Medical marijuana and recreational marijuana are derived from Cannabis Indica or Cannabis Sativa. The important ingredient is the resin produced by the flower. CBD products are derived from the flower of a Cannabis Sativa strain with a different genetic profile than the marijuana Cannabis Sativa. In the following paragraphs I will illustrate why I am concerned about the rise in CBD and THC usage, especially in patients with a psychiatric condition. First, a major caveat: No one under the age of 25 or a patient with schizophrenia and possibly bipolar disorder should use compounds that contain THC. There are two CB (cannabinoid) receptors in human tissues. These are found throughout the body including the brain (CNS or central nervous system). These receptors are CB1 and CB2. In the brain CB receptors are instrumental in neuronal maturation and especially in the expansion and pruning process that occurs starting at about age twelve years and culminating at around age 25 years. Use of marijuana in this age group has been associated with an early onset of schizophrenia. Despite the speculation that CBD may be beneficial in schizophrenia and other conditions, there are virtually no medical studies (especially, double blind, placebo-controlled studies, the gold standard) of any cannabis product on any medical condition. Cannabis products contain approximately 108 cannabinoids and 420 other compounds. CBD preparations are notable for their relative lack of THC (the content is supposed to be about 0.5%). However, this is not a guarantee of any type of purity. Commercially available CBD is still a mixture of a vast number of CBDs and other compounds. Although marketed as CBD or cannabidiol the preparation is far from pure cannabidiol. The reason that this is possible is because the FDA does not regulate the content, purity, safety, or investigate any clinical claim of CBD effectiveness. CBD does not even have to pass the over the counter drug review at the FDA. The over the counter drug review is much less stringent than the review of a prescription medication. From a purely pharmacologic standpoint and for the sake of our conversation at the level of the brain, the major difference
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AuthorAndrew Bishop, MD FAPA Archives
February 2021
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