The Growth of Cannabis Medicine – The CBD Era

(Whatever Happened to Smoking Pot to Get High?)

By Deborah Malka, MD, PhD

                  The main objections to the use of marijuana as a medicine include, 1) it must be smoked and that is detrimental to your health, and 2) that it gets you high, or at worst, disoriented. What if that were not currently the truth as we know it? Times have changed. In the past 8 years that I have been specializing in cannabis medicine, I have seen a drastic change in the usage of marijuana as a medicine in my patient population. Surveys conducted in the 1990s in California reported that over 90% of people who used marijuana as medicine were smoking it. Now, we estimate that about half, 50% of the pot consumed by medical marijuana patients is not smoked, but is delivered by oral, topical or vaporized routes. And, there are an increasing number of patients who not only don’t want to get high, but are actively seeking new forms of the cannabis plant that offer medicinal value without the disruptive disorienting effect. It is a new era for cannabis medicine, and here, in California, there are approximately one million medical marijuana patients who are creating a new history.

We are entering the CBD era of medicinal cannabis. The cannabis plant contains up to 80 different compounds of the cannabinoid type, of which THC (tetrahydrocannabinol), is the most well known. Strains with high levels of THC have previously been the most sought after, as it is responsible for marijuana’s psychoactive effect. In nature, the second most prevalent cannabinoid is CBD (cannabidiol), which is not psychoactive, often found in higher levels in cannabis indica plants. It happens that most of the higher CBD plants were cloned OUT of existence in the modern cannabis market, with the idea that if it doesn’t get you high, it’s not worth much. Correspondingly, it is common to find available strains almost exclusively composed of THC, with THC/CBD ratios (the chemotype) of 99/1.  With the growth of medical marijuana in the US, especially California, a concerted effort has been made over the past 5 years to clone CBD rich plants BACK into existence, and many varieties with a THC/CBD ratio closer to 1:1 levels are now available for medicinal use. About 2 years ago, yet another breakthrough was reported, with the isolation of a strain of cannabis with a THC/CBD ratio of 1/20! This was previously unheard of, and indeed, not even in found in nature. This type of plant is now one of the most sought after designer cannabis strains for medicinal use.

So, what’s so good about CBD rich medicine anyway? Well, for one thing, one can achieve higher doses of the medicine without dysfunctional effects, so it’s our gateway into mega-doses of cannabis, such as are being used in cancer treatment. Secondly, we have our own internal cannabinoid system, the endocannabinoid system. THC and CBD affect the same binding sites that our own “endocannabinoid-potlike” chemicals bind to. CBD modulates the effects of THC at these sites to produce more balanced effects based upon one’s own personal chemistry. The most well known include anti-inflammatory, anti-seizure, anti-psychotic, calming, muscle relaxant, sedating, pain relief, neuroprotection and immune modulating among others. Combining THC and CBD has been found to increase clinical efficacy while reducing adverse effects.

Recently, I have had an influx of young patients coming to my office looking for advice about the use of CBD rich cannabis to treat seizures and autism. This is thanks to a Special Report on CNN In August, entitled “Weed” narrated by Dr. Sanjay Gupta.  Here, he publically reversed his opinion on the efficacy of marijuana as a medicine and came out in support of its use, especially as depicted in the show, to alleviate seizures in a young girl. It’s sad that television media is bringing more current information to potential patients than their own doctors, but the word is getting out there, and a new era in cannabis medicine is underway.

Dr. Deborah Malka is an Integrative Medicine physician and a Cannabis clinical specialist. She practices in Santa Cruz and Monterey. Appointments can be made by calling 831-426-7744. For more information see www.cannabisplus.net.