smoking cannabis does not increase the risk of lung, head, or neck cancers in adults.
  • There’s limited evidence for an association between cannabis use and one particular subtype of testicular cancer.
  • There’s minimal evidence that parental cannabis use during pregnancy is associated with greater cancer risk in children.

RELATED STORY

Cannabis and Cancer

Not much new here, either. The weight of the evidence to date suggests that smoking cannabis, unlike smoking cigarettes, does not increase lung cancer risk. Apparently there is modest evidence for an association between cannabis use and a specific form of testicular cancer. The important caveat for these conclusions is that they’re based on finding (or failing to find) statistical associations between cannabis use and a specific cancer outcome. Controlling for confounding variables, such as tobacco smoking, is critical for interpreting the results.

The association between cannabis and one subtype of testicular cancer is considered limited because the studies finding a link suffered from one or more of the following: they relied on self-reported data, response rates were sometimes low, or potential confounding variables were not controlled for in all studies.

Cannabis and Respiratory Disease

  • Smoking cannabis regularly is associated with chronic coughing and phlegm production.
  • Quitting smoking is likely to reduce these symptoms.
  • It’s unclear if cannabis use is associated with other respiratory problems (e.g. asthma, general lung function).

Again, not much new here. If you smoke cannabis all the time, there’s a good chance you’ll be coughing up some phlegm. We recommend regular smokers consider vaping instead.

RELATED STORY

What is Dabbing and How Do Dabs Work?

Cannabis and Immunity

  • There’s a general lack of data on how cannabis-based therapies affect the human immune system.
  • There is insufficient data on the overall effects of cannabis on immune system competence.
  • There is limited evidence suggesting that cannabis smoke exposure has anti-inflammatory effects.
  • There is insufficient evidence to support an association between cannabis use and adverse immune effects in HIV patients.

This is a section where the authors concluded that limited or insufficient evidence exists across the board. But it’s also an area where a lot of basic research has been done that should be used to guide human clinical research. For example, we know that THC is a more potent anti-inflammatory that aspirin and hydrocortisone, and we know the endocannabinoid system has an important role in regulating the immune system’s inflammatory response. This makes it plausible that there are useful anti-inflammatory applications of cannabis-based therapies, and we should be pursuing human studies to investigate what these might be.

Cannabis and Prenatal, Perinatal, and Neonatal Exposure

  • Smoking cannabis during pregnancy is associated with lower birth weights.
  • The relationship between smoking during pregnancy and other outcomes is unclear.

This one is pretty straightforward. Please don’t smoke anything if you’re pregnant. It’s the only safe and reasonable strategy to take. The report contradicts a 2016 review that Leafly covered, which found that cannabis use was not linked to negative birth weight of preterm delivery outcomes (at least when used without tobacco or other illicit substances). However, the current report points out that there’s reason to think that non-cannabinoid byproducts of combustion that are found in smoke (including carbon monoxide), can impair fetal growth. The only reasonable conclusion here is that pregnant woman should avoid all forms of smoke inhalation.

RELATED STORY

Is Cannabis Safe to Use During Pregnancy? New Study Clarifies Risks

Problem Cannabis Use

  • Using cannabis more frequently and starting at a younger age are associated with developing problem cannabis use.

“Problem cannabis use” here means cannabis use disorder. While cannabis does not have nearly as much habit-forming potential as substances like alcohol, nicotine, or opioids, it is possible to develop a habit. What’s a habit? If you have trouble voluntarily taking a break, and especially if doing so gives you withdrawal symptoms, then you’ve got a habit. Using cannabis very frequently, especially if you start at a young age, increases the chances of habit formation. This is important but also nothing new.

RELATED STORY

CBD and the Brain: What Does It Do and What is It Good For?

Cannabis Use and Abuse of Other Substances

  • Cannabis use is likely to increase the risk of developing dependence for a substance other than cannabis.

This one jumped out at me. If you look at this chapter of the report in detail, things get confusing. The authors reach these three conclusions in the chapter of the full report:

  1. There is limited evidence for an association between cannabis use and the initiation of tobacco use.
  2. There’s limited evidence for cannabis use affecting the rates and patterns of use of other illicit substances.
  3. There is moderate evidence for a statistical association between cannabis use and the development of dependence for other substances, including alcohol, tobacco, and other illicit drugs.

I found this trio of conclusions confusing. The first two conclusions are that there’s limited evidence for an association between cannabis and both initiation of tobacco use and changes in the rate or pattern of use of other illicit substances. But then we’re told that there’s moderate evidence for an association between cannabis use and the development of dependence for other substances. Wouldn’t the development of dependence be considered a change in the pattern of use? And if the chapter summary (the bullet point above) is based on these three conclusions, what justifies the definitive-sounding statement, “Cannabis use is likely to…”?

It isn’t clear me why they separated the studies that were considered for points (2) and (3) above. Point (2) is about changes in patterns of usage, and point (3) is about the development of dependence, which is itself a change in the pattern of usage.

RELATED STORY

U.S. Attorney General Says Cannabis Is Not a Gateway Drug

While some of the studies considered had large sample sizes and controlled a variety of confounds, most or all seem to have relied on self-reported data around consumption of cannabis and other substances. These types of studies also don’t include any biological data that might tell us whether someone is generally predisposed to developing a substance use disorder of some kind.

If lifetime use of one substance is associated with increased use of another, how do we know that using the first substance was what increased the risk of using the second? How do we rule out the existence of a biological predisposition that makes one more likely to develop a dependence on any intoxicating substance? We can’t, at least not from these types of studies. Thus, I find the conclusion given in the chapter highlights, that cannabis “is likely to increase the risk for developing substance dependence,” to be specious and inappropriately phrased given the content of this chapter.

Cannabis Effects on Injury and Death

  • Using cannabis before driving increases the risk of being in a motor vehicle accident.
  • In states with legal cannabis, there’s an increase in unintentional cannabis overdose injuries in children.
  • There is no clear relationship between cannabis use and mortality or occupational injury. 

Without diving into the report in detail I think we can come up with some common-sense conclusions about the first two points: You shouldn’t operate a motor vehicle while under the influence of any psychoactive substance, and you need to be extremely careful about storing your cannabis products if there are children around. That latter point is especially important for cannabis edibles, which can allow unsuspecting individuals to mistakenly consume uncomfortably large amounts of THC.

RELATED STORY

Why are Legal States Setting More Limits on Cannabis?

The last point should come as no surprise, since we know why you can’t die from cannabis consumption. People in states with legal medical cannabis also don’t appear to be getting stoned before heading into work. In fact, we’re seeing lower rates of workplace absenteeism in states with legal medical cannabis.

Psychosocial Effects of Cannabis

  • Recent cannabis use (within the last 24 hours) impairs cognition (memory, attention).
  • A limited number of studies suggest there are such cognitive impairments in people who have stopped cannabis use.
  • Adolescent use is associated with impairments in subsequent academic achievement and other social outcomes.

The first two points are straightforward. The acute effects of THC intoxication involve impairments in cognition (e.g. short-term memory, attention), and there is limited evidence that such impairments can persist after people stop consuming cannabis. The last point about academic impairments associated with adolescent use is true based on the studies considered in this report, but we also highlighted a 2016 study too recent to be considered in this report that didn’t find this type of association (but only after controlling for confounding variables, namely tobacco use). Because childhood and adolescence are critical periods of nervous system development, the use of cannabis or any psychoactive substance should be avoided before adulthood.

RELATED STORY

Why Does Cannabis Cause Paranoia in Some But Helps Anxiety in Others?

Cannabis and Mental Health

  • Cannabis use can increase the risk of developing schizophrenia.
  • Individuals with schizophrenia and a history of cannabis use may show better performance on learning and memory tasks.
  • Cannabis use does not appear to increase the likelihood of depression, anxiety, or PTSD.
  • In individuals with bipolar disorder, near daily cannabis use may worsen symptoms.
  • Heavy cannabis users are more likely to report thoughts of suicide.
  • Regular cannabis use increases risk for social anxiety disorder.

OK, the first two points beg for a double-take. Cannabis use can increase the risk of schizophrenia, but those with both schizophrenia and a history of cannabis use show better performance on learning and memory tasks? What? Box 12-1, titled “Co-Morbidity in Substance Abuse and Mental Illness,” helps us start to digest this. Here are its three main points:

  1. Substance use may be a potential risk factor for developing mental health disorders.
  2. Mental illness may be a potential risk factor for developing a substance abuse disorder.
  3. An overlap in predisposing risk factors (e.g., genetic vulnerability, environment) may contribute to the development of both substance abuse and a mental health disorder.

RELATED STORY

Cannabis and Depression

The report follows with a statement about why the relationship between mental health and substance abuse is so difficult. Substance abuse can affect mental health, mental health can affect substance abuse, and other variables can affect both. In their words:

Although the precise explanation is still unclear, it is reasonable to assume that co-morbidity between substance abuse and mental health disorders may occur due to a mixture of proposed scenarios. With this context in mind, however, it is important to note that the issue of co-morbidity directly affects the ability to determine causality and/or directionality in associations between substance use and mental health outcomes. This is a complex issue, one that certainly warrants further investigation.

Again we see the emphasis on more research. The nature of the link between cannabis use and schizophrenia was debated by scientists in the journal Nature in 2015 (look here and here for opposing views from scientists).

Summary

It will take some time to dissect this 400-page report in more detail. This report looks at a lot of human health issues and how they  may potentially be affected by cannabis use. While I don’t envy anyone tasked with such an enormous undertaking, I was somewhat disappointed to see that the report didn’t consider any basic research findings and instead relied on only human studies. While this allowed the committee to focus on studies directly related to human health, a large proportion of those studies are based on self-reported data that are correlational in nature. Occasionally, some of the language used to summarize their conclusions doesn’t adequately capture these important caveats.

A major emphasis of the report is that we need much more research. Unfortunately, doing the types of well controlled, large-scale clinical studies that we need to be doing is very difficult in the United States today. Given that this report, conducted by a cautious set of researchers, finds conclusive evidence that cannabis has legitimate medical applications, the federal government’s classification of cannabis as a Schedule I Controlled Substance, with “no currently accepted medical use,” must be considered untenable and inappropriate.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

The Benefits of Cannabis on Your Self-Esteem

If I told you that your body is worthy of love, care, and compassion exactly the way it is right this second, would you believe me? If you’re suddenly squirming uncomfortably or rolling your eyes, the odds are you probably aren’t completely comfortable with your body. You’re not alone. A 2012 UK study conducted by the All Party Parliamentary Group found that “roughly two-thirds of adults suffer from negative body image.” Yes, all adults. This is not just a “women’s issue.” People of all genders struggle with body image.

I’ve previously talked about using cannabis to help reframe limiting beliefs. After exploring more deeply, I’ve found cannabis can help cultivate body love as well. Since poor body image can negatively impact mental and physical health, you’re doing yourself a huge favor by taking active steps to improve your relationship with your body. Cannabis is the perfect conduit for such a transformation because it can help muffle some of the negative self-talk in your brain which, at least for me, often feels like it’s communicating exclusively in SHOUTY CAPS.

RELATED STORY

How Does Depression Impact Your Sex Life, and Can Cannabis Help?

For me, cannabis helps me feel more present in my body and more open to pleasurable sensations. In 2010, I spent 100 hours getting certified as a hypnotist and I learned how useful hypnotic trance can be for unlearning negative beliefs and redirecting your attention and intentions. I find cannabis can produce similar effects to being in a trance (relaxation, bringing the unconscious mind into the forefront as the conscious mind recedes slightly, being more open to positive change, etc.)

If you’re interested in utilizing cannabis to re-shape your self-esteem, make sure to avoid a strain or product that might increase anxiety or paranoia (which would be antithetical to your goals). I suggest looking for a 1:1 CBD to THC ratio, and depending on how much time you can commit to the process, choose a shorter-acting method like smoking or vaping. The idea here is not to get so stoned that you “forget” the things you dislike about your body. This is about mindfully choosing cannabinoids and terpene profiles that will augment the positive changes that you’re setting in motion.

RELATED STORY

Can CBD Undo the Anxious Side Effects of THC?

Beta-caryophyllene, a peppery terpene found in many plants from cannabis to cinnamon, has been shown to reduce anxiety and depression. Ask your budtender about strains like OG Kush and Skywalker OG, which tend to be high in caryophyllene, and ask about the lab results (does your dispensary have lab testing results on hand?) to verify the terpene profiles. Part of loving your body means being aware of what goes into it, so be a savvy consumer!

Kayla Arielle, cannabis guru and social media specialist, shared this powerful experience:

“In the movie ‘What The Bleep,’ there’s a scene in which a habitually self-loathing woman realizes the effect that she is having on both her body and reality with her negative thought patterns. She ends up sitting in front of a mirror with a marker and writing letters of love all over her body, in effect deprogramming her hateful thinking and replacing it–in a very tangible way–with positive, loving thoughts. I was going through a really hard time with my marriage then and my condition [juvenile rheumatoid arthritis] as well. I was flared up 24/7 and in so much pain.

RELATED STORY

Can Cannabis Help Repair Arthritic Joints?

“After I saw that scene, I felt extremely moved to do the same thing. I locked myself in my bathroom and alternated between the tub and mirror, marking all over my body, laughing and crying in the process. I definitely used cannabis as a tool and companion during the process…I had bowls and a blunt. It helped my mind to elevate to my intended frequency of soul vibration, as they say, unlocking obstacles and guiding the way back to the light after many years of moving towards despairing darkness. I had started to feel so trapped in this crippling vessel. The hour or so alone in my bathroom brought about so much healing and truly was a milestone of great change in my life.”

RELATED STORY

How to Roll a Perfect Blunt: A Step-by-Step Guide

The exercise she’s describing is deeply transformative, and I would recommend it if you feel inspired and ready for a big change. However, you don’t have to jump right to writing on yourself in marker. It’s all about making small, sustainable changes.

Here’s a bit of homework for you: carve out time for yourself where you’ll be alone and uninterrupted. An hour would be best, but you can do this in as little as 10-15 minutes. Enjoy the cannabis product of your choice–just enough that you feel it in your body, but not so much that it feels distracting. The goal is focused enhancement.

Stand in front of a mirror and look at yourself. Look into your eyes and take a few deep breaths into your belly. Notice the things about some part of your body that you like. For instance, looking at your face, perhaps you like the way your eyes light up when you smile, or a freckle on your cheek, or the way your lips purse when you’re concentrating. Maybe it’s the softness of your skin or the curve of your jaw. Revel in it. You might notice things you don’t like, too. That’s okay, just don’t dwell on them. When a negative thought comes up, just let it pass by. Express gratitude to your body for all the ways it makes you unique and awesome.

RELATED STORY

How Meditative Breathing Can Help Your Consumption Technique

When you’re done looking and appreciating (do this for as long as you can), write down what you remember in a journal. Have one page for positive things you noticed, and on another page spend a few minutes writing about how you felt doing that. What was it like to just focus on the good stuff? How can you make that a habit?

Has cannabis impacted your relationship with your body? If so, share your stories in the comments below!

Got a sex, relationships, or intimacy dating question for Ashley Manta? Send it to tips@leafly.com and we may address your request in a future article! (Don’t worry, we’ll keep your queries anonymous.)


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.