It is becoming a well-known fact that medical cannabis is proving to be an effective treatment for a range of medical conditions. As the interest from the medical world and from patients and governments across the globe continues, we want to investigate CBD vs. THC.
The cannabis plant contains about 120 known Cannabinoids. Cannabinoids have a modulatory effect on our endogenous Endocannabinoid system, helping to regulate a diverse range of major functions from our sleep/wake cycles, appetite, mood as well as numerous immune functions and anti-inflammatory effects.
The Cannabinoids that often receive most publicity for their therapeutic use and are often at the centre of interest are THC (Tetrahydrocannabinol) and CBD (Cannabidiol).
CBD and THC - what’s the difference?
CBD has been shown to be useful for treating a range of conditions including epilepsy as well as having anxiolytic, anti-inflammatory, neuroprotective, immunomodulatory and antipsychotic effects. There are no intoxicating effects from CBD so patients generally do not report any difference in their cognitive ability. A recent report by the World Health Organisation showed CBD to exhibit no effects indicative of any abuse or dependence potential as well as being generally well tolerated with good safety profile. Given CBD’s excellent safety profile and wide range of therapeutic uses, it offers have huge potential as an active pharmaceutical ingredient as well being a useful additive to a wide range of consumer product including food and drinks and cosmetics.
THC is well known for its intoxicating and psychoactive properties and is found in high concentrations in illicit street cannabis. Over the past 20-30 years street cannabis used for recreational purposes has been selectively cultivated to contain high levels of THC which can be detrimental to mental health and may trigger psychosis in at risk and susceptible patient groups.
Despite its intoxicating properties, THC can be very useful medically at carefully monitored doses to treat a wide range of symptoms including chronic pain, spasticity, glaucoma, insomnia and nausea and vomiting. It is particularly useful as an adjunct/add-on treatment when other drugs have failed, side effects are intolerable or to enhance the efficacy of existing medications. When combined with CBD (which is a negative allosteric modulator of CB1 receptors), patients are often able to take a lower dose of THC with for same therapeutic effect and will often report a reduction in psychoactive side effects.
The Endocannabinoid system
The human body has a network of receptors which interact with our natural, endogenous cannabinoids to maintain normal functions; otherwise known as the Endocannabinoid system.
The Endocannabinoid system within the human body consists of Cannabinoid receptors, Endocannabinoids and their metabolic enzymes. CB1 and CB2 are the two main Cannabinoid receptors and Anandamide (AEA) and 2-arachidonoyl-glycerol (2-AG) have been identified as our two main Endocannabinoids. CB1 receptors are found mainly in the central nervous system, the GI system, reproductive system, lung, heart and bladder; whereas CB2 receptors are mainly found within the immune system. Activation of CB1 and CB2 receptors inhibits the release of neurotransmitters playing a key role in homeostasis, helping to regulate many physiological pathways including inflammation, pain perception, immunity and metabolism.
Hemp derived CBD products
Over the counter CBD products contain CBD extracted from hemp which differs from other strains of cannabis as it is naturally high in CBD and low in THC. Hemp derived CBD can be sold legally in the UK (officially classified as a novel food) as long as the amount of THC is less than 0.2% and no specific medical claims or health benefits are made. The CBD industry remains largely unregulated and there have been concerns about the quality and safety of some CBD products. The Food Standards Agency has recently asked producers to apply to the Foods Standards Agency for “novel food authorisation” which will hopefully begin to reassure the public about the safety of specific CBD products.
Since the re-scheduling of cannabis in November 2018, cannabis based medical products containing higher amounts of THC can be prescribed by any specialist doctor on the GMC register as a controlled schedule 2 drug.
Education for doctors
While medical cannabis is now being discussed globally as an additional or alternative treatment for patients, it is important for medical practitioners to fully understand the Endocannabinoid system and the various types of cannabis based medical products that are available to prescribe. Patients are becoming more informed of the medical benefits of cannabis and how it may improve conditions that have not responded well to more conventional therapies. This further heightens the importance of GPs developing their understanding of this new area within clinical medicine.
The Primary Care Cannabis Network aims to expand the knowledge of cannabis-based medical treatments and is focussed on academic research, education, key-papers and open discussions. We focus specifically on the needs of GPs and as more GPs across the UK reach out to the Primary Care Cannabis Network for more information on medical cannabis, a bigger community is forming which will enable GPs to confidently work together and with specialists to understand the various regulatory pathways and that exist for patients within the UK.
Moving forwards into 2020, the PCCN will host a series of events on medical cannabis and will also be key-note speakers at other seminars within the industry. For more information on these events or to be kept up-to-date with the latest news and member meeting, subscribe to our Journal Club today.