Doctor & CBD

What is CBD: Everything You Need To Know

As a doctor, the question I most commonly get asked about CBD is, “What is CBD?” CBD is the abbreviated form of “cannabidiol.” The answer, in short, is that CBD is a compound found in the cannabis plant that offers some therapeutic benefits – although, it does not give users a ‘high’ like its better-known cousin THC.

CBD is a single molecule, which comes from a family of similar compounds called cannabinoids. The cannabinoid family also includes THC, short for “tetrahydrocannabidiol.” There are only slight structural differences between CBD and THC, but they have very different effects. THC is the cannabis compound most widely known for its euphoric side-effects or “high.” Scientists widely agree “that 1 Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016 Grotenhermen, F., Russo, E., & Zuardi, A. W. (2017). Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016; 1 (1): 102–112; DOI: 10.1089/can. 2015.0004. Cannabis and cannabinoid research, 2(1), 1-4. Grotenhermen, F., Russo, E., & Zuardi, A. W. . While both compounds have potential benefits, CBD is currently of the most therapeutic interest.

The difference between the chemical structure of CBD and THC

What Are Cannabinoids?

CBD is a therapeutic cannabis compound, part of a larger group of compounds called cannabinoids. But what are cannabinoids? Cannabinoids are organic compounds that are naturally found in plants and mammals, including humans. Cannabinoids can be further broken down into two categories: endocannabinoids and phytocannabinoids. Endocannabinoids are produced inside mammals’ bodies (endogenously) and the kind produced by plants are called phytocannabinoids (phyto- means relating to a plant). Thus, the two most abundant cannabinoids produced in cannabis plants, CBD and THC, are called phytocannabinoids. Other phytocannabinoids being investigated for benefits include CBG, THCV, and CBC. These are only a few of many cannabinoids found in plants; nearly 150 phytocannabinoids have been identified to date 2 A novel phytocannabinoid isolated from Cannabis sativa L. with an in vivo cannabimimetic activity higher than Δ9-tetrahydrocannabinol: Δ9-Tetrahydrocannabiphorol. Citti, C., Linciano, P., Russo, F., Luongo, L., Iannotta, M., Maione, S., … Cannazza, G. (2019). A novel phytocannabinoid isolated from Cannabis sativa L. with an in vivo cannabimimetic activity higher than Δ9-tetrahydrocannabinol: Δ9-Tetrahydrocannabiphorol. Scientific Reports, 9(1). Citti, C., Linciano, P., Russo, F., Luongo, L., Iannotta, M., Maione, S., … Cannazza, G. .

Common Phytocannabinoids: CBD & THC

What does the research say about these two popular phytocannabinoids? Since the discovery of CBD in 1940, studies have suggested it may have health effects and therapeutic benefits to aid a variety of conditions and diseases, including: inflammation, nausea, anxiety, depression, mild pain, stroke risk, certain seizure disorders, oxidative stress on neurons, and acne 3, 4 The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press. National Academies of Sciences, Engineering, and Medicine. . Although human trials are currently limited, many studies, primarily performed on mice, indicate that CBD has worthwhile clinical research potential. Similarly, THC has properties that help with nausea, inflammation, nerve oxidation, and several forms of pain (chronic, cancer, and neuropathic) 5 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx. . However, there are many people that avoid THC due to the possible side-effects of sedation, euphoria, increased heart rate, anxiety, panic, and dry mouth 6 Medical cannabis adverse effects & drug interactions. Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., … & Kasimu-Graham, J. (2019). Medical cannabis adverse effects & drug interactions. [PowerPoint Slides]. Government of the District of Columbia: Department of Health. Retrieved from: https://dchealth.dc.gov/dcrx Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., & Kasimu-Graham, J. .

CBD can be taken on its own, but there is a decent collection of evidence to show that taking CBD boosts the therapeutic effects of THC while reducing some of its unwanted side-effects 4 Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. Russo E. B. . A review of 16 studies concluded that CBD may reduce some short-term negative effects of THC, like intense experiences of anxiety or psychosis-like effects. CBD is believed to block the formation of 11-OH-THC, which is a form of THC about four times more powerfully psychoactive, and comes from digesting THC-infused edibles 5, 7 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx. .

How does CBD work?

So, how does CBD work? You might remember that I mentioned the two types of cannabinoids earlier: endocannabinoids, the cannabinoids our bodies naturally produce, whether we consume cannabis products or not, and phytocannabinoids, the ones that come from plants.  Cannabinoids, from both plants or ourselves, interact with our body’s endocannabinoid system. This system has two main cannabinoid receptors, CB1 and CB2. CB1 receptors are found all throughout our bodies and are concentrated in the brain and spinal cord. They play a role in things like appetite, pain, and our perceptions 3 The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press. National Academies of Sciences, Engineering, and Medicine. . CB2 receptors are found largely in our immune cells and can change our response to inflammation and pain. However, there are no CB receptors in our brain’s breathing centers, likely explaining the nonexistence of overdose deaths from cannabinoids.

THC can partially activate CB1 and CB2 receptors. By contrast, CBD does not directly activate either CB receptors. This may explain the lack of “high” for the CBD consumer. Instead, CBD increases the levels of our own endocannabinoids and changes their effects. CBD is further different from THC in that it can interact with a greater variety of other receptors in our body, causing a wider range of therapeutic benefits 3 The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press. National Academies of Sciences, Engineering, and Medicine. .

Sources of CBD

CBD can come from two plants: marijuana or hemp. Both hemp and marijuana belong to the same cannabis plant species, but they differ greatly in their production strategies and cannabinoid content. Most notable is their difference in THC content. Cannabis plants that have a greater CBD to THC ratio are called hemp, whereas plants that have a greater THC to CBD ratio are considered marijuana. In general, hemp contains very little THC; it is a more fibrous and non-intoxicating relative of marijuana. In the U.S. and Canada, hemp is required by law to contain less than 0.3% THC, but no specified amount of CBD 5, 8 An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx. . Levels of THC less than 1% cannot get you high. Hemp is most commonly cultivated for its industrial, cosmetic, and cooking benefits, whereas marijuana is cultivated for its therapeutic benefits and its recreational, psychoactive effects. The ratio of THC to CBD produced determines the plant’s recreational potential, medicinal uses, and even legality.

Hemp Versus Cannabis Plant

Interestingly, “both 9 Cannabidiol Critical Review Report World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf World Health Organization . Special enzymes in cannabis plants can turn CBGA into either THCA or CBDA. The “A” just means that they are the acidic, earlier forms of THC and CBD (precursors). They turn into active THC or CBD when triggered by light, heat, or aging.  This is why raw plants and products, like fresh cannabis leaves and flowers that have not been dried or cured, will not have the sought after effects of CBD and/or THC. It isn’t until the plant is cut, dried, and heated that these acidic molecules transform into active CBD and THC.

Hemp oil vs CBD oil

How is hemp oil different from CBD oil? When choosing between hemp and CBD oil, keep in mind that the hemp oil you see at commercial retailers is typically made using only hemp seeds. The seeds are cold-pressed into an oil, which can provide health benefits, but does not offer the same therapeutic effects of CBD, since the hemp seeds contain virtually no detectable amounts of cannabinoids. CBD is mostly concentrated in the female flower buds of the plant, but it can also be found in the leaves and other plant parts as well, so CBD is typically extracted from the whole plant (just not the seeds). In general, CBD oil is made by heating and passing a solvent or oil through cannabis plant material.

It is important to look for third-party testing results before buying any CBD oil. Hemp oil is required to contain less than 0.3% THC, but CBD oil made from whole cannabis can contain all sorts of cannabinoids (including THC) at various levels. A reputable CBD brand should have test results available for their products that show what levels of CBD and THC are present, as well as any impurities.

Different cannabinoid profiles

You will find a wide array of CBD products on the shelves of CBD retailers and dispensaries. This can be intimidating for a first-timer, but I’ll help explain the most common CBD labeling terms: isolate, full-spectrum, and broad-spectrum. Choosing which type of CBD you buy really boils down to what cannabinoids you want to take, and if the seller has third-party testing to prove their worth.

A CBD isolate product should contain only purified CBD, with all other cannabinoids and plant impurities removed. Isolate products will contain no detectable THC, and are >99% pure CBD. This is the most sure-fire way to ensure your product does not contain THC and you will not get high. Still, you may wish to abstain from CBD products altogether if you are subject to THC drug screening. While no detectable amounts of THC may be present at lab testing, there is still a very small chance that tiny amounts of THC can build up over time in your body when taking cannabis products.

Taking CBD by itself as an isolate has many benefits, however, taking CBD with other cannabinoids can boost the therapeutic effects. This is called the entourage effect 4 Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. Russo E. B. . A broad-spectrum product will contain CBD plus a wide range of other cannabinoids (except for THC). Broad-spectrum CBD products may also contain beneficial terpenes. Terpenes are organic compounds found in many species of plants that may improve the actions of cannabinoids 4, Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. Russo E. B. . If you are more interested in making the most of THC and CBD’s therapeutic potential, full-spectrum products will fit the bill.

Cautions About CBD

It is important to be aware of the laws and regulations in your area before purchasing, consuming, or transporting CBD or other cannabinoids. Keeping in mind certain jurisdiction restrictions, . Any plants that are grown with the intention to sell require a license. Things are a bit more complicated in the U.S., as many U.S. states have their own laws on CBD.

Federally speaking, the 2018 U.S. Farm Bill only technically legalized hemp and its derived products, but that does not mean either CBD or THC is federally legal. CBD extracted from marijuana is still a Schedule 1 drug according to the DEA. CBD products made from hemp containing >0.1% THC are now Schedule 5 drugs and may be sold with a permit 10 Epidiolex GW Pharmaceuticals, Inc. (2018). Epidiolex GW Pharmaceuticals, Inc. . However, the FDA still regulates CBD under the FD&C Act.

The FDA maintains that CBD is only clinically approved pharmaceutically in the form of Epidiolex for rare childhood seizure disorders. CBD cannot be sold as a food or dietary supplement. Any health claims related to specific CBD products must first be approved by the FDA. Be wary of sites that claim their CBD products can prevent, treat, mitigate, or cure any serious disease – as that is against the law. This article, for example, is for informational purposes only and does not constitute medical advice.

According to the World Health Organization, CBD is generally safe, well-tolerated, and does not cause dependence 9 Cannabidiol Critical Review Report World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf World Health Organization . However, it can interact with important medications 6 Medical cannabis adverse effects & drug interactions. Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., … & Kasimu-Graham, J. (2019). Medical cannabis adverse effects & drug interactions. [PowerPoint Slides]. Government of the District of Columbia: Department of Health. Retrieved from: https://dchealth.dc.gov/dcrx Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., & Kasimu-Graham, J. . It may also potentially cause liver damage in very high doses 11 Schedules of Controlled Substances: Placement in Schedule V of Certain FDA-Approved Drugs Containing Cannabidiol; Corresponding Change to Permit Requirements. Schedules of Controlled Substances: Placement in Schedule V of Certain FDA-Approved Drugs Containing Cannabidiol; Corresponding Change to Permit Requirements. A Rule by the Drug Enforcement Administration, 21 C.F.R. § 1308 – 1312. 2018. . These reasons, among others, are why it is important to speak with your healthcare provider first before beginning a CBD regimen. You should only take medical advice from your personal doctor. Never stop taking your prescribed medications unless directed by your doctor.

Sources
  1. Grotenhermen, F., Russo, E., & Zuardi, A. W. (2017). Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016; 1 (1): 102–112; DOI: 10.1089/can. 2015.0004. Cannabis and cannabinoid research, 2(1), 1-4.
  2. Citti, C., Linciano, P., Russo, F., Luongo, L., Iannotta, M., Maione, S., … Cannazza, G. (2019). A novel phytocannabinoid isolated from Cannabis sativa L. with an in vivo cannabimimetic activity higher than Δ9-tetrahydrocannabinol: Δ9-Tetrahydrocannabiphorol. Scientific Reports, 9(1).
  3. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press.
  4. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364.
  5. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx
  6. Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., … & Kasimu-Graham, J. (2019). Medical cannabis adverse effects & drug interactions. [PowerPoint Slides]. Government of the District of Columbia: Department of Health. Retrieved from: https://dchealth.dc.gov/dcrx
  7. Freeman, A. M., Petrilli, K., Lees, R., Hindocha, C., Mokrysz, C., Curran, H. V., … & Freeman, T. P. (2019). How does cannabidiol (CBD) influence the acute effects of delta-9-tetrahydrocannabinol (THC) in humans? A systematic review. Neuroscience & Biobehavioral Reviews.
  8. Health Canada. (2019). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about/cannabidiol.html
  9. World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf
  10. GW Pharmaceuticals, Inc. (2018). Epidiolex [package insert].
  11. Schedules of Controlled Substances: Placement in Schedule V of Certain FDA-Approved Drugs Containing Cannabidiol; Corresponding Change to Permit Requirements. A Rule by the Drug Enforcement Administration, 21 C.F.R. § 1308 – 1312. 2018.

How do the effects of THC and CBD differ?

Learn all the in's and outs of using CBD.

Sources
  1. Grotenhermen, F., Russo, E., & Zuardi, A. W. (2017). Even High Doses of Oral Cannabidiol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016; 1 (1): 102–112; DOI: 10.1089/can. 2015.0004. Cannabis and cannabinoid research, 2(1), 1-4.
  2. Citti, C., Linciano, P., Russo, F., Luongo, L., Iannotta, M., Maione, S., … Cannazza, G. (2019). A novel phytocannabinoid isolated from Cannabis sativa L. with an in vivo cannabimimetic activity higher than Δ9-tetrahydrocannabinol: Δ9-Tetrahydrocannabiphorol. Scientific Reports, 9(1).
  3. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press.
  4. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364.
  5. DOH DCRx. (2015). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx
  6. Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., … & Kasimu-Graham, J. (2019). Medical cannabis adverse effects & drug interactions. [PowerPoint Slides]. Government of the District of Columbia: Department of Health. Retrieved from: https://dchealth.dc.gov/dcrx
  7. Freeman, A. M., Petrilli, K., Lees, R., Hindocha, C., Mokrysz, C., Curran, H. V., … & Freeman, T. P. (2019). How does cannabidiol (CBD) influence the acute effects of delta-9-tetrahydrocannabinol (THC) in humans? A systematic review. Neuroscience & Biobehavioral Reviews.
  8. Health Canada. (2019). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about/cannabidiol.html
  9. World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf
  10. GW Pharmaceuticals, Inc. (2018). Epidiolex
  11. Schedules of Controlled Substances: Placement in Schedule V of Certain FDA-Approved Drugs Containing Cannabidiol; Corresponding Change to Permit Requirements. A Rule by the Drug Enforcement Administration, 21 C.F.R. § 1308 – 1312. 2018.

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