Cannabis for 5 Common Conditions
Categories: General Health & Healing
Adapted from CBD: A Patient’s Guide to Medicinal Cannabis—Healing without the High, with reference to The Cannabis Health Index: Combining the Science of Medical Marijuana with Mindfulness Techniques to Heal 100 Chronic Symptoms and Diseases.
Note on the Cannabis Health Index Rating System
Simply put, the Cannabis Health Index (CHI) score is derived from an evidence-based rating system developed by Uwe Blesching that shows degrees of confidence in cannabis as an effective treatment for a specific condition. It takes the type and caliber of the research study into account, which impacts the reliability of a study’s conclusions. Each experiment is scored on a scale of 1 to 5 based on type of study, and then this number is multiplied by +1 (positive one) if the study concluded that medical use of cannabis was effective, or multiplied by -1 (negative one) if the study concluded it was ineffective as treatment for that disorder. Finally, all the ratings for individual studies included in the analysis of a disease are added together to create an overall CHI score. An overall high score means a large amount of high-caliber research has been done and that the probability of efficacy for that disorder is higher based on currently available evidence. However, the score reflects the amount of available published research to a much larger extent than it reflects the actual degree of efficacy to treat the particular disease.
Evidence-Based Ratings of Possible CHI Scores
The ratings are on a scale of zero to five with zero indicating no observed therapeutic value and five indicating significant and demonstrable scientific therapeutic value. The CHI score is the total value points of each study divided by the number of studies conducted for that condition.
One Point: Possible efficacy in treatment of this condition
Two Points: Possible-to-probable efficacy in treatment of this condition
Three Points: Likely probable efficacy in treatment of this condition
Four Points: Probable-to-demonstrable efficacy in treatment of this condition
Five Points: Demonstrable efficacy in treatment of this condition
How to Take the Medicine: Dosage and Delivery
For all of the below conditions, it is suggested that patients work with a health care practitioner experienced in recommending CBD or medicinal cannabis so that dosage and delivery methods can be developed and fine-tuned on an individual basis. At the same time, educated and aware patients can be their own highly informed health consultants.
For all orally administered medicines, such as drops, capsules, or edibles, determine dosage by body weight. Always start with the micro dose to test sensitivity and go up as needed within the dosing range before going to the next, until symptoms subside.
Anxiety and Stress
The oral use of cannabis to treat anxiety appears in a Vedic text dated around 2000 BCE, and it is one of the most common uses of the plant across various cultures. While THC can increase anxiety in some patients, it lowers it in others. However, CBD has been shown to consistently reduce anxiety when present in higher concentrations in the cannabis plant. On its own, CBD has been shown in a number of animal and human studies to lessen anxiety. The stress-reducing effect appears to be related to activity in both the limbic and paralimbic brain areas.
A 2012 research review assessed a number of international studies and concluded that CBD has been shown to reduce anxiety, and in particular social anxiety, in multiple studies and called for more clinical trials. Two years later, researchers in an animal study related to stress and the endocannabinoid system wrote that augmentation of the endocannabinoid system might be an effective strategy to mitigate behavioral and physical consequences of stress. These findings appear to support that the anxiolytic (antianxiety) effect of chronic CBD administration in stressed mice depends on its proneurogenic action in the adult hippocampus by facilitating endocannabinoid-mediated signaling.
How to Take the Medicine: Dosage and Delivery
CBD products with a ratio of 20:1 or higher are recommended and administered as drops, capsules, or edibles. High-CBD cannabinoids can be very effective in reducing chronic anxiety, treating temporary stress, and protecting the body from the physiological effects of both. Varieties high in linalool, a terpene shared with lavender, are known to be effective for relieving anxiety. In particular, the strain AC/DC is very effective.
The micro- to standard dose is usually recommended to treat anxiety and stress. For relief of immediate symptoms, as in a panic or anxiety attack, vaporizing or smoking work well. The medication lasts one to three hours, whereas most ingested products take thirty to sixty minutes before taking effect and last six to eight hours. Vaporizers that use a cartridge filled with the CO2 concentrate are highly effective, and these are available in various ratios of CBD to THC. Herbal vaporizers that use the whole plant are also an effective delivery method. Sublingual sprays or tinctures taken as liquid drops take effect quickly and last longer than inhaled products.
CHI score: 3
Cannabinoids are known to have palliative effects in oncology, including relief of chemotherapy-related nausea and vomiting, appetite stimulation, pain relief, mood elevation, and sleep in cancer patients.
Evidence has been accumulating over the past decades that cannabinoids also have beneficial effects beyond palliative care, entering the “domain of disease modulation.” Better quality research is needed, but the direct anticancer effects that have been demonstrated so far include tumor-shrinking properties, inhibition of the growth of new cancer cells, and prevention of metastases. Researchers have demonstrated regression of a number of different cancer types.
Authors of a 2013 evidence review on CBD and cancer wrote that “cannabinoids possess anti-proliferative and pro-apoptotic effects and they are known to interfere with tumor neovascularization, cancer cell migration, adhesion, invasion and metastasization. However the clinical use of ∆9 THC and additional cannabinoid agonists is often limited by their unwanted psychoactive side effects, and for this reason interest in non-psychoactive cannabinoid compounds…such as cannabidiol (CBD), has substantially increased in recent years.”
A number of studies limited to THC and CBD as synthetic cannabinoids showed anti-cancer effects. A Japanese study using THC determined that it had anti-inflammatory effects and reduced the growth of tumors in mice. Another study found that CBD may prevent cancer caused by smoking tobacco, linked to cytochrome P450, family 1, member A1 (CYP1A1). CYP1A1 is a protein found in humans. This protein is harmless at low levels but has been shown to be cancerous in high amounts. CBD was shown to bind to the protein and was able to keep it from increasing. It controlled CYP1A1 at a normal, healthy level, exerting a preventative effect on cancer caused by smoking.
Using cannabis as a therapy to reduce cancer activity and tumor size does require high doses of cannabis medicine. THC is very effective in shrinking the tumor size, and CBD is very effective in stopping the proliferation of new cancer cells. While both THC and CBD are effective anti-cancer agents, the combination of CBD and THC together has exhibited even greater efficacy for healing. There is a true synergistic relationship between CBD and THC; the whole is greater than the sum of the parts. There is evidence that a combination of the various cannabinoids and terpenes found in products derived from the whole plant is the most effective approach.
“In addition to active cannabinoids, cannabis plants also contain a multitude of other therapeutic agents,” said Dr. David Meiri, a lead researcher in an Israeli study considered the most in-depth so far on cancer patients and cannabis and involving fifty different strains of cannabis and over two hundred cancer cell lines. “Terpenoids and flavonoids are usually present in small quantities, but can have beneficial therapeutic effects, especially as synergistic compounds to cannabinoids.” Varieties high in myrcene, limonene, and linalool are recommended.
A 2013 British study demonstrated that a spectrum of cannabinoids was more effective in the treatment of leukemia cells, compared to each individual compound. Dr. Meiri and his team are conducting a number of studies documenting the effects of cannabinoids and other phytochemicals on tumor growth:
The effects were further investigated in vitro, in various cancer cell lines, and revealed pro-apoptotic (promoting cancer cell death) and antiproliferative response to cannabinoids, as well as inhibition of invasion and migration. However, the medical use of cannabis remains rather limited due to the large number of active compounds that, together with variability among different cannabis strains and cultivation methods, impairs our ability to predict the specific clinical effect and determine the recommended dose.
While the other active compounds in cannabis such as terpenes are being further researched, and higher-caliber studies on human subjects are starting to be published, some cancer patients don’t have time to wait. Hundreds of stories exist of patients whose cancer was cleared after cannabinoid therapy. It is important to note that all of the anti-cancer effects of cannabinoids come from either test tube or animal studies, with no data yet available from studies in humans to support individual patient testimonials.
How to Take the Medicine: Dosage and Delivery
Dosage for advanced cancer is generally in the macro dose range, with a suggested range of 200 mg to 2,000 g of total cannabinoids per day. The most commonly suggested ratio of CBD to THC is 1:1. However, at the macro dose level, patients often have difficulty tolerating medication with the higher amount of THC. At the beginning stages of taking macro doses, most are not able to tolerate more than 20–30 mg THC from an oral application. Over a four-to-six-week period, patients are able to increase their tolerance level and become acclimated to high doses.
When high doses are required, many patients use concentrated forms of cannabis oil and take it orally, either in capsule form or by adding to food (nut butters seem to work well). The purest, most potent concentrates are made using a CO2-extraction process.
For relief of immediate symptoms such as pain, loss of appetite, or nausea, vaporized or smoked cannabis can be highly effective. The medication lasts one to three hours, whereas most ingested products take thirty to sixty minutes before taking effect and last six to eight hours. The most effective vaporizers use a cartridge filled with the CO2 concentrate, and these are available in various ratios of CBD to THC.
CHI scores vary among different types of cancer.
- Bone cancer: 2.7
- Bladder cancer: 3
- Brain cancer: 2
- Breast cancer: 1.5
- Cervical cancer: 1
- Colon cancer: 1.3
- Gastric cancer: 1
- Kaposi’s Sarcoma: 0
- Kidney cancer: 2
- Leukemia: 1.3
- Liver cancer: 1.2
- Lung cancer: 1.2
- Lymphoma: 1.2
- Pancreatic: 1.2
- Prostate: 1.5
- Skin cancer (melanoma): 1
- Skin cancer (non-melanoma): 3.7
- Thyroid cancer: 1.5
Diabetes mellitus refers to a group of metabolic diseases characterized by hyperglycemia caused by defects in insulin secretion, insulin action, or both.
The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, brain, and blood vessels. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to metabolic abnormalities and inflammation that result in insulin resistance.
Cannabinoid treatment may be helpful for both type 1 and type 2 diabetes. Researchers in 2011 concluded that “both central and peripheral aspects of endocannabinoid regulation of energy balance can become skewed and contribute to obesity, dyslipidemia, and type 2 diabetes, thus raising the possibility that CB1 antagonists might be used for the treatment of these metabolic disorders. Evidence is emerging that some non psychotropic plant cannabinoids, such as CBD, CBDV and THCV can be employed to retard β-cell damage in type 1 diabetes.”
In 2013 one of the largest studies on human patients related to cannabis and metabolic processes found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, not to mention smaller waist circumference.
Potential Benefits of Cannabinoids for People with Diabetes Include:
- The stabilization of blood sugars
- Neuroprotective effects that help thwart inflammation of nerves and reduce the pain of neuropathy by activating receptors in the body and brain
- Anti-spasmodic agents that help relieve muscle cramps and the pain of gastrointestinal (GI) disorders
- Vasodilator that keeps blood vessels open and improves circulation, contributing to lower blood pressure over time (vital for diabetics)
- Anti-inflammatory action that may help quell some of the arterial inflammation common in diabetes
How to Take the Medicine: Dosage and Delivery
CBD products with a ratio of 20:1 or higher are recommended and administered as drops, capsules, or edibles. The standard dose is recommended to treat diabetes. Vaporized or smoked cannabis is recommended for relief of immediate symptoms, such as neuropathic pain or “restless legs syndrome.” It is also useful for sleep issues. Sublingual sprays or tinctures taken as liquid drops take effect quickly and last longer than inhaled products.
When neuropathic pain is present, topical products can be applied. These can be made using CBD-dominant cannabis or other strains. Topicals affect the cells near application and through several layers of tissue but do not cross the blood-brain barrier and are, therefore, not psychoactive. These may be available as oils, ointments, salves, or other forms, with varying ratios of CBD and THC (a ratio of 1:1 is often recommended as ideal for skin application). The skin has the highest amount and concentration of CB2 receptors in the body.
CHI Score: 3.8
Research in 2006 and 2008 indicated that CBD treatment could reduce the manifestation of diabetes in animals induced with the disorder. The disease was diagnosed in only 32 percent of the mice in the CBD-treated group, compared to 86 percent and 100 percent in the emulsifier-treated and untreated groups.
Authors of a 2010 study concluded that, “collectively, these results, coupled with the excellent safety and tolerability profile of CBD in humans, strongly suggest that it may have great therapeutic potential in the treatment of diabetic complications, and perhaps other cardiovascular disorders, by attenuating oxidative/nitrative stress, inflammation, cell death and fibrosis.”
Nausea and Vomiting
The anti-emetic (effective against nausea and vomiting) properties of cannabis are probably one of the most recognized and studied medicinal application of the plant, and a clear body of evidence supports its efficacy. The research demonstrates that manipulation of the endocannabinoid system regulates nausea and vomiting in humans and other animals, whether the condition is related to toxins, hormones, or motion. Cannabis has been used to treat nausea and vomiting across cultures for millennia, and in the mid-1970s scientific research began to focus on the treatment of these symptoms among chemotherapy patients. The first studies used high-THC cannabis successfully and resulted in the development of a synthetic THC pharmaceutical called Marinol, still prescribed today for nausea and appetite stimulation related to cancer and AIDS. However, evidence shows that Marinol and other synthetic versions of cannabinoids are not as effective as plant-based products for many diseases. For nausea and vomiting in particular, inhaled products have proven to have a higher success rate since they bypass the GI system and have immediate effect, but oral cannabinoids can also work for chronic issues.
By 2002, researchers began to turn toward cannabinoids without psychoactive side effects, namely CBD, for their therapeutic value in the treatment of nausea.359 Unlike THC, CBD has a low affinity for the CB1 and CB2 receptors but appears to work indirectly on the 5-HT receptor, in the serotonin family of neurotransmitters.
How to Take the Medicine: Dosage and Delivery
For relief of immediate symptoms, vaporizing or smoking works well, and many nausea patients prefer this delivery system as it doesn’t require ingestion (and potentially not being able to keep the medicine down long enough to take effect). Often, the very thought of having to ingest anything, including medicine, will cause the nausea to worsen. The medication effect is immediate and lasts one to three hours, whereas most ingested products take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours. Vaporizers that use a cartridge filled with the CO2 concentrate are highly effective, and these are available in various ratios of CBD to THC. Herbal vaporizers that use the whole plant are also an effective delivery method. Sublingual sprays or tinctures taken as liquid drops also take effect quickly and last longer than inhaled products.
When more chronic nausea is an issue, CBD products with a ratio of 20:1 or higher are recommended and administered as drops, capsules, or edibles. The micro to standard dose is usually recommended to treat nausea and vomiting. For chemotherapy-induced nausea, a higher dose may be required (see more in the section on cancer). Most varieties of cannabis work effectively for nausea, and some treatment plans include starting with 5 mg of THC and scaling up to 15 mg before chemotherapy begins.
CHI Score: 3
More than forty studies have been conducted on the use of cannabinoids to effectively treat nausea and vomiting, and it is considered one of the best-supported therapeutic uses of cannabis according to American and British medical association reviews. One study pooled available data of over one thousand chemotherapy patients and found that oral synthetic THC provided relief of nausea in 76–88 percent of users and smoked cannabis provided relief in 70–100 percent. Commonly prescribed drugs for chemo-related nausea are 5-HT antagonists, which suppress vomiting but do not minimize nausea, and are not effective for delayed nausea and vomiting. Cannabinoids are effective for these symptoms according to a 2011 study.
Sleep Disorders (Insomnia, Sleep Apnea)
Cannabis and sleep have a complex relationship that is only beginning to be understood by science. In general, for most people, indica strains are more relaxing and effective for sleep disorders, whereas sativa strains are more stimulating and tend to keep people awake.
Several studies conducted between 2004 and 2008 demonstrated the variable effect of different cannabinoids on sleep. In one, 15 mg of THC appeared to have sedative properties, while 15 mg of CBD appeared to have alerting properties.416 Another tested the effects of CBD on animal models in both lights-on and lights-off environments and found that this non-psychoactive cannabis compound increased alertness with the lights on and had no discernable effects on lights-off sleep. The study’s authors concluded that CBD might actually hold therapeutic promise for those with somnolence, or excessive daytime sleepiness from a not-so-good night’s rest. Another study found CBD to be wake-inducing for most subjects, though some reported better sleep a few hours after taking it.
“Many of my patients report either better energy or sleepiness on the same high-CBD/low-THC plants,” Dr. Michael Moskowitz reported. “Most, however, feel more energy on high-CBD cannabis.”
In general, indica varieties of THC appear to work best as a sleep aid for most people. However, a significant number of people find THC, even indica strains, will make the mind more active. For these people, CBD tends to work well, providing the relaxation and calm for the mental as well as the physical body. For these people, CBD taken at nighttime as part of a bedtime regime produces a restful sleep, not the alertness produced in the daytime. This bidirectional effect of CBD is the result of balancing the endocannabinoid system.
In relation to sleep apnea, a 2002 animal study observed the ability of THC to restore respiratory stability by modulating serotonin signaling and reducing spontaneous sleep-disordered breathing. In 2013 a trial using the pharmaceutical drug dronabinol, a synthetic THC mimic, noted improvements in fifteen out of seventeen study participants following twenty-one days of treatment.
How to Take the Medicine: Dosage and Delivery
As mentioned previously, while CBD-dominant products help some people sleep, in others it promotes wakefulness. Orally administered THC, especially products from heavier “Kush” strains and Purple cannabis varieties, are very effective for sleep disorders. These tend to be high in myrcene and linalool, a terpene shared with lavender and known to be effective for relaxation. Cannabis combinations with ratios of 1:1, 4:1, or 24:1 CBD:THC can be used when patients want to reduce psychoactivity.
Oral consumption is recommended as it usually lasts the whole night. The micro to standard dose is usually recommended to treat insomnia and sleep apnea. When relaxing indica strains are used with higher THC levels, a dose of 5–10 mg is usually sufficient. Other people find they need larger doses, such as 15–40 mg. CBD taken as a tincture or edible will aid in a restful six to seven hours of sleep. This type of disorder varies widely from one patient to the next. Often, one needs to perform some experimental research and try strains of different CBD:THC ratios to figure out the best protocol.
For immediate medicinal effects, vaporizing or smoking work well. This can be helpful for either initial sleep onset or for wakefulness in the middle of a rest period but only lasts one to three hours. The medication effect is immediate, whereas most ingested products take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours. Vaporizers that use a cartridge filled with the CO2 concentrate are convenient and highly effective, and these are available in various ratios of CBD to THC. Herbal vaporizers that use the whole plant are also an effective delivery method. Sublingual sprays or tinctures taken as liquid drops also take effect quickly and last longer than inhaled products.
CHI Score: 3.4
The use of cannabis-based products for treating insomnia has a rating of likely probable efficacy based on the four studies available at press time (3.4 points). A 2007 study with the pharmaceutical 1:1 CBD:THC spray showed good results in helping patients with chronic pain sleep better. REM sleep behavior disorder (RBD) is characterized by the loss of complete muscle relaxation during REM sleep, associated with nightmares and physical activity during dreaming. Four patients in a case series treated with CBD in 2014 had prompt and substantial reduction in the frequency of RBD-related events without side effects.