What Are Medical Marijuana and Cannabidiol (CBD)? Everything You Need to Know

The cannabis plant, from which marijuana is derived, is often smoked for recreational purposes. But people are increasingly using marijuana to treat medical conditions — and this medical marijuana is not always smoked. It comes in many forms:

• Marijuana cigarettes containing the cannabinoids (chemical compounds) tetrahydrocannabinol (THC) or cannabidiol (CBD), or both THC and CBD
• CBD oils, edibles, tinctures, creams, and capsules
• Cannabis-derived pharmaceutical products approved by the Food and Drug Administration (FDA)

Studies suggest that the medical use of marijuana may help treat the following conditions or help alleviate the following symptoms: (1)

• Anxiety, particularlysocial anxiety disorder
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• Chronic pain
• Cancer-related pain
• Cancer-related nausea
• Loss of appetite due to chemotherapy or HIV/AIDS
• spasticity related to multiple sclerosis (MS)

Some research has suggested that the cannabinoids in marijuana could also be useful in managing these conditions: (2,3,4,5,6,7)

• Inflammation
• Arthritis
• Migraines
• HIV/AIDS
• Digestive disorderslikeCrohn’s diseaseandirritable bowel syndrome(IBS)

According to a 2017 report from the National Academies of the Sciences, Medicine, and Engineering (NASME), the strongest scientific evidence so far has been found in support of using marijuana for chronic pain, cancer-related nausea and vomiting, and MS-related spasticity. (1)

This NASME report, one of the largest of its kind, looked at more than 10,000 studies published since 1999.

How Does Marijuana Affect the Body?

It depends on whether THC or CBD is the cannabinoid at work. They produce similar effects, but there are differences in intensity because they each affect a different neural pathway.

THC is thought to engage with the body’s endocannabinoid system, which helps regulate physiological functioning. THC is similar to a chemical that’s present in this system, and when these two chemicals meet, the similarity allows THC to exert an influence on the body and brain in ways that alter coordination, memory, decision-making, appetite, and mood.

The endocannabinoid system also helps regulate gastrointestinal functions, and this may explain why medical marijuana seems to help digestive disorders like IBS.

CBD, scientists think, affects the brain because of the way it interacts with the neurological pathways that regulateserotonin, the hormone that regulates anxiety, pain, nausea, and appetite.

Some individuals use marijuana instead of addictiveopioidsto treat pain. In these cases, marijuana may actually be responsible for a decrease in the use of — and deaths from — these prescription drugs.

A study published in May 2018 inJAMAInternal Medicinereported that prescriptions for opioids decreased in states that have medical marijuana laws. Researchers looked atbob sports app data from 2010 to 2015 and found that states with active dispensaries saw 3.742 million fewer daily doses of opioids filled by pharmacies. (8)

Another study, published in October 2014 inJAMA Internal Medicine, found that states with medical cannabis laws had a 24.8 percent lower annual overdose rate than states without such laws. (9)

Some states, like Pennsylvania and New York, now consider opioid use disorder as a qualifying condition for medical marijuana use. New York, for example, allows people who qualify to use medical marijuana instead of opioids to treat pain.

Cannabidiol is the cannabinoid in marijuana that, along with interacting with the brain's serotonin system, may also help relax and calm you, but it doesn't alter your perception or affect physical reactions too much. CBD may be particularly effective for: (10)

• Anxiety disorders
• Nausea and vomiting
• Psychotic disorders
• Addiction
• Non-cancer-related pain
• Depression
• Addiction
• Sleep problems
• Epilepsy(Dravet syndromeand Lennox-Gastaut syndrome)

Staci Gruber, MD, is an associate professor of psychiatry at Harvard Medical School in Boston and the director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital in Belmont, Massachusetts, which is researching the neurological effects of medical marijuana use.

In a large study that she’s conducting on theuse of medical marijuana, Dr. Gruber says the second most commonly reported use of medical marijuana among subjects is for anxiety. She’s also about to begin an FDA-approved clinical trial of a CBD sublingual (administered under the tongue) tincture, consisting of CBD in acoconut oilbase, for the treatment of anxiety. (Tinctures are medicines — in this case CBD — dissolved in a liquid like alcohol or glycerine.)

Indeed, anecdotal evidence points to the effectiveness of CBD as an anxiety and stress reducer, as well as a sleep aid. Eric*, a busy sales executive in San Francisco, has been sleeping more soundly since he started using a high-CBD, low-THC product via a vaporizer three months ago for work-related stress and anxiety.

“The quality of my sleep is better, I’m sleeping longer and deeper, and I now have no problem falling and staying asleep,” he says. “It has changed my life.”

In addition to being a potentially powerfultreatment for anxietydisorders, a growing body of research is suggesting that CBD may help treat symptoms of neurological disorders such as帕金森病andAlzheimer's disease. (11,12)

Scientists think that CBD acts in yet to be determined ways that protect the brain against inflammation and oxidative stress. (13)

Research also points to CBD as a potential treatment for psychosis andschizophrenia. (14,15)

Medical marijuana may also be effective in palliative care. In one Canadian case study, published in 2013 inCase Reports in Oncology, physicians reported that CBD oil, administered orally, was a successful treatment for a 14-year-old patient in palliative care with an aggressive form ofleukemia. (16)

CBD oil is made by extracting resins from CBD-rich marijuana plants and then adding ethanol (a form of alcohol) to the resins to refine the oil. The oil can be found in edibles, tinctures, capsules, creams, butters, and vape pens.

Because CBD isn’t psychoactive like THC, CBD oil won’t give you the high that THC does.

There are numerous ways to extract the resin, and some ways are safer than others. Certain preparations rely on chemicals like petroleum and butane for extraction; other methods involve using carbon dioxide.

CBD oil is also extracted from hemp plants, but since hemp plants don’t contain as much CBD as marijuana plants, the effects of these oils may not be as potent.

CBD extracted from marijuana plants should have little to no THC content.

What Are the Benefits of CBD Oil?

可能没有足够的科学研究— to prove without a doubt that CBD oil has medicinal and health benefits. Most of the studies that have been conducted on CBD have been done using CBD in pharmaceutical-grade preparations like oral solutions or pills.

But many people report that CBD oils have helped them conquer everything from anxiety to pregnancy-related nausea to chronic pain. Calley Nelson, a writer and artist based in Brooklyn, New York, says she's been able to transition off ofantidepressantssince she started taking CBD oil for anxiety in June.

People also give it to their pets to help treat arthritis, seizures, anxiety, and illness-related loss of appetite.

If you do decide to try CBD oil to treat a condition or alleviate symptoms, make sure you talk to your doctor before you begin taking it.

Where Can I Buy CBD Oil?

If it’s legal in your state of residence, you can buy CBD oil online or through dispensaries.

Bottles of CBD oil or oil-based tinctures can cost anywhere from $30 to $70. (17,18)

Is CBD Oil Safe?

Experts say that for the purest, most effective oil, it’s a good idea to buy it from companies that follow these practices:

• They use a carbon dioxide extraction method.This method ensures that you’re getting a potent oil that’s free (or nearly free) of harmful chemical by-products.
• They use third-party lab testing.这意味着公司发送CBD油laboratory that’s going to examine the product and serve as an unbiased judge of its quality and safety.

Scientists say that it may be best to avoid using CBD vape pens. They’re made with a harmful chemical called propylene glycol, which is also used ine-cigarettes. When the temperature’s high enough, propylene glycol can turn into a molecule that can affect your lung tissue.

And in a report published inJAMA2017年11月,研究人员测试了84 CBD名单ts sold online and found that 26 percent of those products contained less CBD than labeled. They also detected THC in an estimated 21 percent of the products. (19)

If you’re concerned about safety and quality, it may be a good idea to talk to your dispensary about the growers they work with, or to the companies that manufacture the CBD products you use.

A good vendor of CBD and other marijuana products will be up front about their processes and their safety profile. Read their websites carefully, and ask questions if you need to.

Is CBD Oil Safe for Teenagers?

As with adults, no one knows yet for sure what the long-term effects of regular use of CBD oil would be.

Regular recreational use of THC is not beneficial for teenagers (20), but CBD is not psychoactive like THC and does not seem to act on the brain in the same harmful way.

CBD-rich pharmaceutical-grade medical marijuana preparations have been shown to help treat seizures in children who suffer from rare forms of epilepsy — so much so that they were recently approved by the FDA. (21)

But the research on those drugs was based on pharmaceutical-grade cannabis preparations, not what medical professionals call artisanal preparations: those made by small companies or by individuals who may or may not be capable of or willing to make sure that their product is free of potentially harmful impurities.

In addition to the case report of palliative care use with a 14-year-old mentioned earlier, two physicians published a case report in the fall of 2016 inThe Permanente Journalthat discussed the use of CBD oil to treat thepost-traumatic stress disorder–related anxietyandinsomniaof a 10-year-old girl. After five months of treatment, the girl reported less anxiety and significantly improved sleep; she did not report any adverse or side effects. (10)

In California, emancipated minors may apply for medical marijuana cards. (22)

But the American Academy of Pediatrics says that it opposes medical marijuana outside of products that have been or can be approved by the FDA, citing recreational marijuana’s serious effects on adolescent health and development, such as reduced educational attainment. (23)

According to the National Institute on Drug Abuse, the regular recreational use of marijuana may cause negative — and possibly permanent — changes to the brain that can affect your ability to remember things or to make decisions. (24)

Psychiatric disorders such as psychosis or mania may be worsened by chronic use of marijuana, and it may also worsen theeffects of depression, according to the University of Washington’s Alcohol and Drug Abuse Institute. (25)

According to the National Alliance on Mental Illness, if you are susceptible to these psychiatric disorders, your risk will increase the longer you use marijuana and the earlier you start regularly using marijuana. (26)

A study published in March 2014 inNeuropsychopharmacologyalso found that regular marijuana use seemed to shrink the regions of the brain associated with emotional and motivational processing. (27)

Research has further shown that long-term use can create respiratory problems such as chronicbronchitis. (1) But unlike with cigarettes, there is no evidence showing that smoking marijuana causeslung cancer. (28)

How Will Long-Term Medicinal Use of Marijuana Affect Me?

The research is still new and ongoing, so experts aren’t absolutely sure yet about what the long-term effects of marijuana for medicinal use may be.

Since CBD does not produce as many adverse effects as THC, and helps mitigate those of THC, scientists are increasingly conducting more studies on the compound and its medical benefits.

Does Marijuana Come in Pill Form?

The FDA has approved the sale of four cannabis-based prescription drugs in the United States.

Most recently, theFDA approved Epidiolex, a drug that is prescribed to treat seizures associated with Dravet syndrome and Lennox-Gastaut syndrome, two rare and severe forms of epilepsy.

The others go by these names:

• Marinol (dronabinol), prescribed to treat chemotherapy-related nausea
• Syndros (dronabinol), prescribed totreat anorexiain those with AIDS
• Cesamet (nabilone), prescribed to treat chemotherapy-related nausea

Each state has its own procedure for allowing its residents to purchase medical marijuana. Check your state’s department of health website to find out exactly what the process in your state entails.

Each state also has a list of qualifying conditions that they’ve approved for the use of medical marijuana. These lists, while they vary from state to state, often include conditions like cancer, anxiety, and inflammatory bowel disease.

Your state’s department of health website should tell you what the qualifying conditions are.

No matter what state you’re in, in order to buy medical marijuana, you will have to take these steps:

• Find a registered physician who will confirm in writing that you have a qualifying condition that would be improved by the drug.
• Submit this information to your state’s department of health.
• Receive an ID card that allows you to purchase medical marijuana at a dispensary.

States, and sometimes counties within states, charge fees for card applications. Some, like California, will waive or reduce the fee for eligible patients. (22)

These fees are usually around $100 to $150 for a card that’s valid for one year. Some states, like Vermont, charge $50. (22,29,30) The fees increase if you want a card that’s valid longer.

Dispensaries are the medical marijuana equivalent of pharmacies. They sell marijuana and other cannabis-derived products to people who have been certified by their home state to purchase it.

Depending on what state you live in, you can also purchase marijuana for recreational use at dispensaries.

*To protect his privacy, Eric requested that his full name not be used.