CBD vs. cannabis/THC – what is the difference?

I live in Denver, Colorado, and for the reason that legalization of recreational marijuana in 2014, I’ve seen the industry explode, with cannabis dispensaries popping up in most major city neighborhoods. One cannabis-based product that’s receiving loads of attention is cannabidiol (CBD) oil, which is used to treat anxiety, insomnia, joint pain, inflammation, and depression (Hilderbrand, 2018). The oil is usually administered in the shape of drops sublingually, but it’s also added to products (lotions, sports creams, lotions), drinks (infused water, coffee) and foods (jams, jellies). What exactly is CBD oil and the way does it differ from cannabis?

Background (Hill, 2015; Pressman and Clemens, 2019)

Marijuana () has been used for hundreds of years. By 100 AD, the Chinese had discovered over 100 medicinal uses for marijuana. Both the traditional Egyptians and Greeks used marijuana to treat conditions similar to glaucoma, inflammation and edema. In the early twentieth century, marijuana was an ingredient in several drugs and was used as a pain reliever, sedative, and to treat muscle spasms. It was during this time that recreational use was introduced, and by the Thirties, several states began to manage the drug. Cannabis was defined as a Schedule I substance within the federal Controlled Substances Act of 1970 because of its high potential to cause abuse and addiction and its lack of proven medical use on the time (Federal Drug Administration [FDA], 2019). There are currently roughly 35 million regular users (greater than twice a month) within the United States, making it essentially the most widely used illicit drug.

Cannabis could be inhaled, taken orally, sublingually and topically. Although research is restricted, medicinal marijuana is used to treat chemotherapy-induced nausea and vomiting, cancer-related anorexia, irritable bowel syndrome, chronic pain, multiple sclerosis, epilepsy, amyotrophic lateral sclerosis, Parkinson’s disease, addiction, and schizophrenia (Khalil, 2018). ; O’Malley, 2019). The California Compassionate Use Act of 1996 was the primary state law to legalize the usage of cannabis for pain relief and vomiting in AIDS patients (O’Malley, 2019). Unlike the road version, medicinal marijuana have to be quality tested, labeled by the grower, and verified by an independent third party for its lively ingredients – cannabinoids (CB).

Cannabis comprises over 100 CB varieties that interact with the body’s endocannabinoid system in various ways (Khalil, 2018). The hottest CBs are delta-9 tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN). THC is a natural ingredient that binds to CB 1 receptors situated within the brain and nervous system, producing euphoria and other psychoactive effects. CBN is barely psychoactive and has a greater affinity for CB 2 receptors present in the immune system (Khalil, 2018). CBD barely binds to CB receptors, if in any respect, but it could possibly interfere with the activity of THC, leading to a reduced psychoactive effect. Although CBD and THC have the identical molecular structure (21 carbon atoms, 30 hydrogen atoms and a pair of oxygen atoms), they’ve different structures (World Health Organization [WHO]2017), which can explain their opposing mechanisms.

The table below summarizes the differences between CBD and Cannabis/THC:

FDA-Approved Cannabis Medicines (FDA, 2019)

There are currently 4 FDA-approved cannabinoid-based drugs in the marketplace: three synthetic compounds, including Marinol, Syndros, and Cesamet, and one purified form, Epidiolex. Marinol and Syndros contain an artificial THC called dronabinol and are used to treat weight reduction secondary to acquired immunodeficiency syndrome and chemotherapy-induced nausea. Cesamet comprises nabilone and can also be used to treat chemotherapy-induced nausea and vomiting. Epidiolex is the primary purified marijuana drug to be approved by the FDA for the treatment of two rare forms of seizure disorders in children, Lennox-Gastaut syndrome and Dravet syndrome. Side effects include drowsiness, increased liver enzymes, decreased appetite, diarrhea, rash, fatigue, malaise, weakness, insomnia, sleep disturbances, poor sleep quality, and infections (Pressman and Clemens, 2019). Baseline liver function tests (LFTs) ought to be collected and assessed before treatment is initiated and repeated after one, three and 6 months of treatment. Assess the patient for signs and symptoms of liver disease, including nausea, vomiting, upper right abdominal pain, fatigue, anorexia, jaundice, and dark urine (Pressman and Clemens, 2019). Patients ought to be trained to make use of the measuring device included within the package.

The marijuana industry is growing rapidly because the trend toward legalization continues. There are many CBD products in the marketplace that claim to have therapeutic value but aren’t FDA approved. Nurses must have a basic understanding of each approved and unapproved cannabis-based products and their effects as a way to properly educate and manage patients effectively.

Food and Drug Administration (2019). FDA Regulations on Cannabis and Hemp-Derived Products: Questions and Answers. Downloaded from https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-questions-and-answers#approved

Hilderbrand, South Africa (2018). Hemp and cannabidiol: What is a drug? . 115 section 4, 306-309.
Hill, K. (2015). Marijuana: the unbiased truth about the most well-liked marijuana on the earth. Center City, Minnesota: Hazelden Publishing.

Khalil, H. (2018). Medicinal cannabis: presenting possible treatments for the longer term. International Journal of Evidence-Based Healthcare.

O’Malley, Pennsylvania (2019). Therapeutic and recreational marijuana – secure practice within the network of politics, science, law and nursing. Clinical Nurse Specialist. X(X), 110-113.

Pressman, P. and Clemens, R. (2019). Introduction: Cannabis in modern society. . 54 section 2, 78-83.
World Health Organization (2017). Cannabidiol (CBD) Preliminary Review Report. Downloaded from https://www.who.int/medicines/access/control-substances/5.2_CBD.pdf