What Doctors Need to Know About Help
The general public usually turns to physicians to consult about medi- cal treatments and therapies. Yet when it comes to medical cannabis and hemp, a recent study found that fewer than one in five patients thought their doctor was a good source of information.
A physician’s understanding of hemp and CBD, and their ability to discuss therapeutic uses, dosing, and drug interactions, can be the difference between compliance and failure. And with so many hemp and CBD products available over the counter, it is crucial that those conversations between practitioner and patient take place.
The following is an introduction to hemp and CBD for physicians and healthcare professionals
What is Hemp?
Hemp is a name for cannabis varieties that have no or extremely low levels of THC, the main psychotropic chemical responsible for the euphoric and intoxicating effects most commonly associated with the plant. While there are over 550 distinct chemical compounds in the cannabis plant, federal law in the United States defines hemp as containing less than 0.03% THC, and it generally has much higher levels of cannabidiol (CBD). Hence, the terms hemp and CBD are often used interchangeably.
The hemp plant’s flowers are used for medicinal purposes, its stalks and stems are used for fiber, and its seeds as food and nutritional supplements.
How Hemp Interacts with the Body
Attached to cells throughout the human body are cannabinoid receptors. While the body produces endogenous cannabinoid receptor ligands like Narachidonoylethanolamine (“Anandamide”) and 2-Ara- chidonoylglycerol (“2-AG”), phyto-cannabinoids present in hemp and other cannabis plants (like THC and CBD) also act as partial agonists or antagonists of these receptors, respectively.
There are two main cannabinoid receptors. CB1 receptors, G-protein coupled receptors (GCPR), are most abundant in the central and peripheral nervous systems, and they are actually the most abundant GCPR in the brain. CB2 receptors are also a part of the GCPR family and are more commonly found in the tissues and cells of the immune system, as well as in some liver and nerve cells.
CB1 receptors in the hypothalamus help regulate metabolism, while those in the amygdala help regulate emotional responses.
CB2 receptors modulate many autonomic processes, and in the immune, system by inhibiting cytokine/chemokine release.
CBD, the main ingredient in hemp, is a very weak antagonist of both CB1 and CB2, thou
Attached to cells throughout the human body are cannabinoid receptors. While the body produces endogenous cannabinoid receptor ligands like Narachidonoylethanolamine (“Anandamide”) and 2-Ara- chidonoylglycerol (“2-AG”), phyto-cannabinoids present in hemp and other cannabis plants (like THC and CBD) also act as partial agonists or antagonists of these receptors, respectively.
There are two main cannabinoid receptors. CB1 receptors, G-protein coupled receptors (GCPR), are most abundant in the central and peripheral nervous systems, and they are actually the most abundant GCPR in the brain. CB2 receptors are also a part of the GCPR family and are more commonly found in the tissues and cells of the immune system, as well as in some liver and nerve cells.
CB1 receptors in the hypothalamus help regulate metabolism, while those in the amygdala help regulate emotional responses.
CB2 receptors modulate many autonomic processes, and in the immune, system by inhibiting cytokine/chemokine release.
CBD, the main ingredient in hemp, is a very weak antagonist of both CB1 and CB2, though it does appear to serve as a non-competitive negative allosteric modulator of CB1 receptors. CBD also operates through other targets such as ion channels, receptors, and enzymes. In addition, CBD can also increase anandamide levels by blocking FAAH activity, act as an antioxidant, and act as a positive allosteric modulator of glycine receptors. Much of the activity of THC, on the other hand, is mediated through its function as a partial agonist of both CB1 and CB2 receptors.
The endocannabinoid system has been found to interact with various basic functions and body systems, including: memory and learning, appetite regulation, thermoregulation, immune system function, fe- male reproductive processes, sleep and sleep cycles, pain perception, blood pressure, and digestion. CBD in particular is associated with alagesic, anti-ischemic, anti-epileptic, anxiolytic, anti-nausea, and anti-inflammatory effects.
It is important to note that most of the available published research has been based on trials that used cannabis with higher THC concen- trations and not on hemp-derived products.
How to Choose a Hemp Product
There are a number of factors that a patient or doctor might consider when deciding what hemp or CBD product to use. Those factors can affect how the drug is metabolized, what effects it has, what the patient is comfortable with, and ensuring a sustainable treatment regimen.
With so little regulation and the sheer number of products on the market these days, both over the counter and through a state medical program, it is crucial to educate yourself about how to make that decision that results in finding the appropriate product for you.
The following will provide the information you need to understand hemp and CBD products, but if you have more questions or still need help deciding, click here for a free clinical consultation with one of our experts.
Delivery Methods and Types of Products
Cannabinoid medicine has come a long way since the days when you had to smoke a joint to get relief. Most hemp and CBD products on the market today come as oil extracts, tinctures, edibles, and topical creams or balms. That said, in some states CBD-rich hemp flower is available in forms that can be smoked or vaporized. Each of these methods and types of products have unique properties that could make them the right or wrong choice for you. You may also need to do some trial and error before finding the best one.
Oral
The two main ways to take hemp or CBD products orally are sublin- gually or through the gastrointestinal tract.
The most common types of hemp and CBD products these days
are oil extracts and tinctures. Typically taken sublingually, they are absorbed through blood vessels in the mouth and enter the blood- stream directly. Sublingual extracts are therefore a fast-acting way to take hemp and CBD products. The bioavailability, or how much of the active ingredients make it into the bloodstream, is also generally higher. The main advantages of oils and tinctures is that dosing can be much more accurate than most other methods. Many patients prefer oils and tinctures because they are discreet and do not require smoking or inhalation.
Edibles, like gummies or chews, as well as pills and tablets, are ingested through the digestive system like food. Extracts can also be ingested orally. By traveling through the GI tract, however, the active ingredients are processed first by the liver and metabolized there be- fore entering the bloodstream, transforming into different metabolites and often losing some bioavailability. Products that are taken orally include:
• Oil extracts • Tinctures • Edibles and Chewables • Tablets and Pills • Powders
What Is the Endocannabinoid System?
The endocannabinoid system is made up of three parts, all of which work in unison with one another.
Cannabinoid receptors, which were named because they interact with cannabinoids produced by the cannabis plant, are located on the surface of cells in almost every part of the body. These receptors, which you can think of as locks, are activated by two primary keys produced by the body known as endocannabinoids. The cannabis plant and its cannabinoids also hold the key to those receptors. The third part, a special set of enzymes, synthesize and later break down those cannabinoids.
The two main cannabinoid receptors are:
Cannabinoid medicine has come a long way since the days when you had to smoke a joint to get relief. Most hemp and CBD products on the market today come as oil extracts, tinctures, edibles, and topical creams or balms. That said, in some states CBD-rich hemp flower is available in forms that can be smoked or vaporized. Each of these methods and types of products have unique properties that could make them the right or wrong choice for you. You may also need to do some trial and error before finding the best one.
CB1 (cannabinoid receptor 1) are scattered throughout the body. Their highest concentrations are located in the central nervous sys- tem, although they are also found in nerves elsewhere in the body.
CB2 (cannabinoid receptor 2), also located all over the body, are most concentrated in the peripheral nervous system, and regulate organ function, muscle movement, and play a role in the immune system and inflammatory responses.
The two main endocannabinoids are:
Anandamide, sometimes called the “bliss molecule,” is involved in the regulation of functions such as mood and emotion.
2-AG is involved in reducing inflammation and regulating other parts of the immune system. It is also involved in modulating pain perception, emotion, mood, memory, sleep, and even reproductive health.
It is because the cannabinoids produced by the cannabis plant
— known as phytocannabinoids — also interact with cannabinoid receptors, that medical cannabis and other hemp and CBD products have so much therapeutic potential. The endocannabinoid system itself was only discovered in the 1990s, partly due to long-standing legal prohibitions the research into how phytocannabinoids work is still in its early days, but we already know a lot about what it can do and how much potential it has.
The Cannabis Plant 101
Hemp, cannabis, CBD, full spectrum, broad spectrum — there is an entire lexicon surrounding the world of medical cannabis. Luckily, you don’t need to learn all of the hundreds of chemical components of cannabis or become an expert in all the myriad uses of the plant. Having a solid grasp of the basics can go a long way in making informed decisions.
What is Cannabis?
Cannabis is a term used to refer to the Cannabis sativa plant, which has long been prized for its variety of health benefits. It has also been stigmatized for much of the past century due to the prohibition of marijuana and concerns over abuse.
What is Hemp?
Cannabis plants that have very low THC levels — in the United States, 0.3% or less — are legally defined as “hemp.” They are gener- ally cultivated for the extraction of CBD as well as for industrial uses, namely, to produce textiles from its stalks and stems and oils from its seeds.
Hemp plants have a different chemical profile than non-hemp varieties of cannabis. While they characteristically have very low levels of THC, they are often grown to have high levels of cannabidiol (CBD). CBD is the main active ingredient in hemp flowers that provides many of its health benefits — without the high of marijuana.
Although hemp grown for industrial purposes is often much taller and stalkier than marijuana, hemp plants grown for CBD are often indistinguishable from their intoxicating counterparts.
