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Updated on April 13, 2023
Article Summary
Cannabidiol (CBD) and tetrahydrocannabinol (THC) are both rising stars in the medical community as researchers uncover increasing evidence of their efficacy and the legal barriers to their use are dismantled. However, many individuals are unclear about the differences between the two substances.
This is understandable, given their close relationship; both CBD and THC are produced by the cannabis sativa and cannabis indica ferns and activate the cannabinoid receptor system, leading to partially overlapping mechanisms of action. However, the two substances have significant differences that inform both application and tolerability. For individuals who are interested in integrating cannabinoids in their treatment plans, understanding these differences is essential for optimizing therapeutic benefits while minimizing risk.
THC can produce a broad range of physiological and psychological effects, including euphoria, anxiolysis, calming of the stomach, hunger, divergent thinking, altered perceptions, and analgesia. Although several of these effects primarily drive recreational use, others offer significant therapeutic value for individuals experiencing health conditions like chronic pain, anxiety, anorexia, nausea, and depression.
This has led to widespread use of THC in not only the treatment of specific disorders and illnesses, but also in palliative care and to manage the side effects of chemotherapy. THC has also been found to lower intraocular pressure in individuals who have glaucoma, but the short duration of this effect and subsequent need for frequent redosing precludes it from being a viable treatment option for most.
Although THC is commonly consumed via inhalation of combusted cannabis, many users—particularly therapeutic users—choose to consume THC via oils, food products, or vaporized liquid. The method of administration is a critical determinant of user experience because it informs both the rate of absorption and the duration of action.
When consumed orally, THC can take as long as 1.5 hours to be absorbed, whereas onset can occur within seconds or minutes when it’s inhaled. Likewise, inhaled THC can remain active as quickly as 45 minutes or as long as a few hours, while consuming THC orally can lead to up to eight hours of therapeutic or recreational effects. Methods of administration can also create qualitatively different experiences, with many individuals reporting more intense reactions—both positive and negative—to edibles and oils than to inhaled products.
It is important to note that THC therapeutics rarely contain only THC, but include CBD and other cannabinoids as well. The ratio of THC and other cannabinoids can drastically alter the individual’s experience of relief or of side effects. This is a critical area for individuals to consider, because the side effects of THC can be significant, including suppression of executive functions, restlessness, fatigue, anxiety, mood disturbances, paranoia, delusions, and hallucinations. In some cases, avoiding side effects is simply a matter of finding the right formulation. However, some individuals cannot tolerate any meaningful amount of THC due to unpleasant reactions.
Some populations are particularly vulnerable to negative and even dangerous effects. Consistent THC consumption in adolescence has been found to have detrimental impacts on the developing brain, and even isolated use might trigger the onset of psychosis in predisposed individuals.
Likewise, individuals with mental health disorders—including depression, anxiety, bipolar disorder, and schizophrenia—might experience aggravation of symptoms from both short and long-term use. Meanwhile, individuals with executive functioning disorders like ADHD might find their symptoms appear to improve during therapy, only to significantly worsen after cessation.
Additionally, while THC is often heralded as a safer alternative to opioid painkillers, recent research suggests that, unlike CBD, THC might increase relapse risk in individuals with existing opioid addictions. This is because THC weakly increases the sensitivity of the body’s sigma and mu-opioid receptors, a property that it shares with opiate-class drugs. Increasing the sensitivity of the receptors causes them to have a larger physiological effect if they are subsequently activated, enhancing the euphoria, analgesia, anxiolysis, and sedation caused by opioids.
In other words, THC potentiates opiate-class drugs. At the same time, this potentiating ability presents possibilities for safer opioid administration in some individuals, because THC can be co-administered with opiates to keep absolute dosages of the opiate medications low. Furthermore, THC might minimize withdrawal symptoms in long-term opioid users who are decreasing or eliminating opioid use.
A more pressing concern for many is the addictive potential of THC. Although it does not carry the risk of physical dependence, some users—including those who initially used THC therapeutically—lose control of their consumption and continue to use it despite negative consequences. Additionally, the psychoactive effects of THC can cause both long-term and short-term cognitive disturbances and behavioral changes that interfere with everyday function and potentially damage emotional, physical, social, and professional well-being.
So what is the difference between CBD and THC?
Although CBD shares its origin with THC and has a broad spectrum of therapeutic applications, it does not have recreational value or addictive potential. Significantly, while CBD targets many of the same endocannabinoid pathways as THC, it does not cause euphoria, disordered thinking, psychosis, or intoxication. Because CBD lacks these effects, many individuals find it to better fit their lifestyle and therapeutic needs compared to THC-based therapeutics. And although CBD-based therapeutics also contain a very small amount of THC, that THC is typically leftover from the CBD’s source and is rarely present in detectable concentrations.
Given the current evidence, CBD’s safety profile is largely superior to THC’s, and it causes only minor side effects, like somnolence and fatigue, and only with comparatively large doses. As such, CBD is preferred by many individuals because it is more suitable for long-term and frequent use, it does not typically interfere with functionality, and it does not carry significant risks for any particular population. Additionally, CBD has a number of beneficial applications that go beyond those of THC.
CBD is an effective analgesic when used in conjunction with THC, but it can also be used alone for both acute and chronic pain. Interestingly, CBD has been found to assist in keeping pain from spreading from its originating location, a feature particularly vital for individuals with neuropathic and/or arthritic pain. Additionally, CBD might lead to a weaker interaction between pain and mood, allowing individuals to tolerate the pain with less distress.
This capability is likely linked to the ability of CBD to manage anxiety. Notably, CBD is far more predictable in its anxiolytic effects than THC, which can sometimes cause individuals to become paradoxically anxious. CBD’s rate of paradoxical reactions is much lower, making it a safer option for many.
Research indicates that CBD might be particularly effective in managing conditioned anxiety, such as in complex psychological trauma or post-traumatic stress disorder (PTSD). More specifically, research suggests CBD might help individuals diminish and better cope with traumatic memories and triggers.
In one experiment, mice were administered a mild shock in conjunction with a common environmental noise they would not find frightening. After several rounds of the shock being paired with the noise, the mice exhibited a fearful response when they heard the noise, even when there was no shock. Next, researchers administered CBD to a group of the mice and played the noise again. Fifty percent of the CBD group exhibited the fear response when they heard the noise, in contrast to 80 percent of the control group. Impressively, the researchers then demonstrated that CBD enabled the mice to disassociate the memory of being shocked with the noise more rapidly; with repeated exposure to the noise without any concomitant shock, the mice in the treatment group exhibited 10 percent fewer fear responses after each time they heard the noise.
This extinguishing response is doubtlessly a result of CBD’s ability to affect neuronal energy utilization, a feature that researchers link to its potential as an antiepileptic. According to a 2018 meta-analysis of 36 studies on the use of CBD in the treatment of epilepsy, more than 44 percent of participants were capable of reducing their frequency of seizures by 50 percent or more with CBD therapy. Furthermore, 8.5 percent of participants were able to become seizure-free using CBD therapy in isolation, and 55.8 percent of participants experienced an improved quality of life on CBD treatment, meaning its utility as an antiepileptic is superior to other drugs indicated for treatment-resistant epilepsy. Participants whose epilepsy resulted from Dravet syndrome appeared to benefit even more, with 89.3 percent reporting positive impacts on appetite, mood, and sleep quality. These results were preserved among the studies examined by the meta-analysis, meaning the case for using CBD to manage epilepsy is very strong.
Significantly, while CBD, like THC, might reduce reliance on opioid painkillers, it might also be safer for individuals currently addicted to opioids. In fact, CBD could be used as an aid to addiction treatment; CBD causes a different sensitization response of the opioid receptors, indicating it would be a more useful tool in helping individuals lower their dose of opiates. CBD might also address drug-seeking behavior and cravings, and it could be effective in assisting with the discomfort of withdrawal from alcohol and opioids.
Importantly, CBD’s ability to affect cravings indicates it can have a beneficial effect on the brain’s dopamine system, a property that has led researchers to hypothesize it might be helpful for disorders like schizophrenia. This stands in sharp contrast to THC, which is associated with earlier onset of schizophrenia and greater severity of symptoms.
CBD is typically consumed as a capsule, an oral spray, a liquid, or within a food product. Most manufacturers of high-quality CBD therapeutics, like Charlotte’s Web, offer CBD in oil format because it is easy to dose and provides a reliable 8-hour duration per dose. This long-lasting effect is critical for many individuals who use CBD to manage the symptoms of chronic disorders, such as epilepsy.
Although CBD appears to be the more clinically promising cannabinoid compared to THC for many conditions, many questions remain regarding their separate or simultaneous usage. The majority of the available evidence suggests that CBD is safe for children, but in-depth investigations have not yet been performed.
THC, in comparison, has no recognized medical use for children and there is evidence that exposure negatively impacts the developing brain, particularly long-term exposure. Furthermore, researchers have yet to characterize the residual social stigma that cannabinoid therapeutics are likely to face in less progressive regions. Importantly, this social stigma is worsened by criminalization of therapeutic THC in some areas. CBD, on the other hand, does not suffer from the same legal implications.
As our understanding of medicinal cannabinoid use grows, the medical community will undoubtedly expand and refine the therapeutic roles of CBD and THC. In the meantime, however, there is undeniable evidence of efficacy for a number of health conditions. Individuals who want to take advantage of these therapies should speak with their medical providers to formulate an appropriate treatment plan and seek out high-quality therapeutics to optimize outcomes.
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