q&a part 2

Medical Cannabis Q&A Part Two

In our previous Q&A we answered questions including: ‘Is cannabis addictive?’, ‘What is CBD?’ and ‘Can you overdose on medical cannabis?’. In this Q&A we answer more of your burning questions:

What’s in a cannabis plant?

Cannabis plants have a number of constituent parts, with researchers believing cannabis plants contain around 545 compounds. The main constituents of the cannabis plant are cannabinoids (or phytocannabinoids), terpenes and flavonoids.

Of the 545 purported compounds in the cannabis plant, around 113 compounds are thought to be cannabinoids. These are chemical compounds that act on the body’s cannabinoid receptors, altering the neurotransmitter release of the brain.

Phytocannabinoids are compounds naturally occurring in the cannabis plant that are distinct from synthetic cannabinoids that are man-made and endocannabinoids, which are cannabinoids naturally occurring in the body.

Terpenes are compounds that are responsible for giving cannabis its distinctive smell, with these fragrant oils being deemed responsible for the plant’s flavour, with different strains of the plant possessing distinct tastes dependent upon their terpene content.

Flavonoids are natural phytonutrients and compounds that are found both in the cannabis plant and in a large number of fruits and vegetables. There are thought to be 23 cannabis-unique flavonoids which are also known as cannoflavins.

Are there ways to counteract the negative side effects of cannabis?

As increasing levels of THC may be required by patients over time, an overriding prescription rule is to ‘start low and go slow’. This method involves initially trying higher CBD formulations before gradually introducing and increasing levels of THC as required to suit a patient’s needs. It is considered best practice to start both cannabis naïve and non-naïve patients on high CBD/low THC products initially.

Through using this method initially, the person using medical cannabis products can ensure that they don’t reach levels of THC that would produce negative side effects for them.

However, if negative psychoactive effects do occur, physician Jordan Tishler recommends to simply: ‘Get to a quiet, safe space, relax, have a trusted person stay with you and perhaps hold your hand’. The general consensus from professionals is to simply wait for the effects to pass, as they are rarely serious and tend to pass with time.

Is cannabis a gateway drug?

Although research ‘generally supports the notion that cannabis use is a risk factor for subsequent use of “harder” illicit drugs’, this says little about the actual nature of cannabis specifically and more about the typical reality that those who go on to use harder drugs have often used a variety of softer drugs prior to using harder, more addictive drugs.

Cannabis may not actually be a direct cause of further drug use. There is no proof of causation, rather the use of cannabis and use of harder drugs is merely linked. There are likely many other causal factors involved in someone starting to use hard drugs.

What is full-spectrum CBD?

Full-spectrum CBD contains CBD as well as a number of other cannabinoids, flavonoids and terpenes found naturally in the cannabis plant. This may, in some cases, include THC.

What is CBD isolate?

CBD isolate is practically pure CBD (often 99.9% pure) that’s separated through extraction from the rest of the cannabis plant’s compounds. It often comes in a solid, crystallised form which is then usually ground into a fine powdery consistency.

Does THC cause psychosis?

A persistent controversy around cannabis and medical cannabis use relates to its effect on the risk of psychiatric and psychotic disorders. There has been a school of thought that proposes high-THC content cannabis can possibly trigger psychosis due to its psychotomimetic effect.

A study by Di Forti et. al. (2009) explains that whilst overall cannabis might have a higher average THC content than 30 years ago, we still know that high-THC content cannabis was in circulation at that point in time. Moreover, whilst cannabis usage and potency has increased, it appears that the incidence of psychosis in the overall population actually hasn’t. This would obviously suggest that THC does not directly cause psychosis, however, the complexities of epidemiological studies mean that a causal relationship is difficult to establish here.

For more information on studies related to cannabis, psychosis and schizophrenia, we highly recommend you take a look at our evidence base; a ground-breaking systematic review of the history of research in this area and a global first-of-its-kind searchable database for clinical referencing.

Can CBD and cannabis help with sports performance?

In 2019, WADA (the World Anti-Doping Agency) removed cannabidiol (CBD), from their prohibited list of drugs, with various sporting bodies thereby allowing the use of CBD by their respective athletes for the first time.

Although scientists and specialists remain inconclusive about whether cannabis can be classed as an ergogenic (performance-enhancing) or ergolytic (performance-impairing) drug, the substance remains banned from use in competition by WADA. In their Prohibited List, WADA cite that ‘considering existing current human and animal studies, the drug may be performance enhancing for certain athletes and those in particular sports disciplines’.

Can CBD and cannabis help sports recovery?

As suggested by researchers in a review published in the clinical journal of sports medicine: ‘self-reported cannabis use among NCAA athletes was predominantly for social and recreational purposes (61%); only 0.6% stated that the use of cannabis was primarily for performance-enhancing purposes’. They concluded that ‘cannabis use among athletes may therefore be more related to social norms of behaviour rather than to enhance performance’.

However, some specialists believe that cannabis can help sports players improve their focus and recover following injuries due to the plant’s cannabinoids’ supposed analgesic effects upon the endocannabinoid system.

How exactly cannabis may help athletes is still largely unknown as much more high quality and controlled research in this area is required.

Will one administration method of cannabis affect me differently than another?

With oil and capsule dosing methods, the dosage is very easy to control, making it far less likely that you’ll dose more than you intend or get any unintended side effects.

Vaporizing offers patients a controllable, quicker onset and shorter-lasting way of using medical cannabis than ingesting capsules.

However, oil-based vaping methods of administration otherwise known as ‘dabbing’ (heating cannabis resin on a hot nail or piece of metal) are not recommended for medical use due to its high risk for adverse effects including hallucination, intoxication and an immediate high dose of THC delivered to the brain with little mitigating CBD.

For long term conditions like chronic pain, edibles can produce longer lasting effects which might make them a better method of ingestion in this case than oils and capsules. From a medical point of view the positive impacts of edibles are less certain than some other ingestion methods. This is mainly because the bioavailability of edibles is far more variable than the highly specific dosing of oils and capsules as edibles have to pass through the liver, partially metabolising some of the cannabinoids in the process. Oils, by contrast, are taken under the tongue meaning all the cannabinoids are absorbed into the bloodstream for a more certain dosing effect.

Smoking joints may cause physical damage to airways and increase the risk of bronchitis and related issues; this is particularly the case for people vulnerable to such illnesses from previous smoking or pre-existing lung diseases. Joints, due to their THC content will also elicit psychoactive effects and create a high for the user.

What are synthetic cannabinoids?

Synthetic cannabinoids are human-made chemicals that act like THC, cannabis’ main psychoactive cannabinoid, as they affect the same receptors in the brain. However, synthetic cannabinoids are considered to be far more dangerous and unpredictable than cannabis as they affect the brain in a more powerful way, creating far more serious side effects.

For more information on CBD, THC and other cannabinoids and constituents of the cannabis plant, take a look at our evidence base, a ground-breaking systematic review of the history of research in this area and a global first-of-its-kind searchable database for clinical referencing.

The rest of our comprehensive resources on medical cannabis are available on our website. We urge anyone considering the use of medical cannabis products to consult with a trained medical professional prior to beginning use.

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