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CBD: Medical “Marijuana” Without the High

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Now legal in 29 states, medical cannabis (aka marijuana) can treat a wide variety of ailments from cancer pain to seizures. But what if you don’t want to get high to get relief?

That’s where cannabidiol (CBD), a compound derived from marijuana, comes in. Unlike its more famous cousin, tetrahydrocannabinol (THC), CBD doesn’t cause even mild euphoria…or give you the munchies.

Yet CBD is the subject of some of the most exciting medical research in the field today—it has numerous potential therapeutic applications that may turn it into the next wonder drug for treating epilepsy, anxiety, Alzheimer’s and a host of other diseases and ­ailments.

Case in point: Epidiolex, a newly developed drug (key ingredient: CBD), reduces seizures by 39% in children with a rare form of epilepsy, Dravet syndrome. It’s been submitted to the FDA for approval as a prescription drug.

But many people aren’t waiting for FDA approval to buy CBD. It is widely available in many states and online, even though the Federal Drug Enforcement Agency classifies it as an illegal narcotic.

To learn more about its medical uses, Bottom Line Personal spoke with David Bearman, MD, a leading authority on cannabinoid medicine. He emphasized that people with medical conditions who are interested in CBD should first discuss it with their doctors. His ­answers to our questions…

Isn’t CBD actually psychoactive—the reason medical marijuana is so ­controversial?

It is—but not the way people might think. Like THC, it crosses the blood-brain barrier and binds to receptors in the brain—that’s how it can reduce pain. It also affects the immune system to reduce inflammation. But unlike THC, CBD doesn’t cause euphoria or dysphoria—feeling uneasy, anxious or too out of touch with reality.

What forms does CBD come in?

It’s available in a wide variety of forms including a liquid tincture, capsules, an oil for use in a vaporizer (aka vaping) and in sprays that can be inhaled or sprayed under the tongue. There also are topical CBD creams to help with muscle pain. Some companies also produce synthetic forms of CBD.

Is CBD addictive?

No. There is no addictive aspect to CBD whatsoever—or, for that matter, to THC.

What do we know currently about what kinds of patients CBD can help?

The list of diseases and conditions that CBD can improve and the symptoms that it can relieve actually is quite long. I’ll discuss a few…

Epilepsy. Research shows that CBD helps prevent seizures. Many doctors now are not waiting for an FDA-­approved drug—they already are recommending it in tincture or capsules.

Anxiety. A New York University School of Medicine review found that CBD can treat anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Other research has found that it has effects similar to some antipsychotic drugs—it may be effective in treating patients with schizophrenia.

Alzheimer’s and Parkinson’s. CBD’s neuroprotective properties may help stem the progression of Alzheimer’s disease and Parkinson’s disease, among other brain diseases. While more research is needed, I believe that people at high risk for either disease—and certainly those in the early stages—should use CBD.

Other conditions. CBD is being studied for its possible therapeutic effect on diabetes, stroke, rheumatoid arthritis, psoriasis, multiple sclerosis, fibromyalgia and osteoarthritis. It also contributes to the inhibition of cancer cell growth. But more research is needed in all these areas.

There always are drawbacks with any drug—what are CBD’s?

CBD may cause fatigue, nausea and changes in appetite. A more serious concern is that CBD reduces the speed at which the body metabolizes the blood thinner warfarin (Coumadin)—if you’re taking the two together, let your doctor know. He/she will want to monitor your blood-clotting factors closely and may need to reduce your warfarin dosage.

Are there conditions for which using CBD in combination with THC is more beneficial than CBD alone?

Absolutely. In my experience, CBD paired with THC works better for treating epilepsy and for reducing chronic pain. CBD’s principle contribution to treating chronic pain is its anti-inflammatory properties. Often the THC dose can be low enough (5 mg or less) that there’s no sense of being high. Plus, CBD partially reduces the euphoric effect of THC. A patient may want to start with CBD and then, if needed, add a little THC to see whether it makes a beneficial ­difference.

How can doctors and patients tell the right amount of CBD to take?

There’s not enough research to make any definitive statements about dosing. Every individual is different—your size, age and the illness you’re treating will affect how much you require for treatment.

My advice: Work with a knowledgeable health professional who can help you adjust the dose, the THC/CBD ratio, discuss whether to include other cannabinoids, explore the best way for you to take CBD, address possible side effects—and follow your medical progress. My advice to my patients is to start at a low dose and increase it slowly if needed.

What’s the best form to take?

I generally advise taking CBD orally, not by inhalation or topically. You’ll get the fastest effects with inhaling/vaping, but those effects last only about three hours. Taking CBD orally means that the effects can last up to seven hours.

The route of CBD administration depends on how rapidly you need it to start working…and how long you want the therapeutic effects to last. Different patients prefer different routes of administration—respiratory (vaping)…oral (tinctures, edibles, pills)…topical or suppository. But with so many routes of administration, it is best to discuss your preference with your ­physician.

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Source: David Bearman, MD, vice president of the American Academy of Cannabinoid Medicine and author of the forthcoming book Abridged Guide to Cannabinoid Medicine Practice. He is in private practice in Goleta, California. Date: April 15, 2018
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