Posts by Daniel Whitelocke, M.D.

Dr. Daniel's Take on Cannabis

CBD vs THC, Which is Right for Me?

by January 1, 2020

With the explosion of cannabis products into the mainstream, this topic couldn’t be hotter. Although cannabis has hundreds of identified cannabinoids compounds, Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are present in the highest concentrations and account for the bulk of beneficial physiologic properties that can be attributed to cannabis plants.

These two compounds have important differences for users, so having the right information about them and what they do is crucial to becoming a more informed patient and making healthier decisions.

THC vs CBD: Psychoactive effects

The most striking difference between these two are the psychoactive effects. THC administration results in an unmistakable euphoric “high” whereas CBD does not have overt psychoactive properties. For this reason, some users might seek out one or the other at a particular time or setting. 

CBD has a much more marked effect on peripheral nerves and produces a more marked effect of a body relaxation due to it’s soothing anti-inflammatory properties.

For example, long haul truck drivers might not want to risk using THC for legal and safety reasons, but still might desire the beneficial effects of cannabinoids. In this case, CBD would be a more logical choice.

CBD can help safely promote relaxation and sooth hyperactive nerves, without impairing one’s judgement. 

THC - MMJ

On the other hand, a home-bound patient who might have anxiety and pain issues may benefit more greatly from the euphoric distraction provided by THC compounds.

Research has shown the the highest yield medicinal cannabis strains contain a balanced of both THC and CBD.

The decision on which to use primarily depends on the patient’s comfort level with feeling the euphoric “high” associated with THC administration.

What are Cannabinoids?

Cannabinoid Guide

Simply put, cannabinoids are compounds that interact with the endocannabinoid system. Cannabinoids can either by synthesized by the body (yes, really) and are thus called ENDOcannabinoids. The two best characterized of endocannabinoids are Anandamide and 2-Acylglycerol, or 2-AG for short. These compounds are made in the body and have similar structures to cannabinoids made in plants. The phytocannabinoids synthesized in plants bind to the same receptors in the body as the endocannabinoids and are degraded by the same enzymes.

This opens up another huge topic of the endocannabinoid system which we will delve into as a recurring theme on future blogs. In short, this system is present in humans and other mammals and has evolved over thousands of years to restore homeostasis, or natural balance, to our physiologic systems when we are encountered with stimuli that perturb our natural balance. As a matter of fact, the endocannabinoid system is a collective of hormones, receptors, and enzymes with active sites in the brain, digestive system, immune cells, reproductive systems, pain sensory nerves, emotional centers, sleep and wakefulness sites, and memory to name a few. With such far reaching functions, it is clear to see why people are so interested in cannabis products making a resurgence as medicine.

Cannabinoids are the lipophilic, fat soluble substances that interact with the receptors of the cannabinoid system. It is only after binding to their specific receptor that cannabinoid compounds exert their effects. Once bound to their cannabinoid receptors, known as the CB1 and CB2 receptors,  a cascade of reactions follow within the target cell that result in the release of neurotransmitters or hormone that further medicate and/or amplify the effects of cannabinoids.

THC vs CBD: A closer look at the chemistry

Cannabinoid Guide

On first look, Tetrahydrocannabinol and Cannabidiol seem almost identical. They share a common chemical formula and have an equivalent molecular weight. Looking at their chemical structure looks almost identical even to the untrained non-chemist. But upon closer look at the THC compound, you can notice a cyclic structure with an Oxygen atom sandwiched in between two carbon atoms in what is called an Ether bond. This enables THC to sit comfortable in its receptor like a lock and key and exert its effects.

On the other hand, Cannabidiol has opened up that ring structure and you notice a hydroxyl group (-OH) at the end where the oxygen was formerly bound on each side by carbon atoms. Now the structure has two -OH groups and is therefore called a -Diol. This means that this structure cannot sit comfortably in the same receptor as THC because of its nonpermissive shape. In fact, when CBD comes into contact with the CB1 receptor, it actually restricts binding of THC to the active site of tis receptor. This modulation of THC’s activity by CBD receptor binding is called Allosteric inhibition.

THC vs. CBD: Legal status

At the time of this writing, products containing higher than 0.3% THC are still considered illegal on a federal level in the United States as a schedule I drug. CBD based products with less than 0.3% THC are not psychoactive and are completely legal for consumption in all US States and do not require a Medical Marijuana Card in order to get CBD from a retailer. On the other hand, in states that have a medical marijuana program, patients can still obtain medical marijuana with appropriate physician certification and licensure by that state despite marijuana’s status as a federally illegal drug. This means that if patients abide by the rules of their respective state’s medical marijuana program, they will not be subject to criminal prosecution by local and state authorities. The Rohrabacher-Farr Amendment of 2014 prohibits the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws. 

THC vs. CBD: Will I pass a drug test?

Patients taking THC containing products should be advised that use will likely result in a positive test on a most employment-based drug screens. Most drug tests will not show positive for most CBD based products that are below the 0.3% threshold but certain high sensitivity tests might show positive. Pure CBD isolates contain no THC, but CBD products labeled as “Full Spectrum” contain the full entourage of cannabinoids and it is possible to show positive for THC despite not having psychoactive effects. For the most part, however, users can rest assured that most products marketed as CBD that are below 0.3% THC will not test positive for THC.

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