For high-level athletes, and those of us who strive to reach such heights, the search for performance-enhancing substances is eternal and challenging. Supplements have to conform to anti-doping laws, be safe, and preferably natural.
Enter CBD, or cannabidiol. CBD is currently creating ripples among athletes, who claim benefits as varied as accelerated recovery from injury, sounder sleep, and reduced muscle pain.
Although many organizations regard cannabis’ other main cannabinoid, THC, an illicit substance, the World Anti-Doping Agency permits the use of pure CBD isolate. CBD is a non-intoxicating cannabinoid with anti-inflammatory, neuroprotective, anti-anxiety, and analgesic properties, and could represent a legal, game-changing supplement.
But is the power of CBD just hype? Is there substantial evidence that CBD can offer athletes that elusive edge? Or are these claims simply PR spin for a trending cannabinoid?
The complete guide to CBD (cannabidiol)
What do studies say about CBD?
According to recent research released in 2020, CBD may support athletes in many ways.
Reduced inflammation and pain
A 2020 review published in Sports Medicine analyzed preclinical animal studies and clinical CBD trials in non-athlete populations. The authors found that CBD may promote physiological, biochemical, and psychological effects potentially beneficial to athletes.
One of the key findings of the review is that CBD could help alleviate inflammatory pain associated with tissue damage and neuropathic pain caused by nerve damage or irritation. This could signal an important advantage for endurance athletes: repetitive, long-distance workouts can provoke inflammation and irritation in peripheral nerves.
Protection against gastrointestinal damage
The above Sports Medicine study also found that CBD may protect against gastrointestinal damage. Athletes who regularly engage in strenuous activity can reduce oxygen and nutrient delivery to their gastrointestinal (GI) tract.
GI stress can negatively influence exercise performance and recovery due to nausea, vomiting, and impaired nutritional uptake. Preclinical research has shown that CBD can reduce tissue damage and restore the permeability of the intestine.
The above authors additionally provided evidence that CBD may support healthy bone deposition and help heal fractures. Healthy bones are essential for athletes, and bone health is sometimes compromised by traumatic injuries or inadequate energy availability.
Management of sports performance anxiety
CBD may also help athletes manage sports performance anxiety, according to the Sports Medicine review. Anxiety before a competition can cause sleep loss, increase energy expenditure, and impair nutritional intake.
According to the authors of the review, studies in non-athlete human populations have indicated that CBD may relieve anxiety in stressful situations. CBD could even be more effective when teamed with psychological interventions such as cognitive behavioral therapies.
How to use CBD for anxiety
Neuroprotective qualities to protect against brain injury
Another 2020 study, published in Pharmacological Research, also weighed the validity and applicability of existing CBD research for athletes. These authors emerged with similar conclusions but with a slightly different emphasis.
CBD’s neuroprotective properties were singled out for their potential to counteract harm that can occur following a sports-related concussion. These concussions are considered a variation of mild traumatic brain injury and can lead to harmful long-term complications such as neuronal damage.
The authors of the study emphasize recent research in an animal model demonstrating that CBD oil could help treat pain, aggression, and depression linked to mild traumatic brain injury. CBD oil also helped to counteract neuronal damage in the brain’s prefrontal cortex. The cannabinoid additionally inhibits oxidative stress and neuroinflammation, conferring further neuroprotective benefits.
These are promising findings as there are currently no effective pharmacological therapies available to manage mild traumatic brain injury. Repetitive traumatic brain injury, which can be common in contact sports, may also lead to chronic neurodegenerative diseases such as chronic traumatic encephalopathy (CTE).
Sleep and wake cycles
The 2020 Pharmacological Research study also underlined the sleep-altering potential of CBD. Research in animal models has discovered that CBD may be both a sleep-inducing agent and a wake-promoting agent. This ability to produce opposite effects—known as biphasic effects—depends on the dose being used and seems to work most successfully when the natural sleep-wake rhythm has been disturbed.
Lower doses of CBD seem to promote wakefulness, while higher doses appear to sedate and usher in sleep. Both properties may be beneficial: While the quest for a solid night’s sleep is invaluable before a big game, staying awake could also be performance-enhancing for athletes competing in ultra-marathons or endurance events.
But do any of these advantages come at a cost to performance on the field? Enhanced recovery and sound sleep may sound attractive, but not if they mean compromised balance or coordination.
According to the Sports Medicine study, however, the answer is no. The researchers assessed clinical trials investigating the impact of CBD on cognitive and psychomotor function and found that current data suggests CBD is unlikely to negatively impact either in healthy individuals.
Does CBD help or hinder sleep?
What do experts and athletes say about CBD?
For Dr. Elaine Burns, medical director of Southwest Medical Marijuana Physicians Group and founder of Dr. Burns’ ReLeaf CBD products, CBD holds promise for athletes. Burns cautions nonetheless that current knowledge is limited, because most data is based on animal studies where animals tend to receive high doses of CBD.
“There is much to learn about translating dosing from animals to humans,” she said. That being said, the potential benefits are abundant, especially when it comes to treating and reducing inflammation.
“CBD can help athletes with recovery by reducing inflammation and aiding in muscle relaxation,” said Burns. “It’s an anti-inflammatory that works by reducing pro-inflammatory markers in the body. There’s also research showing that CBD is effective in combating neuroinflammation, making CBD interesting for athletes who play sports like football or boxing where concussions are common.”
For athletes curious to experiment with CBD, Burns advises opting for sublingual tinctures.
Is CBD legal in your state? Check this chart to find out
“I think drops administered sublingually should be the preferred method. This way CBD gets into your system quicker and has higher bioavailability so that dose can be reduced.”
For Stu Kam, jiu-jitsu athlete and owner of ATH Organics, CBD gummies represent a non-negotiable part of his supplemental regime.
“As a Brazilian jiu-jitsu athlete and competitor, CBD has been a staple in my training regimen to help with my recovery and specifically my rest,” said Kam.
He continued: “Every night I take 25mg of CBD gummies to help me sleep after training. Prior to using CBD, I’d have a hard time falling asleep after training, which ultimately led to poor recovery. Since taking CBD, I’ve noticed a much deeper sleep and the ability to train at my full potential the next day.”
The final word
As is often the case with cannabis research, more data on human populations is needed for more conclusive outcomes. The authors of both the Sports Medicine and Pharmacological Research studies emphasize the preliminary nature of their findings. While the current data is very promising, clinical research in athlete populations will provide more definitive insights into CBD’s utility.
Fortunately, it looks like such research initiatives are already getting underway. In 2019, Aurora Cannabis teamed up with the UFC to develop clinical research on CBD, athlete wellness, and recovery, and other research is sure to come. Expect to see more studies unfolding in this space in the near future.
The U.S. Supreme Court has declined to consider Washington v. Barr, a case that challenged the federal Schedule I status of cannabis. The news came in a routine Supreme Court announcement earlier this morning. The court listed Washington v. Barr among the many cases that were denied certiorari.
The court’s action wasn’t surprising, but it came as a disappointment to the many plaintiffs and lawyers who have been working on the case for more than three years.
The lawsuit began in 2017, when it was called Washington v. Sessions, because Jeff Sessions was then the U.S. Attorney General. Five plaintiffs, including former NFL player Marvin Washington; 12-year-old Colorado medical refugee Alexis Bortell; youngster Jagger Cotte; US military veteran Jose Belen; and the Cannabis Cultural Association, a nonprofit that helps people of color benefit from cannabis in states where it’s legal, challenged the constitutionality of the classification of marijuana under the federal Controlled Substances Act. The case received its first hearing in federal court in 2018.
Leading the case was David C. Holland, a litigator in New York City and the executive and legal director of Empire State NORML. He’s former counsel to High Times Magazine and a member of the New York Cannabis Bar Association.
The case had been rejected in a series of lower federal court rulings. Plaintiffs had hoped to secure certiorari before the U.S. Supreme Court and force the nation’s highest court to confront the baseless standing of marijuana’s Schedule I classification.
Sebastien Cotte, whose son Jagger was a plaintiff in the case, told Marijuana Moment associate editor Kyle Jaeger: “While not surprising, as less than one percent of all petitions to the Supreme Court get a hearing, it is still very disappointing, as we been fighting for this case for over three years now.”
NM judge orders state health department to loosen medical cannabis reciprocity rules New Mexico Political Report
Gastrointestinal (GI) illnesses are a frequent reason for using medical cannabis. These conditions include gastroesophageal reflux disease (GERD), two inflammatory bowel diseases — Crohn’s disease and ulcerative colitis — and irritable bowel syndrome (IBS).
The gut has two main functions, namely digestion of food and host defense, protecting us from foreign invaders like bacteria and viruses. The endocannabinoid system, which is widely distributed throughout the gastrointestinal system, is a key player in keeping these two important functions regulated. It is found in the gut’s nerves and in the cells of the immune system, working to maintain homeostasis of gastric motility (the muscular contractions that work to move food through the bowel), intestinal pain signaling, intestinal inflammation, and maintenance of the barrier of the gut lining.
The nerves in the gut are called the enteric nervous system, sometimes called the “second brain.” Cannabinoid receptors (CB1 and CB2) are found throughout these nerves. All disorders of the gut are thought to involve the enteric nervous system, making these receptors an attractive target for treatment when illness is present. Scientists have found that the number of cannabinoid receptors can increase (upregulate) in certain intestinal illnesses, indicating that the endocannabinoid system is mounting a response to try to restore balance.
In addition to cannabinoid receptors, other receptors, such as PPARs, GPR55, and TRPV1, are found throughout the gut and are involved in intestinal inflammation and pain. Since cannabinoids, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with these receptors, CB1 and CB2 are also therapeutic targets for treatment by anyone using cannabis medicine for gastrointestinal disorders.
Almost 80 percent of your immune system resides in the gut. The endocannabinoid system, including the CB2 receptors, is also present in these immune cells, ready to go into action to decrease inflammation when needed. However, if your endocannabinoid system is not working properly, it may not be able to mount the appropriate response to these triggers, leading to chronic intestinal symptoms.
Interestingly, people who have a mutation in the gene coding for one of the endocannabinoid system components are more likely to have IBS and chronic abdominal pain – evidence that endocannabinoid dysfunction may be one of the root causes of gut disorders.
GERD is very common, affecting 20 percent of all adults. GERD occurs when the stomach contents flow backward into the esophagus, causing symptoms of heartburn, chest pain, difficulty swallowing, and/or a sensation of a lump in the throat. GERD is often treated with medications; however, there are reports of possible increased risk of dementia and cancer from these drugs. Other interventions include altering the diet, remaining upright after meals, losing weight, and stopping tobacco use.
Animal studies have shown that cannabinoid stimulation of the CB1 receptor inhibited acid secretion and decreased damage and inflammation in the lining of the stomach. Preclinical research also showed that cannabinoid activation of the CB1 receptor kept the lower esophageal sphincter (the “gate” between the esophagus and stomach that works to keep stomach contents from flowing back into the esophagus) from relaxing, thereby decreasing reflux. In one human study, synthetic THC given to healthy volunteers was shown to decrease the reflux rate (although there were issues in the study since the dose was very high and caused side effects). It is clear that more research is needed to understand the role of cannabis in the treatment of GERD.
Clinically, some medical cannabis patients with GERD report benefits, although some do not. (As with all conditions, it is unclear as to exactly why some patients respond to cannabis and others do not.) Anecdotal reports from positive responders state they have fewer episodes of heartburn, and if they have an episode, taking cannabis decreases their discomfort.
Most patients finding benefits are including some THC in their cannabis regimen, as this seems to be the cannabinoid most helpful for GERD, at least anecdotally. Some patients report a low-ratio CBD:THC product (such as 1:1, 2:1, or 4:1) helps decrease GERD symptoms with less intoxicating effects compared to THC-dominant products. Two aromatic cannabis terpenes, limonene and terpinolene, may also be beneficial for GERD symptoms.
Inflammatory Bowel Disease
IBD is a general term that refers to chronic inflammation of the bowel. The two main IBD conditions are Crohn’s disease and ulcerative colitis. The Centers for Disease Control reports approximately three million adults were diagnosed with IBD in 2015, up from two million diagnosed in 1999. The exact cause of IBD is unknown, but recent scientific investigation reports the changes in the gut are due to “uncontrolled activation of intestinal immune cells in a genetically susceptible host.” Remember that immune cells are regulated by the endocannabinoid system, suggesting that endocannabinoid dysfunction may be a root cause of IBD and may serve as a therapeutic target.
Crohn’s disease can affect any part of the gut but most commonly the small intestine, causing inflammation, ulcers, pain, bleeding, diarrhea, and weight loss. Ulcerative colitis is a chronic inflammatory condition affecting the large intestine, causing symptoms similar to Crohn’s. Both conditions are associated with an increased risk of colorectal cancer. According to a recent article, “current therapeutic options are insufficient for a successful treatment leading to a high rate of disability and intestinal surgery in IBD patients.”
Activation of the CB1 and CB2 receptors in animal models of colitis reduces inflammation. In a review of 51 scientific studies on cannabinoid treatment of colitis (only two were in humans), twenty-four different compounds, including synthetic cannabinoids as well as THC, CBD, and CBG, were found to be effective in reducing the severity of colitis.
Studies done in a number of different countries show about 10 to 12 percent of people with IBD are using cannabis to treat their symptoms. Studies in humans are limited but promising:
- A 2012 study investigating 11 patients with long-standing Crohn’s disease and 2 patients with ulcerative colitis reported that after 3 months of treatment, patients reported improvement in general health perception, social functioning, ability to work, physical pain, and depression. There was a statistically significant weight gain and increase in body mass index.
- A 2011 survey of 30 Crohn’s patients in Israel revealed 21 improved significantly with cannabis, finding less need for other medication and reduced need for surgery.
- A 2013 survey of 292 patients receiving care for IBD revealed approximately half reported either past or current use of cannabis. Of those, 32 percent reported medical use for abdominal pain, poor appetite, nausea, and diarrhea. Most reported that cannabis either completely relieved or was very helpful for symptoms. In this study, current users noted significant improvement in abdominal pain, poor appetite, nausea, and diarrhea.
- In a 2013 study of 21 patients with Crohn’s disease who did not respond to conventional treatments, inhaled THC or inhaled placebo was given over 8 weeks. Complete remission was achieved in 45 percent of the cannabis group and 10 percent of the placebo group; 90 percent of the cannabis group had lower severity scores versus 40 percent of the placebo group. Three patients using cannabis were able to wean off steroids. The cannabis patients reported better sleep and appetite with no significant side effects. Interestingly, all patients who achieved remission relapsed within two weeks of discontinuing the cannabis treatment.
- In 2019, two reports were published that reviewed hospital records through the National Inpatient Sample database, allowing researchers access to thousands of medical records. The first report looked at 615 hospitalized Crohn’s disease patients who used cannabis (legally or not) and compared them to Crohn’s patients who did not use cannabis. Cannabis users were found to have:
– Less stricturing disease (scarring built up secondary to chronic intestinal inflammation)
– Fewer bowel obstructions
– Fewer fistulas and abscesses
– Shorter hospital stays
– Fewer blood transfusions
– Less colectomy surgery (removal of the colon)
– Reduced IV nutrition requirements
- The second report, using the same database of medical records, included 6,002 patients with Crohn’s disease (2,999 cannabis users and 3,003 nonusers) and 1,481 patients with ulcerative colitis (742 cannabis users and 739 nonusers). This review found:
– Crohn’s patients using cannabis had statistically significant lower incidence of cancer, less need for IV nutrition, less anemia, and shorter hospital stays with lower hospitalization costs; however, this report found an increase in fistula/abscess, GI bleeding, and hypovolemia (a decrease in circulating blood in the vessels).
– Ulcerative colitis patients using cannabis have statistically significant lower frequency of postoperative infections and shorter hospital stays with lower hospitalization costs; however, fluid/electrolyte imbalance and hypovolemia were increased.
These reports stated that “recreational” cannabis was used. There was no mention of the type of cannabinoids used (THC, CBD, or other), nor was delivery method (smoking, edibles, etc.) or duration of use reported. Both significant benefits and risks were found, warranting further human clinical trials.
I have evaluated many patients with gastrointestinal disorders who have had successful results with cannabis treatment. Almost all patients with Crohn’s disease or ulcerative colitis who have been seen in my office have exhausted conventional options prior to seeking cannabis treatment, finding that they either were nonresponders or experienced intolerable side effects. Similar to the findings already mentioned, my patients report that their symptoms, including nausea, poor appetite, abdominal pain, diarrhea, and bloating, respond to cannabis treatment.
Many patients prefer to inhale THC since the onset of relief is immediate. Patients who are reluctant to use THC-rich cannabis can use lower CBD:THC ratios, such as 1:1 or 4:1, with similar benefits but less chance of intoxication. THCA (the unheated, nonintoxicating version of THC ) was found to be the main phytocannabinoid helping to regulate intestinal inflammation. With the increased availability of tinctures containing THCA, and CBDA as well, patients are finding that daily use of these raw cannabinoids, sometimes combined with CBD, is effective for anti-inflammatory effects, helping to prevent flare-ups.
Irritable Bowel Syndrome
As the most common diagnosis made by gastroenterologists, IBS affects thirty-five million people in the US alone. IBS is characterized by episodes of abdominal pain, bloating, excessive gas, and altered bowel habits (constipation, diarrhea, or mixed type). No clear cause of IBS has been identified, although endocannabinoid deficiency is suspected. There usually are no abnormalities on blood tests or an endoscopy, making IBS a diagnosis based solely on the patient’s history and symptoms, after ruling out other causes. IBS sufferers often struggle with other conditions, such as fibromyalgia, migraine headaches, temporomandibular joint disorders, chronic fatigue, gastroesophageal reflux, anxiety/depression, or chronic pelvic pain. Chronic stress has been linked to both the development and/or the exacerbation of IBS and should also be a focus of treatment.
There are three published human studies of cannabis use for IBS, all employing synthetic THC as the study drug. Not surprisingly, one study reported all participants to have had side effects and no benefits; the study dose of 10 milligrams THC was clearly too much for the non-cannabis users who participated. The second study used lower doses, 2.5 milligrams or 5 milligrams of synthetic THC compared to placebo, and found participants with IBS diarrhea or IBS mixed type had a reduction in colonic motility, meaning THC slowed down how fast food moved through the gut. And the third study involved giving low-dose dronabinol (pharmaceutical THC) for two days and had no effect on IBS diarrhea. As mentioned before, findings from studies using single synthetic cannabinoid compounds are difficult to translate to outcomes in patients using whole-plant preparations.
Dr Bonni Goldstein
Clinically, many medical cannabis patients with IBS report benefits, most stating simply that “it helps calm the gut.” Some patients report substantial efficacy from low doses of THC taken in the evenings or just as needed when their gut is acting up. Others report using CBD preparations on a daily basis to control their symptoms. Additionally, some patients have reported that either THCA or CBDA, or both in combination, has helped with IBS, often with the patient achieving improvements in symptoms with low doses. Proper diet, regular exercise, and stress management support the endocannabinoid system, and in cases of IBS, patients find these additional interventions to be quite effective when combined with cannabinoid therapy.
It is important for patients with gut disorders to understand that long-standing inflammation will take time to respond to cannabinoid treatment. It may take eight to twelve weeks to experience significant benefits, although many report symptom reduction in the first few weeks. Edibles may cause further GI upset, so you should always read product labels to be sure you are not eating an ingredient that is a trigger for your symptoms. Terpenoids that have been found to specifically help the gut include terpinolene, beta-caryophyllene, limonene, and pinene.
This excerpt continues with a personal story of a young Crohn’s patient who benefited from a doctor-supervised medical cannabis regimen. Read more.
NOTE: All source references are included in Dr. Bonni Goldstein’s book, Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain. Copyright (C) 2020. Available from Little, Brown Spark, an imprint of Hachette Book Group, Inc.
Some 66% of Americans now support cannabislegalization, according to Pew and Gallup polling in 2019. That means convincing the holdouts is going to become even harder.
Thisgeneral election on Nov. 3, 2020, five tough states includingMississippi have marijuana law reform on the ballot. Plus, the winners of 35 openSenate seats, as well as the race for President will either advance legalization federally, or thwart it.
Meanwhile, at the state and local level, there’s choices about allowing cannabis stores in towns or banning them; or just decriminalizing cannabis.
Because cannabis is a medicine
It’s a scientific fact that cannabis fights nausea in chemo patients, and intractable seizures in kids. For anxiety, marijuana is less addictive and toxic than benzodiazepines like lorazepam (ativan). The medical benefits go on and on.
Under federal law, cannabis is considered as dangerous as methamphetamine and heroin. Almost no one thinks that’s true. Humans have been using cannabinoids to feel less pain and inflammation, and feel more relaxation and oneness with the universe, for several thousand years.
We should stop wasting scarce resources
Each year, police make 663,000 pot arrests, costing the US tens of billions of dollars in police time and money that should be better spent testing the rape kit backlog and arresting violent felons.
Just like alcohol prohibition, cannabis prohibitionpays for a massive, violent illicit market. The original goal of marijuana prohibition in the 1930s was to discourage use of it. The opposite happened—in the last 90 years cannabis use exploded in the United States. Virtually any American who wants to obtain cannabis today can find it; they just can’t buy taxed, tested, regulated herb.
We should preserve freedom and increase justice
Everyone has the right to life, liberty, and the pursuit of happiness—as long as they aren’t harming others. It’s a matter of freedom and personal choice for adults to be able to choose weed.
Cannabis prohibition infringes on many rights, including the right to own a gun, and the right to privacy, especially around traffic stops and searches. In legal states like California, marijuana arrests have collapsed from historic highs of more than 100,000 per year to1,181 felony arrests in 2019—the fewest since 1954. And you don’t have to worry about being pulled over and hassled for the mere smell of weed, which cops can fabricate.
Prohibition has become a pretext for arresting decent, law-abiding people
The United States has the largest prison population of any nation in the world, and marijuana prohibition is a major driver of that shameful state of affairs.
In states where cannabis is illegal, any cop can stop and search any person at any time based on a claimed suspicion or smell of marijuana. These pretext “stop-and-frisk” searches became notorious in New York City, but they happen all the time in other jurisdictions as well. The slightest amount of weed, or even an empty pipe, can result in arrest and a life hobbled by the thousands of repercussions that a drug arrest carries.
Black Americans do not use more cannabis per capita than white people, but police arrest Black people 3.73 times as often as whites for cannabis crimes. The war on marijuana has been a war on the poor and people of color from day one. “ It’s an extension of the old Jim Crow laws,” said Nate Bradley, a former cop, and head of the Cannabis Consumer Policy Council.
Legalization creates jobs and raises tax revenue
Legalization raises money. Prohibition burns it. Legal, state-licensed cannabis is already a $10.73 billion industry in the US responsible for243,700 jobs in the US.
In California’s second year of legal sales, 2019, the state collected $305.3 million in cannabis excise tax revenue alone, and an estimated$635 million total in state and local revenue.
In Colorado, cannabis pays for scholarships for teens instead of causing them to be sent to prison.
Thanks to legal record expungement programs, job seekers face fewer barriers to hiring, and fewer qualified employees face the loss of a job due to their own legal off-the-job use of cannabis.
Legalization increases product safety
In a legal state, homemade mystery brownies are replaced by edibles that are precisely dosed and regulated for food safety. Adults can regulate their THC intake responsibly.
Prohibition doesn’t make cannabis use go away. Instead, it drives all facets of the industry underground, making cultivation, production, distribution, and possession more expensive and dangerous. During alcohol prohibition, ‘bathtub gin’ killed tens of thousands of Americans. In 2019, adulterated THC vape cartridges in the illicit market killed nearly 100 Americans and sickened thousands.
Regulating cannabis like alcohol takes the chaos out of production and distribution. Licensed and regulated companies replace violent drug cartels and street gangs. Consumers get safe, tested cannabis products, instead of pesticide and mold-contaminated products.
Marijuana is less harmful than alcohol
Research has found that moderate, adult cannabis use is less harmful in the short, medium, and long-term than other legal substances.
The CDC found 35,823 alcohol-induced deaths in the US in 2017. By contrast, the CDC did not report a single cannabis-induced death. Alcohol carries 114 times the mortality risk of cannabis. The most potent cannabis concentrate will never kill you, just make you go to sleep. By contrast, a handle of Jack Daniels from the corner store can kill a teen in a couple hours.
Alcohol carries 114 times the mortality risk of cannabis.The journal Scientific Reports, 2015
Unlike alcohol or tobacco, cannabis use is not independently associated with increased cancer risk. By contrast, tobacco is associated with 30% of all cancer deaths in the US and 87% of lung cancer deaths.
No drug is right for everybody, and adults with contra-indications for cannabis use—like a family history of schizophrenia—should avoid it. Legalization generates funding for health messaging and treatment.
Legalization has not led to increased road deaths
Legalization critics have promised road carnage in the wake of popular votes. Instead road safety has not been meaningfully impacted by legalization. This is largely because the same people are smoking, they’re just doing it legally now.
The gateway theory has been debunked. So has ‘amotivational syndrome’
Cannabis legalization has not ushered people onto harder drugs. “The majority of people who use marijuana do not go on to use other, ‘harder’ substances,” the CDC states.
The charge that marijuana causes an amotivational syndrome has also been debunked. It’s an impossible syndrome to quantify, nor is it easy to isolate cannabis in a causal role. Some people who like to smoke pot also like to sit on the couch—others like to exercise.
Unlike alcohol, cannabis usedoes not damage IQ. Recent twin studies have put that myth to rest.
Legalization has not increased teen use
We are six years into legal marijuana sales, and teen use rates in those states are flat or falling.
“Legalization of marijuana for adults was associated with an 8% decline in past 30-day marijuana use and a 9% decline in frequent use among teens,” the Journal of the American Medical Association reported in 2019.
The tobacco taxation and messaging model has all but snuffed out tobacco smoking among youth—a public health victory. That model has begun to reduce teen use of cannabis in legalization states. By contrast, during past decades of prohibition, teens consistently reported high levels of access to marijuana. That’s because prohibition’s profit margins ever-entice people without money (“Money grows on trees!”). Criminal weed dealers don’t check IDs. Licensed stores do.
They say the endocannabinoid system (ECS) is as unique as a fingerprint, and cannabis affects us all differently. Company EndoCanna Health is exploring this by offering a DNA test that will show your body’s genetics and suggest a cannabis profile accordingly, as well as products for that profile.
This tool wouldn’t be with us today without a real Bob Ross of a happy accident—the moment Len May, CEO of EndoCanna Health, accidentally found an effective way to manage his ADD. According to May:
“I was kind of hanging out with some older kids, and they asked me if I wanted to smoke a cigarette—and I was like, yeah, you know, I’m dabbling with cigarettes, I’m gonna be cool—and the cigarette was actually filled with weed instead. After I got done coughing, I went back to class, and the windows in my head [referring to what it’s like to think with ADD] they sort of slowed down, and I could focus. So I found my medicine, it was mine.”
After getting kicked out of the house for cannabis—ironically, his parents now use his cannabis formulations—he became a cannabis activist and started working in medicinal genomics, which eventually led to EndoCanna Health, and the ability to use cannabis on a truly personal level.
How does EndoCanna Health’s DNA test work?
While receiving the $199 test can take a month or two, taking the test is a matter of seconds: carefully swab the inside of your cheek, then pop the swab into a tube. After registering your test into their HIPAA-compliant, fully anonymous portal, seal the swab and tube in a plastic bag, pop it into the provided paid envelope, and send ‘er off to the lab. If you have DNA data already, it’s faster and only costs $49.95.
Once your results are ready, log into your profile, which will have an itemized breakdown of your report and suggestions for types of cannabis. The report is broken down into:
- Cognitive function & behavior
- Drug dependence
- Drug metabolism
- Musculoskeletal & immune
- Pain, nausea, & neurologic
- THC side effects
Digging into my report
Clicking through the various reports shows how cannabinoids interact with your genetic profile in specific ways. For instance, clicking on “Anxiety” brings three more reports: “Fear Extinction,” “PTSD,” and “Stress Reactivity.”
Under “Fear Extinction,” for example, is this summary of my specific DNA marker findings, as well as suggestions for types of cannabis to use:
In this case, it suggests I start using high-CBD ratio products, as well as cannabis with terpene profiles that include linalool and beta-caryophyllene. These responses are called “formulations,” and my report suggests seven different ones for specific needs.
Also, the Personalized Wellness Plan links to relevant scientific studies and provides a link to products that match the formulation.
CEO May explained that although EndoCanna Health does sell terpene blends used in some recommended products, they don’t profit directly from sales of products recommended on the Wellness Plan: “We look at certificates of analysis from different product manufacturers and run them to a matching algorithm, and we look for several things: Number one, we look for the percentage of CBD, THC; Secondary, terpene profile; and then some others, like essential oils.”
How to use your cannabis DNA test results
“The best way to get the most out of your results is to understand what your genetic predispositions are to avoid an adverse effect and then to understand which products you can actually take,” said May.
With your test results, you’re equipped to treat symptomatic conditions based on specific genotypes in your body. “If you have a predisposition to anxiety or stress reactivity, you will know that there are certain cannabinoid and terpene profiles that can actually turn that genetic expression on,” said May.
For example, if you have a marker associated with not producing endocannabinoids when anxious—as the body ought to—you’ll be able to know what kind of cannabis can be substituted effectively.
And it’s a living document as well, meaning it will evolve as research does. “We have a HIPAA-compliant portal that is dynamically built with lifetime updates, meaning that if there is any research that is happening now that gets published, we provide that as an update to your report on a lifetime basis. And we’re fully secure and anonymized. All the data resides on Amazon’s AWS; it’s fully encrypted,” said May.
May continued to speak on what’s ahead: “The future is this whole feedback loop: It’s the ability to be able to get a response from people, how you know product ‘A’ is really working for you, learn from your experience, and then be able to produce better individualized products.”
EndoCanna Health is a research lab as well, working on studies all over the world. The company is also looking into expanding the use of epigenetic data and using biomarkers, like Fitbit info, to create a dashboard that will further personalize your experience.
Is the test worth it?
My take is probably obvious by now: I think this is a fantastic resource. I love that it breaks down which cannabinoids and terpenes will help various aspects of my body makeup. As a medical cannabis user, I find this especially relevant—it also confirmed I’m high-risk for flu severity—but these reports will also be helpful for anyone without any medical issues because we all have different bodies and cannabis will interact with each body differently.
EndoCanna Health is also looking to collaborate on research, even with competitors, because “the only way to remove this ridiculous stigma is through science,” said May.
I love it. Let’s science our way from being disregarded as just stoners to having data to improve specific conditions or for overall health, and knowing how best to use cannabis for those specifications.
And all this magic started with a teenager trying to smoke a cig, and failing. C’est la vie, eh?
Cannabis is celebrated for the benefits it offers in the management of certain medical conditions. As awareness around cannabis grows, consumers are becoming better versed in the therapeutic potential of cannabinoids in the treatment of specific autoimmune diseases, inflammation, and gastrointestinal disorders.
But how does cannabis affect the immune system as a whole? If you’re a regular consumer, you may have pondered whether cannabis weakens or boosts your immune system. Can frequent cannabis use render you more prone to infections or contagious diseases?
As it turns out, research into cannabis and the immune system hasn’t historically piqued the interest of scientists. However, as our understanding of the effects of cannabis on the body becomes more sophisticated, we need to also broaden our knowledge of how cannabis influences the immune system.
Present evidence suggests that cannabis can suppress immune system function. While this can be helpful for individuals with autoimmune illnesses, it may not be so beneficial for those with functional immune systems.
Meet your immune system
The immune system is one of the body’s most sophisticated networks. A collection of specialized cells, endogenous chemicals, and organs work in concert to ward off pathogens and infections, protecting the health and homeostasis of the body.
The immune system is multifaceted, and its core components that actively combat infection include white blood cells, the complement system, antibodies, the lymphatic system, the spleen, the thymus, and bone marrow, but we’ll mainly talk about white blood cells.
Memories of every microbe previously defeated by the immune system are logged in white blood cells. These memories enable the fast tracking and elimination of infections that have already been experienced. The immune system is also responsible for detecting and eradicating malfunctioning cells.
The knowledge we have about the interaction of cannabis with specific immune elements is limited. While there is some research exploring the effects of cannabinoids on white blood cell count and the lymphatic system, we know less about how cannabis impacts the thymus or the complement system.
Cannabis, the endocannabinoid system, and the immune system
An elegant connection exists between the body’s endocannabinoid system (ECS) and its immune system. The ECS is generally considered to be one of the gate-keepers of the immune system, preventing the onset of overwhelming inflammatory responses that may result in disease. The ECS can also influence the function of immune cells.
CB1 and CB2 receptors in the endocannabinoid system mediate the effects of cannabis within the immune system. The two major cannabinoids, THC and CBD, appear to have distinctive effects on the immune system due to their unique interactions with cannabinoid receptors. Abundant literature suggests that cannabinoids affect the functions of most types of immune cells.
A 2020 review found robust evidence that CBD suppresses certain inflammatory responses in the immune system and may induce cellular death in immune cells. Immune cell death isn’t always a bad thing—it’s a normal part of the cellular life cycle, and helps to protect a person by alleviating inflammatory responses.
Like CBD, THC also suppresses immune activity, dialing down inflammatory responses. THC has also been shown to alter the function of immune cells responsible for antimicrobial activity.
How does cannabis affect the immune system?
When scientists discuss cannabis and the immune system, they often discuss its effects as immunomodulatory or immunosuppressive. Immunomodulation refers to any therapy that modifies the immune system response. When cannabis suppresses the expression of aspects of the immune system, this form of modulation is known as immunosuppression.
It’s vital to point out here that marijuana’s ability to subdue or suppress immune system cells can be useful if the immune system is dysregulated and in need of suppression. If not, immune suppression might not be helpful.
Research published in 2017 indicated that both CBD and THC have an immunomodulatory effect on the human intestinal lymphatic system, the major host of immune cells. The lymphatic system also contains more than half the body’s lymphocytes—white blood cells that play a critical role in finding and destroying foreign cells or substances that have infiltrated the body.
The study’s authors found that oral administration of CBD and THC with fats resulted in extremely high cannabinoid levels in the intestinal lymphatic system: CBD concentrations in lymph cells were 250 times higher than in plasma, while THC concentrations in lymph cells were 100 times higher than in plasma.
So, what’s the significance of this? For individuals with autoimmune diseases, cannabis can achieve higher concentrations in the lymphatic system and suppress unhealthy inflammatory immune responses more successfully.
The pros and cons of cannabis as an immunosuppressant
While the immunosuppressive properties of cannabis may be just what the doctor ordered for autoimmune patients, they can cause problems for other cannabis users.
Research carried out in 2003 on healthy volunteers suggests that regular cannabis may subdue immune function. Cannabis users were found to have fewer proinflammatory cells and more anti-inflammatory cells.
While less potential for inflammation may sound like a win, in this case, it was associated with a significant reduction in white cell functionality, and impaired white cells can mean a hindered ability to fight off infections. Regular cannabis users also had decreased amounts of natural killer cells, which limit the spread of tumors and microbial infections.
The study also indicated that there may be a dose-response relationship between cannabis use over an individual’s lifetime, and a decrease in certain immune system markers, meaning those who use cannabis regularly may be more susceptible to the progression of infectious disease.
What about the effects of cannabis on extremely immunocompromised individuals? Unfortunately, cannabis can substantially decrease infection-fighting cells in people undergoing chemotherapy. This suppressive response may further add to the detrimental effects of chemotherapy on immune systems of those with cancer.
Research on people with HIV+ and AIDS, who are particularly vulnerable to infections, however, indicates that there is no firm evidence that cannabis adversely affects immune function.
Instead, findings suggest cannabis use among HIV+ patients may enhance the immune system by producing a statistically significant decrease in viral load and an increase in CD4 cells. CD4 cells can be considered a marker that indicate the robustness of the immune system.
While existing research allows us to glean insights into cannabis and the immune system, we need more rigorous data to paint broad brushstrokes. According to the most recent 2017 report from the National Academies of Science, Engineering, and Medicine (NASEM), there’s insufficient research on the effects of cannabis or cannabinoid-based medicines on the human immune system to draw firm conclusions.
Cannabis in the time of coronavirus
Within the current global climate shaped by COVID-19, there’s an impulse among the research community to enhance our understanding of the impact of cannabis on the immune system. Some cannabis researchers are currently channeling their focus into investigating whether cannabis may be helpful or harmful in treating COVID-19.
More profound exploration into the effects of cannabinoids on the immune system is also being encouraged. Watch this space as new frontiers are forged.
In order for a prescription drug to reach the market, it must be extensively studied, first in animal and then in human clinical trials. Safety, efficacy, and risks must be determined. But as anyone who has seen a commercial for a prescription drug knows, there are still side effects. There are risks in stopping a prescription. And, of course, there are the risks of addiction.
Prescription opioid painkillers have increased drastically from common-use pill to massive public health crisis. At the same time, the perception of marijuana has shifted away from it as a gateway drug to using it as medicine.
Now, several recent studies show that public opinion is shifting to the point of substituting cannabis for opioids and other prescription drugs that have high risks or low efficacy. In addition to opioids, drug substitution is most common for benzodiazepines, like Valium or Klonopin, and antidepressants.
The benefits of substituting a substance for an addictive drug seem obvious, but there is a serious hidden risk in doing so without talking to a doctor. For example, with CBD, its interactions with prescription drugs have barely been studied. Complications can arise from drug interactions and withdrawal symptoms, resulting in incorrect dosages and potentially unknown side effects.
Patients are substituting prescriptions with cannabis
With unregulated whole-plant and hemp-derived CBD easily available online and in grocery stores across the United States, as well as recreational and medical cannabis in shops in the US and Canada, some people are doing just that.
One specific substitution holds promise, but also danger: benzodiazepines.
Benzos—such as Klonopin (clonazepam) and Valium (diazepam)—are commonly prescribed for anxiety, insomnia, seizures, alcohol withdrawal, and muscle spasms, all of which also have the potential to be treated with medical cannabis, especially CBD. But unlike CBD, benzodiazepines have been around the scientific block, completing the clinical trial process and landing on the market in the 1960s. Also unlike CBD, they are known to be addictive.
“There’s this great opportunity because of the opioid crisis to find alternatives,” said Dr. James Corroon, Medical Director at the Center for Medical Cannabis in California, who published a study on cannabis substitution for pharmaceutical prescriptions last year. Of 2,774 participants, 46% reported substituting cannabis for a pharmaceutical drug. “There’s reason to be hopeful,” he said, “but we need more data.”
There’s also reason to be concerned. Self-identified “medical” consumers were about five times as likely to substitute drugs with cannabis than recreational consumers, according to the study. And almost a quarter of recreational consumers also reported substitution.
Non-prescribed swapping of THC or CBD for a prescription drug often occurs accidentally at first: A chronic pain patient might smoke marijuana recreationally and notices it helps; an insomnia patient might eat a CBD chocolate for anxiety but then is able to sleep; a person might get a medical marijuana card for anxiety and discover it helps with pain and insomnia.
While this might seem like a serendipitous coincidence for patients, the pattern is a warning to doctors. “These people aren’t getting the right care,” said Dr. Corroon. The concern is with drug interactions.
If you add CBD to a drug regimen of an opioid or a benzo, it creates an amplification effect, Dr. Corroon explained. With CBD and Valium, for example, the liver metabolizes CBD first. The Valium is then sent back into the bloodstream, allowing the same dose to last longer. As a result, the patient may be unintentionally overmedicating. This also means a patient could be prescribed a lower dose of Valium to experience the same relief.
This can be great if a healthcare worker is supervising a patient and their drug substitutions, but doses of benzos need to be slowly decreased to be safely stopped, regardless of whether another drug is added.
Rapid decreases of any drug can be dangerous. Benzodiazepines depress the central nervous system and an abrupt change can leave the brain struggling for balance. Benzodiazepine withdrawal can cause a return of symptoms, additional anxiety, insomnia, and flu-like symptoms. More severe symptoms include panic attacks, hand tremors, depression, and seizures.
Without medical advice and supervision, a person could experience withdrawal, unnecessarily low or high doses, or vacillation between the two as anxiety decreases and returns, said Dr. Corroon.
Can cannabis help?
Cannabis treatment is being broadly studied as a partial or full substitution for opioids, but research is just beginning on its possible use in reducing benzodiazepine use.
“There is a role for benzodiazepines in clinical practice,” said Dr. Chad Purcell, a surgical resident at Dalhousie University. But there’s an issue with benzodiazepines that is similar to that of opioids, he said.
In a small study, Dr. Purcell and his associates analyzed information provided by patients new to cannabis treatment who were already taking benzodiazepines. Almost a third stopped their benzodiazepine treatment within two months. And almost 45% ended use by four months.
“There seems to be something at play here,” Dr. Purcell said. But he cautioned against drawing a direct line between the two. Just because two things happened—starting cannabis and stopping benzodiazepines—doesn’t mean one caused the other.
Another recent study, led by Dr. Phillipe Lucas, VP of Patient Research at cannabis producer Tilray, showed high trends of cannabis substitution across all types of prescription drugs.
Dr. Lucas and authors analyzed cannabis use patterns and substitutions of 2032 Canadian medical cannabis patients who responded to a survey.
Many participants reported more than one substitution. About 45% reported substituting cannabis for alcohol, 31% substituted it for tobacco, and 26% substituted it for illicit drugs. A whopping 69% reported substituting cannabis for prescription drugs.
Unsurprisingly, opioids were the most common among pharmaceutical substitutions, at 35%. Antidepressants and anti-anxiety prescriptions came in close behind at 21%.
Detailed questions revealed that chronic pain and mental health issues were the two most common reasons participants took cannabis, both at just under 30%.
Chronic pain is often accompanied by mental health conditions, especially anxiety and insomnia, said Dr. Lucas. It’s a common trifecta of diseases and a troubling one. The conditions can exacerbate each other and the knot of symptoms can be difficult to untangle. It’s not uncommon for endless pain to cause severe anxiety and prevent sleep, Dr. Lucas said. Roughly half of participants reported experiencing all three as primary symptoms, according to the study.
Patients experiencing this medical triad often take more than one daily prescription as treatment, so it’s not surprising that many study participants substituted for more than one drug, Dr. Lucas explained. And it’s possible that, if a cannabis substitution could more effectively treat a root cause of chronic pain, medications for anxiety, insomnia or depression could become unnecessary.
For those people who are making a conscious choice to substitute, and doing so with medical guidance, there seems to be only an upside. It’s the people who accidentally substitute or self-prescribe that worry Dr. Lucas. “It gives me great concern.”
Stay informed and healthy
Always talk to your doctor before starting or stopping a new medication. Ask about potential prescription interactions and options. If you already take a prescription medication, talk to your prescribing physician about your marijuana and/or CBD use.