If you didn't already know — CBD and THC have the exact same In closing, CBD and THC share many similarities, but they also have distinct. An excellent example is the use of CBD (and also THC) products for the .. and input from international experts, recently concluded that CBD. There is a big difference between THC & CBD -- one is psychoactive and the other is not. Find out which We can, however, conclude a few important things.
Conclusion THC: CBD vs
Five studies included for other indications reported depression as an outcome measure; 4 evaluated chronic pain and 1 evaluated spasticity in MS patients. Two studies were rated as having unclear risk of bias and 3 as having high risk of bias.
Three studies suggested no difference between cannabinoids dronabinol and nabiximols and placebo in depression outcomes. One parallel-group trial that compared different doses of nabiximols with placebo reported a negative effect of nabiximols for the highest dose sprays per day compared with placebo mean difference from baseline, 2.
One small parallel-group trial, judged at high risk of bias, evaluated patients with generalized social anxiety disorder.
Additional data about anxiety outcomes provided by 4 studies 1 parallel group in patients with chronic pain also suggested a greater benefit of cannabinoids dronabinol, nabilone, and nabiximols than placebo but these studies were not restricted to patients with anxiety disorders.
Two studies 5 reports; 54 participants evaluated cannabinoids nabilone specifically for the treatment of sleep problems. One was a parallel-group trial judged at high risk of bias. The other was a crossover trial judged at low risk of bias in patients with fibromyalgia and compared nabilone with amitriptyline. Nineteen placebo-controlled studies included for other indications chronic pain and MS also evaluated sleep as an outcome.
There was some evidence that cannabinoids may improve sleep in these patient groups. Psychosis was assessed in 2 studies 9 reports; 71 participants judged at high risk of bias, which evaluated cannabidiol compared with amisulpride or placebo. One very small crossover trial 6 participants judged at unclear risk of bias compared tetrahydrocannabinol THC; 5 mg , cannabidiol 20 mg , cannabidiol 40 mg oromucosal spray, and placebo. This trial found no difference between placebo and cannabinoids on measures of intraocular pressure in patients with glaucoma.
Two small placebo-controlled studies 4 reports; 36 participants - suggested that THC capsules may be associated with a significant improvement in tic severity in patients with Tourette syndrome. Data about AEs were reported in 62 studies reports. Figure 4 shows the results of the meta-analyses for the number of participants experiencing any AE compared when compared with controls, stratified according to cannabinoid.
No studies evaluating the long-term AEs of cannabinoids were identified, even when searches were extended to lower levels of evidence. We conducted an extensive systematic review of the benefits and AEs associated with medical cannabinoids across a broad range of conditions.
We included 79 RCTs participants , the majority of which evaluated nausea and vomiting due to chemotherapy or chronic pain and spasticity due to MS and paraplegia.
Other patient categories were evaluated in fewer than 5 studies. Most studies suggested that cannabinoids were associated with improvements in symptoms, but these associations did not reach statistical significance in all studies. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy dronabinol and nabiximols , weight gain in HIV dronabinol , sleep disorders nabilone, nabiximols , and Tourette syndrome THC capsules ; and very low-quality evidence for an improvement in anxiety as assessed by a public speaking test cannabidiol.
There was low-quality evidence for no effect on psychosis cannabidiol and very low-level evidence for no effect on depression nabiximols. There was an increased risk of short-term AEs with cannabinoid use, including serious AEs. Common AEs included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting.
There was no clear evidence for a difference in association either beneficial or harmful based on type of cannabinoids or mode of administration. Only 2 studies evaluated cannabis. This review followed recommendations for rigorous systematic reviews.
Both published and unpublished trials were eligible for inclusion. There were no date or language restrictions. In order to minimize bias and errors, the main Embase strategies were peer reviewed by a second independent information specialist and all stages of the review process were performed independently by 2 reviewers.
We used the Cochrane risk of bias tool 11 to assess the included RCTs. This highlighted a number of methodological weaknesses in the included trials including failure to appropriately handle withdrawals, selective outcome reporting, and inadequate description of methods of randomization, allocation concealment, and blinding.
An additional limitation of many included studies was their very small sample sizes. The synthesis combined a narrative discussion of individual study results with meta-analysis for studies in which suitable data were available , supplemented by interpretation following guidance of the GRADE Working Group. The included studies used a large variety of measures to evaluate outcomes, and even very similar outcomes were often assessed using different measures.
Furthermore, a wide range of time points were reported in the included trials, which limited the applicability of the findings of these studies. Multiple different cannabinoids were evaluated in the included studies. We stratified analyses based on type of cannabinoid to investigate whether there were differences in associations based on type of cannabinoid.
The majority of the studies were 2-group trials with a placebo control group; however, some studies included active comparisons and multiple groups comparing more than 1 form of cannabinoid, different doses of cannabinoids, or active and placebo comparator groups.
This necessitated selecting a single result from each trial to contribute to the meta-analysis to avoid double counting of studies. Where possible, we selected the result for the treatment or dose most similar to the other studies contributing to that meta-analysis and for placebo-controlled comparisons rather than active comparisons.
For the short-term AE analysis, we selected the highest-reported cannabinoids dose because we hypothesized that this would be most likely to be associated with AEs—additionally, this analysis would present a worst-case scenario.
Studies evaluated various forms of cannabis administered via various routes oral capsules, smoked, vaporized, oromucosal spray, intramuscular injection and active comparators differed across trials. These differences in form, combined with the variety of outcome measures and the broad indication groupings considered by this review, resulted in a very heterogeneous set of included studies, which meant that meta-analysis was not always possible or appropriate.
Many studies reported insufficient information to allow meta-analysis eg, reporting only P values for group differences or no information on the analysis performed. A further difficulty with the continuous data were that even for the same outcomes, some studies reported results as difference between groups at follow-up and others reported results for difference in change from baseline.
As advised by the Cochrane Handbook for Systematic Reviews of Interventions , we combined both types of data when estimating summary mean differences. Additionally, studies of this design were rarely analyzed appropriately and none reported the required data accounting for their crossover design to permit appropriate inclusion in meta-analyses. Our search identified a number of existing reviews that assessed the use of medical cannabinoids for MS, - nausea and vomiting due to chemotherapy, - pain, - psychosis, - and Tourette syndrome.
As far as we are aware, our review is the first comprehensive review to evaluate the safety and efficacy of cannabinoids across a broad range of indications. A key strength of review was that it allowed us to conduct pooled analysis for the AEs associated with medicinal cannabinoids, adding considerable power to this analysis. Further studies evaluating cannabis itself are also required because there is very little evidence on the effects and AEs of cannabis. Future trials should adhere to the CONSORT Consolidated Standards of Reporting Trials reporting standards and ensure that appropriate methods are used for randomization, allocation concealment, patient and outcome assessor blinding, handling of withdrawals, and avoiding selective outcome reporting.
Future studies should assess patient-relevant outcomes including disease-specific end points, quality of life, and AEs using standardized outcome measures at similar time points to ensure inclusion in future meta-analyses. There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity.
There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome. Dr Whiting had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Acquisition, analysis, or interpretation of data: Critical revision of the manuscript for important intellectual content: Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and declare support from the Swiss Federal Office of Public Health FOPH for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
No additional disclosures were reported. The FOPH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The decision to submit the article for publication was a condition of the funding and was made before any results were available. Dr Whiting drafted the article, produced tables and figures and performed the analysis.
Mr Duffy and Ms Misso conducted the literature searches. Drs Whiting, Wolff, and Lang screened searched results and selected full-text studies for inclusion. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Neither of these individuals received additional compensation in association with their work on this article.
This article was corrected online June 26, , for incorrect axis labeling in Figure 4; on July 13, , for a corrected average reduction to the Ashworth spasticity scale as reported in the Abstract ; on November 5, , for an incorrect nonproprietary name and approved use for a drug in Table 1; and on April 12, , for an incorrect effect estimate.
Flow of Studies Through the Review Process. Search Strategy eAppendix 3. Nausea and Vomiting Due to Chemotherapy eAppendix 4. Chronic Pain eAppendix 6. Spasticity in MS and Paraplegia eAppendix 7. Anziety Disorder eAppendix 9. Sleep Disorder eAppendix Tourette Syndrome eAppendix A practical and natural taxonomy for cannabis.
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A randomised multicentre single blind comparison of a cannabinoid anti-emetic levonantradol with chlorpromazine in patients receiving their first cytotoxic chemotherapy. Eur J Cancer Clin Oncol. A multi-institutional phase III study of nabilone vs placebo in chemotherapy-induced nausea and vomiting. Double-blind, randomized, crossover trial of nabilone vs placebo in cancer chemotherapy.
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A trial assessing the effect of nabilone on pain and quality of life in patients with fibromyalgia. THC is an agonist, or activator, of the cannabinoid 1 CB1 receptor. When cannabis is given to people who have had their CB1 receptors blocked by a different drug, called an antagonist , cannabis cannot get them high.
So, we know that the CB1 receptor must be the critical target in the brain that produces intoxication. Brain imaging studies have shown increased blood flow to the prefrontal cortex region of the brain during THC intoxication. This region of the brain is responsible for decision-making, attention, and other executive functions, like motor skills.
In short, THC intoxication can affect any of these functions to varying degrees depending on the person. Ultimately, the activity in these regions produces pleasurable sensations and emotions that encourage us to revisit that greasy burger place for a calorie-dense meal or ask a potential mate out on another date.
But THC is far from the only ingredient in cannabis that has a direct impact on brain function. The most notable comparison is with cannabidiol CBD , which is the second most abundant cannabinoid found in the plant. Any substance that has a direct effect on the function of the brain is considered to be psychoactive.
CBD most certainly does this, as it has very powerful anti-seizure and anti-anxiety properties. In fact, evidence suggests that it actually interferes with the activity of the CB1 receptor, especially in the presence of THC. When THC and CBD work together to affect CB1 receptor activity, users tend to feel a more mellow, nuanced subjective high and have a much lower chance of experiencing paranoia compared to the effects felt when CBD is absent.
Why THC Gets You High and CBD Doesn’t
CBD and Δ9-THC interact uniquely with the endocannabinoid system .. In the article they concluded their results based on the strength of the. Conclusion: This review also illustrates that some important toxicological parameters are .. Often combinations of THC and CBD were used. depth reviews and concluded that medicinal cannabis should be available. . The anti cancer properties of THC, CBD, CBG and other cannabinoids are well.