Medical Marijuana, Cannabis, & CBD for Lyme
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Medical Marijuana and CBD Can Help Lyme
I lived in Washington state until late 2018 where state law provides for both medicinal and recreational use of marijuana. Federal law does not allow for medical marijuana, but it allows for the unrestricted sale of products derived from hemp. Hemp and marijuana are forms of cannabis. I recommended medical cannabis in my Seattle practice from marijuana or hemp for some of my Lyme disease patients based on the limited science available and based on the positive responses I witness. In this article I review
- how medical cannabis and medical marijuana works,
- CBD and THC,
- conditions cannabis and marijuana helps,
- how to take medical cannabis and medical marijuana,
- starting doses, and
- possible safety concerns.
Note:This is a long article with a lot of background. Skip to the bottom to see the conditions medical marijuana helps and information on how to take it.
Marty Ross MD on CBD and Marijuana in Lyme Disease
The Politics of Medical Marijuana
As I write this article twenty five states in the USA allow medical marijuana use and eight all marijuana recreational use. USA federal law currently allows for the use of CBD derived from hemp in all 50 states. Unfortunately the federal government, under the Trump administration, has put out some worrisome writings that it thinks hemp should be regulated the same as marijuana. In addition, US Attorney General Sessions calls for the federal government through US Attorneys at their discretion to enforce federal marijuana laws putting an end to state recreation and medical marijuana usage.
Cannabis, Marijuana, Hemp, CBD, THC
There are two varieties of cannabis plants. They differ in their appearance and chemical make up. The two plants are Cannabis Indica and Cannabis Sativa. Both of these plants are called marijuana. Hemp is a variety of Cannabis Sativa that has less than .3% delta-9-tetrahydrocannabinol (THC). THC is the psychoactive component of cannabis that gets people high. Both Indica and Sativa that have more than .3% THC are regulated as illegal drugs by the US government. Federal courts have ruled that industrial hemp, cannabis sativa with less than .3% THC, cannot be regulated as a drug. Thus cannabidiol (CBD) derived from hemp can be sold as a supplement across state lines and through the internet.
Cannabinoids & The Endocannabinoid System
There are over 400 chemicals called cannabinoids in cannabis that interact with the body’s natural cannabis system. Our natural marijuana/cannabis system is called the endocannabinoid system. The two main cannabis chemicals are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These chemicals interact with our endocannabinoid system in a variety of ways. In addition to cannabinoids, cannabis has terpenes. Terpenes give the flavor and aroma to cannabis. They also change the absorption and effects of CBD and THC.
The endocannabinoid system is distributed throughout the entire body with receptors found in the brain and many major organ systems. There are two major chemical receptors called cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). in addition to CB1 and CB2 there are some other minor receptors.
CB1 receptors are found on many organs including the brain and nervous system. They regulate the release of neurotransmitters in the brain and are psychoactive. CB1 regulates the heart and blood vessels, energy, thinking, memory, emotions, pain, muscle control, sensory regulation, the intestinal system, and much more.
CB2 is primarily anti-inflammatory and regulates the immune system. These receptors are found on a variety of white blood cells including B cells that make antibodies, T cells that fight Lyme, bacteria, and viruses, and macrophages that fight viruses. In addition to fighting infections, T cells release inflammatory cytokines that cause most Lyme symptoms. So regulating CB2 can lead to improvements in most of these symptoms.
The endocannabinoid system produces a number of chemicals that bind to the CB1, CB2 and minor receptors. The two major known ones are anandamide and 2-arachidonoylglycerol (2-AG). These two chemicals are broken down by a number of enzymes.
THC works by binding directly to CB1 and CB2 receptors. CBD works indirectly by limiting the destruction of 2-AG and anandamide. This leaves more of these chemicals available to bind to CB1 and CB2 receptors. In addition to indirectly raising anandamide and 2-AG, CBD may bind to minor receptors exerting a direct influence on the organs and the nervous system.
THC is also psychoactive. This is what gives a person the high of smoking or eating THC. CBD does not have this effect. CBD is thought to decrease the psychoactive effect of THC. Because it is psychoactive, THC can cause some thinking impairment which could be a draw back for people in Lyme who have difficult thinking. By comparison, CBD does not seem to give thinking problems.
One other major difference of THC and CBD is that THC produces more sleepiness while CBD is more upping. Thus THC is better for night use compared to CBD which is better for day use.
THC can cause psychosis. And CBD and THC can lower blood pressure and even cause heart attacks. So THC should not be used in people with psychotic mental health conditions. And both CBD and THC should be avoided in someone with low blood pressure or at risk for a heart attack. For instance someone with Lyme and paroxysmal orthostatic hypotension syndrome (POTS) should not use medical cannabis. And if a person has cognitive impairment on either CBD or THC, he or she should not drive.
What Does Medical Marijuana Help?
The research data base for medical cannabis is very limited due to US federal law that limits research on marijuana. Below I detail what is known through research on various medical conditions. However, there has not been any specific research on cannabis and someone with Lyme disease.
In 2016 the National Academy of Sciences published a review of the science and medical cannabis. Here is a list of its findings supported by research:
- Prevents chemotherapy induced peripheral neuropathy in animal studies,
- Inhaled cannabis reduces pain in HIV related neuropathy,
- Can help with pain through a helpful interaction with opioid receptors (animal studies) and can help reduce pain for patients on narcotics,
- Helps chemotherapy induced vomiting and nausea,
- Decreases anorexia and wasting in HIV,
- Reduces muscle spasticity in ALS and MS,
- Decreases saliva production in ALS,
- Reduces symptoms of depression in ALS,
- Anecdotal reports shows help with depression, anxiety and stress,
- CB1 receptor binders decrease seizures (in mice anandamide levels rise after seizures which stops the seizure),
- THC in some animal studies decreases seizures,
- CBD lowers seizures too through a number of proposed mechanisms by increasing anandamide levels, blocking enzymes that lower 2-AG and anandamide, or lowering glutamate levels,
- Limited human experiments shows lower seizure thresholds,
- Open label CBD studies show can lower seizures in humans,
- THC can help HIV cachexia and wasting syndrome,
- In HIV inhaled cannabis alleviates nerve pain,
- In HIV can help with nausea,
- Cannabis can alleviate symptoms of Chron’s and Ulcerative colitis like abdominal pain, nausea, and diarreha,
- Decreases MS muscle spasm and pain,
- Reduces pain,
- In Parkinsons, decreases tremors, and stiffness like bradykinesia, and dyskinesia, and
- In Post Traumatic Stress Disorder (PTSD) can help alleviate the hyperarousal state and insomnia.
Kills Lyme:In Canada, Dr. Erni Murakami did laboratory experiments showing CBD kills Lyme spirochetes. However there are no human experiments that show this to occur.
Medical Cannabis Benefits in Lyme
Based on the above research and what I see in my patients I recommend medical marijuana and medical cannabis for people with Lyme for the following reasons or conditions:
- As an anti-inflammatory working through CB2 receptors it protects the health of the nervous system and brain,
- Anxiety (I prefer CBD over THC),
- Depression (I prefer THC over CBD),
- Nerve pain,
- Muscle and joint pain,
- Insomnia (THC, not CBD),
- Stomach and Intestinal dysfunction like diarrhea and cramping,
- Seizures or seizure-like symptoms,
- Difficulty maintaining weight,
- Muscle spasms
- Muscle stiffness,
- Improve immune function by lowering inflammatory cytokines, and
- To decrease narcotics or to enhance their effect for pain control.
Kills Lyme?I am skeptical that it actually kills Lyme in any meaningful way in humans, although I am interested in this potential based on Dr. Murakami’s experiments. I have not seen improved killing of Lyme in my patients who use medical cannabis.
How to Take Medical Marijuana and CBD in Lyme
Medical cannabis comes in a variety of forms. Loose plant and oils can be inhaled either by using a vaporizer or directly smoking (plant). Of the inhaled methods, I prefer the vaporizer to limit harmful chemicals and irritants entering the lungs through smoking. Edible forms come in pills, drops, or in food. Also drops and sprays can be used in the mouth. There are creams and lotions which may have an effect where they are placed, but not throughout the body. The delivery method determines how quickly the effect will occur and how long it will last.
|Delivery Method||Time to Feel Effect||Time of Peak Effect||Length of Effect|
|Vapor or Smoke||90 sec||15 – 30 min||2 – 3 hours|
|Edibles/Pills/Drops||90 min||2 – 6 hours||4 – 12 hours|
|Mouth Sprays||.5 – 2.5 hour||1.5 – 4.25 hours|
Note: There is a lot of dfference in effects between different people.
Starting Dose: For someone who is new to cannabis and marijuana a good starting dose is 5 mgto see what the effect is. Based on that add more or less. Be careful with edibles because it could take 90 minutes or more to feel the effect.
CBD versus THC: CBD tends to be more activating and generally is good for daytime use. THC is more psychoactive creating sleepiness and the high; so it is better for before bed time use.
With CBD and THC from marijuana, there are products that are higher or lower in THC to CBD ratios. For instance a high THC product could have THC:CBD of 10:1. This type of product is good for night use. On the other hand a product of THC:CBD of 1:10 is good for day use.
Dose Frequency: Take high CBD ratio products up to 2 times during the day and high THC products before bed.
Experiment with Ratios: For some people THC works better for symptom management than CBD does. So for daytime use a person may need to find a higher THC:CBD ratio that works for that person.
How to Limit the High: Vaporizing or smoking high THC products gives less of a high than edible forms. THC from edible forms is altered by the liver into a more psychoactive substance giving a greater high. Also CBD can lower the high too.
Talk to The Bud Keeper: Medical marijuana stores have bud keepers. Good ones know the products in the store. Talk with them before you purchase to help find the best product for your situation. There is a lot of variation in products including mixes of THC, CBD, other cannabanoids in the products, and terpenes that effect how any given product works.
In Washington State, medical marijuana stores were combined with recreational stores in 2017. In my experience, the bud keepers in recreational shops are generally not as skilled at finding the right medical product as bud keepers in medical marijuana stores. Fortunately, in Washington state, some stores have certification in medical marijuana. These medical certified stores tend to have bud keepers who know the medical properties of there products.
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Medical marijuana/cannabis including CBD & THC helps many Lyme symptoms. Marty Ross MD LLMD reviews how and why to use it in a Lyme disease treatment.
Can medical marijuana help treat Lyme disease? A doctor’s perspective.
by Daniel A. Kinderlehrer, M.D.
I have a confession to make. I proposed a talk on medical marijuana at ILADS because it would force me to learn everything I could on the topic. I live in Colorado where it seems there is a dispensary on every corner, and many of my patients have been using medical cannabis. But the huge assortment of products is confusing, and I wanted to give specific recommendations to help patients get the most benefit. Here is what I learned.
Marijuana has 483 phytocannabanoids, which are naturally occurring compounds that can affect many body processes such as appetite, mood and sleep. Most people have heard of one of them—THC, or tetrahydrocannabinol—the psychoactive component of marijuana. THC can make you high, giddy, or euphoric, and provide seemingly awesome universal insights that may appear quite trivial the next day.
Some strains of marijuana now available are not your father’s weed—they have a much higher THC content. It’s important to choose the appropriate strain for your needs, and some people may want to avoid THC entirely. However, it has been clearly established that THC is quite beneficial for pain, sleep, nausea, appetite, and PTSD, so there are medically valid reasons for choosing it.
Most of the non-THC phytocannabanoids fall into the category of cannabidiols, or CBDs. CBDs were once considered to be physiologically inactive unless paired with THC, but it turns out that is not the case. There is compelling scientific research documenting its independent activity, and now there is extensive clinical experience as well.
Did you know that we make our own CBDs? All vertebrates going back 600 million years on the evolutionary tree have an endocannabanoid system, which modulates immune and nervous system function. CBDs are potent anti-inflammatory agents, they regulate neurotransmitters, and they may enhance immune competence. CBDs decrease neuroinflammation and are neuroprotective. They can significantly reduce pain and anxiety.
Marijuana is not the only product that supplies CBDs. Hemp, a variety of cannabis that is used to make rope, fabric and paper, contains CBDs. Hemp has less than 0.3% THC, and is not psychoactive.
There are two strains of cannabis: indica and sativa. Indica is great for pain but is sedating, so it is best used in nighttime. Sativa is activating, can increase energy, and is better suited for daytime use. The difference between indica and sativa is another ingredient, terpenes. Terpenes modify the activity of CBD and THC. There are also a number of hybrid strains now available that essentially cross categories.
If your problem is pain, consider taking CBDs in the form of hemp oil in the daytime. My patients have had excellent responses to a liposomal sublingual extract (taken under the tongue), and it is activating, not sedating. In the evening, you can take a marijuana extract with equal parts THC and CBD, since these together will have additive pain-relieving effects. There are a number of delivery systems available, including smoking, vaping, edibles and sublingual extracts. I recommend the extracts since the onset is reasonably quick, usually in about 30 minutes, and the dose can be easily titrated by adjusting the number of drops under the tongue.
Both hemp-derived CBD and marijuana are available as balms that can be applied topically to relieve pain. Whether taken systemically or applied locally, these products can help many patients significantly decrease their need for pain medication. In fact, states that have legalized medical marijuana have experienced a 25% decrease in opiate overdose deaths. That’s right. This scourge, which took 42,000 lives in 2016 (66,000 including all drug overdose deaths), was significantly reduced by the availability of marijuana.
For sleep, take a THC-dominant indica strain. THC is not only sedating, it increases the time spent in the deeper stages of sleep, so sleep is more restorative. If your problem is difficulty falling asleep, use a short-acting vehicle like vaping, which kicks in within 15 minutes. Vaping is high-tech smoking without the ill effects of the smoke. Alternatively, use a sublingual extract, which has an onset within 30 minutes. Both of these will hang around for up to an hour.
If your problem is staying asleep, then take an edible. It takes 60-90 minutes to get into the circulation, and hangs around for an average of 3-4 hours. I don’t recommend cookies or candy, as they usually have a lot of junk in them—you can take pure THC tablets. The average dose is 10mg, but start with 2.5mg to see how well you tolerate it.
If you have problems with both sleep initiation and maintenance, you can take sublingual extract or vape to fall asleep, and a THC tablet to stay asleep. The table below includes some considerations for choosing among the available options.
While THC is only available in states that have legalized medical marijuana, CBD from hemp oil is available everywhere—although the attorney general in Nebraska seems to be confused about that. You can buy it on the Internet, travel across state lines, and I have even taken it out of the country when I traveled to Israel to visit my daughter.
CBD can lessen anxiety, without any of the psychoactive giddiness of THC. CBD is anti-inflammatory—it not only decreases pain, it can improve energy, cognitive function and general well being. When I started selling it in my office, it went flying off the shelf. The full effects of CBD from hemp oil do not kick in for two to three weeks.
While properly administered marijuana has been extremely effective in helping people with PTSD, in some people it will make anxiety worse. Similarly, THC can help depression in some people, but in others can make depression worse, particularly if it is abused by chronic users. If you develop tolerance to the benefits of cannabis because of chronic use, it is important to take a drug holiday. Pregnant women should not take marijuana.
The legal status of marijuana is dicey. It is unjustifiably classified as a Class I controlled substance by the Food and Drug Administration, in the same category as heroin, and the Obama administration declined to enforce federal laws regarding marijuana in states where it was legalized and properly regulated. The current administration is trying to change that, but I predict it will be like trying to put toothpaste back in the tube.
The analgesic, anti-inflammatory and neuroprotective properties of cannabis make it extremely valuable as an adjunct to the treatment of tick-borne diseases. There is a lot of research available on the medical uses of cannabis. A couple of good resources are listed below.
Kowal MA et al. Review on clinical studies with cannabis and cannabinoids 2010-2014. Cannabinoids 2016;11(special issue):1-18
Dr. Daniel Kinderlehrer specializes in the treatment of tick-borne disease in Denver, Colorado. He has found that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.
A Colorado Lyme doctor reports that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.