2. Niesink R, van Laar M. Does cannabidiol protect against adverse psychological effects of THC? Front Psychiatry. 2013;4:130.
Plan of Care
The patient was considering but was skeptical of using cannabis, since it had historically made her uncomfortable and paranoid. I explained that THC could have that effect, but, when combined with adequate CBD, these adverse effects could be ameliorated.2 In the meantime, I recommended an organically grown, broad spectrum (containing additional cannabinoids, terpenes, and flavonoids found in the plant), hemp-based CBD.
Because I’ve seen dramatic results in hundreds of clients in my practice—in particular for anxiety, pain, and insomnia—with little to no side effects, I urge health care professionals to consider CBD and cannabis as viable adjuncts to treatment.
A 48-year-old woman presented with a history of anxiety and depression, pain, insomnia, constipation, and focal nodular hyperplasia (benign tumors of the liver). She was looking to reduce her medications for these conditions and to improve her overall health. She had been prescribed the following medications: venlafaxine (Effexor), progestin (Norethindrone), Tylenol PM for sleep, plus Advil and Tylenol, as needed for pain.
She also stated that since starting CBD, she has more energy and clarity and can focus better at work. Three coworkers have asked her why she is so productive lately. She’s also been able to exercise because of a reduction in pain and now plans to work with her physician to slowly decrease her dose of Effexor. Even though constipation was not a primary complaint, she’s seen a significant improvement in bowel function since starting CBD. Ten drops twice daily was determined to be her optimal dose, which is about 20 mg per day.
One advantage of a tincture is that the patient can self-titrate depending on the severity of symptoms. For many of my clients, this particular nano-enhanced water-soluble tincture has proven to be effective at lower doses than those required with other tinctures or soft gels. I encouraged the patient to keep a journal of her symptoms and the dosage used and to increase the number of drops slowly until she found relief. This journaling helps clients find their optimal doses.
CBD can be an effective treatment for anxiety, depression, insomnia, and pain, which can certainly improve quality of life.5,6 This patient is a good example of these benefits. Being more focused and productive at work, being able to exercise, and not getting upset with disagreeable people are a few of the positive effects she’s seen. The improvement in her constipation is not surprising, as there are cannabinoid receptors in the gut, and cannabis has been used effectively for digestive issues for centuries.7,8
After three months, the patient reported that she was still sleeping well and that her anxiety was markedly decreased. She shared one example of a situation that historically had caused a fair amount of stress. At a recent annual family gathering, she was very calm and did not feel the need, as in the past, to “bite someone’s head off!”
The endocannabinoid system has been recognized as a potential therapeutic target. Either highly purified cannabidiol (such as Epidiolex recently approved in the United States for use in Lennox–Gastaut or Dravet syndrome) or formulations with different Δ 9 -tetrahydrocannabinol (THC) to cannabidiol (CBD) ratios (such as Sativex, an oromucosal spray for the treatment of multiple sclerosis-associated spasticity) are being investigated for other disease states. Although the use of cannabinoids for the treatment of pain is supported by some controlled clinical trials [3–5], currently and according to systematic reviews and meta-analysis [6–8], there is only moderate evidence to support the use of cannabinoids in treating chronic pain and larger and higher quality clinical trials are needed. Despite this fact, chronic pain relief is by far the most common condition cited by patients using cannabis for medical purposes and very little is known about potential pharmacokinetic interactions with common medication prescribed for chronic pain.
Pregabalin and gabapentin share a similar mechanism of action, and both undergo renal excretion . Based on the renal elimination of these drugs, no DDIs between these gabapentinoids and cannabinoids should be expected. With regard to efflux transporters, some authors’ results  suggested that a combined treatment of pregabalin with Pgp inhibitors enables the prolongation of dose interval of this drug. However, no studies in literature found increased pregabalin levels in the brain with the use of Pgp inhibitors.
Antiepileptic drugs are used worldwide to treat several disorders other than epilepsy, such as neuropathic pain, migraine, and bipolar disorder . The first-line options for the treatment of various neuropathic pain conditions are carbamazepine, gabapentin, and pregabalin .