Patient Guidance

Adapted with permission from ProjectCBD.org. (Swipe left to see more.)

What is Medical Marijuana?

Cannabis has been at the center of one of the most exciting developments in modern science. Research on marijuana's effects led directly to the discovery of a previously unknown biochemical communication system in the human body, the Endocannabinoid System, which plays an important role in regulating our physiology, mood, and everyday experience. Endocannabinoid receptors respond to cannabinoid compounds that our own bodies make, and they respond to cannabis.

The U.S. Food and Drug Administration (FDA) has not recognized or approved marijuana as medicine. Nonetheless, there is a great deal of research—much of it sponsored by the US Government—showing that cannabis contains compounds that may help treat a range of illnesses or symptoms, generally by working on the Endocannabinoid System.

Cannabinoids and other components in cannabis can modulate many systems in the human brain and body. More than 100 cannabinoids have been identified in the marijuana plant. Of these marijuana molecules, tetrahydrocannabinol (THC) and cannabidiol (CBD) have been studied most extensively.

What Is CBD?

Cannabidiol or CBD is a component of the cannabis plant with enormous therapeutic potential. Although it doesn't make people feel high like THC, CBD is causing quite a buzz among scientists, health professionals, and medical marijuana patients who are using CBD-rich products to treat a wide range of conditions—including chronic pain, cancer, Crohn's, diabetes, rheumatoid arthritis, PTSD, cardiovascular disease, anxiety, antibiotic-resistant infections, multiple sclerosis, schizophrenia, and more. Academic research centers around the world are currently studying the effects of CBD on these and other ailments.

Scientists refer to CBD as a "promiscuous" compound because it confers therapeutic benefits in many different ways while tapping into how we function physiologically and biologically on a deep level. Extensive preclinical research and some clinical studies have shown that CBD has strong anti-oxidant, anti-inflammatory, anticonvulsant, anti-depressant, anti-psychotic, anti-tumoral, and neuroprotective qualities. Cannabidiol can change gene expression and remove beta amyloid plaque, the hallmark of Alzheimer's, from brain cells.

What About THC?

CBD and THC are the power couple of cannabis therapeutics. They appear to work best together. For example, CBD is believed to boost THC's painkilling and anticancer properties. CBD can also lessen the side effects of too much THC including anxiety and rapid heartbeat. "Relaxing but not intoxicating" is how some patients described CBD-rich cannabis. CBD and THC both stimulate neurogenesis, the creation of new brain cells, in adult mammals, which may prove helpful for stroke and Parkinson's patients.

Products made from industrial hemp that contains little or no THC are currently being marketed widely. But recent scientific studies suggest that CBD-only products made from hemp of synthetic CBD may be less effective therapeutically than cannabis-based medicines because they lack critical secondary cannabinoids and other medicinal compounds that interact with CBD and THC to enhance their therapeutic benefits. Scientists call this the "entourage effect." Numerous cannabis compounds have medicinal attributes, but the therapeutic impact of whole plant cannabis seems to be greater than the sum of its parts.

What's the Best Way to Take Marijuana?

The best delivery system is one that provides an optimal dose for a desired duration with few unwanted aside effects. Flower for smoking or vaping is available in many medical marijuana dispensaries, but many medical patients prefer smoke-free products made from cannabis extract.

The time of onset and duration of effect vary depending on the method of administration. CBD-rich cannabis oil products can be taken sublingually, orally (as edibles or gel caps), or applied topically. Concentrated cannabis oil extracts can also be heated and inhaled with a vape pen. Inhalation is good for treating acute symptoms that require immediate attention. The effects can be felt within a minute or two and typically last for a couple of hours. The effects of orally administered CBD-rich cannabis oil can last for four hours or more, but the onset of effects is much slower (30-90 minutes) than inhalation.

How Do I Figure Out the Right Dose?

Interest in CBD is huge and growing, particularly among new medical marijuana patients who don't want to get high. But many health professionals have little experience with cannabis therapeutics and have a hard time guiding people in this area.

An effective dosage can range from as little as a few milligrams of CED-enriched cannabis oil to a gram or more. Begin with a small dose of high CBD/low THC oil, especially if you have little or no experience with marijuana. Take a few small doses over the course of the day rather than one big dose. Use the same dose and ratio for several days. Observe the effects and if necessary adjust the ratio or amount. Don't overdo it. Cannabis compounds have biphasic properties, which means that low and high doses of the same substance can produce opposite effects. Small doses of cannabis tend to stimulate; large doses sedate. Too much THC, while not lethal, can amplify anxiety and mood disorders. CBD has no known adverse side effects, but an excessive amount of CBD could be less effective therapeutically than a moderate dose. "Less is more" is often the case with respect to cannabis therapy.

What to Look For

Look for products with clear labels showing the quantity and ratio of CBD and THC per dose, a manufacturing date, and a batch number (for quality control). Select products with quality ingredients: No corn syrup, transfats, GMOs, artificial additives, thinning agents or preservatives. Medical marijuana should be lab tested for consistency and verified as being free of mold, bacteria, pesticides, solvent residues, and other contaminants. It's best to avoid products extracted with toxic solvents like butane or other hydrocarbons. Many cannabis vape oil products include a thinning agent to dilute the cannabis oil. Beware of vape pen oil that contains propylene glycol. When overheated, this chemical additive produces a carcinogen byproduct. If vaping, be sure to find a product with pure cannabis oil and no diluting agents.

Care By Design products are all natural, lab tested and formulated, and contain no harmful ingredients!

What CBD:THC Ratio Should I Take?

There's no single ratio that's right for everyone or every condition. You'll want to find the balance of CBD and THC that works you. A person's sensitivity to THC is a key factor in finding the right ratio and dosage. Many people like the cannabis high. Others find THC unpleasant. CBD can lessen the mind-altering effects of THC, so, a greater ratio of CBD-to-THC (18:1) means less of a high. Care By Design offers several ratios of CBD:THC so you can adjust or eliminate psychoactive effects as you prefer.

Some patterns are beginning to emerge. For anxiety, depression, spasms, psychosis, and seizure disorders, some people report they do best with little THC. For cancer, autism, and other diseases, some patients say they benefit more from a balanced ratio of CBD and THC like the 4:1 or 2:1. Extensive clinical trials conducted outside the United States have shown that a 1:1 CBD:THC ratio can be effective for neuropathic pain. Some people use cannabis products with different CBD:THC ratios at different times of the day, using for example more CBD in the day, more THC at night.

Cautions

Medical marijuana and CBD, in particular, are a very safe, but patients taking other medications should check with their doctor about drug interactions. At sufficient dosages, CBD will temporarily deactivate cytochrome P450 enzymes, thereby altering how we metabolize a wide range of compounds.

Cytochrome P450 enzymes metabolize more than 60 percent of pharmacueticals. CBD is a more potent inhibitor of cytochrome P450 than the grapefruit compound Bergapten, so ask your doctor if grapefruit interacts with your medication. If grapefruit does, then CBD probably does, too. Patients on medical marijuana should monitor changes in blood levels of prescription medications and, if need be, make adjustments as directed by their doctor.

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