THC, CBD: Understanding the Popular Cannabinoids

 

Cannabis has a number of active compounds in it, called cannabinoids. There are 100 different cannabinoids found in cannabis. The two most common and most studied are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Aphria currently offers three types of cannabinoid-dominant products: CBD dominant products, THC dominant products, and THC:CBD balanced products.

Understanding the differences between each product type is important when using cannabis for medicinal purposes as the ratio of THC to CBD in product impacts the therapeutic effects of the product.  How Cannabis Works in Pain Management

Cannabinoids, such as THC, act on cannabinoid receptors that are located throughout the body and are involved in relaying and processing sensory information from painful stimuli 8. Animal studies have shown that activation of cannabinoid receptors following a painful event has analgesic properties (e.g., neuropathic pain, inflammatory pain) 7,9. While it is still unclear how exactly cannabinoids can lead to a reduction in pain, research suggests that their effects involve both CB1  and CB2  receptors, with some actions being tied to modulation of inflammatory responses 7. More research involving placebo-controlled clinical trials are needed, however, to understand the actions and efficacy of cannabis/cannabinoids for treating chronic non-cancer pain.

Therapeutic Uses of THC and CBD

Both THC and CBD contribute to the therapeutic effects of cannabis. The type and ratio of cannabinoids present in a product help to determine its benefits. Research indicates that THC dominant, CBD dominant and THC:CBD balanced products can be helpful for treating certain diseases and/or symptoms including the following:

 

Therapeutic Use* CBD dominant THC dominant THC: CBD Balanced Reference
Suppression of nausea and vomiting as a result of chemotherapy X [5,6]
Improvement of symptoms resulting from multiple sclerosis and spinal cord injury X [7-10]
Epilepsy X [11-14]
Chronic non-cancer or neuropathic pain X X [15-18]
Glaucoma X [19-20]
Sleep Disorders X [21-22]

 

In addition, THC is the cannabinoid responsible for the intoxicating effects of cannabis (i.e., causes the feeling of being high), whereas CBD produces little to no feelings of intoxication [1,2]. In general, undesired effects from cannabis products (i.e. dizziness, increased heart rate, and fatigue) are related to the amount of THC consumed [1,2]. Some studies show that CBD can decrease potential unwanted side effects that may be caused from THC (i.e. anxiety) [3,4]. Although further research is needed to better understand the interaction between THC and CBD, patients that are seeking the therapeutic effects of THC may wish to use a balanced product if they have experienced or have concerns about experiencing side effects. 

 

When considering using cannabis oil for medicinal purposes it’s important to first speak with your healthcare practitioner so that a proper assessment, diagnosis and product recommendation can be made. It’s also important to let your doctor know which types of medication you are taking, as THC and CBD can interact with certain drugs.

* This table has been provided for informational purposes only and is not intended to be used for product selection purposes.

 

The therapeutic effects of medical cannabis are influenced by the cannabinoids that are present in that product. The ratio of the cannabinoids (eg. THC to CBD) helps to determine the potential therapeutic effects, as well as possible associated side effects. After working with your healthcare practitioner to select a product and determine dosage, remember start low and go slow until an effective dosage that maximizes therapeutic effects and minimizes the potential for unwanted side effects is found.

 

References

[1] Health Canada (2016). Acccess to Cannabis for Medical Purposes Regulations – Daily Amount Fact Sheet (Dosage). [Online}.

[2] MacCallum and Russo (2018) Practical consideration in medical cannabis administration and dosing. European Journal of Internal Medicine 49:12-19.

[3] Robson PJ (2014) Therapeutic potential of cannabinoid medicines. Drug Test. Anal. 6(1-2):24-30.

[4] Zuardi, et al. (1982). Action of cannabidiol on the anxiety and other effects produced by 9-THC in normal subjects. Psychopharmacology 76(3):245-250.

[5] Meiri E, Jhangiani H, Vredenburgh JJ, Barbato LM, Carter FJ, Yang HM, Baranowski V. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin 2007 03;23(1473-4877; 0300-7995; 3):533-43.

[6] Elder JJ, Knoderer HM. Characterization of dronabinol usage in a pediatric oncology population. J Pediatr Pharmacol Ther 2015 Nov-Dec;20(6):462-7.

[7] Vaney et al. (2004) Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patient with multiple sclerosis: a randomized, double-blind placebo controlled crossover study. Multiple Sclerosis 10:417-424.

[8] Flachenecker et al. (2014) Nabiximols (THC/CBD Oromucosal Spray, Sativex ®) in clinical practice -results of a multicenter non-interventional study (Move 2) in patients with multiple sclerosis spasticity. European Neurology 71:271-279.

[9] Freidel et al. (2015) Drug resistant MS spasticity treatment with Sativex ® add-on and driving ability. Acta Neurologica Scandinavia 131:9-16.

[10] Ferre et al. 2016. Efficacy and safety of nabiximols (Sativex ®) on multiple sclerosis spasticity in a real-life Italian monocentric study. Neurol Sci 37:235-242.

[11] Devinsky et al. (2016) . Cannabidiol in patients with treatment-resistant epilepsy: An open-label interventional trial. Lancet Neurol 15(3):270-8.

[12] Devinsky et al. (2017) Cannabidiol in Dravet Syndrome Study Group. Trial of cannabidiol for drug-resistant seizures in the dravet syndrome. N Engl J Med 376(21):2011-20

[13] Devinsky et al. (2018) Effect of cannabidiol on drop seizures in the lennox-gastaut syndrome. N Engl J Med 378(20):1888-97.

[14] Tzadok et al. (2016) CBD-enriched medical cannabis for intractable pediatric epilepsy: The current israeli experience. Seizure 35:41-4.

[15] Svendsen et al. (2004). Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomized double blind placebo controlled crossover trial. BMJ 329:253-60.

[16] Rog et al. (2005) Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 813-819

[17] Nurmikko et al. (2007). Sativex successfully treats neuropathic pain characterised by allodynia: A randomised, double-blind, placebo-controlled clinical trial. Pain 133: 210-20.

[18] Hoggart et al. (2015) A multicentre, openlabel, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain. J Neurol 262(1):27-40

[19] Flach AJ (2002) Delta-9-tetrahydrocannabinol (THC) in the treatment of end-stage open-angle glaucoma. Trans Am OphthalmolSoc 100:215-22.

[20] Tomida et al. (2006) Effect of sublingual application of cannabinoids on intraocular pressure: A pilot study. J Glaucoma 10: 349-53.

[21] Roitman et al. (2014) Preliminary, Open-Label, Pilot Study of Add-On Oral ∆9-Tetrahydrocannabinol in Chronic Post-Traumatic Stress Disorder. Clin Drug Investig 34:587-591.

[22]  Brady et al. (2004) An open-label pilot study of cannabis-based extract for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis 10:425-433.

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