About the Author 5

Introduction 7

History of Cannabis 9

What is CBD? 13

Where does CBD come from? 15

Types of CBD Products 16

CBD Regulations 19

CBD Contamination 22

How Does CBD Work? 24

The Endocannabinoid System 24

Receptors & Cannabinoids 27

Pharmacokinetic of Cannabis 29

Potential Uses 32

Anxiety 34

Stress 38

Chronic Pain 40

Gastrointestinal Function 42
 Cannabis and Cancer 43

Contraindications 47

References 49
 Copyright 2019 Kristyn Bango

Puro Company, LLC

All rights reserved.

For correspondence, contact

kristyn@puro.co

www.kristynbango.com

www.puro.co

The website and content included in the e-book are for educational purposes
only. No liability is assumed for any loss or damages due to the information
provided.

 About the Author

Kristyn began her career in natural skin

care where she has worked to develop a

wide range of personalized products for

her clients and her business. Through the

course of her work, she has studied

Aromatherapy and Dietary Supplement

Sciences at the Franklin Institute of

Wellness receiving degrees in both. In addition, she has studied

Herbalism for over a decade. She is a level 3 Certified Clinical

Aromatherapist (National Association for Holistic Aromatherapy), a

Master Herbalist and Dietary Supplement Specialist. Kristyn uses

these approaches to inspire and educate everyone to reclaim their

health and find peace in healing through natural health practices.

Her holistic approach to healing and skincare includes the whole

health of a person including nutrition, lifestyle and emotional factors.

She emphasizes the fact that healthy skin is a reflection of inner

health, and promotes the use of natural products and holistic

approaches to achieve healthy skin and a healthy body.

Find out more about Kristyn’s offerings at www.kristynbango.com

and www.puro.co



 Introduction

CBD is all the rage and just like with any new health craze there can

be so much conflicting information out there that it can be hard to

know who to trust. The aim of this e-book is to help you sort out the

facts involving CBD and its uses from an evidence-based approach.

As the author, my goal to help provide a balanced and accurate view

of CBD, what it is, and its uses. I have no affiliations to any

manufacturer or CBD products and aim to provide unbiased

education on CBD to help the readers of this book make an informed

decision on natural health products.

In this e-book, we will cover a brief history of cannabis use, some

potential sourcing issues, how it works in the body, common uses

backed by science and some contraindications and warnings. We

will take a look at not only CBD but cannabis as a whole including

THC where the literature shows it to be effective when used in

combination.

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 History of Cannabis

Looking at the Cannabis plant, there are two main subspecies:

Cannabis sativa and Cannabis indica. Typically when you see

Cannabis being discussed, it is Cannabis sativa. This plant has a rich

history of use throughout history and can be found in ancient texts.

Cannabis Sativa (cannabis) is the most common strain of cannabis

and among the earliest plants cultivated by man. Historical findings

indicate that the plant was cultivated for a number of purposes,

including the production of seed oil, food, hemp fiber (for clothes

and rope), medicine, and even recreation with some uses dating

back to 4.000 B.C.

Throughout history, Cannabis has been used in both traditional

Ayurvedic and Chinese medicine for centuries. It has also been

described in texts in Egyptian, Greek, and Middle Eastern cultures.

The uses of cannabis as a medicine by ancient Chinese was

reported in the world's oldest pharmacopeia, the pen-ts'ao ching. In

India, the medical and religious use of cannabis probably began

together around 1000 years B.C. The Atharva Veda mentions

cannabis as one of five sacred plants. It is referred to as a source of

happiness, donator of joy and bringer of freedom.

The use of cannabis continued to spread, being introduced into

Western medicine in the 19th  century. The therapeutic use of

cannabis was first seen written in 1839, in a 40-page article by W. B.

O'Shaughnessy.

Cannabis derivatives for medicinal use continued to spread through

Western medicine. The Committee on Cannabis Indica of the Ohio

State Medical Society published physicians reports in 1860 that told

of success in treating stomach pain, childbirth psychosis, chronic

cough, and gonorrhea with hemp products. (PMID: 4883504)

As cannabis use continued to grow so did the medical indications.

At the beginning of the 20th century, they were summarized in

Sajous's Analytic Cyclopedia of Practical Medicine (1924) in three

areas:

1) Sedative or Hypnotic: in insomnia, senile insomnia, melancholia,

mania, delirium tremens, chorea, tetanus, rabies, hay fever,

bronchitis, pulmonary tuberculosis, coughs, paralysis agitans,

exophthalmic goiter, spasm of the bladder, and gonorrhea.

2) Analgesic: in headaches, migraine, eye-strain, menopause, brain

tumors, tic douloureux, neuralgia, gastric ulcer, gastralgia

(indigestion), tabes, multiple neuritis, pain not due to lesions, uterine

disturbances, dysmenorrhea, chronic inflammation, menorrhagia,

impending abortion, postpartum hemorrhage, acute rheumatism,

eczema, senile pruritus, tingling, formication and numbness of gout,

and for relief of dental pain.

3) Other uses: to improve appetite and digestion, for the 'pronounced

anorexia following exhausting diseases', gastric neuroses, dyspepsia,

diarrhea, dysentery, cholera, nephritis, hematuria, diabetes mellitus,

cardiac palpitation, vertigo, sexual atony in the female, and

impotence in the male.

Cannabis was listed in the American pharmacopeia until 1944 when

it was removed. In 1986 the FDA authorized the use of THC for

medical purposes such as treatment for nausea and vomiting in

patients receiving chemotherapy.

There was a renewed interest in the 1990s in the use of cannabis for

medicinal purposes with the description of cannabinoid receptors

and the identification of an endogenous cannabinoid system in the

brain.

Currently the growth of scientific interest for cannabis, and its

therapeutic effects have led to renewed research, with more

accurate scientific methods. The therapeutic effects of THC and

other cannabinoids such as Cannabidiol (CBD) in various conditions

and indications are currently being investigated as treatments and

adjunct therapies. Cannabis products must still be used cautiously

despite growing popularity as many longer-term studies are not

available, and the effects are not yet known.


 What is CBD?

The cannabis plant, like all plants, contains a diversity of chemicals,

such as cannabinoids which are naturally occurring compounds

found in the cannabis plant.

Cannabidiol (CBD) is one of the most prevalent cannabinoids found

in the cannabis plant, however the plant contains more than 500

components, of which 104 cannabinoids have presently been

identified.

Cannabinoids are one class of diverse chemical compounds, some

of the most well known being CBD (Cannabidiol) and

tetrahydrocannabinol (THC).

• CBD (cannabidiol) - one of the phytocannabinoid molecules of

hemp, a non-psychotropic compound - believed to be responsible

for many medicinal effects

• THC (tetrahydrocannabinol) - the psychoactive compound

Most CBD products claim to have <.3% THC. There are currently no

regulations to ensure these claims, which may make them unreliable.

More on this in the regulations section.

CBD may have a protective effect against certain negative

psychological effects from THC. The effects of CBD are in many

cases, the opposite of THC's effects. CBD appears to have

antipsychotic, anxiolytic, anti-epileptic, and anti-inflammatory

properties.

 Where does CBD come from?

Cannabis is a classification of plants with various species. Hemp and

Marijuana are both species of plant within the Cannabis family.

Marijuana contains high amounts of THC while  hemp has a low

amount of THC. CBD can be derived from both the industrial hemp

plant and the marijuana plant. The major difference between

industrial hemp and medical marijuana is that industrial hemp is

exclusively made from Cannabis sativa that was specifically bred to

produce the lowest concentrations of THC possible. CBD oil is

derived from the flowers of the hemp plant. The seeds of the hemp

plant don't contain CBD but it can be processed for hemp seed oil

used for culinary and skin care applications.


 Types of CBD Products

CBD and THC are lipid soluble compounds and can be extracted

using a variety of methods such as:

• Infused Oil: herb infused in a carrier oil to extract the active

compounds.

• Essential Oil: steam distilled, extracts compounds with low

molecular weight, not as chemically diverse, very potent.

• Supercritical CO2: potent extract, contains volatile compounds,

waxes, and other chemicals found in herb.

During the extraction process, other compounds found within the

plant are also extracted, including terpenes, flavonoids, and other

cannabinoids. The composition of the end product will depend on

the strain and extraction process used.

Once extracted, a company may choose to refine the products or

isolate certain chemicals.

Full Spectrum products will contain all the compounds of the plant

from the extraction process including terpenes, essential oils, and

other cannabinoids. This includes THC. A product can’t be full

spectrum (by definition) without containing THC

(tetrahydrocannabinol - psychoactive compound).

CBD isolate is produced by removing all other compounds found in

the plant including terpenes, flavonoids, plant parts, and other

cannabinoids.

Broad Spectrum products contains multiple cannabinoids, however,

like CBD Isolate, THC is completely removed. This results in more

chemical diversity than a CBD isolate but without the THC

compound.

There is a myth that CBD is the medicinal compound and THC is the

psychoactive compound. This is not completely accurate though.

CBD is a key ingredient, not the only active ingredient in cannabis.

This means it works in synergy with other compounds in the plant to

achieve effects. There are dozens of active compounds that have

been identified, including THC and CBD. Many other compounds,

including THC, in some cases have been identified as being

responsible for the product’s effects on pain, inflammation, and

anxiety.

Each method of extraction result has benefits and drawbacks.The

best extraction method will ultimately depend on the desired end

product and use. One thing to be conscious of when it comes to

extraction is the medium being used, and if it’s being chemically

extracted. This may result in undesirable residue left in the final

product.

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 CBD Regulations

Like many herbal products and supplements, there are currently no

regulations for CBD products. This means there can be extreme

variation in composition from brand to brand.

Recently a study compared ingredients listed on the labels of

cannabidiol products sold online to actual product constituents

determined by laboratory analysis.

Eighty-four products were purchased and analyzed (from 31 different

companies).

Of the samples tested for CBD, 42.85% of products were under

labeled, 26.19% were over labeled, and 30.95% were accurately

labeled. The concentration of unlabeled cannabinoids was generally

THC that was detected (up to 6.43 mg/mL) in 18 of the 84 samples

tested.

“Of tested products, 26% contained less CBD than labeled, which

could negate any potential clinical response. The over labeling of

CBD products in this study is similar in magnitude to levels that

triggered warning letters to 14 businesses in 2015-2016 from the US

Food and Drug Administration (eg, actual CBD content was

negligible or less than 1% of the labeled content), suggesting that

there is a continued need for federal and state regulatory agencies to

take steps to ensure label accuracy of these consumer products.

Underlabeling is less concerning as CBD appears to neither have

abuse liability nor serious adverse consequences at high doses

however, the THC content observed may be sufficient to produce

intoxication or impairment, especially among children.” (PMID:

29114823)

Like with all herbal supplements, it’s important to research the

products you’re purchasing. If they are not readily available, do not

hesitate to ask companies about third party testing (unaffiliated,

outside, unbiased sources). Any company should be happy to supply

these to customers. If they don’t that should be a red flag.

With the lack of regulations, it’s important to be your own

investigator and advocate.


 CBD Contamination

Another potential area of concern when it comes to CBD is the

possibility for contamination.

Did you know cannabis has the potential to be contaminated with

heavy metals?

Cannabis is an accumulator plant, this means it takes up everything

from its environment - the soil that it’s grown in. Because of this,

cannabis plants have actually been used to absorb powerful toxins in

the environment to help clear radioactive material and contamination

from the soil in areas where catastrophic events have occurred.

This process is called phytoremediation. Phytoremediation uses

plant remediation of environmental pollution exploiting capability of

plants or wild weeds for the remediation of contaminated soil. (PMID:

28324308)

Heavy metals can accumulate in the plant through the root system of

the plant if it’s grown in contaminated soil. This may come from

fertilizers with large amounts of heavy metals or contaminated soil or

contaminated water sources. Bioaccumulation occurs when

contaminated plants are ingested and humans consume those

plants and they become concentrated in the body.

What that means is plants grown for human health should be

evaluated for contamination from substances found in the soil. When

purchasing cannabis products, it is important to look for a company

that does third-party testing for contamination.


 How Does CBD Work?

The Endocannabinoid System

Have you ever wondered why cannabis effects us the way it

does or why it can effect people differently? This is actually a very

new field of study as it has only been in the last couple of decades

that scientists have even begun to understand the ways cannabis

works within our bodies.

In 1964, a scientist from Israel named Raphael Mechoulam was able

to identify and isolate THC for the first time. Prior to this, scientists

were only able to identify CBD. Then in 1988, the first cannabinoid

receptor was found in the brain of a rat. Soon after this discovery,

researchers started using a synthetic form of THC to start mapping

the CB receptors in the brain. Then 1992 the first endocannabinoid

was discovered. Since then, we have found out that the

endocannabinoid system is responsible for maintaining many of our

normal bodily functions.

Most of the biological properties related to cannabinoids rely on their

interactions with the endocannabinoid system in humans.

“CBD itself has been shown in vitro and animal studies to possess,

among others, anti-anxiety, anti-nausea, anti-arthritic, anti-psychotic,

anti-inflammatory, and immunomodulatory properties. CBD is a very

promising cannabinoid as it has also shown potential as therapeutic

agents in preclinical models of central nervous system diseases such

as epilepsy, neurodegenerative diseases, schizophrenia, multiple

sclerosis, affective disorders and the central modulation of feeding

behavior. Interestingly, CBD presents also strong anti-fungal and

antibacterial properties, and more interestingly powerful activity

against methicillin-resistant Staphylococcus aureus (MRSA)” (PMID:

26870049)

The ECS is a group of cannabinoid receptors located in the brain

and throughout the central and peripheral nervous system that

consists of neuromodulatory lipids and their receptors. This system

is involved in the physiological process including pain sensation,

mood, memory, and appetite.  Evidence suggests that

endocannabinoids may function as neuromodulators and

immunomodulators.

Two endocannabinoid receptors, CB1 and CB2, have been identified

in the human body.

Endocannabinoids are thought to modulate or play a regulatory role

in a variety of physiological processing including appetite, pain-

sensation, mood, memory, inflammation, insulin, sensitivity and fat,

and energy metabolism. (PMID: 26870049)

CB1 receptors are primarily found in the brain, and limbic system.  It

is involved with cognitive function, fear, and memory.

CB2 receptors are primarily found in the immune system or immune-

derived cells, peripheral structures of the body and digestion. CB2

receptors appear to be responsible or anti-inflammatory responses.


 Receptors & Cannabinoids

The endocannabinoid system is made of receptor sites where

naturally produced cannabinoids fit.  Think of a lock and key. The

body’s ECS produces its own cannabinoids and the system is

activated during times of mental or physical stress and affect

emotions, along with the nervous and digestive systems. The

compounds from cannabis may interact with these receptor sites.

These phytocannabinoids, like those found in CBD, may help to

bolster this system and help maintain the balance needed for the

system to function optimally.

• Endocannabinoids are cannabinoids naturally occurring in the

body.

• Phytocannabinoids are cannabinoids that occur naturally in the

cannabis plant.

Endocannabinoid levels may decline in connection with

inflammation, low omega-3 intake, internal and external stressors,

and chronic disease. In these situations, phytocannabinoids may be

helpful. 

 Pharmacokinetic of Cannabis

“According to a review by British Journal of Psychiatry, about 50% of

the THC in a joint of herbal cannabis is inhaled in the mainstream

smoke; nearly all of this is absorbed through the lungs, rapidly enters

the bloodstream and reaches the brain within minutes. Effects are

perceptible within seconds and fully apparent in a few minutes.

Bioavailability after oral ingestion is much less; blood concentrations

reached are 25-30% of those obtained by smoking the same dose,

partly because of first-pass metabolism in the liver. The onset of

effect is delayed (0.5-2 hours) but the duration is prolonged because

of continued slow absorption from the gut.

Once absorbed, THC and other cannabinoids are rapidly distributed

to all other tissues at rates dependent on the blood flow (Fig. 2).

Because they are extremely lipid soluble, cannabinoids accumulate

in fatty tissues, reaching peak concentrations in 4-5 days. They are

then slowly released back into other body compartments, including

the brain. Because of the sequestration in fat, the tissue elimination

half-life of THC is about 7 days, and complete elimination of a single

dose may take up to 30 days. Clearly, with repeated dosage, high

levels of cannabinoids can accumulate in the body and continue to

reach the brain. Within the brain, THC and other cannabinoids are

differentially distributed. High concentrations are reached in

neocortical, limbic, sensory and motor areas.

Fig. 2 Distribution of THC in the body. The distribution of THC after a single
administration in plasma and body tissues. Note the ‘biphasic’ disappearance in
plasma. The rapid phase (in minutes) indicates a rapid uptake of the drug by fat-
containing tissues. The slow phase (in days) shows the release of THC by these
tissues (Nahas, 1975). THC, tetrahydrocannabinol.

Cannabinoids are metabolised in the liver which produces

metabolites. A major metabolite is 11-hydroxy-THC which is possibly

more potent than THC itself and may be responsible for some of the

effects of cannabis. More than 20 other metabolites are known,

some of which are psychoactive and all of which have long half-lives

of several days. The metabolites are partly excreted in the urine

(25%) but mainly into the gut (65%) from which they are reabsorbed,

further prolonging their actions. Because of the pharmacokinetic

characteristics of cannabinoids — both the sequestration in fat and

the presence of active metabolites — there is a very poor

relationship between plasma or urine concentrations and degree of

cannabinoid-induced intoxication.”

 Potential Uses

The body of research continues to grow on cannabis and its

potential uses. Despite some drawbacks with sources, regulations

and possible contaminations, there are promising findings emerging

using cannabis as an alternative and adjunct therapies.

Possible areas of uses and future uses include:

• Pain & Inflammation

• Mental Health

• Gastrointestinal Complaints

• Cancer

Different products are being evaluated as to how they best address

these and other issues. Some of these issues may see benefits with

a combination of CBD & THC, others may see a benefit from a CBD
only product. The root cause will really play an important role in

choosing the best product.

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 Anxiety

Anxiety related disorders are said to affect over 40 million Americans

over the age of 18, or about 18% of the population.  1 in 8 children

suffers from anxiety. These numbers may be under-reported as it is

estimated only ⅓ of individuals seek treatment for anxiety-related

disorders.

Fear and anxiety are adaptive responses essential to coping with

threats to survival. Excessive or persistent fear may keep individuals

from adapting to situations and become debilitating.  Symptoms that

may arise from excessive fear and anxiety may occur in a number of

disorders including generalized anxiety disorder (GAD), panic

disorder (PA), post-traumatic stress disorder (PTSD), social anxiety

disorder (SAD), and obsessive-compulsive disorder (OCD). Anxiety

related disorders are associated with a reduced sense of well being,

elevated unemployment rates, poor relationships, and elevated

suicide risk. Current treatment options are associated with limited

response rates, reoccurring symptoms and adverse reactions that

may limit tolerability and adherence.

CBD has potential as a possible treatment for some anxiety related

conditions.  CBD, which does not contain THC, has no psychoactive

effects and does not affect cognition. It is reported to have broad

therapeutic properties that may be effective across a wide range of

neuropsychiatric disorders stemming from central nervous system

actions.  CBD has broad pharmacological actions, including

interaction with several receptors known to regulate fear and

anxiety-related behaviors. For this reason, CBD has gained interest

as a potential anxiolytic treatment.

According to studies, it has an adequate safety profile, good

tolerability, positive results in trials with humans, and a broad

spectrum of pharmacological actions. This makes it promising as a

future therapy for those with anxiety.

Studies in animal and human models have shown evidence

supporting CBD as a treatment for generalized anxiety disorder,

panic disorder, social anxiety disorder, obsessive-compulsive

disorder, and post-traumatic stress disorder when administered

acutely. There are only a few studies that have investigated long-

term CBD dosing for these purposes.

According to studies, CBD reduced anxiety associated with a

simulated public speaking test in healthy subjects, and in subjects

with a social anxiety disorder (SAD).

In a study involving public speaking, researchers found that a single

dose of CBD decreased anxiety after the SPS test in healthy

volunteers. In another study, researchers found that social anxiety

disorder patients presented higher anxiety, cognitive impairment,

and discomfort, as well as increased alertness during their speech

performance when compared with healthy controls. After CBD

treatment, however, a significant reduction in anxiety-related

measures obtained during their speech performance was observed.

When tested over a wide range of doses, the anxiolytic effects of

CBD presented a bell-shaped dose-response curve, with anxiolytic

effects observed at moderate but not higher doses. (PMID:

27157263, PMID: 26341731)

“In individuals with social anxiety, CBD dosage at 400 mg

considerably decreases anxiety measures versus placebo; measures

were correlated with decreased activity within the limbic and

paralimbic areas on functional magnetic resonance imaging  

One clinical trial in healthy volunteers has shown that acute CBD

administration (300-600 mg) seems to decrease experimentally

induced anxiety without modifying baseline anxiety levels; it would

also seem to decrease social phobias.” (PMID: 29302228)

CBD products show promise as a treatment for chronic stress, acute

stress, anxiety, and PSTD.  THC is not necessary for these results

and may possibly inhibit effectiveness.


 Stress

According to the American Institute of Stress, it is estimated that

75-90% of all visits to primary care physicians are for stress

complaints or disorders. Although stress is a normal and healthy

function of the body, when left unchecked or when stress becomes

chronic, it can have severe negative health impacts. Stress has been

linked to all major causes of death and disease. When stress can be

managed effectively it can have positive effects on health outcomes

and may show a reduction in other seemingly unrelated symptoms

like headaches, weight loss, and pain.

Conditions that may see improvement with stress reduction include

but are not limited to:

• Poor memory and cognitive function

• Poor sleep or sleep disturbances

• Social anxiety disorders

• Fibromyalgia

 • Chronic headaches or migraines

• Traumatic Brain Injuries

• PTSD

This may seem like a wide range of unrelated issues but the inability

to cope with a perceived threat to emotional, mental, physical or

spiritual well-being results in physiological responses if left

unchecked and manifests itself in different ways inside the body.


 Chronic Pain

Chronic pain can greatly impact the quality of life and often times be

debilitating and associated with a poor quality of life. The risk of

suicide doubles for people who suffer from chronic pain.  It affects

approximately one in five people in the developed world. It is

estimated that 80% of the world population has no or insufficient

access to treatment for moderate to severe pain.

Of the limited treatment options that do exist, few are without

negative side effects.

CBD may be a possible option as part of a multimodal treatment

plan.

In a systematic review of randomized trials involving cannabinoids

for the treatment of chronic non-cancer pain, researchers found

evidence that cannabinoids are safe and modestly effective in

neuropathic pain with preliminary evidence of efficacy in fibromyalgia

and rheumatoid arthritis.

This review included smoked cannabis, extracts of cannabis-based

medicine, and THC based drugs. The review showed significant

analgesic effects of cannabinoid as compared with placebo and

several reported significant improvements in sleep. There were no

serious adverse effects. Adverse effects most commonly reported

were generally well tolerated, mild to moderate in severity and led to

withdrawal from the studies in only a few cases. Drug-related

adverse effects were generally described as well tolerated, transient

or mild to moderate and most commonly consisted of sedation,

dizziness, dry mouth, nausea and disturbances in concentration.

15  out of 18 studies reviewed found a significant reduction in pain.

CBD only products had less significant outcomes. Products

containing THC were shown better outcomes for pain reduction.

These studies were all short term ranging from 1-2 weeks. More

studies are needed for long term use. (PMID: 21426373)

Cannabis-Based Medicines (which generally contain THC) not CBD

 exclusively have been used for pain relief, especially associated with

chronic pain.

 Gastrointestinal Function

The endocannabinoid system is involved in the regulation of a variety

of gastrointestinal functions, including motility, gut–brain-mediated

fat intake and hunger signaling, inflammation and gut permeability,

and dynamic interactions with gut microbiota. It may also play

important roles in signaling the gut-brain axis via the vagus nerve,

although this sensory transmission is not yet fully understood.

It has been proposed that endocannabinoid signaling mechanisms in

the gut may play a role in the control of food intake and energy

balance from indirect actions with the vagus nerve. The vagus nerve

bidirectionally communicates neurotransmission between the gut

and brain.

Evidence suggests that dysregulation of the endocannabinoid

system may play a role in intestinal disorders, including inflammatory

bowel disease, irritable bowel syndrome, as well as obesity

Cannabinoids may play a role in gut mobility and in the treatment of

inflammatory gut disorders. (PMID: 27413788)


 Cannabis and Cancer

Research into cannabis use for palliative care specifically in cancer

treatment began in the 1970s.

Early research found that cannabis possessed analgesic effects and

could help manage pain without significant side effects.  They found

it also had the ability to manage chemo-induced nausea and

vomiting.

Commercially available cannabinoids, such as dronabinol and

nabilone, are approved drugs for the treatment of cancer-related side

effects.

According to the National Cancer Institute, the potential benefits of

medicinal Cannabis for people living with cancer include antiemetic

effects, appetite stimulation, pain relief, and improved sleep.

Although few relevant surveys of practice patterns exist, it appears

that physicians caring for cancer patients in the United States who

recommend medicinal Cannabis do so predominantly for symptom

management.

One systematic review studied 30 randomized comparisons of

delta-9-THC preparations with placebo or other antiemetics from

which data on efficacy and harm were available. Oral nabilone, oral

dronabinol, and intramuscular levonantradol (a synthetic analog of

dronabinol) were tested. Inhaled Cannabis trials were not included.

Among all 1,366 patients included in the review, cannabinoids were

found to be more effective than the conventional antiemetics

prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine,

haloperidol, domperidone, and alizapride. Cannabinoids, however,

were not more effective for patients receiving very low or very high

emetogenic chemotherapy. Side effects included a feeling of being

high, euphoria, sedation or drowsiness, dizziness, dysphoria or

depression, hallucinations, paranoia, and hypotension. (NIH)

Another analysis of 15 controlled studies compared nabilone with

placebo or available antiemetic drugs. Among 600 cancer patients,

nabilone was found to be superior to prochlorperazine,

domperidone, and alizapride, with nabilone favored for continuous

use. (NIH)

One double-blind random-controlled 2010 study compared a

placebo with CBM (cannabis-based medicine) added to standard

antiemetic therapy and found it to be well tolerated and provide

better protection chemotherapy-induced nausea and vomiting. This

study used a THC plus CBD product with the standard of care

versus a placebo plus standard of care.  Patients were allowed to

increase dosing over a short period. More adverse reactions were

reported in the cannabis group but they were not serious. 


** the sample size was limited in this study **

A 2018 interview and questionnaire study with 2970 participants

found that cannabis as a palliative treatment for cancer patients

seems well tolerated, effective and a safe option to help patients

cope with malignancy-related symptoms. About 70% of the patients

reported a good quality of life after 6 months of cannabis use.

This study is limiting as it lacks a control group. The time delay from

the end of chemotherapy may also explain some of the improved

symptoms.

Studies that found success with CBM almost always included THC

as an active component with a 1:1 CBD to THC ratio appearing to be

the most beneficial.

Two studies examined the effects of oral delta-9-THC on cancer

pain. The first, a double-blind, placebo-controlled study involving ten

patients, measured both pain intensity and pain relief. It was

reported that 15 mg and 20 mg doses of the cannabinoid delta-9-

THC were associated with substantial analgesic effects, with

antiemetic effects and appetite stimulation.

In a follow-up, a single-dose study involving 36 patients, it was

reported that 10 mg doses of delta-9-THC produced analgesic

effects during a 7-hour observation period that were comparable to

60 mg doses of codeine, and 20 mg doses of delta-9-THC induced

effects equivalent to 120 mg doses of codeine. Higher doses of THC

were found to be more sedative than codeine. (NIH) (PMID:

30707319)

 Contraindications

CBD interacts with one of the most important pathways for drug

metabolism. Taking CBD with other drugs can increase or decrease

the metabolism and clearance of CBD. This can affect dosing.

Some studies suggest that early-onset cannabis use can induce

cognitive deficits and apparently acts as a risk factor for the onset of

psychosis among vulnerable youths.

Presently no long-term studies exist to describe the potential effects

of extended CBD usage. Many studies are evaluating the efficacy

and conclude after six to eight weeks or sooner.

According to the National Cancer Institute cannabinoid receptors,

unlike opioid receptors, are not located in the brainstem areas

controlling respiration, lethal overdoses from cannabis and

cannabinoids do not occur. However, cannabinoid receptors are

present in other tissues throughout the body, not just in the central

nervous system, and adverse effects include tachycardia,

hypotension, conjunctival injection, bronchodilation, muscle

relaxation, and decreased gastrointestinal motility.

Withdrawal symptoms with some products such as irritability,

insomnia, sleep disturbances, restlessness, and other symptoms

have occurred. These appear to be mild compared with withdrawal

symptoms associated with opiates and dissipate after a few days

Always consult with a physician and let your medical providers know

if you are taking a CBD product.

Get my CBD Facts - Printable Reference Guide FREE at

www.kristynbango.com/cbd-facts-reference-guide
 References

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Steele, G., Arneson, T., & Zylla, D. (2019). A Comprehensive Review

of Cannabis in Patients with Cancer: Availability in the USA, General
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Lafaye, G., Karila, L., Blecha, L., & Benyamina, A. (2017). Cannabis,
cannabinoids, and health. Dialogues in clinical neuroscience, 19(3),
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