How they’re similar, how they’re different, and what you need to know.
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Those of us who live in the city are used to stress. Whether it’s an overcrowded 6 train or a noisy neighbor, things tend to get stressful when you cram more than eight million people into five boroughs. These daily frustrations are the counterweights to the culture and sophistication of the city, and we eventually learn to live with and even appreciate them.
The coronavirus presents different kinds of stress. Apart from potentially contracting the virus, there are also the stresses of self-isolation, quarantine, and worrying about the economic fallout in the wake of the pandemic. Given these concerns, many people may be experiencing not only the burden of stress, but symptoms of anxiety, as well. In fact, many medical professionals now believe that the pandemic will leave a lasting scar on the nation’s psyche, and that many people may be exploring different ways to treat symptoms of anxiety.
One of these options might be cannabis.
Those who do not know a great deal about the plant, may not know where to begin. To answer some questions about cannabis and its therapeutic use, I reached out to Dr. Samoon Ahmad, founder of the Integrative Center for Wellness in Manhattan and co-author of the book Medical Marijuana: A Clinical Handbook, which will be published by Wolters Kluwer later this year.
CBD and THC
Despite the oversized countercultural role of cannabis for much of the twentieth century, it is important to remember that it is just a plant. Like other plants, it contains hundreds of chemical compounds. Some of these compounds, such as terpenes, terpenoids, and flavonoids, are found throughout the plant world. “The terpene limonene, for example, is found in citrus peels. It gives them their lemony scent,” Dr. Ahmad said. “Limonene is also found in cannabis. In high enough concentrations, it may result in a lemony scent or flavor. Other terpenes have equally distinctive scents and flavors that they also impart to cannabis.”
Apart from these compounds, cannabis also contains what are known cannabinoids, which are believed to be unique to cannabis. “At least 120 individual cannabinoids have been isolated thus far. Some have been studied. Most have not,” he said. “The two that have received the largest amount of attention are tetrahydrocannabinol (THC) and cannabidiol (CBD). Each has a distinct therapeutic value. For example, THC is very good for pain and nausea, among other things, while CBD appears to be a potent anti-inflammatory agent.
“The two also have different psychological effects on users, as well. THC is the primary intoxicant in cannabis and leads to the effects most people think of when they think of marijuana. CBD, meanwhile, does not cause intoxication, but it can produce a feeling of relaxation,” Dr. Ahmad explained. “Studies have also found that the two work very well together in concert, and that specific ratios of CBD to THC may ultimately be better at reducing symptoms associated with anxiety and even post-traumatic stress disorder. Research has also found that CBD on its own can be very effective in this regard.”
Cannabis, Hemp, and Marijuana
THC and CBD are also important because of the legal distinction between hemp and marijuana, which fall under the umbrella term cannabis (there is some debate about whether cannabis is a single species (Cannabis sativa) with multiple variants or multiple species). “As an analogy, think of breeds of dog,” Dr. Ahmad said. “A poodle and a bulldog may seem very different, but they are both dogs. Similarly, industrial hemp and a cultivar of marijuana with a name like Maui Wowie may seem very different, but both are cannabis.”
Ultimately, THC content determines if cannabis is marijuana or hemp, according to the Agriculture Improvement Act of 2018. If the plant produces more than 0.3% THC, then it is marijuana. If it produces less than that amount, then it is hemp. Products that contain hemp-derived CBD can be legally purchased by anyone in New York. Products that contain THC can only be purchased in New York by participants in New York State’s medical marijuana program.
Who Is Eligible for New York’s Medical Marijuana Program?
By the standards of other blue states, New York’s medical marijuana program is relatively strict. Patients may only purchase a 30-day supply of non-smokable products from licensed dispensaries, of which there are only a handful in New York City. To qualify, a patient must have one of the following conditions:
ALS Cancer Chronic pain Epilepsy HIV/AIDS Huntington’s disease IBD MS Neuropathy Opioid substitution Parkinson’s disease PTSD Spinal cord damage
Here’s where things get interesting. Medical professionals are not allowed to prescribe drugs if the federal government has determined that they are potentially dangerous and of no medical use. These are known as Schedule I drugs. Marijuana is a Schedule I drug. Additionally, researchers have been prevented from performing trials that would evaluate the potential medical uses of marijuana to remove it from Schedule I status. The reason they can’t do these trials? It is a Schedule I drug. This is the kind of logic that Kafka would enjoy.
Since 1996, 33 states and the District of Columbia have legalized its use for medical purposes, despite its being a Schedule I drug. To get around federal regulations, these jurisdictions allow some practitioners to recommend (not prescribe) marijuana. In New York, practitioners must qualify with these three conditions to recommend it:
Be in good standing.
Have completed a course approved by the Commissioner of the Department of Health and registered with the NYS Department of Health Medical Marijuana Program.
Be either a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Certified Nurse Practitioner (CNP), or Physician Assistant.
Patients who have obtained a recommendation from a qualifying practitioner can then find information and register online with the Department of Health’s Medical Marijuana Program. From there, they will be instructed on how to obtain their card, which will allow them to purchase marijuana at a dispensary. Unlike some other states, New York does not have a reciprocity program, which means you must be a New York resident with a valid New York State medical marijuana card to legally buy marijuana from a dispensary.
“Marijuana cannot be recommended to treat mood, anxiety, or sleep disorders in New York, but CBD products can potentially ease some of the symptoms associated with these issues,” Dr. Ahmad said.
Unlike marijuana, CBD that has been extracted from hemp plants can be purchased virtually anywhere, and there are literally hundreds of these products on the market. They are sold at pharmacies, bodegas, health food stores, a new breed of store dedicated to nothing but CBD, and a host of online retailers. A deep dive into the subject can get very, very deep.
Without going too far down the rabbit hole, Dr. Ahmad has a few tips for those who are new to CBD. “First, I would advise against buying any CBD product from your corner bodega. These products may be more affordable, but they are poorly regulated, and you will unfortunately get what you paid for. Secondly, you should consider CBD products that are labeled either ‘whole plant’ or ‘full spectrum.’
“There are hundreds of compounds in cannabis besides CBD and THC. Some are cannabinoids. Some are terpenes and terpenoids. Apart from affecting the taste and smell of the cannabis, they appear to modify the effects of CBD and THC. In some cases, these compounds are discarded after the CBD or THC has been extracted from the vegetative matter of the plant, despite their potential therapeutic value. Products labeled ‘full spectrum’ or ‘whole plant’ do not discard these compounds.”
For example, CBD by itself is a stimulant. It does not put you to sleep and is not suitable for someone suffering from insomnia. However, CBD cultivars that are high in the terpene known as myrcene appear to have sedative qualities. In other words, if you want to use CBD as a sleep aide, you will want to look for a full spectrum product that may want to look for a product that contains CBD and myrcene rather than just CBD.
When asked if full spectrum or whole plant CBD products may cause intoxication, Dr. Ahmad replied in the negative. “Full spectrum CBD products should not contain more than 0.3% THC. Typically, they contain far, far less. If they are used as indicated, the possibility that one will become intoxicated is very remote.”
Because CBD appears to interact with other cannabinoids and terpenes, individuals seeking pandemic-related anxiety relief and a better night’s sleep should do their research online and find products that work for them. Two good places to start, Dr. Ahmad said, are leafly.com and leafreport.com.
Dr. Ahmad urged caution when using marijuana. “While it is often treated as a harmless plant, adverse effects can occur. Some people may be hypersensitive to cannabis. This is relatively rare, but it does happen, and they should avoid marijuana, CBD products, and even hemp seeds. Hypersensitivity may lead to a burning sensation in the skin, flushing, hives, swollen lips, and throat tightness. It is effectively an allergy.
Additionally, Dr. Ahmad advised that individuals who have psychotic or mood disorders or individuals who are at an increased risk of developing these disorders should avoid marijuana. “The science is not entirely conclusive, but there is evidence to suggest marijuana may exacerbate symptoms associated with these two disorders. This is particularly the case with younger individuals who may be predisposed to these conditions. Marijuana may be the catalyst that leads to their first manic or psychotic episode.”
Another concern is that patients who are new to marijuana may not know their limits and they may take too much. “My advice is to start low and go slow,” Dr. Ahmad said. This is especially the case with edible forms of marijuana, which may not take effect for upwards of 90 minutes. “Be patient and follow the instructions on the packaging. It is an extremely safe drug, but taking too much can cause very unpleasant experiences.”
Apart from feeling intoxicated, common side effects of marijuana/THC include:
Common side effects of CBD are usually extremely minor, though it may cause drowsiness. Those taking CBD should not drive afterwards until they know how it affects them, and no one should get behind the wheel while feeling high on THC. Finally, Dr. Ahmad stressed that patients should speak with their doctor before using cannabis to inquire about any potentially harmful interactions with drugs they have been prescribed.
The coronavirus pandemic is one of the most significant events in modern history. It should come as no surprise that many of us are finding it difficult to fully apprehend the gravity of its immediate effects and the possibility of a slow and arduous process of recovering and establishing a new normal. Especially for those of us in New York City, this may mean having to adapt to new and unfamiliar rhythms in confined spaces, and may require finding ways to cope with feelings of anxiety.
“Cannabis may offer one solution to some who want to mitigate these symptoms of anxiety,” Dr. Ahmad said, “but it is not a panacea. It can only offer so much immediate relief. Ideally, if one chooses to use cannabis, it should be only a part of a larger wellness regimen that includes at least 150 minutes of moderate aerobic exercise each week, a diet that is rich in fruits and vegetables, and other therapies that promote relaxation—yoga, meditation, and guided breathing exercises.”
. . . . . . . . . . . . Samoon Ahmad, M.D. is a professor of Psychiatry at the NYU School of Medicine and a featured blogger on Psychology Today. A practicing physician for over twenty years, Dr. Ahmad has dedicated his professional life to helping individuals find balance in their mental and physical wellbeing. He founded the Integrative Center for Wellness to execute his innovative vision of incorporating psychiatric treatments with nutritional therapies in order to emphasize wellness of both the body and the mind. He specializes in treating patients with depression, anxiety, bipolar disorder, ADHD, stuttering, and weight management issues.