CBD: A GuidePresented by the Hamre Center for Health and Wellness

Table of Contents: To skip to specific sections, click the links below:

Introduction

Harm Reduction Model

What Is CBD?

How Is CBD Ingested?

How Does CBD Affect the Mind?

What Are the Effects of CBD Use?

How Does CBD Interact with Medications and Physical and Mental Illnesses?

How Does CBD Interact with THC?

Conclusion

IntroductionWelcome to the Hamre Center’s CBD guide! Thank you for wanting to learn more about CBD products and how they can affect you.

This guide is designed to be a science-based resource to help inform people about CBD products. We use a harm-reduction model, which we’ll talk about more in the next slide.

If you have any concerns regarding your own personal health and cannabis products, we strongly recommend that you reach out to your health care provider. No matter the legal status of cannabis in your state or country, health care providers are confidential resources. Your health is their primary concern.

Harm Reduction Model

● The harm reduction model used in this curriculum is about neither encouraging or discouraging use.

● At its core, harm reduction simply aims to minimize the negative consequences of behaviors.

● Please read through the Hamre Center’s statement on usage and harm reduction below.

“The Hamre Center knows pleasure drives drug use, not the avoidance of harm. We do not condone or promote the use of illegal drugs. We DO promote the use of common sense when going about one’s daily activities. These suggestions represent information that may provide some guidance in reducing the risk of harm only. Note that no amount of planning and care can ensure you will have either a safe or enjoyable experience when you take drugs.”

What Is CBD?● Cannabidiol (CBD) is a non-psychoactive natural compound

derived from the cannabis plant. The compound is commonly credited with pain and anxiety relief. (Alcohol and Drug Abuse Institute, 2013; Alcohol and Drug Foundation, 2020).

● Despite both being found in the cannabis plant, CBD shouldn’t be confused with the other main compound in cannabis, THC. The two two substances have opposing effects: while CBD generally decreases anxiety and generally instills a sense of calm, THC leads to psychological reactions that can vary from a pleasant high to anxiety to a psychotic break. When taken together in similar doses, CBD may negate some of THC’s psychoactivity (Zerrin, 2012).

● If you want more information on THC, check out our website.

How Is CBD Ingested?There are many different ways CBD is ingested, and each method has its

own unique effects on the body and mind.● Smoking:

○ One of the most common methods of CBD ingestion, smoking involves the incineration and inhalation of the cannabis plant, delivering the chemicals to the bloodstream via the lungs.

○ Almost all cannabis plants (except hemp)contain a lot of THC in addition to CBD. Thus, it’s impossible to ingest pure CBD without experiencing the psychoactive effects of THC via smoking. Growers can modify the THC and CBD contents of their crops to produce different highs; most strains smoked today have far higher THC contents than the cannabis smoked during the 60s and 70s (Stuyt, 2018). The CBD will lessen the effects of the high levels of THC in these strains, but only slightly.

○ If buying from a dispensary, ask about the different ratios of CBD to THC in their available strains and the effects they may have. If dispensary workers either don’t know or won’t tell you, you may want to consider finding a new dispensary.

How Is CBD Ingested?● Vaping:

○ Just as nicotine and THC vapes have become more popular in recent years, so too have CBD oil vapes. By using oil instead of the hemp plant, vaping avoids introducing particulate into the lungs while being an efficient method of delivery (Abrams et al., 2007).

○ Vaping CBD oil cannot be considered an inherently safe way of ingesting the compound, however. As the vaping market grew in early 2019, some manufacturers effectively tried “cutting” their oils with synthetic cannabis oils (Mohr, 2019). In a few cases, some users have been sent to hospitals in comas. If purchasing oil for vapes, look for independent certifications (e.g. the U.S. Hemp Authority) and be sure to buy from an established, trustworthy source.

How Is CBD Ingested?● Dabbing:

○ Dabbing is similar to vaping, though far more potent. Rather than using a mixture that merely contains CBD oil, pure CBD concentrate is vaporized and inhaled. Users feel the effects very quickly, and may perceive the method to be a clean way of ingesting CBD (Alta Mira Recovery, 2020).

○ While CBD concentrate may seem to be incredibly clear of contaminants such as ash, the manufacturing process often involves carinocengic butane gas, leading to cancer-causing substances being caught in the finished concentrate (Meehan-Atrash et al., 2017). In short, dabbing isn’t all that clean.

How Is CBD Ingested?● Oral ingestion (edibles):

○ CBD can be consumed orally in the form of chocolates, gummy edibles, or baked goods that are infused with the oil.

○ As public opinion on cannabis products has changed, many producers have taken to selling pure CBD oil pills or extracts (Barrus et al., 2016). It should be noted, however, that because the FDA has yet to recognize the benefits of CBD extract, there are no certification methods or ways of verifying how much CBD is actually in a product (Barrus et al., 2016).

○ As with anything that is produced rather than grown, there can be variation in the amount of CBD from edible to edible, even if they were made in the same batch. Similarly, other substances that can affect one’s health may be present in the product; see the section on vaping above for more detail about “cutting.”

How Is CBD Ingested?● Sublinguals:

○ Consumed most often in the form of drops or sprays, sublinguals are compounds containing CBD oil -- or sometimes simply pure oil -- that are applied under the tongue.

○ These sort of products avoid the lung problems associated with smoking and vaping while affecting the body incredibly quickly (Echo, 2017), and are considered a safe and effective way to ingest CBD.

○ There has been very little research into the costs and benefits of sublinguals, however, so many accounts are simply anecdotal.

How Is CBD Ingested?● Topicals:

○ Topicals are often used for localized pain and inflammation relief by those who want the calming effects of cannabis without the psychoactive elements (Hammell et al., 2015). Consequently, most cannabis-based topicals employ CBD oil rather than THC (Bilodeau, 2019).

○ Low to moderate concentration CBD topicals aren’t able to penetrate the bloodstream, only the skin--hence the localization of effects. High concentration transdermal patches can enter the bloodstream, potentially leading to whole-body effects while bypassing the stomach (Hammell et al., 2015).

○ As public opinion in the U.S. has begun to shift in favor of CBD, patches and lubricants have become increasingly available for both professional/medical and recreational use (Gill, 2019). The adverse effects of topicals are both understudied and underreported, however, and there is a risk of rashes or itchiness from other substances in the product (Caceres, 2019).

○ Purchasing from an unregulated source increases the likeliness of exposure to undeclared chemical contaminants. Certified products will be marked on the packaging, so keep an eye out for these and stick to trustworthy sources.

How Does CBD Affect the Mind?● Once CBD hitches a ride through the bloodstream to the brain, the compound interacts with

the endocannabinoid system (ECS). Under normal circumstances, the ECS serves in part as a sort of regulator for communication within the brain, moderating the flow of some neurotransmitters that maintain homeostasis (Mechoulam and Parker, 2012).

● When CBD is introduced to the equation, however, the ECS is altered. Though the verdict is still out on exactly how this happens, CBD has been observed activating receptors in the brain associated with alleviating symptoms of depression, anxiety, PTSD, and psychosis (Maroon and Bost, 2018).

● As opposed to THC, which will throw the ECS completely off-balance, CBD can actually refine the ECS and reverse the effects of THC (Khan et al., 2016).

What Are the Effects of CBD Use?

● While anecdotal evidence and preliminary research suggests CBD has a wide array of effects, it must be noted that no conclusive research has been conducted. If you’re thinking about using CBD products, please consult with your health care provider beforehand.

● Very little research has been done on the long-term effects of CBD use, if any; with that said, there is evidence that CBD is not physiologically addictive (WHO, 2017).

What Are the Effects of CBD Use?Early research suggests the CBD has a wide array of short-term effects on the mind and body:

Effects on the mind:● Relaxation and decreased anxiety

○ Relatedly, increased ease of falling asleep, and, for some users, greater clarity and focus in everyday living.

● Can lessen depressive symptoms● May be able to treat PTSD● Very early research indicates that CBD may be able to intervene in and break cycles of

addiction (Prud’homme et al., 2015)● Can lessen the symptoms of people who are experiencing psychosis, especially if the

illness is in its early stages (Batalla et al., 2019)● Can treat epilepsy symptoms in children, though it is unclear if adults will experience similar

relief (Grinspoon, 2018)

What Are the Effects of CBD Use?Effects on the body:● Lung damage (if smoked)● Scarring to small blood vessels within the lungs (if smoked)● Can limit tumor growth in esophageal cancer patients (Gotfried et al., 2017)● Preliminary research indicates that CBD has potential to treat chronic pain and inflammation

(Russo, 2008)● Can induce nausea in some users if orally consumed, especially in high doses (Grinspoon, 2018)● Has been closely linked to reductions in chronic inflammation and pain (Bruni et al., 2018)● CBD can serve as a blood thinner, affecting other medications in one’s system

(Grinspoon, 2018)● A recent study has shown that high doses of CBD can interact negatively with certain

prescription medications (MedlinePlus, 2020; check here for more detailed information on the effects of CBD)

If you use a prescription or have a preexisting condition, please consult with your health care provider before using CBD products.

CBD Interactions With Medications, Physical and Mental Illnesses

● Medications:○ CBD can interact with some medications

(MedlinePlus, 2020). While little research has been done into the wide array of specific medication-marijuana interactions, health professionals have noticed some particular drugs that interact poorly with the oils. Please consult with your health care provider if you have any medications and plan to use any sort of cannabis product.

CBD Interactions With Medications, Physical and Mental Illnesses

● Mental illnesses:○ Induce relaxation and decreased anxiety○ Increased ease of falling asleep, and, for some users, greater

clarity and focus in everyday living○ May lessen depressive symptoms○ May offer relief for PTSD symptoms ○ Can lessen the symptoms of people who are experiencing

psychosis, especially if the illness is in its early stages (Batalla et al., 2019)

○ Can treat epilepsy symptoms in children, though it is unclear if adults will experience similar relief (Grinspoon, 2018)

○ CBD may intervene in addictive behaviors, though the verdict is still out on this one (WHO, 2017)

CBD Interactions With Medications, Physical and Mental Illnesses

● Physical illnesses:○ As previously noted, preliminary research has indicated that CBD may have a wide

array of therapeutic effects including pain and inflammation relief. CBD thus has the potential to alleviate the symptoms of chronic pains, multiple sclerosis, epilepsy, glaucoma, certain cancers, arthritis, and other issues (Kogan and Mechoulam, 2007; Hammell et al., 2016; WHO, 2017).

We want to emphasize that these uses of CBD have not received extensive consideration by researchers, and very few conclusions have been definitively drawn about CBD. Please consult with your health care provider if you’re thinking about using CBD products.

Also, remember cannabis and CBD products can contain a wide array of different substances, all of which can interact uniquely with medications. If purchasing CBD products, try to stick to sources like dispensaries that have oversight.

How Does CBD Interact With THC?● As noted earlier, CBD is quite distinct from THC. If you’d like

more information about THC, please check out the Health Promotion website.

● If only THC is taken, only the THC effects will be experienced; the same goes for CBD.

● If both are taken together in similar, small quantities, the CBD will help to dampen the effects of the THC. Some (but not all) of the psychoactivity will be diminished, notably anxiety and paranoia. This is a part of something called the entourage effect, where all cannabis compounds work together to modulate the psychoactive effects of the plant. Each compound has its own unique effects, and this changes when presented with other compounds. The closer to a 1:1 ratio of CBD to THC, the more balanced the experience will be.

ConclusionThank you again for reading through our guide! We hope it was informative and that it’ll be helpful if making decisions about CBD product use.

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