Five Things I’ve Learned About Reducing Anxiety with CBD

I have had the privilege of working with Cannabidiol (CBD) since 2011- when  Marijuana products high in CBD became available. Here are a few things I’ve learned in the past eight years about using CBD to reduce Anxiety.

1. The research on CBD lags far behind THC research, including CBD’s value in the treatment of anxiety.

2. I have treated lots and lots of patients (sorry not to be able to give the exact number, but surely in the thousands) who have found that CBD significantly helps reduce their anxiety.

3. CBD products purchased outside of the licensed dispensary system in California are, in my experience,  a waste of money,  principally  because you can’t be confident exactly what you are getting.

4. Dose matters when it comes to CBD induced anxiety-reduction. Generally, the more CBD, the more anxiety reduction. Ironically, with THC, it is just the opposite: high dose THC can induce anxiety!

5. Route of Administration matters, too! Immediate and intensive anxiety reduction is achievable through inhalation,  not through sublingual and edible routes.

Two patient experiences last week highlighted the importance of informing patient’s CBD practices with some of the insights gained over these last 8 years.

One patient came in with a bag full of CBD tinctures. Some were quite expensive. Only one came from a dispensary. She wanted to know how to use her most recent and most expensive purchase – Hemp based product bought on-line.

She is not alone. Hemp based CBD products are all the rage! I hear fitness clubs sell them.  I know Bed Bath and Beyond in El Cerrito does!

Don’t waste your money. A recent study found staggering problems with these products and we in California have the distinct privilege of being able to avoid them by purchasing lab tested product (including Hemp based product).

Moreover, CBD combined with the other components of the Marijuana plant  – including THC, THCA, and terpenes- can contribute to CBD’s anti-anxiety effect. Hemp may not contain sufficient quantities of these other constituents to bolster the effect of CBD. Since I don’t work with Hemp based products other than topicals, I am not able to speak to  its medicinal value in anxiety for patients I have treated.

The second patient experience relates to two issues near and dear to me as a Cannabis prescribing physician – dose and route of administration.

This patient has been using sublingual CBD in the form of a 20:1  oil based tincture. She believed she was  getting  anti-anxiety benefit from the medicine at a dose of about 3 mg two or three times a day.

After about six months, she returned and said that she was not sure if she was getting anxiety relief.  Many patients relate a similar uncertainty.

But her reason for wondering was different. Her partner was using a pen vaporizer that was primarily CBD and she said that she took one “dose”and she experienced a profound  (and welcomed) release from her anxiety. Therefore, since she did not have that kind of anxiety reduction with the sublingual medicine, she now wonders if she is benefiting from it.

What is this about? Dose and Route of Administration

The greater the dose, the bigger the effect with CBD, until you hit a ceiling. And inhalation concentrates CBD in your blood far quicker and more efficiently than any other form of delivery.

The patient was getting mild relief at the dose she was taking and with the inhalation had the experience of getting extraordinary relief with immediate bioavailability of a higher dose of CBD.

This patients profound anti-anxiety experience with inhalation demonstrates the difference dose and route of administration can make.

So what’s a patient to do?

If you have found relief through CBD, this email is not meant to change your ways.

If you have not found the anxiety relief you seek from Medicinal Marijuana, here are some things you might consider:

Don’t use so-called “pure CBD” without a trace of anything else.  “Pure CBD” is not very effective unless you use huge amounts that are unaffordable and can cause unpleasant side effects.This is essentially what  FDA approved Epidiolex is : pharmaceutical grade  CBD (99% CBD)  that has to be used in high quantities for seizure relief that is up to four times the amount needed of CBD herbal extracts to achieve the same or even superior effects. Moreover, high dose pharmaceutical grade CBD has far more troublesome side effects than the more moderately dosed herbal extracts.

You want a little bit of THC and some terpenes that contribute to the “entourage effect” in your CBD. Nothing to fear about small amounts of THC, including getting stoned. It just doesn’t happen at low doses.

Up your dose:  If you are using sublingual tinctures, 2.5 mg three times a day is the minimum dose.  Many patients may need up to 25 mg per dose and two to three doses a day. While  that’s ten times the minimum dose, it is not considered high dose CBD therapy. In Canada, it is not uncommon for patients to try 100 mg per dose.

To find product high in CBD, read my recent Field Trip to Synergy Wellness – the Bay-area’s CBD Mecca.

Consider inhaling: Inhalation is a more efficient way of using Medical Marijuana and can provide higher blood levels, resulting in more “intense” medicinal benefits from your medicine. Unfortunately, I am not a fan of inhaled concentrates (like pen vaporizers) because there is no safety data on their health consequences over time .However, there is safety data on inhaling the flower itself – studies that have followed inhalers for decades and have not found evidence it causes cancer or other serious diseases.   

At medicinal doses, inhaling the flower is safe. Inhalation 101  – Naturally Healing MD’s class  designed to help patients learn the steps entailed in inhaling Cannabis medicinally – is offered monthly and is free to Naturally Healing MD patients with a current recommendation.

In a quandary about what to do?  You are always welcome to come in. If you are a current patient and considering a dosage change, a  Medication Management appointment  for  $49 might be all you need.  Schedule on-line