A tale of
two compounds
Whilst THC and CBD are currently the most researched, the potential for the medical application of a number of the other 100 cannabinoids that have been discovered in the cannabis plant, are emerging worldwide.
Windor’s clinicians are able to prescribe precise and personalised pharmaceutical preparations of CBD and THC to patients.
There is a growing volume of information supporting the credibility of cannabis medicines as a safe and effective treatment for patients with long-term medical problems that have been unable to effectively achieve the desired quality of life through more conventional treatments. It is this area of using precisely controlled cannabis-based medicines as treatment that Windsor are especially skilled in.
The two most commonly discussed therapeutic compounds within cannabis are CBD (Cannabidiol) and THC (tetrahydrocannabinol).
CBD is currently available to buy over the counter from health food and vape shops, and although some may find relief from these products, the CBD content is often too low to provide alleviation of more severe symptoms experienced by those with chronic conditions. Cannabis Based Products for Medical use, prescribed by clinicians and dispensed by pharmacists, are manufactured under strictly regulated conditions covering the whole process from the seed used to grow the plant to the manufacture and eventual delivery to the patient.
THC is more ‘psychoactive’, which may have earned it a bad reputation among those without recent medical experience of using cannabinoids. However, there is evidence that THC has a diverse range of potential medical applications such as regulating pain signalling, as an anti-convulsant, neuroprotectant, anti-spasmodic, appetite stimulant and anti-depressant. Medications containing THC are only available on prescription in the Jersey and cannot be obtained over the counter.
Modern biomedical science is beginning to provide a much more helpful understanding of the use of CBD and THC for treating medical problems. We now understand that for the most effective results, precise doses of THC and CBD, often carefully combined, should be used to deliver maximum benefit whilst minimising unwanted effects.
Cannabis Ingredients
Cannabis has two main active ingredients; CBD and THC.
THC can have harmful effects, like paranoia, if given alone. CBD counteracts these if used in the right proportions (1:1). Cannabis contains up to 147 cannabinoids, numerous flavonoids and >100 terpenes.
CBD alone has been found to be an effective anticancer treatment at the right dose, but it can interact with some cancer treatments, so always check with your oncologist, There is even a school of thought that it may prevent cancers forming.
You can buy CBD oil (containing up to 3% THC :CBD) over the counter without a prescription and gradually getting up to a good dose of full spectrum CBD oil can be an excellent treatment alone, before you get to the clinic. We recommend 10% CBD oil and starting at 1 drop per day, building gradually every few days to 9 drops per day in three divided doses. This is produced locally at Jersey Hemp and we recommend a ‘full spectrum’ product which has good levels of terpenes and flavinoids. Absorption is best from under the tongue, and swallowing it affects some of the medication in a process called 1st pass metabolism. Taking CBD oil alongside cannabis potentiates the cannabis effects, saving you money and protecting you from harmful side effects. Some terpenes may have similar effects.
The Cannabis Plant
Different parts of the Cannabis plant contain vastly different concentrations of the active medications. Unfertilised female flowers contain the highest concentrations of medication in the plant (20x that of leaves). Medicinal cannabis is often much stronger than anything you may have been exposed to before, and for this reason, if you’re transitioning from self medication with illegal cannabis to medical cannabis you will be treated with a smaller dose until your reaction can be assessed.
The Cannabis Flower
Cannabis flower is expensive and a good vaporiser will extract more of the medication so that you’re not throwing as much medication away. Taking cannabis via the lungs makes about 40% available in your blood, but taking it via the gut, only about 10% reaches your circulating blood. If you take it via the lungs, the concentration rises and falls much more quickly than via the gut. For this reason, vaping is great for getting to sleep, but not great for keeping you asleep all night without some longer acting treatment (like oil) at the same time. Heating the flower in a vaporiser changes inactive ingredients to the active ones in a process called decarboxylation. Burning cannabis in a ‘joint’, pipe or ‘bong’ releases harmful chemicals, like those associated with smoking tobacco. These chemicals cause lung cancer, chronic lung disease and many other cancers. For this reason, smoking medicinal cannabis remains illegal, while vaping has been legalised in a medical context. Evidence is still lacking, but convection vaporisers of the plant may be good for your lungs, while smoking is bad. Indeed, some cannabinoids are used to treat asthma.
Oils
The big advantages of starting with an oil is no need for additional equipment like a grinder or vaporiser. The disadvantage is a much slower onset of action (up to 2 hours) and if you have an adverse reaction it may be 9 hours before it’s out of your system. For this reason the adage, “start low and go slow” is crucial with oils.
There are 2 main strains of the plant, Indica and Sativa. Cannabis ruderalis is sometimes hybridised with these to change growing and flowering properties. As bud/flos/flower/granulate Indica is good for sleep and Sativa is good for alertness. When these are taken as oil, the differences between the two stains are lost.
Side Effects
Medicinal cannabis may cause side effects; disorientation / drowsiness / dry mouth / imbalance / anxiety / nausea / confusion / euphoria / blurred vision / headache / high or low blood pressure / paranoia / depression / rapid heart rate / diarrhoea / vomiting / difficulty urinating / hallucinations / difficulty swallowing / difficulty with bright light.
Many people worry about becoming addicted to cannabis. Dependency is more frequent with almost any other pharmaceutical, including coffee. Dependency occurs in only 1:10 people. Dependency can be avoided by using weaker strains, products where the THC is balanced by CBD in equal or greater strength or by taking CBD products in parallel. CBD can be taken sublingually, by mouth and by vape. Having a few days per week where you abstain may help to reduce tolerance. When people do develop tolerance, eating foods rich in terpenes, like mango, can potentiate cannabis effects. Some commercial terpene preparations are available too like ‘Raw Terp Spray’.
It is not known what effects cannabis might have on a developing foetus/baby, so it’s important not to get pregnant while taking cannabis. Cannabinoids are secreted in breast milk, so don’t take cannabis or CBD oil if you’re breast feeding. The jury is still out on the precise effect of cannabis on the various contraceptives and surprisingly the required studies have not been conducted. Cannabis reduces the effect of oestrogen, possibly making oestrogen based contraceptives like the combined oral contraceptive pill, Nuvaring and the contraceptive patch, less effective. The greatest risk is with the low oestrogen contraceptives. It can affect the body’s processing (metabolism) of progesterone too. Cannabis will not affect barrier methods of contraception (like condoms) or implantation blocking methods (like the coil). If you are trying to conceive, cannabis may reduce your chances, but it is not a reliable contraceptive. Although, this evidence is mixed, one American study found increased sperm counts amongst cannabis users whilst another study found it shrank monkey’s testicles.
Prof Barnes has launched a podcast and quarterly ‘Cannabis Health’ magazine to keep you up to date. More information about cannabis products can be found on the producer websites: Bedrocan, Spectrum Therapeutics, Breath of Life and Althea. There are some urban myths about cannabis.
Store your Cannabis Based Medical Products in their original packaging as this will keep it fresh.
Medicinal cannabis isn’t a magic bullet and doesn’t always work.
Don’t take any illicit drugs alongside your medicinal cannabis and ask about interactions if starting any other medication either on prescription or over the counter at your pharmacy. If your doctor doesn’t know about these interactions, please direct them to read the doctor page on this site
Travelling with medicinal cannabis
If you’re traveling with your medicinal cannabis, ensure that it’s legal in the countries that you’re visiting and passing through en route. Wikipedia is a good source of information about the legal status of cannabis around the world. You could also contact the Foreign Office. If you decide to travel with your medication, ask for a letter explaining that you’re receiving cannabis, on prescription, to show to authorities. Canada issued guidance to it’s legal recreational cannabis community advising that if you’re traveling with recreational cannabis to another country where recreational cannabis is legal, and the plane gets diverted, ditch it in the on board toilet. For this reason, if traveling with medicinal cannabis; keep it in your hand baggage, keep a hard copy of the legality link and if the plane gets diverted to a cannabis unfriendly nation, ditch your cannabis and avoid prison.
Medical cannabis can cause your blood pressure to go up or down. Keep an eye on it. Consider getting a home blood pressure monitor and check your blood pressure and pulse regularly. Alternatively, ask your GP, pharmacist or us to check this for you.
Rare side effects can include: hallucinations/ suicidal thoughts – you MUST contact the clinic URGENTLY should you experience any of these side effects so we can quickly resolve your treatment.
Should you experience any thoughts of self-harm whilst taking this medication you can also urgently contact help: 999 or Samaritans: 116123
If you develop symptoms of a stroke or chest pain while taking medicinal cannabis, seek immediate medical attention. If your pulse becomes rapid and irregular, but you feel well, it’s okay to wait and see your GP. If you don’t feel well with a rapid, irregular pulse, seek immediate medical assistance. Of course, this is true, even if you haven’t taken any cannabis.