Narinka Guichette

written by

Narinka Guichette

LJG 2021

reviewed by

Laura Geftman, LCSW

Narinka Guichette

written by

Narinka Guichette

LJG 2021

reviewed by

Laura Geftman, LCSW

Military personnel are amongst those advocating for the descheduling of cannabis due to their all too common experience of Post Traumatic Stress Disorder (PTSD.) Our soldiers are often exposed to life-threatening experiences that can greatly affect their mental health. According to the U.S Department of Veterans Affairs, the number of veterans with PTSD varies per service era. Veterans diagnosed with PTSD are as follows:

    • 11-20% of Iraqi Freedom Veterans 
    • 12% of Gulf War Veterans
    • 15% of Vietnam War Veterans

Our soliders also experience the trauma of sexual assault and harrassment while serving at the following rates:

    • 23% reported sexual assault
    • 55% of women reported sexual harassment
    • 38% of men reported sexual harassment

This equates to over 800,000 veterans who have been diagnosed with PTSD. That’s staggering, isn’t it!? That’s a lot of people who need a lot of healing.

The VA and their patients have become a focal point for cannabis activists due to this larger population of people who may benefit from medical cannabis treatment. More and more veterans have begun speaking out about the effective treatment they are receiving, and their desire to be granted the use of the federally illegal substance that jeopardizes their federally subsidized medical benefits.

This is one fight the soldier’s don’t seem to be backed down from. Here’s why…

Veterans & PTSD: One Soldier’s Story

Mike Whiter served as a Marine for eleven years, and fought in the Iraq war on two combat tours. He was medically discharged after being diagnosed with PTSD. Upon returning home, Whiter not only struggled with acclimating to civilian life but also with a desire to continue living. Whiter experienced bouts of depression and attempted suicide three times over the course of five years.. Until trying medicinal cannabis for PTSD that is… 

Whiter’s whole life has turned around since he started medicating with cannabis. He is living proof of the benefits of cannabis to treat PTSD. Consequently Whiter has become an outspoken cannabis advocate having worked to decriminalize cannabis in his state- Pennsylvania. He now works as a Producer for NowThis News where he often features stories about cannabis legislation, decriminalization, and recreation.

What is PTSD?

According to Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5)- also known as the “Therapist’s Bible,” Post-Traumatic Stress Disorder (PTSD) is defined as a condition triggered by a terrifying event or an experience that causes recurring physical and psychological distress. PTSD is an anxiety disorder that some people develop after seeing or living through a dangerous or distressing event. This can be an experience that scares a person so much it affects their day-to-day life. It can trigger the “fight, flight, freeze, fawn” reaction that’s normal at the time but can linger much longer with PTSD after the danger has passed. 

Common PTSD symptoms include:

    • Anxiety, panic attacks or constantly looking out for danger
    • Depression or hopelessness
    • Feelings of guilt or shame
    • Reliving the event through bad memories, flashbacks or nightmares
    • Avoiding activities you used to enjoy
    • Avoiding situations that remind you of the trauma (e.g., not driving, or staying away from crowds)
    • Irritability
    • Withdrawing from loved ones or even thinking that they would be better off without you
    • Having trouble concentrating at work or school

Those struggling with undiagnosed PTSD commonly say that instead of feeling better as time goes on, you feel as though things are progressively getting worse and worse. But know- PTSD is treatable. The sooner you seek help, the easier it will be to overcome.

How PTSD Affects Veterans

Some of the experiences veterans face can include losing a fellow soldier, being severely injured, witnessing war, sexual assault, rape, harassment, and for many- difficulty readjusting to civilian life once they’re home. Veterans re-experience their trauma through nightmares, flashbacks, intrusive thoughts, and more. For all those reasons and more, hundreds of thousands of veterans are in need of PTSD treatment.

The number of veterans diagnosed with PTSD is at a 23% high in the United States. Seventeen percent of returning veterans also meet the criteria for depression.This is important because PTSD symptoms can mimic or overlap with depression. Some of the similarities of  PTSD and depression symptoms include oversleeping, loss of interest, anger, and hypervigilance. 

In addition to the use of pharmaceutical drugs, Veterans often increase the consumption of alcohol and the medications prescribed by their doctors. Addiction is a major concern in the veteran community. According to the US National Library of Medicine National Institutes of Health in a study using diagnostic criteria found that alcohol use addiction was widespread at 32 percent. Clearly addiction is an undeniable challenge for this population.

Treatment Options for Veterans with PTSD

According to Whiter, PTSD initially cost him his career, social life, and self-esteem, and medicating the problem didn’t help. “Over the span of five years, I was put on 40 different kinds of medications.” He wasn’t sure what he was suffering from at first. When he was diagnosed with PTSD, he originally thought it was a personality disorder. 

Many veterans search for possible treatments to combat PTSD and are prescribed psychiatric medications like Zoloft, Paxil and Prozac. Antidepressants have been shown to reduce flashbacks and nightmares, and anti-anxiety medications may reduce the physiological arousal in PTSD patients. They use medication to numb their pain in order to gain some control of their lives. 

Aside from medication, the VA also commonly offers their patients psychotherapy including cognitive, behavioral, and exposure therapies. Cognitive-behavioral therapy is considered to have the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other non-drug treatment. Research has shown that exposure therapy has been more effective because it provides a safe place to relieve trauma. The downside is that not many people want to re-experience a trauma or have conversations about that trauma. 

After researching and educating himself, he knew there had to be a better way to medicate his condition but he knew the VA defense to PTSD is pills and psychotherapy. Whiter’s research didn’t end there. He learned of another treatment thought to be a safer choice than anything the VA had plied him with…cannabis…

Treating PTSD with Cannabis

“I learned about veterans using cannabis for their PTSD via a National Geographic special,” said Whiter. “So, I asked my friend to get me some. We sat in the living room. I laughed, smiled and felt good. That was the turning point of my life.”  

There’s been a growing interest in the uses of cannabis to treat illnesses such as epilepsy, glaucoma, cancer, anxiety, and yes, you guessed it- PTSD. The use of cannabis in reducing PTSD works by lessening the brain’s inflammation, therefore reducing the PTSD symptoms such as anger, nightmares, and intrusive thoughts (Jackson, Bassett,  Zvolensky, & Borsari, 2016). It does this by activating cannabinoid receptors known as CB2. This type of receptor is found throughout the body, and acts as a messenger. The chemical compounds in cannabis work to modulate nerve signal transmission which minimizes the feeling of fear associated with PTSD. When cannabis is consumed it also affects the brain chemicals serotonin, norepinephrine, and dopamine to manage anxiety, motivation, and compulsions, and balance your minds and bodies.

Cannabis is also a safer choice that helps alleviate symptoms while also managing substance abuse. Cannabis can be used for medical purposes without a high risk of overdose compared to pills. 

Where Do We Go From Here? 

The stigma around cannabis has changed over the years, which can potentially open doors for more research and resources to help. We can use sources such as The Calm, Cool & Collected to educate ourselves on cannabis and for Veterans who are searching for alternatives to therapy can rely on the site to educate themselves on cannabis and see if it may be an option for them. 

Whiter can also be a great inspiration to become more active in your community to ensure Veteran’s rights to the use of cannabis. Be sure to get involved in your local organizations like Norml, Women Grow, and more.

Abizaid Alfonso, Merali Zul, Anisman Hymie.Cannabis: A potential efficacious intervention for PTSD or simply snake oil? US National Library of Medicine National Institutes of Health Search Database, Retrieved from https://www-ncbi-nlm-nih-gov.ezproxyemc.flo.org/pmc/articles/PMC6397040/

Berman, M. (2014, February 24,). How public opinion on marijuana  has changed over the last half-century. The Washington PostRetrieved from https://www.washingtonpost.com/news/post-nation/wp/2015/02/24/how-public-opinion-on-marijuana-has-changed-over-the-last-half-century/

Feingold, D. (2020). Working with clients who self-medicate using cannabis: Mind the gap in knowledge. Professional Psychology: Research and Practice, 51(4), 313-316. doi:10.1037/pro0000345

How to overcome PTSD (post-traumatic stress disorder). Health Prep, Retrieved from https://healthprep.com/topics/mental-health/how-to-overcome-ptsd-post-traumatic-stress-disorder/?xcid=624&utm_source=bing&utm_medium=ppc&utm_campaign=370292343&utm_content=1264438982654820&utm_term=what%20is%20post%20traumatic%20stress%20disorder&msclkid=662ffaaf6cb31ad8ed6ba5843ed6ef8c#

Metrik, J., Jackson, K., Bassett, S. S., Zvolensky, M. J., Seal, K., & Borsari, B. (2016). The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychology of Addictive Behaviors, 30(7), 743-754. doi:10.1037/adb0000210

https://www.youtube.com/watch?v=1iIENII-lVo

Lan, C., Fiellin, D. A., Barry, D. T., Bryant, K. J., Gordon, A. J., Edelman, E. J., . . . Marshall, B. D. L. (2016). The epidemiology of substance use disorders in US veterans: A systematic review and analysis of assessment methods. The American Journal on Addictions, 25(1), 7-24. doi:10.1111/ajad.12319

Reisman, M. (2016). PTSD treatment for veterans: What’s working, what’s new, and what’s next. P&T (Lawrenceville, N.J.), 41(10), 623-634. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27757001

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003

Aronson J. K. (2004). Classifying drug interactions. British journal of clinical pharmacology, 58(4), 343–344. https://doi.org/10.1111/j.1365-2125.2004.02244.x

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Jiang R, Yamaori S, Takeda S, et al. Identification of cytochrome P4540 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165-170.

Rebecca L Hartman, Timothy L Brown, Gary Milavetz, Andrew Spurgin, David A Gorelick, Gary Gaffney, Marilyn A Huestis, Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, Volume 61, Issue 6, 1 June 2015, Pages 850–869, https://doi.org/10.1373/clinchem.2015.238287

Toennes SW, Schneider K, Kauert GF, Wunder C, Moeller MR, Theunissen EL, Ramaekers JG. Influence of ethanol on cannabinoid pharmacokinetic parameters in chronic users. Anal Bioanal Chem. 2011 Apr;400(1):145-52. doi: 10.1007/s00216-010-4449-2. Epub 2010 Nov 30. PMID: 21116612.

Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

Pin it

HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Everything You Need to Know About THC (But Might be Afraid or Too High to Ask)
Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Tetrahydrocannabinol (THC), is the most known and talked about compound in the cannabis plant. Of course following right behind is CBD, though THC tends to be the main star of the cannabis community and for good reason. THC is known for making you feel “high,” which plays a large influence on its popularity.  Its popularity has grown in more recent years as the chemical compound holds many beneficial effects, specifically in medicinal properties supported by evidence-based practices. While THC can be helpful for some, we must address that its effectiveness may lead to adverse side effects, if not careful. THC affects everyone differently, so we should take our time and learn about how THC can produce a euphoric effect that may be a positive and/or negative experience. 

What are Cannabinoids?

Aside from cannabinoids being the most mispronounced word in cannabis science- kuh–nab–uh-noid- they actually comprise approximately 100 of the 500 chemical compounds, responsible for psychological and physiological effects. Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. 

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the cell’s surface. The effects of cannabinoids depend on the part of the body or brain being targeted for symptom relief. When deficiencies or problems arise in the endocannabinoid system, unpleasant symptoms and physical complications may occur. Neurotransmitters mediate communication between cells to stabilize these symptoms or deficiencies within our endocannabinoid system as the cannabinoids activate receptors to maintain internal stability and health. 

Most cannabinoids are not intoxicating by themselves and are needed in combination with other cannabinoids to influence different effects. There is a diverse range of cannabinoids influencing targeted receptors by bonding with them to produce effects for achieving homeostasis or balance. In our case, THC is considered a phytocannabinoid or exogenous cannabinoid. 

What is a Phytocannabinoid?

Phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis Sativa plant. If you know any Latin- “Phyto” means “of a plant or relating to plants,” so in our case, phytocannabinoids are derived from or a product of the cannabis plants. Phytocannabinoids are made in the plant’s glandular trichomes, which are small hairs found on the surface of its leaves and secrete resin to protect phytocannabinoids. Since production takes place on the external surface, phytocannabinoids are also referred to as “exogenous cannabinoids” as they develop on the outside of an organism. Like addressed before, the cannabis plant has over 500 compounds and 100 of those compounds belong to this class of cannabinoids. Below is a common list of cannabinoids, you may be familiar with found in this class:

🍃 tetrahydrocannabinol (THC)
🍃 cannabidiol (CBD)
🍃 cannabidiolic acid (CBDA) 
🍃 tetrahydrocannabinolic acid (THCA)
🍃 cannabinol (CBN)
🍃 cannabigerol (CBG)
🍃 cannabichromene (CBC)
🍃 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids that make them critical to the treatment of physical and mental health complications is its homeostatic tendencies. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching or influencing the receptors. They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease, and stimulation of appetite. 

What is THC?

THC stands for Tetrahydrocannabinol. THC is the main and most well-known compound in the cannabis plant. THC is known for its psychoactive properties of feeling “high,” though how does it make you feel high? THC shares nearly the same structure as a natural chemical called anandamide. Anandamide acts as a neurotransmitter that serves the purpose of increasing dopamine. THC and Anandamide bind to the same receptors in our brain creating the psychoactive effect that we all feel… aka feeling high as a kite. 

What are the potential effects of THC? 

THC can make everyone feel different, the most common psychoactive effects reported include but are not limited to: 

🌿 euphoria
🌿 relaxation
🌿 introspection
🌿 creativity
🌿 sedation
🌿 sensory alteration
🌿 appetite stimulation
🌿 focus 
🌿 energy-boosting

THC can also produce some common undesired effects which may include but are not limited to:

😵‍ red eyes
😵‍ disorientation
😵‍ dizziness
😵‍ anxiety 
😵‍ paranoia 

THC can also assist with common medicinal needs including but not limited to:

🌿 pain relief
🌿 inflammation
🌿 anti-inflammatory 
🌿 autoimmune disorders
🌿 insomnia
🌿 nausea
🌿 depression
🌿 anxiety 
🌿 PTSD
🌿 sleep apnea 
🌿 migraines 
🌿 Alzheimer’s disease

Let’s put it all together 

THC binds with our receptors in our brain producing increased dopamine levels, and as a result, creating a euphoric feeling. Effects can make everyone feel different, for some symptoms may improve, and for others, it can make symptoms worse. You know your body more than anyone, so trust your process and body sensations. It is always important to start small when trying cannabis for the first time. It may also be a good idea to keep track of what strains work best for you, including their effects, positive or negative. Whether you are a recreational user or a medical patient no one likes being too “high”, so be patient with yourself when exploring THC. 

Campo, P. (n.d.). Cannabinoids 101: THC – The Apothecarium. Https://Apothecarium.com/. Retrieved June 26, 2021, from https://apothecarium.com/blog/2018-7-9-cannabinoids-101-thc/?s=thc

Cao, C., Li, Y., Liu, H., Bai, G., Mayl, J., Lin, X., Sutherland, K., Nabar, N., & Cai, J. (2014). The Potential Therapeutic Effects of THC on Alzheimer’s Disease. Journal of Alzheimer’s Disease, 42(3), 973–984. https://doi.org/10.3233/jad-140093

Elsevier Enhanced Reader. (n.d.). Reader.elsevier.com. Retrieved August 14, 2021, from https://reader.elsevier.com/reader/sd/pii/S2352250X16302342?token=DDE675D1B41A7C5354437B97C3BC847DB8C70DBCDD7A2FEB4AC258D0CEC01831BE0FB200416D78D2440344F07AE77A92&originRegion=us-east-1&originCreation=20210814234227

Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008

Lland, R. (2018, July 9). What Is THC (Tetrahydrocannabinol)? Leafly. https://www.leafly.com/news/cannabis-101/what-is-tetrahydrocannabinol

Maroon, J., & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical Neurology International, 9(1), 91. https://doi.org/10.4103/sni.sni_45_18

Triangale, MD, R., & Jensen, MD, C. (2011). Cannabis and Insomnia. http://files7.webydo.com/92/9209805/UploadedFiles/5E9EC245-448E-17B2-C7CA-21C6BDC6852D.pdf

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

CBD for anxiety

A pounding heart, sweaty palms, racing thoughts: For those living with an anxiety disorder, these unwelcome symptoms can make everyday life feel debilitating.

One in 13 people around the world live with an anxiety disorder, making them the most common mental health disorder worldwide, according to the World Health Organization (WHO). For those living with anxiety, finding a safe method for managing symptoms is a critical concern.

Quick-acting anti-anxiety medication, such as Xanax and Valium, may offer instant relief but can become addictive. Long-range anxiety medications, such as Prozac, may help reduce symptoms over time, but don’t work for everyone.

Enter cannabidiol, better known as CBD. CBD has recently captured the spotlight as an alternative or complementary treatment for anxiety.

CBD: Snake oil or powerful anxiety treatment?

Clinical research on CBD as a treatment for anxiety disorders has proliferated in recent years with accumulating evidence pointing to its therapeutic potential.

Although most studies on CBD are preclinical and use animal models, clinical studies using human participants are now emerging.

In a double-blind study from 2019, 37 Japanese teenagers with social anxiety disorder (SAD) received 300 mg of CBD oil or a placebo every day for four weeks. The teens were assessed with surveys used to diagnose and measure SAD symptoms. The anti-anxiety properties of CBD reduced symptoms aligned with the disorder, providing relief comparable to Paroxetine, a drug commonly used to treat the condition.

Interestingly, in the follow-up, nine of the seventeen teenagers who received the CBD intervention also declared that they had decided to seek some form of treatment. Teenagers with SAD rarely seek help due to the stigma surrounding the condition and for fear of interacting with therapists.

A 2019 retrospective case study reviewed outpatients at a mental health clinic in Fort Collins, Colorado. Forty-seven of the patients sampled had expressed concerns about anxiety. Over three months, the majority of patients were given 25 mg of CBD daily in addition to treatment.

After the first monthly assessment, 79.2% of patients experienced an improvement in anxiety. After two months, 78.1% of patients reported a further improvement compared with the previous month.

However, there were also patients who reported that the symptoms of their anxiety worsened after taking CBD—15.3% felt their anxiety had become exacerbated after the first month and 19.5% felt their anxiety had worsened further after the second month.

Another study, done in 2018, also suggests that CBD may heighten anxiety. It included a small sample of individuals with paranoid traits and found that CBD exacerbated anxiety among some of the participants. Anxiety was measured through symptoms such as cortisol concentration, heart rate, and systolic blood pressure.

These contradictory findings may be due to factors such as small sample sizes and variations in dosing. CBD is a bidirectional medicine, which means it can cause opposing responses at different doses. We’ll delve deeper into this below.

How should I consume CBD for anxiety?

If you’re curious about using CBD oil as a tool to help manage your anxiety, education is critical. Understanding the pros and cons of the various ingestion methods can help you determine which form of consumption best suits your needs.

tinctures and oils represent a quick, easy, and accurate way to consume CBD. Most tinctures contain CBD in an alcohol base. CBD oils contain CBD extracts infused into a carrier oil, such as coconut or hemp seed oil.

Tinctures and oils are taken using a dropper, which allows you to easily measure intake. The cannabinoid rapidly enters the bloodstream when taken sublingually—results can kick in as quickly as ten minutes and last up to three to four hours.

CBD vape oils can be vaped using a special pen that vaporizes the oil. At present, the safety of vaping has come under intense scrutiny. A serious lung condition known as VAPI, or EVALI, has hospitalized more than 2,000 people and led to the deaths of 42. The federal Centers for Disease Control has found that most cases have been linked to the use of illicit-market THC vape cartridges tainted with vitamin E oil (tocopheryl-acetate).

CBD vape cartridges purchased in legal state-licensed cannabis stores are highly regulated, while CBD cartridges purchased from other sources are completely unregulated. Proceed with caution when considering any vaping product in an unregulated environment.

edibles CBD can be added to almost every food under the sun. While super easy to consume in this form—and often delicious, particularly as gummies—it may take an hour or more before results are felt.

What’s more, the oral bioavailability of CBD can hinder CBD absorption—when you consume CBD orally, it has to pass through your gastrointestinal tract before it is metabolized by the liver. As a result, a limited quantity of CBD makes it into the circulatory system.

It’s important to also note that the FDA has recently deemed food containing CBD illegal. You’ll have to get CBD edibles in state-licensed adult-use markets.

smoking provides an almost instantaneous method for enjoying the effects of CBD. Smoking sends the cannabinoid directly to the alveoli of the lungs, and from there, CBD molecules enter the bloodstream for rapid absorption. However, measuring your CBD intake can be tricky when you smoke, and the act of smoking itself can cause lung inflammation.

Dosing CBD for anxiety

If you read the studies cited above, you’ll notice that the dosing varied significantly between them. The teens in the Japanese study were provided with 300 mg of CBD daily, while the outpatients in the Colorado study received 25 mg. Why such a large discrepancy in dose?

As most scientists and clinicians will readily admit, there is no universally recommended dosage for CBD, and, to date, there haven’t been any large-scale clinical trials to inform dosage guidelines. In addition, the FDA is still learning about CBD—such as its cumulative effects on the body—before it decides on how to regulate it.

This doesn’t necessarily mean CBD is unsafe. Existing research already suggests that it appears to be a safe, well-tolerated treatment. If you’re interested in experimenting with CBD to manage your anxiety symptoms, aim for an informed, cautious approach to dosing (which is always a good idea). Below are some dosing considerations.

General dosing tips

Some basic factors that you should consider when devising a CBD dose include:

👉 body weight

👉 metabolism

👉 concentration of CBD

👉 severity of your anxiety

The concentration of CBD varies between products, and is generally expressed as milligrams (mg) per container.

Once you know the potency of the CBD product you hold, you can use a dosage calculator or an app such as Accugentix to help settle on your perfect dose. Dosage calculations can provide a recommended dose in milligrams based on your body weight and the severity of your symptoms.

Your unique body chemistry also affects how you respond to CBD. Some individuals metabolize medicine faster than others, which can be attributed to genes or lifestyle. If you know that you metabolize medication quickly, it’s possible that you may benefit from a higher dose.

Bidirectional effects

CBD may do different things at different doses, a phenomenon known as bidirectional effects. Overstimulation of the body’s endocannabinoid system may exacerbate symptoms instead of alleviating them.

Additionally, high levels of CBD, such as 300 mg, have been known to promote sleepiness and relaxation. Conversely, low levels of CBD may create an elevating response, inciting wakefulness and alertness. The best way to avoid unwanted bidirectional effects is to follow the adage: start low, go slow.

Start low, go slow

Titration refers to the process of adjusting the dosage of a medication to get its maximum benefits without adverse effects. CBD has been shown to be safe even when taken in high doses (300-600 mg), nonetheless, it’s advisable and more cost-effective to start with a low dose and increase it incrementally, observing how you feel as you go.

This method forces you to pay attention to subtle changes in your body as it responds to the medication. Everyone’s optimal dosage and tolerance is unique, and this process allows you to get acquainted with yours.

Dr. Dustin Sulak, a cannabis medicine expert at Healer, offers educational resources for novice and seasoned cannabis users alike to find their optimal dosage.

Talk to an expert on medical cannabis

If you’re still feeling unsure and you live in a state where you can safely converse with a health professional about CBD, consider scheduling a consultation. Some cannabis dispensaries also have medical experts on hand who can provide you with sound advice and dosage recommendations.

Leafly logo

This article written by Emma Stone was originally posted on Leafly.com.

Blessing, E.M., Steenkamp, M.M., Manzanares, J. et al. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics 12, 825–836 (2015). https://doi.org/10.1007/s13311-015-0387-1

https://adaa.org/understanding-anxiety/facts-statistics

Hundal H, Lister R, Evans N, Antley A, Englund A, Murray RM, Freeman D, Morrison PD. The effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group. J Psychopharmacol. 2018 Mar;32(3):276-282. doi: 10.1177/0269881117737400. Epub 2017 Oct 31. PMID: 29086614.

Nobuo, Masataka. Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers With Social Anxiety Disorders. Frontiers in Psychology 10, 2466 (2019). DOI=10.3389/fpsyg.2019.02466    

Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003

Aronson J. K. (2004). Classifying drug interactions. British journal of clinical pharmacology, 58(4), 343–344. https://doi.org/10.1111/j.1365-2125.2004.02244.x

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Jiang R, Yamaori S, Takeda S, et al. Identification of cytochrome P4540 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165-170.

Rebecca L Hartman, Timothy L Brown, Gary Milavetz, Andrew Spurgin, David A Gorelick, Gary Gaffney, Marilyn A Huestis, Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, Volume 61, Issue 6, 1 June 2015, Pages 850–869, https://doi.org/10.1373/clinchem.2015.238287

Toennes SW, Schneider K, Kauert GF, Wunder C, Moeller MR, Theunissen EL, Ramaekers JG. Influence of ethanol on cannabinoid pharmacokinetic parameters in chronic users. Anal Bioanal Chem. 2011 Apr;400(1):145-52. doi: 10.1007/s00216-010-4449-2. Epub 2010 Nov 30. PMID: 21116612.

Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Everything You Need to Know About THC (But Might be Afraid or Too High to Ask)
Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Jessica Christion

written by

Jessica Christion

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Tetrahydrocannabinol (THC), is the most known and talked about compound in the cannabis plant. Of course following right behind is CBD, though THC tends to be the main star of the cannabis community and for good reason. THC is known for making you feel “high,” which plays a large influence on its popularity.  Its popularity has grown in more recent years as the chemical compound holds many beneficial effects, specifically in medicinal properties supported by evidence-based practices. While THC can be helpful for some, we must address that its effectiveness may lead to adverse side effects, if not careful. THC affects everyone differently, so we should take our time and learn about how THC can produce a euphoric effect that may be a positive and/or negative experience. 

What are Cannabinoids?

Aside from cannabinoids being the most mispronounced word in cannabis science- kuh–nab–uh-noid- they actually comprise approximately 100 of the 500 chemical compounds, responsible for psychological and physiological effects. Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. 

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the cell’s surface. The effects of cannabinoids depend on the part of the body or brain being targeted for symptom relief. When deficiencies or problems arise in the endocannabinoid system, unpleasant symptoms and physical complications may occur. Neurotransmitters mediate communication between cells to stabilize these symptoms or deficiencies within our endocannabinoid system as the cannabinoids activate receptors to maintain internal stability and health. 

Most cannabinoids are not intoxicating by themselves and are needed in combination with other cannabinoids to influence different effects. There is a diverse range of cannabinoids influencing targeted receptors by bonding with them to produce effects for achieving homeostasis or balance. In our case, THC is considered a phytocannabinoid or exogenous cannabinoid. 

What is a Phytocannabinoid?

Phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis Sativa plant. If you know any Latin- “Phyto” means “of a plant or relating to plants,” so in our case, phytocannabinoids are derived from or a product of the cannabis plants. Phytocannabinoids are made in the plant’s glandular trichomes, which are small hairs found on the surface of its leaves and secrete resin to protect phytocannabinoids. Since production takes place on the external surface, phytocannabinoids are also referred to as “exogenous cannabinoids” as they develop on the outside of an organism. Like addressed before, the cannabis plant has over 500 compounds and 100 of those compounds belong to this class of cannabinoids. Below is a common list of cannabinoids, you may be familiar with found in this class:

🍃 tetrahydrocannabinol (THC)
🍃 cannabidiol (CBD)
🍃 cannabidiolic acid (CBDA) 
🍃 tetrahydrocannabinolic acid (THCA)
🍃 cannabinol (CBN)
🍃 cannabigerol (CBG)
🍃 cannabichromene (CBC)
🍃 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids that make them critical to the treatment of physical and mental health complications is its homeostatic tendencies. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching or influencing the receptors. They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease, and stimulation of appetite. 

What is THC?

THC stands for Tetrahydrocannabinol. THC is the main and most well-known compound in the cannabis plant. THC is known for its psychoactive properties of feeling “high,” though how does it make you feel high? THC shares nearly the same structure as a natural chemical called anandamide. Anandamide acts as a neurotransmitter that serves the purpose of increasing dopamine. THC and Anandamide bind to the same receptors in our brain creating the psychoactive effect that we all feel… aka feeling high as a kite. 

What are the potential effects of THC? 

THC can make everyone feel different, the most common psychoactive effects reported include but are not limited to: 

🌿 euphoria
🌿 relaxation
🌿 introspection
🌿 creativity
🌿 sedation
🌿 sensory alteration
🌿 appetite stimulation
🌿 focus 
🌿 energy-boosting

THC can also produce some common undesired effects which may include but are not limited to:

😵‍ red eyes
😵‍ disorientation
😵‍ dizziness
😵‍ anxiety 
😵‍ paranoia 

THC can also assist with common medicinal needs including but not limited to:

🌿 pain relief
🌿 inflammation
🌿 anti-inflammatory 
🌿 autoimmune disorders
🌿 insomnia
🌿 nausea
🌿 depression
🌿 anxiety 
🌿 PTSD
🌿 sleep apnea 
🌿 migraines 
🌿 Alzheimer’s disease

Let’s put it all together 

THC binds with our receptors in our brain producing increased dopamine levels, and as a result, creating a euphoric feeling. Effects can make everyone feel different, for some symptoms may improve, and for others, it can make symptoms worse. You know your body more than anyone, so trust your process and body sensations. It is always important to start small when trying cannabis for the first time. It may also be a good idea to keep track of what strains work best for you, including their effects, positive or negative. Whether you are a recreational user or a medical patient no one likes being too “high”, so be patient with yourself when exploring THC. 

Campo, P. (n.d.). Cannabinoids 101: THC – The Apothecarium. Https://Apothecarium.com/. Retrieved June 26, 2021, from https://apothecarium.com/blog/2018-7-9-cannabinoids-101-thc/?s=thc

Cao, C., Li, Y., Liu, H., Bai, G., Mayl, J., Lin, X., Sutherland, K., Nabar, N., & Cai, J. (2014). The Potential Therapeutic Effects of THC on Alzheimer’s Disease. Journal of Alzheimer’s Disease, 42(3), 973–984. https://doi.org/10.3233/jad-140093

Elsevier Enhanced Reader. (n.d.). Reader.elsevier.com. Retrieved August 14, 2021, from https://reader.elsevier.com/reader/sd/pii/S2352250X16302342?token=DDE675D1B41A7C5354437B97C3BC847DB8C70DBCDD7A2FEB4AC258D0CEC01831BE0FB200416D78D2440344F07AE77A92&originRegion=us-east-1&originCreation=20210814234227

Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. Journal of Pain and Symptom Management, 39(2), 167–179. https://doi.org/10.1016/j.jpainsymman.2009.06.008

Lland, R. (2018, July 9). What Is THC (Tetrahydrocannabinol)? Leafly. https://www.leafly.com/news/cannabis-101/what-is-tetrahydrocannabinol

Maroon, J., & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical Neurology International, 9(1), 91. https://doi.org/10.4103/sni.sni_45_18

Triangale, MD, R., & Jensen, MD, C. (2011). Cannabis and Insomnia. http://files7.webydo.com/92/9209805/UploadedFiles/5E9EC245-448E-17B2-C7CA-21C6BDC6852D.pdf

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

CBD for anxiety

A pounding heart, sweaty palms, racing thoughts: For those living with an anxiety disorder, these unwelcome symptoms can make everyday life feel debilitating.

One in 13 people around the world live with an anxiety disorder, making them the most common mental health disorder worldwide, according to the World Health Organization (WHO). For those living with anxiety, finding a safe method for managing symptoms is a critical concern.

Quick-acting anti-anxiety medication, such as Xanax and Valium, may offer instant relief but can become addictive. Long-range anxiety medications, such as Prozac, may help reduce symptoms over time, but don’t work for everyone.

Enter cannabidiol, better known as CBD. CBD has recently captured the spotlight as an alternative or complementary treatment for anxiety.

CBD: Snake oil or powerful anxiety treatment?

Clinical research on CBD as a treatment for anxiety disorders has proliferated in recent years with accumulating evidence pointing to its therapeutic potential.

Although most studies on CBD are preclinical and use animal models, clinical studies using human participants are now emerging.

In a double-blind study from 2019, 37 Japanese teenagers with social anxiety disorder (SAD) received 300 mg of CBD oil or a placebo every day for four weeks. The teens were assessed with surveys used to diagnose and measure SAD symptoms. The anti-anxiety properties of CBD reduced symptoms aligned with the disorder, providing relief comparable to Paroxetine, a drug commonly used to treat the condition.

Interestingly, in the follow-up, nine of the seventeen teenagers who received the CBD intervention also declared that they had decided to seek some form of treatment. Teenagers with SAD rarely seek help due to the stigma surrounding the condition and for fear of interacting with therapists.

A 2019 retrospective case study reviewed outpatients at a mental health clinic in Fort Collins, Colorado. Forty-seven of the patients sampled had expressed concerns about anxiety. Over three months, the majority of patients were given 25 mg of CBD daily in addition to treatment.

After the first monthly assessment, 79.2% of patients experienced an improvement in anxiety. After two months, 78.1% of patients reported a further improvement compared with the previous month.

However, there were also patients who reported that the symptoms of their anxiety worsened after taking CBD—15.3% felt their anxiety had become exacerbated after the first month and 19.5% felt their anxiety had worsened further after the second month.

Another study, done in 2018, also suggests that CBD may heighten anxiety. It included a small sample of individuals with paranoid traits and found that CBD exacerbated anxiety among some of the participants. Anxiety was measured through symptoms such as cortisol concentration, heart rate, and systolic blood pressure.

These contradictory findings may be due to factors such as small sample sizes and variations in dosing. CBD is a bidirectional medicine, which means it can cause opposing responses at different doses. We’ll delve deeper into this below.

How should I consume CBD for anxiety?

If you’re curious about using CBD oil as a tool to help manage your anxiety, education is critical. Understanding the pros and cons of the various ingestion methods can help you determine which form of consumption best suits your needs.

tinctures and oils represent a quick, easy, and accurate way to consume CBD. Most tinctures contain CBD in an alcohol base. CBD oils contain CBD extracts infused into a carrier oil, such as coconut or hemp seed oil.

Tinctures and oils are taken using a dropper, which allows you to easily measure intake. The cannabinoid rapidly enters the bloodstream when taken sublingually—results can kick in as quickly as ten minutes and last up to three to four hours.

CBD vape oils can be vaped using a special pen that vaporizes the oil. At present, the safety of vaping has come under intense scrutiny. A serious lung condition known as VAPI, or EVALI, has hospitalized more than 2,000 people and led to the deaths of 42. The federal Centers for Disease Control has found that most cases have been linked to the use of illicit-market THC vape cartridges tainted with vitamin E oil (tocopheryl-acetate).

CBD vape cartridges purchased in legal state-licensed cannabis stores are highly regulated, while CBD cartridges purchased from other sources are completely unregulated. Proceed with caution when considering any vaping product in an unregulated environment.

edibles CBD can be added to almost every food under the sun. While super easy to consume in this form—and often delicious, particularly as gummies—it may take an hour or more before results are felt.

What’s more, the oral bioavailability of CBD can hinder CBD absorption—when you consume CBD orally, it has to pass through your gastrointestinal tract before it is metabolized by the liver. As a result, a limited quantity of CBD makes it into the circulatory system.

It’s important to also note that the FDA has recently deemed food containing CBD illegal. You’ll have to get CBD edibles in state-licensed adult-use markets.

smoking provides an almost instantaneous method for enjoying the effects of CBD. Smoking sends the cannabinoid directly to the alveoli of the lungs, and from there, CBD molecules enter the bloodstream for rapid absorption. However, measuring your CBD intake can be tricky when you smoke, and the act of smoking itself can cause lung inflammation.

Dosing CBD for anxiety

If you read the studies cited above, you’ll notice that the dosing varied significantly between them. The teens in the Japanese study were provided with 300 mg of CBD daily, while the outpatients in the Colorado study received 25 mg. Why such a large discrepancy in dose?

As most scientists and clinicians will readily admit, there is no universally recommended dosage for CBD, and, to date, there haven’t been any large-scale clinical trials to inform dosage guidelines. In addition, the FDA is still learning about CBD—such as its cumulative effects on the body—before it decides on how to regulate it.

This doesn’t necessarily mean CBD is unsafe. Existing research already suggests that it appears to be a safe, well-tolerated treatment. If you’re interested in experimenting with CBD to manage your anxiety symptoms, aim for an informed, cautious approach to dosing (which is always a good idea). Below are some dosing considerations.

General dosing tips

Some basic factors that you should consider when devising a CBD dose include:

👉 body weight

👉 metabolism

👉 concentration of CBD

👉 severity of your anxiety

The concentration of CBD varies between products, and is generally expressed as milligrams (mg) per container.

Once you know the potency of the CBD product you hold, you can use a dosage calculator or an app such as Accugentix to help settle on your perfect dose. Dosage calculations can provide a recommended dose in milligrams based on your body weight and the severity of your symptoms.

Your unique body chemistry also affects how you respond to CBD. Some individuals metabolize medicine faster than others, which can be attributed to genes or lifestyle. If you know that you metabolize medication quickly, it’s possible that you may benefit from a higher dose.

Bidirectional effects

CBD may do different things at different doses, a phenomenon known as bidirectional effects. Overstimulation of the body’s endocannabinoid system may exacerbate symptoms instead of alleviating them.

Additionally, high levels of CBD, such as 300 mg, have been known to promote sleepiness and relaxation. Conversely, low levels of CBD may create an elevating response, inciting wakefulness and alertness. The best way to avoid unwanted bidirectional effects is to follow the adage: start low, go slow.

Start low, go slow

Titration refers to the process of adjusting the dosage of a medication to get its maximum benefits without adverse effects. CBD has been shown to be safe even when taken in high doses (300-600 mg), nonetheless, it’s advisable and more cost-effective to start with a low dose and increase it incrementally, observing how you feel as you go.

This method forces you to pay attention to subtle changes in your body as it responds to the medication. Everyone’s optimal dosage and tolerance is unique, and this process allows you to get acquainted with yours.

Dr. Dustin Sulak, a cannabis medicine expert at Healer, offers educational resources for novice and seasoned cannabis users alike to find their optimal dosage.

Talk to an expert on medical cannabis

If you’re still feeling unsure and you live in a state where you can safely converse with a health professional about CBD, consider scheduling a consultation. Some cannabis dispensaries also have medical experts on hand who can provide you with sound advice and dosage recommendations.

Leafly logo

This article written by Emma Stone was originally posted on Leafly.com.

Blessing, E.M., Steenkamp, M.M., Manzanares, J. et al. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics 12, 825–836 (2015). https://doi.org/10.1007/s13311-015-0387-1

https://adaa.org/understanding-anxiety/facts-statistics

Hundal H, Lister R, Evans N, Antley A, Englund A, Murray RM, Freeman D, Morrison PD. The effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group. J Psychopharmacol. 2018 Mar;32(3):276-282. doi: 10.1177/0269881117737400. Epub 2017 Oct 31. PMID: 29086614.

Nobuo, Masataka. Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers With Social Anxiety Disorders. Frontiers in Psychology 10, 2466 (2019). DOI=10.3389/fpsyg.2019.02466    

Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041

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