I lived in Washington state until late 2018 where state law provides for both medicinal and recreational use of marijuana. Federal law does not allow for medical marijuana, but it allows for the unrestricted sale of products derived from hemp. Hemp and marijuana are forms of cannabis. I recommended medical cannabis in my Seattle practice from marijuana or hemp for some of my Lyme disease patients based on the limited science available and based on the positive responses I witness. In this article I review
- how medical cannabis and medical marijuana works,
- CBD and THC,
- conditions cannabis and marijuana helps,
- how to take medical cannabis and medical marijuana,
- starting doses, and
- possible safety concerns.
Note:This is a long article with a lot of background. Skip to the bottom to see the conditions medical marijuana helps and information on how to take it.
The Politics of Medical Marijuana
As I write this article twenty five states in the USA allow medical marijuana use and eight all marijuana recreational use. USA federal law currently allows for the use of CBD derived from hemp in all 50 states. Unfortunately the federal government, under the Trump administration, has put out some worrisome writings that it thinks hemp should be regulated the same as marijuana. In addition, US Attorney General Sessions calls for the federal government through US Attorneys at their discretion to enforce federal marijuana laws putting an end to state recreation and medical marijuana usage.
Cannabis, Marijuana, Hemp, CBD, THC
There are two varieties of cannabis plants. They differ in their appearance and chemical make up. The two plants are Cannabis Indica and Cannabis Sativa. Both of these plants are called marijuana. Hemp is a variety of Cannabis Sativa that has less than .3% delta-9-tetrahydrocannabinol (THC). THC is the psychoactive component of cannabis that gets people high. Both Indica and Sativa that have more than .3% THC are regulated as illegal drugs by the US government. Federal courts have ruled that industrial hemp, cannabis sativa with less than .3% THC, cannot be regulated as a drug. Thus cannabidiol (CBD) derived from hemp can be sold as a supplement across state lines and through the internet.
Cannabinoids & The Endocannabinoid System
There are over 400 chemicals called cannabinoids in cannabis that interact with the body’s natural cannabis system. Our natural marijuana/cannabis system is called the endocannabinoid system. The two main cannabis chemicals are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These chemicals interact with our endocannabinoid system in a variety of ways. In addition to cannabinoids, cannabis has terpenes. Terpenes give the flavor and aroma to cannabis. They also change the absorption and effects of CBD and THC.
The endocannabinoid system is distributed throughout the entire body with receptors found in the brain and many major organ systems. There are two major chemical receptors called cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). in addition to CB1 and CB2 there are some other minor receptors.
CB1 receptors are found on many organs including the brain and nervous system. They regulate the release of neurotransmitters in the brain and are psychoactive. CB1 regulates the heart and blood vessels, energy, thinking, memory, emotions, pain, muscle control, sensory regulation, the intestinal system, and much more.
CB2 is primarily anti-inflammatory and regulates the immune system. These receptors are found on a variety of white blood cells including B cells that make antibodies, T cells that fight Lyme, bacteria, and viruses, and macrophages that fight viruses. In addition to fighting infections, T cells release inflammatory cytokines that cause most Lyme symptoms. So regulating CB2 can lead to improvements in most of these symptoms.
The endocannabinoid system produces a number of chemicals that bind to the CB1, CB2 and minor receptors. The two major known ones are anandamide and 2-arachidonoylglycerol (2-AG). These two chemicals are broken down by a number of enzymes.
THC works by binding directly to CB1 and CB2 receptors. CBD works indirectly by limiting the destruction of 2-AG and anandamide. This leaves more of these chemicals available to bind to CB1 and CB2 receptors. In addition to indirectly raising anandamide and 2-AG, CBD may bind to minor receptors exerting a direct influence on the organs and the nervous system.
THC is also psychoactive. This is what gives a person the high of smoking or eating THC. CBD does not have this effect. CBD is thought to decrease the psychoactive effect of THC. Because it is psychoactive, THC can cause some thinking impairment which could be a draw back for people in Lyme who have difficult thinking. By comparison, CBD does not seem to give thinking problems.
One other major difference of THC and CBD is that THC produces more sleepiness while CBD is more upping. Thus THC is better for night use compared to CBD which is better for day use.
THC can cause psychosis. And CBD and THC can lower blood pressure and even cause heart attacks. So THC should not be used in people with psychotic mental health conditions. And both CBD and THC should be avoided in someone with low blood pressure or at risk for a heart attack. For instance someone with Lyme and paroxysmal orthostatic hypotension syndrome (POTS) should not use medical cannabis. And if a person has cognitive impairment on either CBD or THC, he or she should not drive.
What Does Medical Marijuana Help?
The research data base for medical cannabis is very limited due to US federal law that limits research on marijuana. Below I detail what is known through research on various medical conditions. However, there has not been any specific research on cannabis and someone with Lyme disease.
In 2016 the National Academy of Sciences published a review of the science and medical cannabis. Here is a list of its findings supported by research:
- Prevents chemotherapy induced peripheral neuropathy in animal studies,
- Inhaled cannabis reduces pain in HIV related neuropathy,
- Can help with pain through a helpful interaction with opioid receptors (animal studies) and can help reduce pain for patients on narcotics,
- Helps chemotherapy induced vomiting and nausea,
- Decreases anorexia and wasting in HIV,
- Reduces muscle spasticity in ALS and MS,
- Decreases saliva production in ALS,
- Reduces symptoms of depression in ALS,
- Anecdotal reports shows help with depression, anxiety and stress,
- CB1 receptor binders decrease seizures (in mice anandamide levels rise after seizures which stops the seizure),
- THC in some animal studies decreases seizures,
- CBD lowers seizures too through a number of proposed mechanisms by increasing anandamide levels, blocking enzymes that lower 2-AG and anandamide, or lowering glutamate levels,
- Limited human experiments shows lower seizure thresholds,
- Open label CBD studies show can lower seizures in humans,
- THC can help HIV cachexia and wasting syndrome,
- In HIV inhaled cannabis alleviates nerve pain,
- In HIV can help with nausea,
- Cannabis can alleviate symptoms of Chron’s and Ulcerative colitis like abdominal pain, nausea, and diarreha,
- Decreases MS muscle spasm and pain,
- Reduces pain,
- In Parkinsons, decreases tremors, and stiffness like bradykinesia, and dyskinesia, and
- In Post Traumatic Stress Disorder (PTSD) can help alleviate the hyperarousal state and insomnia.
Kills Lyme:In Canada, Dr. Erni Murakami did laboratory experiments showing CBD kills Lyme spirochetes. However there are no human experiments that show this to occur.
Medical Cannabis Benefits in Lyme
Based on the above research and what I see in my patients I recommend medical marijuana and medical cannabis for people with Lyme for the following reasons or conditions:
- As an anti-inflammatory working through CB2 receptors it protects the health of the nervous system and brain,
- Anxiety (I prefer CBD over THC),
- Depression (I prefer THC over CBD),
- Nerve pain,
- Muscle and joint pain,
- Insomnia (THC, not CBD),
- Stomach and Intestinal dysfunction like diarrhea and cramping,
- Seizures or seizure-like symptoms,
- Difficulty maintaining weight,
- Muscle spasms
- Muscle stiffness,
- Improve immune function by lowering inflammatory cytokines, and
- To decrease narcotics or to enhance their effect for pain control.
Kills Lyme?I am skeptical that it actually kills Lyme in any meaningful way in humans, although I am interested in this potential based on Dr. Murakami’s experiments. I have not seen improved killing of Lyme in my patients who use medical cannabis.
How to Take Medical Marijuana and CBD in Lyme
Medical cannabis comes in a variety of forms. Loose plant and oils can be inhaled either by using a vaporizer or directly smoking (plant). Of the inhaled methods, I prefer the vaporizer to limit harmful chemicals and irritants entering the lungs through smoking. Edible forms come in pills, drops, or in food. Also drops and sprays can be used in the mouth. There are creams and lotions which may have an effect where they are placed, but not throughout the body. The delivery method determines how quickly the effect will occur and how long it will last.
|Delivery Method||Time to Feel Effect||Time of Peak Effect||Length of Effect|
|Vapor or Smoke||90 sec||15 – 30 min||2 – 3 hours|
|Edibles/Pills/Drops||90 min||2 – 6 hours||4 – 12 hours|
|Mouth Sprays||.5 – 2.5 hour||1.5 – 4.25 hours|
Note: There is a lot of dfference in effects between different people.
Starting Dose: For someone who is new to cannabis and marijuana a good starting dose is 5 mgto see what the effect is. Based on that add more or less. Be careful with edibles because it could take 90 minutes or more to feel the effect.
CBD versus THC: CBD tends to be more activating and generally is good for daytime use. THC is more psychoactive creating sleepiness and the high; so it is better for before bed time use.
With CBD and THC from marijuana, there are products that are higher or lower in THC to CBD ratios. For instance a high THC product could have THC:CBD of 10:1. This type of product is good for night use. On the other hand a product of THC:CBD of 1:10 is good for day use.
Dose Frequency: Take high CBD ratio products up to 2 times during the day and high THC products before bed.
Experiment with Ratios: For some people THC works better for symptom management than CBD does. So for daytime use a person may need to find a higher THC:CBD ratio that works for that person.
How to Limit the High: Vaporizing or smoking high THC products gives less of a high than edible forms. THC from edible forms is altered by the liver into a more psychoactive substance giving a greater high. Also CBD can lower the high too.
Talk to The Bud Keeper: Medical marijuana stores have bud keepers. Good ones know the products in the store. Talk with them before you purchase to help find the best product for your situation. There is a lot of variation in products including mixes of THC, CBD, other cannabanoids in the products, and terpenes that effect how any given product works.
In Washington State, medical marijuana stores were combined with recreational stores in 2017. In my experience, the bud keepers in recreational shops are generally not as skilled at finding the right medical product as bud keepers in medical marijuana stores. Fortunately, in Washington state, some stores have certification in medical marijuana. These medical certified stores tend to have bud keepers who know the medical properties of there products.