THC vs CBD: A Primer
What are CBD & THC and how are they related to hemp and marijuana?
CBD (cannabidiol) and THC (delta-9-tetrahydrocannabinol) are two compounds called cannabinoids found in plants belonging to the cannabis family. Although both CBD and THC can be found in both hemp and marijuana, hemp tends to be very low in THC and higher in CBD, and marijuana tends to be very high in THC and very low in CBD. Additionally, over the past two decades THC content has escalated in marijuana, to the point that an average joint of today's recreational marijuana is about 7x as potent as a joint of Woodstock-era pot (3% vs. 21%). Concentrates can be over 30x stronger (90% pure or more).
What is the difference between “medical marijuana” and “recreational marijuana”?
There is no difference between "medical marijuana" and "recreational marijuana," just as there is no difference between taking oxycodone for pain and taking oxycodone to get high. In states that have both recreational and medicinal programs, the difference between the two generally only extends to 1) the amount that can be purchased at one time, and 2) how high the taxes are on the product. The vast majority of products sold in marijuana dispensaries are high-potency THC products, despite most therapeutic indications for THC coming at very low doses (5mg or less per dose). CBD has been more strongly associated with therapeutic effects; however, CBD products do not need to be purchased from marijuana dispensaries, as they are legal nationwide. There are some strains of marijuana that have higher CBD content, although these are very much the minority of what is sold in medical dispensaries. Additionally, once someone has a medical marijuana authorization ("card"), they can purchase any product they want from a dispensary, regardless of any existing medical literature. For example, if an individual receives a marijuana card for the purpose of treating chronic seizures, the data would indicate they should buy high CBD products. However, there is nothing stopping them at that point from instead buying a 90% THC concentrate.
How do health-related claims of THC & CBD compare to reality?
The claims of therapeutic applications of both CBD and THC far outpace actual peer-reviewed research. CBD is essentially an anti-inflammatory, and while it has shown promise in several areas related to inflammation reduction, most of its purported uses are unvalidated. However, given that CBD is not addictive and has shown virtually no adverse effects and low to moderate doses, it is essentially a low risk intervention that will be ineffective at worst and helpful at best.
THC has been shown to increase appetite, decrease nausea, and be helpful in decreasing certain types of pain. However, as THC is addictive and in higher doses has clear links to significant negative mental health outcomes (most notably depression, anxiety, suicide, and psychosis), regular use of THC is much more concerning than regular use of CBD.
It's also worth mentioning that on top of the absence of good data related to the effectiveness of cannabinoids for the vast majority of conditions approved by medical marijuana programs, we also have virtually no data on the difference between administration routes. For example: THC and CBD products can be packaged and sold to be smoked, vaped, baked into foods, taken on an empty stomach as a liquid, rubbed on the skin, or absorbed rectally through an enema. There are different implications for each related to absorption rate, how quickly the cannabinoids reach the brain, bioavailability, and metabolism. The cart is very much before the horse right now in terms of the medical marijuana industry.
What are the risks of CBD & THC?
The risks of CBD are relatively minor. We've seen hepatic (liver) toxicity with CBD in very high doses, but as long as someone is generally healthy, the risks are minimal. Of more concern than CBD itself is the purity and label accuracy of CBD products - a recent 2020 sample review by the FDA of 125 CBD products found that 50% contained THC, and the majority did not contain the amount of CBD listed on the label.
THC, however, is a different story. The primary risks of THC for those 25 and over are addiction and mental health problems (particularly depression, anxiety, suicide, and psychosis). For those under 25, and especially for teenagers, there is also a risk of permanently impacting the structure of the developing brain, particularly in the prefrontal cortex (responsible for personality, motivation, and executive functions) and hippocampus (the memory center). These risks are greater the greater the concentration of THC that is consumed at one time.
In terms of "overdose," cases of acute THC toxicity do occur, and can take several forms. One type of overdose is known as "greening out," and can involve a number of different symptoms including paranoia, dizziness, nausea, and sweats. Excessive THC can also lead to cannabinoid hyperemesis syndrome (CHS), a condition in which you have severe abdominal pain and uncontrollable vomiting, and which can be fatal if not controlled. The last major type of overdose is a psychotic break, which can either be acute (short-lasting) or persistent (long-lasting; schizophrenia). A major study in Lancet Psychiatry from 2019 found that using today's standard of high-potency marijuana raises the risk of a psychotic break by 50%, and use of concentrates and extracts increases the risk by 500%.
What effect does CBD and THC have when combined? Is it safe?
THC and CBD are often taken together, as both are naturally occurring in some marijuana strains. There is no reason to believe that taking CBD along with THC would cause any harm in fact, anecdotal reports indicate that strains of marijuana with higher CBD content have been found to have a protective effect from the most impairing effects of THC, although these reports have yet to be fully defined and measured in empirical studies.
What are the three most important differences that people should know about CBD versus THC?
THC is addictive - CBD is not.
CBD is the cannabinoid most strongly associated with positive health effects, and you do not need to go to a marijuana dispensary to buy CBD products.
The risks of using CBD regularly to treat a chronic condition are very low, compared to the risk of using THC, which is an addictive chemical with many potential negative effects, particularly for those under 25.
If you need help, more information is available on my website related to working with me for online addiction counseling for marijuana – in addition to my concierge therapy practice, I also have a small in-network practice with Equipoise Teletherapy in Chicago. I also provide non-clinical parent coaching services upon request. For any other questions, please feel free to reach out to me directly!