Does CBD mitigate harms of cannabis?

Does CBD mitigate harms of cannabis?

By Dr. Liji Thomas, MD Nov 20 2022
Reviewed by Benedette Cuffari, M.Sc.

Cannabis is a psychedelic drug being increasingly legalized throughout the

western world for medicinal and recreational purposes. Simultaneously, more
potent drug preparations are being used in terms of their ∆9-
tetrahydrocannabinol (THC) concentrations. THC is known to cause acute
adverse effects and may result in long-term impairments when consistently
used in high doses.

A recent Neuropsychopharmacology study investigates whether these adverse

outcomes could be alleviated by increasing the concentrations of cannabidiol
(CBD) in these products.

Study: Does cannabidiol make cannabis safer? A randomised, double-blind,

cross-over trial of cannabis with four different CBD:THC ratios. Image Credit:
IRA_EVVA / Shutterstock.com

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Introduction
Cannabis users who have a low frequency of use have been reported to develop
acute loss of memory and attention with high-THC cannabis preparations, along
with psychotic symptoms. Over more extended periods of use, this could result
in a greater likelihood of psychosis and developing cannabis use disorder.

As a chemical, CBD fails to affect cognitive functions and prevent the

development of psychosis, with the risk of both being lower among users who
smoke high-CBD cannabis, irrespective of their frequency of use. When CBD is
first given, followed by THC, the memory and psychotic effects of THC have
been reported to be mitigated in light users, but not with frequent use.

About the study

The current study examines the acute effects of cannabis at four different
dosages of CBD in relation to THC. These CBD:THC ratios of 0:1, 1:1, 2:1, and
3:1 were tested in 46 healthy volunteers between 21 and 50 years of age who
infrequently used cannabis. More specifically, the study participants had used
the drug once or more in the past but not more than once a week during the
last year.

None of the study participants had a substance use disorder or used synthetic
cannabinoids.

The current study followed a double-blind randomized pattern using vaporized

cannabis containing 10 mg THC and either 0, 10, 20, or 30 mg of CBD. The
researchers assessed their effects on cognition regarding verbal recall using the
Hopkins Verbal Learning Task. Simultaneously, psychotic symptoms were
assessed using the Positive and Negative Syndrome Scale (PANSS) positive
subscale.

The study participants first inhaled cannabis, following which they completed a
set of cognitive tasks and were assessed for pleasurable effects based on their
enjoyment of chocolate and music compared to baseline. The participants were
then asked to purchase something from a hospital shop.

After this, the study participants were given time for the drug’s effects to wear

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off. Finally, they completed questionnaires to describe their psychological

experiences, including persecutory thoughts, self-assessment of psychotic
thoughts, and a visual analog scale for their subjective feelings following drug
use.

Finally, they completed an interview to apply the PANSS-P.

What did the study show?

In all cases, peak THC and THC metabolite levels in blood were similar.
However, peak CBD levels rose with the THC:CBD ratio.

THC exerted the same effects at all ratios, with impaired immediate and
delayed verbal recall as compared to baseline, irrespective of the presence or
ratio of CBD. Herein, THC induced higher rates of intrusive psychotic-like
thoughts, both immediate and delayed.

Positive psychotic effects were significantly greater following inhalation, with

half of the total participants showing an increase in their PANSS-P scores by
three points compared to baseline at all ratios and without significant
differences between ratios. Psychotic thoughts also increased across the cohort
without any difference between different ratios.

However, persecutory thoughts did not increase with the use of the drug at any
ratio.

Other tests showed that pleasurable effects or euphoria were evenly distributed,
irrespective of the CBD:THC ratio. In addition, the euphoric feeling did not
correlate with the plasma levels of either compound.

While heart rate increased after inhalation, there were no changes in blood
pressure or temperature. However, coughing during inhalation was significantly
greater with the CBD dose. Moreover, with longer periods required to inhale the
full dose, peak concentrations were reduced at higher CBD:THC ratios.

What are the implications?

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The co-administration of CBD with THC had no effect on the

induction of either cognitive impairments or psychotic symptoms
following cannabis use.”

Furthermore, the presence of CBD at increasing ratios did not change the
subjective feeling of being high or the pleasurable effects of THC.

The current study is important, as it measured these effects using CBD:THC

ratios usually found in recreational or medicinal cannabis. Unfortunately several
participants dropped out at the first visit, more so with the 3:1 ratio, due to the
intolerably unpleasant effects of the drug.

The remaining study participants may have been less sensitive to cannabis,
especially CBD, but still registered significant changes in cognitive and
psychological tests.

The primary observation that CBD does not modulate THC's psychotic or
cognitive effects corroborates earlier studies; however, two previous studies
reported a weakening of such effects with CBD. These used larger doses of CBD
that are often greater than those usually present in medicinal or recreational
cannabis. Such doses may require non-inhalation routes of administration.

Conversely, one previous study reported reduced risk with higher CBD:THC
ratios which may be explained by the fact that plants that produce cannabis
with higher ratios do so by producing more CBD at the expense of THC, as both
come from the same precursor compound.

The purported reduced risk from using high CBD varieties may
thus not be an effect of the high CBD content, but due to the
relatively low THC content.”

The study findings show that CBD offers no protection against the acute effects
of THC; however, its potential long-term protection remains to be studied.
Meanwhile, it appears that CBD content is not a critical factor in regulating or
defining cannabis formulations and may not alleviate the adverse effects of
THC.

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Journal reference:
Englund, A., Oliver, D., Chesney, E., et al. (2022). Does cannabidiol make
cannabis safer? A randomised, double-blind, cross-over trial of cannabis
with four different CBD:THC ratios. Neuropsychopharmacology.
doi:10.1038/s41386-022-01478-z.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College,
University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in
obstetrics/gynecology in a private hospital for a few years following her graduation.
She has counseled hundreds of patients facing issues from pregnancy-related
problems and infertility, and has been in charge of over 2,000 deliveries, striving
always to achieve a normal delivery rather than operative.

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