As THC and CBD use becomes more and more prevalent recreationally and for self-medication, hospitals and emergency rooms are seeing increasing numbers of patients who use cannabis products.
A recent study found that emergency department visits and hospitalizations are 22 percent higher among people who use cannabis versus those who do not. As such, clinicians need to know and understand today’s THC-CBD environment.
Increased Demand for Self-Medication
The first question is why there is such a demand for self-medication. Reasons vary, but include:
Health care costs are rising, leading people to seek cheaper alternatives. Per capita, health spending has risen dramatically in the last five decades, from $353 per person in 1970 to $12,531 in 2020.
Patient concerns regarding the motives of pharmaceutical companies have increased.
The politicization of medicine has led to increased skepticism about medical treatment data accuracy, particularly for vaccines.
There is increased motivation among retailers to make alternative treatments more readily available, including those lacking scientific evidence-based research.
You see the products sold everywhere: convenience stores, tobacco and vape shops, and individuals peddling the products via multilevel marketing companies. Whole Foods Market is offering CBD products in many of its stores and several celebrities, including Martha Stewart, Kourtney Kardashian, and John Legend, have started CBD brands.
The narrative around THC and CBD is unregulated. Information gleaned from the internet could be just as easily described as misinformation, often inaccurate and not backed by sound science. Information “dispensed” at cannabis dispensaries is no better.
THC and CBD use is ubiquitous. The market for these products drives widespread availability, which, in turn, increases demand. It’s a vicious cycle.
THC and CBD Defined
Cannabis contains more than 100 compounds called cannabinoids, which include THC and CBD.
CBD and THC both have the same chemical formula, consisting of 21 carbon atoms, 30 hydrogen atoms, and two oxygen atoms. The difference is in the atomic arrangement, which provides CBD and THC with differing chemical capabilities, affecting the body in varying ways.
THC, or tetrahydrocannabinol, is the psychoactive component of cannabis (i.e., the part that makes you high). Typically, it is found in two forms: Delta-9, the form most people refer to simply as THC, and Delta-8, a less potent variant. Both produce euphoria, relaxation, and potential pain relief. CBD, or cannabidiol, is not psychoactive and is legal if it contains less than .03 percent THC.
THC and CBD come in many forms: edibles are very popular, as are oils and lotions. The compounds are also found in vapes, pills, gummies, and joints.
In addition to these more traditional delivery methods, we have over-the-counter sales of synthetic marijuana-like substances (K2/spice). The dried plant-based products are sprayed with various compounds including hallucinogens and are sold at convenience stores. A completely unregulated industry, these substances yield severe toxicity syndromes that present to ED not infrequently.
Cannabis has been used medicinally for thousands of years. Surprisingly, there wasn’t much opposition when it was deemed illegal in the western world. But higher demand for its use started in the 1960s, and proponents cited medicalization as part of their argument for legalization. Today, we know that at the very least, criminalizing marijuana made it harder to study.
There are many advocacy efforts regarding legalization in 2022, but contrary to appearance, they aren’t all grassroots. In fact, many efforts are led mainly by cannabis companies looking out for their self-interests.
Currently, marijuana is legal in some form in 37 states and the District of Columbia.
Cannabis Alleged Health Benefits
Proponents of cannabis legalization claim the drug offers health benefits to a range of chronic illnesses, including:
Marijuana use advocates also say it helps to treat everything from post-traumatic stress disorder to anxiety, weight gain, insomnia, cancer, and addiction. However, there is insufficient evidence to support most claimed health benefits.
Cannabis has been proven to help with certain disorders, although not as many as its proponents claim, including some of those listed above. For example, sleep disorders show improvement with CBD. Fibromyalgia also saw slight gains in eight trials.
There is significant evidence showing improvement in nausea and vomiting for cancer patients, not unlike other medications. However, patients seem to prefer it because of better side effects. It may also have some antitumor effects but is not curative.
Cannabis significantly decreases seizure frequency in specific pediatric epilepsy by reducing excitability in brain cells. It shows the most promising results in chronic pain sufferers — a 40 percent improvement in pain.
While the mentioned examples represent some known diagnoses that improve with cannabis treatment, many more do not have sufficient evidence to back up their claims, and often may have evidence to the contrary.
Cannabis Health Risks
Additionally, researchers know little about optimal doses and routes. Some studies are controversial at best, hampered by unfounded claims. Regardless of the health benefits cannabis and related products hold, it is not a panacea.
Evidence shows risk with a narrow therapeutic interval, which can result in a “U curve.” A low dose may be therapeutic, but a high amount has a reverse effect.
For example, a low dose may reduce anxiety, while a high dose triggers panic attacks. A low dose may help prevent seizures; a high dose increases their frequency. As toxicologists say, “The dose makes the poison.”
THC and CBD addiction are possible but less habit-forming than alcohol, nicotine, and cocaine. However, dependence can intensify in keeping with an increase in the percentage of THC.
According to statistics, nine percent of those who abuse these products go on to become addicted. Teenagers face higher risks of 17 percent, which can increase to 35–50 percent for daily users.
Withdrawal generally occurs within one week. Patients can experience a broad range of symptoms: irritability, anger, nervousness, anxiety, insomnia, low appetite, restlessness, depression, tremors, abdominal pain, and diaphoresis.
As a clinician, you are responsible for informing patients of the benefits and risks of THC and CBD use. That’s especially true for vulnerable populations, such as pregnant women, women who are breastfeeding, children and adolescents, and people with a history of substance use disorder, psychosis, or coronary artery disease.
THC and CBD use isn’t going away. If anything, it’s growing in popularity. That means clinicians must stay aware of the current environment surrounding THC and CBD, so they are ready to provide their patients with accurate information and effective treatment options when and where needed.