All too often, physicians refrain from recommending cannabis use by patients because they learned nothing about cannabis and the endocannabinoid system in medical school and cannot knowledgeably advise patients about dosage, safety, side effects, mechanism of action, etc.
Cannabidiol and THC act synergistically to potentiate their respective therapeutic attributes. Thus, a CBD-dominant strain or product, while appropriate in some cases, is not necessarily a superior treatment option compared to a balanced CBD-rich remedy with an equal amount of CBD and THC.
Different ratios of CBD and THC are more suitable for different conditions and different individuals.
CBD is a non-psychoactive compound that can lessen or neutralize the psychoactivity of THC, which some people find unpleasant and difficult to tolerate. A patent’s sensitivity to THC is a key factor in determining appropriate dosages and ratios for a CBD-rich treatment regimen.
A balanced CBD-THC ratio may be optimal for experienced cannabis users who are comfortable with the mild high generated by THC. A patient with little or no experience with cannabis might begin by using a CBD-dominant remedy with little THC – and then gradually increase the amount of THC until he or she finds a ratio suitable for their condition and temperament.
Determining an appropriate dosage greatly depends upon what condition is being treated. For anxiety, certain mood disorders, and seizure disorders, for example, it is often best to use a CBD-dominant remedy with a ratio of at least 15 to less than 1 CBD:THC.
With pain issues, many patients report that they a need more THC, and therefore a 1:1 CBD:THC ratio, much like the GW Pharmaceuticals Sativex spray, may work best.
Questions were put to a source familiar with both HortaPharm’s and GW Pharmaceuticals’ research into CBD-rich cannabis. He generalized:
“At low doses, equal amounts of CBD will blunt the peak effect of THC somewhat, but not eliminate it by any means. If given first, CBD can block the high of THC. At higher doses, the effects of THC overwhelm those of CBD, and one can still become extremely high.”
It is important to keep in mind that cannabinoid compounds have biphasic properties, whereby small doses and high doses of the same substance can produce opposite effects. CBD has no known adverse side effects at any dose, but “too much,” while not harmful, could be less effective therapeutically than a moderate dose.
Most preclinical studies with cannabidiol utilize synthetic, single-molecule CBD produced by biochemical laboratories for research purposes – whereas whole plant CBD-rich extractions typically include THC and more than 400 trace compounds, which interact synergistically to confer a holistic “entourage effect” so that the therapeutic impact of the whole plant is greater than the sum of its parts.
It is important to consider the entourage effect (or lack thereof) when extrapolating data based on preclinical studies: 100 milligrams of synthetic CBD is not equivalent to 100 milligrams of a CBD-rich whole plant cannabis extract. Single molecule synthetic CBD is not as effective therapeutically as a whole plant CBD-rich extract.
‘Less is more’ is often the case with respect to cannabinoid therapeutics. Yosef Sarne, an Israeli scientist, reports that ultra-low doses of THC confer cardioprotective and neuroprotective effects in lab animals. We await the results of Sarne’s studies with ultra-low doses of CBD.
Although banned by federal law, dosed cannabis medicine is currently available in California (and elsewhere in the United States) in the form of concentrated oil extracts – with varying ratios of CBD and THC calibrated to suit the needs and sensitivities of individual patients.