In the first part of this episode of the Medical Cannabis Podcast: A Beginner’s Guide, we looked at “Who should not use Cannabis” according to the British Columbia College of Physicians and Surgeons.
And in the second part of this episode we looked at Cannabis and anxiety. (Particularly CBD for anxiety.) Why do some people say Cannabis causes anxiety, yet others use Cannabis to treat their anxiety?
You can listen to the episode right here on this webpage by clicking the large green triangle below.
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BC Doctors say Medical Cannabis is “generally not appropriate” for these people
We are highlighting this list from one province’s Medical community (British Columbia). Other jurisdictions may have a completely different list of people who shouldn’t use medical cannabis.
I give a brief explanation as to why I think each of these types of people are on the list.
- are under the age of 25
- have a personal history or strong family history of psychosis
- have a current or past cannabis use disorder
- have an active substance use disorder
- have cardiovascular (angina, peripheral vascular disease, cerebrovascular disease, arrhythmia) or respiratory disease
- are pregnant, planning to become pregnant or are breastfeeding
Patients under the age of 25
The doctors’ concern here is that cannabis may affect the young person’s own internal Endocannabinoid system.
Because a young person’s Endocannabinoid System is still developing doctors are worried that using phytocannabinoids from the cannabis plant will augment or change the way the person’s Endocannabinoid System develops.
Can loosely think of it as affecting the growth and development of the person’s Endocannabinoid system.
Patients that have a personal history or strong family history of psychosis
The concern here is that if a patient is consuming a cannabis product containing THC (the phytocannabinoid that can cause the high or stone associated with Cannabis) they may be at increased risk of experiencing psychosis-symptoms or worsening of their existing schizophrenia symptoms.
Earlier use in life, for instance in their teen years, may also cause people to start experiencing schizophrenia symptoms earlier than non-users.
Researchers from Israel found that using cannabis when you’re a teenager may act like a catalyst and tip the scales for people that are at risk of schizophrenia. This ties in to the notes above about people under the age of 25 using Cannabis.
This report from the US’ National Institute on Drug Abuse states that there is likely a genetic issue involved, and that they consider the relationship between Cannabis and schizophrenia an “association” not a cause (at least currently with the existing level of evidence). But you can see why the BC College of Physicians and Surgeons are being cautious at this point.
Interestingly, the other most popular phytocannaboid, Cannabidiol (or CBD for short), may actually help improve schizophrenia symptoms. At this point the exact mechanism – or way it works – as an antipsychotic is not known, but it is being researched.
I believe this discrepancy between how THC affects schizophrenia versus how CBD affects schizophrenia will one day result in BC’s College of Physicians and Surgeons being more clear in their statement.
So instead of just saying people with a history of schizophrenia should avoid cannabis, they may want to say “avoid high-THC or THC-dominant Cannabis products.” But that will take more research.
Patient that have a current or past cannabis use disorder
This makes sense from a Doctor’s standpoint: why would they suggest a drug when the patient already overuses it or has overused it in the past.
It is a little tough to tease out the data between medical users and recreational cannabis users, but some data has suggested that 9% of cannabis users develop an addiction. Once again, this is based on recreational users who usually seek a higher-THC product in order to experience a high or a stoned effect.
Patients that have an active substance use disorder
I think this makes sense that doctors are cautious here as well. If they have a patient that already overuses and abuses another substance then they are worried the patient may be at risk of developing a cannabis use disorder.
Patients that have cardiovascular (angina, peripheral vascular disease, cerebrovascular disease, arrhythmia) or respiratory disease
This is an interesting one because the Doctor’s have changed the wording on their list since we recorded the audio for the podcast back in August 2018. A few months ago it didn’t have the “(angina, peripheral vascular disease, cerebrovascular disease, arrhythmia)” part. It simply stated patients “with cardiovascular or respiratory disease.”
In the podcast you’ll hear me state that I think the Doctor’s need to change the wording and get more specific about what they mean by “cardiovascular disease.” And they have done that. (Not by my prodding, but on their own.)
THC can affect heart rate (generally if you take too much compared to what you’re used to). It can speed up your pulse and in medical terms they call this “tachycardia.”
If a patient already has a heart arrythmia where their heart doesn’t beat “properly” then you can see the concern with them taking something that could further affect heart rate.
Authors of a study on PubMed (listed below) claim that Cannabidiol (CBD) does not affect heart rate like THC. CBD doesn’t raise the pulse or affect blood pressure under normal conditions and may actually lower or maintain normal heart rate and blood pressure in stressful conditions.
“A Systematic Review and Meta-Analysis of the Haemodynamic Effects of Cannabidiol.” in the journal Frontiers in Pharmacology.
Available online with the link below: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323388/
I believe the respiratory disease portion of the statement is that Doctors are concerned with patients with lung disorders smoking cannabis. Smoking cannabis doesn’t have same effect as cigarettes on the lungs (in most regards) but smoking it can cause airway irritation. So you can see why they don’t want to further aggravate irritated airways by inhaling combustion by-products (aka smoke).
Patients that are pregnant, planning to become pregnant or are breastfeeding
This ties in to part 1 above. If they believe a person under the age of 25 shouldn’t use it, then they sure don’t want a baby in the womb or a breastfeeding infant to be “using” it. There just isn’t the data (that I’m aware of anyway) to support Cannabis use in this population.
Part Two of the Podcast- Cannabis and Anxiety
When some people use cannabis they experience anxiety or paranoia, yet other people use medical cannabis for anxiety.
Why is that?
This generally depends on what type of cannabis product the patient is using.
If the patient is not used to consuming THC…we call this THC-naïve…and then they consume too much at once, they may experience anxiety (an unpleasant adverse effect). Reports claim that having some CBD in with your THC may help offset these negative effects of THC. It may help “balance” out THC’s effects.
CBD for Anxiety
CBD is said to have anxiolytic properties.
If you ever read that a product has “anxiolytic” properties this means it can reduce anxiety. The “anxio” part meaning pertaining to anxiety, and the suffix “lytic” means destruction. So it breaks down or destroys anxiety.
Some of the anxiety studies used pure Cannabidiol (pure CBD, likely from a lab). Most of the individuals I know that use Medical Cannabis for anxiety use a CBD-rich whole plant extract.
There is a belief that using the plant as a whole may provide an “entourage” effect. So instead of just using CBD made in a lab you consume an extract from the plant which contains other cannabinoids and terpenes (the fragrant molecules in the plant).
Public Speaking Tests to Stimulate Anxiety
In the podcast I mention a study where they give CBD to people before giving a public speech. (The link is below.)
They use public speaking as a way to cause anxiety in people. They know most people dread the thought of public speaking! So they pretreat them with their study drugs to see how the drug affects their reaction to the public speaking.
In the study I refer to they use pure CBD powder. They don’t use plant-based medicine. And the pure CBD did work to relieve some anxiety symptoms in the study participants.
They found a “bell-shaped curve” or “upside-down U” type response to CBD dose and benefits. So a higher dose isn’t better for anxiety.
I do wonder if CBD-rich whole plant extract could achieve similar results but require a lower dose than the 300mg used in the study? We’ll likely find answers to questions like these in the next few years as more research is performed.
In the book “Cannabinoids and the Brain” by Linda Parker she states that CBD can reduce anxiety at lower doses.
This is likely due to an interaction with Serotonin receptors. But once you start increasing the dose, CBD starts interacting with different receptors. And then it seems to no longer work at higher doses. The author claims that higher doses of CBD doesn’t cause anxiety, but that it just no longer works to reduce anxiety.
This helps to reiterate the point about “Start Low and Go Slow” when it comes to dosing medical cannabis.
Start Low and Go Slow
After you talk to your doctor about Cannabis, and if you decide that Medical Cannabis is appropriate for you, you need to start low and go slow especially if you are using it for anxiety. Because if you ramp up your dose too quickly you may inadvertently increase your dose beyond the effective anti-anxiety dose. Then you’ll say, “This doesn’t work!” Where really you should say “This dose isn’t working.”
And remember that every person is different. So, a dose that worked on your friend or family may not be appropriate for you.
Thank you very much for checking out this information highlighted on Episode 4 of the Medical Cannabis Podcast: A Beginner’s Guide.
If you have any friends or family that you think may benefit from this information, please share it with them.