Benefits of CBD and THC together

by Apoorva Shivankar, M.D

Benefits of CBD and THC together

A German philosopher Friedrich Schiller once rightly said, ‘Even the weak become strong when they are united’. Can you imagine what will happen if the two giants from cannabis world come together? Here we are referring to the most-researched and predominant compounds found in cannabis plant – CBD and THC.

Cannabidiol(CBD) as such has an impressive therapeutic resumé even as a stand-alone molecule that too without any major side-effects or psycho-activity. On the other hand, THC is a blacklisted/infamous compound responsible for a notorious HIGH and the forbidden status of cannabis as well.

So, what’s your guess? What will be the final outcome of this combination?

  1. Nullified effects.
  2. Enhanced benefits.
  3. More negative effects
  4. None.

Mark your answer.

Here comes the detailing for your help:

CBD and THC

These are the two major components amongst the group of over 100 cannabinoids, flavonoids and several terpenes found in a cannabis plant. Both act through a widespread homeostatic regulator of the body referred to as the Endocannabinoid System (ECS) to maintain an internal balance by regulating mood, emotions, sleep, inflammation, stress, appetite and many more. Yes, THC can also help to maintain the internal peace of the body ruling out our most common perception that it is purely recreational.

Surprised? To add more to your astonishment, let me add here a complete list of beneficial effects of THC and compare them with those of CBD. You will be amazed to know that even THC is nowhere less than CBD in terms of medical values.

Properties

THC

CBD

Anti-inflammatory

+

++

Analgesic

++

+

Antioxidant

+

++

Antidepressant

+

+

Muscle relaxant

++

+

Relieves nausea

++

+

Neuro-protection

+

+

Suppress cancer cells

+

+

Natural sleep promotor

-Can induce drowsiness

+

Anticonvulsant

-/+

++

Anxiolytic

-Can cause panic attacks

++

Antibacterial

-

+

Antimicrobial

+

-

Appetite stimulator

+

-

Relieves neuropathic pain

++

+

PTSD

++

+

Psychoactive

++

-

 

Poor THC, all these positives are overshadowed by its notorious HIGH. Isn’t it unfair to ignore all the goodness just for the sake of its psychoactiveness.

And not to forget, this HIGH is not always that unwanted.

How can THC and CBD work so much?

Credit goes to the Endocannabinoid System (ECS) which acts through a network of endocannabinoids (anandamide, 2-AG), enzymes, and CB1 and CB2 receptors spread all over the body.

THC directly binds to the CB1 receptors which are mainly positioned in brain and nervous tissues activating the brain’s reward system and release dopamine. This dopamine is responsible for the alterations in the level of consciousness creating a sense of wellbeing, relaxation, euphoria and the characteristic HIGH effect.1 THC also replaces and mimics endocannabinoids to activate ECS and bring about its medical effects.

CBD, on the other hand, modulates ECS indirectly. In case of imbalance such as anxiety, pain etc. endogenous cannabinoids get used up in an attempt to restore homeostasis. CBD towns down the degradation of endogenous anandamides making more of it available to handle the stressful situation. This restores body balance, stress levels, sleep, appetite, mood, etc. Lack of CB1 activity explains the no psychoactive action of CBD.

Coming to our questions

CBD + THC?
What are the results?
How does the combination work?
Is it really needed?

Yes, it is. It’s already proven that THC has a wide array of health benefits that can be a boon to the wellness industry especially for those battling with chemotherapy, glaucoma, AIDS, severe spinal injuries, etc. wherein only a strong THC effect can provide a relief. But THC’s mind-bending action stands out as a big hurdle in its journey towards the medical world. As a rescue enters CBD.

When used as a team CBD counterbalances the negative effects of THC (sedation, psychosis, palpitations, paranoia, euphoria, sluggishness, hunger, memory loss) greatly helping the patients who need the medical powers of THC but don’t want the HIGH. Moreover, for those who use THC for recreational purposes, CBD can be a saviour to get down an uncomfortably high effect in no time.

In return, THC also enhances the following medical potential of CBD:

  • Pain-relief
  • Anxiety-relief
  • Anti-inflammation
  • Anti-epilepsy
  • Cancer related symptoms
  • Relieve muscle spasms

So, CBD and THC together can handle difficult to manage conditions including rheumatoid arthritis, diabetes, cancers, antibiotic-resistant infections, neurological disorders, alcoholism, etc. more effectively with their combined efforts.

Science behind this teamwork:

  • The Entourage effect:

    An age-old saying ‘Unity is strength’ forms the basis of an important phenomenon in cannabis known as the entourage effect. It states that when more and more cannabis compounds including the cannabinoids (THC, CBD, CBC, CBG, etc.), terpenes, flavonoids come together, they enhance the effects of each other and work synergistically to maximize their overall therapeutic benefits to a level more powerful than what they produce individually.
  • Some theories suggest that when taken along with THC, CBD can bind to CB1 receptors, change their shape and thus weaken their ability to bind to THC. This finally tames THC’s infamous HIGH and towns down the THC-induced untoward effects like paranoia, anxiety, hunger, sedation, etc.3

  • Another line of thought is that CBD by inhibiting the hepatic breakdown of THC make the THC effect last longer than usual.

  • Combining THC and CBD thus upsurge the range, as well as the intensity of medical benefits, and limit the individual adverse effects, giving a thumbs up to the combination over solo use.

Supporting Studies

A 2011 study2 published in the British Journal of Pharmacology supported the entourage effect of cannabis and also showed the downfall of THC side-effects by the addition of CBD. Similar findings were demonstrated in the research works of Russo EB7 (2019) and Samarut E, et al. (2019)8 too.

A 2012 study9 published in the Journal of Psychopharmacology also backed up CBD’s role in inhibiting the THC-induced paranoia and hippocampal-dependent memory impairment.

A 2010 randomised, placebo-controlled study5 published in Journal of Pain and Symptom Management demonstrated that THC and CBD work better together than THC alone in treating chronic pain in cancer patients, improving sleep function, nausea, and even relieving discomfort.

Another research work by the same researchers in 20136 proved that apart from efficacy and safety, this combination might also take over the habit-forming effect of THC-extract, making the same dose effective over a longer period of time whereas Dr Jordan Tishler, a cannabis physician confirmed that adding a little amount of THC-extract can prolong benefits of CBD products which otherwise wears-off after a few months of regular use.

According to the research work4 published by researchers Pamplona et al, in 2018, a whole plant CBD-rich cannabis extract is far more beneficial in treating resistant epilepsy with significantly fewer untoward effects than monotherapy.

Research by Marcu JP et al. (2010)10 elicited that adding CBD to a high-THC extract for glioblastoma, potentiates the anti-proliferative action of THC making the treatment more efficient. 10 

There are more studies suggesting CBD’s role in lessening the sedative as well as appetite inducing11 actions of THC while potentiating its pain-fighting abilities12.

Mathematics of CBD+THC

As we understand that THC and CBD together can-do miracles, the next essential step is

How to blend them?

Here comes the role of the CBD:THC ratio.

Keeping in mind that everyone’s goal and response to combine THC and CBD are different, while determining the combination, one has to check which health advantage they are aiming at and which adverse effects are purely no-no for their condition.

THC is better

  • Anti-emetic
  • Anti-nauseating
  • Muscle relaxant
  • Much stronger analgesic

Rule of thumb says:

Higher the CBD more is the clear-headedness; higher the THC, more is the psycho-activity.

More the CBD in the combination, less is the HIGH you'll get from the THC.

To keep a balance, the combinations can be broadly divided into

  1. CBD dominant (More CBD, less THC)

Some of the common ratios are

2:1 or 3:1 or 5:1

Ideal for someone who wish to avoid the euphoria due to THC extract.

Suitable to combat autoimmune disorders, depression, general aches, pains, gastrointestinal issues like Crohn’s and colitis, arthritis, paediatric seizure disorder, spasms and even psoriasis wherein both THC and CBD work together to maximize the efficacy of the treatment.

>10:1

Perfect for beginners or those who cannot take chance with psychoactive effects, eg drivers.

Good for treating anxiety, mood disorders, psychosis and even some form of epilepsies because CBD itself is a potent anxiolytic and antipsychotic whereas THC can precipitate anxiety and psycho-activity (except in very low doses).

Here you get the benefits of both with almost nil intoxication.

Balanced

1:1- equal parts THC and CBD.

Commonest form.

It’s the most effectual way of tackling pain especially neuropathic pains as THC is a master of regulating neurotransmitters and modulating the pain perception by the brain.

Apart from neuropathic pains, balanced CBD:THC effectively manages other severe pains like arthritis wherein THC handles pain perception, alters mood and CBD takes care of inflammation and THC-induced adverse effects.

Other uses include insomnia, fibromyalgia, autism, chronic pain, spasticity, reduced appetite, and skin diseases.  

THC dominance

(more THC, less CBD)

Commonly used ratio 

1:2

THC in double the amounts of CBD.

Often recommended as a sleep aid. THC is a well-known sedative due to its CB1 action; however, THC-rich compound alone can cause increased anxiety and other undesirable effects. By adjusting CBD:THC, it is possible to block these undesirable effects while still retaining sedating properties.

Also helps to induce appetite (in chronic illnesses like cancer, HIV/AIDS, heart disease, and some metabolic disorders), reduce nausea (in patients on chemotherapy), aches, muscle spasms, with enhanced relaxing effects.

>1:9

High-THC combinations with an assured psycho-activity.

Still, these THC-dominant strains are considered essential to tame the very severe grades of intractable cancer-related pains, severe nausea, extreme levels of stress, unbearable pains (migraines, trauma), or for those who have developed a high degree of tolerance. The presence of CBD can dampen some of the side-effects of higher THC, making it more acceptable.

Extremely high THC to CBD levels are used mostly for uplifting moods and recreational purposes due to its intense psychoactive effects. 

Always consider ‘No one size fits all’. Keep trying till you get your best. Final call depends on the severity of ailment and the response of your body to the cannabinoids.

Tips for trying THC and CBD

  • Always look for high-quality products.
  • Always start with a low-dose THC and CBD combination, follow slow up-titration till you get the desired results.
  • If you are new to THC, start with highest CBD: THC ratio (with <5mg THC) to avoid intoxication and other side-effects. Once you get used to it, start increasing the THC levels to get the results.
  • If you're extra-sensitive to THC, try a CBD-rich strain with lower levels of THC.
  • Try different delivery methods such as tinctures, capsules, gummies, topicals. Be extra cautious with THC-vapes as they are rapid and sometimes can be deleterious too.
  • In case of drug interactions, try topicals instead of edibles or vapes under physician guidance as these topicals do not enter bloodstream as long as they’re not a transdermal solution intended to do so.

To conclude:

Yes, there is more power in unity than division in case of cannabis compounds too.

An efficient CBD and THC combination not only amplifies the medical benefits but also mitigates the negativities, thereby complementing each other perfectly. These fewer side-effects allow the patients to enjoy medical marijuana more flexibly.

FAQs

Q. What drugs should not be taken with Cannabidiol?

CBD competes with the following drugs for liver enzymes involved in their metabolism, so they must not be taken with CBD products.

  • Blood thinners like warfarin.
  • Amiodarone.
  • Thyroid drugs.
  • Anti-seizure medications such as clobazam, lamotrigine, and valproate.

Q. How can I make my CBD more effective?

By combining it with other cannabinoids and terpenes. The more the cannabis compounds coming together, more will be the entourage effect they produce.

Q. Does CBD help anxiety?

Yes. By modulating the ECS system, CBD can effectively manage anxiety issues.

Q. Can this combination be given in pregnant ladies?

No. FDA strongly advises against the use of these compounds in pregnant and lactating females due to the concerns regarding the potential negative health effects on the developing foetal brains and overall development.

References:

  1. https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects
  2. Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011 Aug;163(7):1344-64. doi: 10.1111/j.1476-5381.2011.01238.x. PMID: 21749363; PMCID: PMC3165946.
  3. Vučković S, Srebro D, Vujović KS, Vučetić Č, Prostran M. Cannabinoids and Pain: New Insights From Old Molecules. Front Pharmacol. 2018 Nov 13;9:1259. doi: 10.3389/fphar.2018.01259. PMID: 30542280; PMCID: PMC6277878.
  4. Pamplona FA, da Silva LR, Coan AC. Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis. Front Neurol. 2018 Sep 12;9:759. doi: 10.3389/fneur.2018.00759. Erratum in: Front Neurol. 2019 Jan 10;9:1050. PMID: 30258398; PMCID: PMC6143706.
  5. Johnson JR, Burnell-Nugent M, et al. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable cancer-Related Pain. Journal of Pain and Symptom Management. Vol. 39 No. 2 February 2010
  6. Journal of Pain and Symptom Management. Johnson JR, Burnell-Nugent M, et al. An Open-Label Extension Study to Investigate the Long-Term Safety and Tolerability of THC/CBD Oromucosal Spray and Oromucosal THC Spray in Patients With Terminal Cancer-Related Pain Refractory to Strong Opioid Analgesics. Journal of Pain and Symptom Management. volume 46, issue 2, P207-218, August 01, 2013
  7. Russo EB. The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No "Strain," No Gain. Front Plant Sci. 2019 Jan 9;9:1969. doi: 10.3389/fpls.2018.01969. PMID: 30687364; PMCID: PMC6334252.
  8. Samarut É, Nixon J, Kundap UP, Drapeau P, Ellis LD. Single and Synergistic Effects of Cannabidiol and Δ-9-Tetrahydrocannabinol on Zebrafish Models of Neuro-Hyperactivity. Front Pharmacol. 2019 Mar 20;10:226. doi: 10.3389/fphar.2019.00226. PMID: 30949046; PMCID: PMC6435997.
  9. Englund A, Morrison PD, Nottage J, Hague D, Kane F, Bonaccorso S, Stone JM, Reichenberg A, Brenneisen R, Holt D, Feilding A, Walker L, Murray RM, Kapur S. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. J Psychopharmacol. 2013 Jan;27(1):19-27. doi: 10.1177/0269881112460109. Epub 2012 Oct 5. PMID: 23042808.
  10. Marcu JP, Christian RT, Lau D, Zielinski AJ, Horowitz MP, Lee J, Pakdel A, Allison J, Limbad C, Moore DH, Yount GL, Desprez PY, McAllister SD. Cannabidiol enhances the inhibitory effects of delta9-tetrahydrocannabinol on human glioblastoma cell proliferation and survival. Mol Cancer Ther. 2010 Jan;9(1):180-9. doi: 10.1158/1535-7163.MCT-09-0407. Epub 2010 Jan 6. PMID: 20053780; PMCID: PMC2806496.
  11. Morgan JA, Freema TP, Schafer GL, Curran HV, et al. Cannabidiol Attenuates the Appetitive Effects of Δ9-Tetrahydrocannabinol in Humans Smoking Their Chosen Cannabis.
    Neuropsychopharmacology. 2010 Aug; 35(9): 1879–1885.
  12. Russo E, Guy GW. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Medical Hypotheses. 2006 ;66(2):234-246. DOI: 10.1016/j.mehy.2005.08.026.