The Importance of THC in Cannabis for Patients

Studies support the potential health benefits of THC in cannabis for: seizure, cancer treatment, nausea, low appetite, insomnia,  and more.

THC is like the middle child, living in the shadow of the perfect sibling (CBD) and accepting the onus of reckless intoxication on behalf of the whole cannabis family. Not to mention, it is far easier to access Cannabidiol (CBD). This is largely because hemp-based CBD products are legal across many parts of the world. Of course, the regional rules vary on CBD edibles, but it is generally more acceptable to access hemp-based CBD (less than 0.3% THC) than cannabis (with higher levels of THC). Yet certainly there are many potential benefits to THC in cannabis, and it’s time that access rules changed in favor of the patient.

Some are Against THC Because it’s Psychoactive

Would it surprise you to know that CBD is also psychoactive? As a matter of fact, the word ‘psychoactive’ simply refers to a substance that affects how the brain works. This can include mood, emotions, and behavior. Some of the psychoactive substances we regularly use include caffeine, nicotine, alcohol, and opioids.

Importantly, a substance that is psychoactive can have benefits for mental wellness. What’s more, recent studies have already investigated psilocybin (magic mushrooms) for depression and CBD for psychosis. Basically, the status of a substance as psychoactive should never be a reason to negate its medicinal worth.

Why do THC Limits (THC Caps) Exist?

If we cut down a little deeper, it’s not likely that psychoactivity is at the root of this issue. In other words, it’s something a little more controlling: keeping the people from experiencing euphoria. Traditionally, authority doesn’t want you to get high and start exploring the limits of your consciousness. Surely, you need look no further than a recent smattering of American states pushing for THC caps on medical cannabis. Importantly, at the time of publication, Florida, Massachusetts, Montana, and Washington all has bills at various stages of legislating the maximum allowable THC potency.

One of the most strict is relating to Florida cannabis access, called measure HB 1455. It puts the THC cap at 10% for all flower and 60% for concentrates. Unfortunately, at the time of publication, it has already cleared the Florida House (March 2021) with all Republicans in favour and all Democrats against.

Certainly, the appetite to place control on your experience of cannabis is strong. Sadly, this is true even in states where legal adult-use weed is possible. Astonishingly, Colorado, one of the most cannabis progressive states, recently tried to put forth a THC cap measure. The backlash was so hard and swift, the ink wasn’t even dry on the idea before it was shut down.

Unfortunately, capping THC levels is just a new form of prohibition. Additionally, it puts patient health at risk.

THC Caps Harm Cannabis Patients

Aside from personal aversion to living in a nanny-state, THC potency caps can have a devastating effect on patients. As a matter of fat, some truly need high levels of THC, such as chronic pain patients. Others can’t stop the painful spasms of Multiple Sclerosis without a strong concentrate. These are just two examples, in a wide population of medical cannabis consumers, who need latitude in choosing the cannabis medicine that best suits their need.

In addition, an interesting characteristic of treating with cannabis is that the patient soon reaches tolerance and no longer feels the euphoria associated with their therapeutic dose. In short, they are no longer feeling high even at very high doses of THC. So, in this way, THC potency caps are a bit redundant or unnecessary.

Finally, if the people are consuming cannabis with the intent to get high, is that something we should legislate away? What are the individual rights of a free person to experience elevated states of being? Should the government have control over access to that experience? Unfortunately, debating these questions will have to be another article, but feel free to leave your thoughts in the comment section.

For now, let it be resolved that THC has definitive medicinal importance, as proven by science.

The Medicinal Importance of THC in Cannabis

THC, like other cannabinoids, interacts with CB receptors within the endocannabinoid system. The result is a contribution to the maintenance of homeostasis in major body systems. These include reproductive, immune, and digestive functioning.

THC works in a similar way to an endogenous cannabinoid known as anandamide. Both molecules bind to CB1 receptors and increase dopamine ^[1]Zuzana Justinova, Marcello Solinas, Gianluigi Tanda, Godrey H. Redhi, and Steven R Goldberg. The Endogenous Cannabinoid Anandamide and Its Synthetic Analog R(+) Methanandamide are Intravenously … Continue readinglevels in the brain.

And what is the result of these interactions between THC and CB receptors?

In 2019, researchers at the University of New Mexico completed a study that demonstrated THC had the strongest correlation with therapeutic relief. Published in Scientific Reports, the UNM study is titled, “The Association Between Cannabis Product Characteristics and Symptom Relief.” ^[2]Sarah S. Stith, Jacob M. Vigil, Franco Brockelman, Keenan Keeling, Branden Hall. The Association between Cannabis Product Characteristics and Symptom Relief. Scientific Reports, 2019; 9 (1) DOI: … Continue reading

The findings reflect results from a large database of real-time cannabis patient (American) input, collected via the ReLeafApp. The App collates information on symptom relief, combustion method, chemovar (strain), and cannabinoid ratios (THC:CBD). Then it educates by giving feedback on health status, medication choices, outcomes based on symptom relief and side effects.

Medical cannabis patients using the app report that cannabis potent in THC is useful for: pain management, spasms, dementia, even for spiritual pursuits.

THC for Pain Relief

One of the top reasons patients consume cannabis is to help manage the symptoms of chronic pain. Research suggests that while THC may not beat opioids for eliminating some painful sensations, it is able to alter our perception away from a focus on pain. And this is good enough in terms of getting people back to functioning within their own lives.

Additionally, the benefits of cannabis include a high safety profile with few side effects. This is something opioids can’t offer.

Managing Neuropathy with THC in Cannabis

Despite this generalization that cannabis can’t beat opioids, there are certain types of pain that may actually be better managed by the herb. A patient survey included in the study from Current Pain and Headaches Reports (2015), ^[3]Jensen, B., Chen, J., Furnish, T. et al. (2015). Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Current Pain Headache Rep 19: 50. … Continue reading and a study from the Journal of Pain (2013), ^[4]Wislsey, Barth et al. (2012). Low-Dose Vaporized Cannabis Significantly Improves Neuropathic Pain. The Journal of Pain. vol 14, Issue 2, 136-148: https://doi.org/10.1016/j.jpain.2012.10.009 found that cannabis surpassed opioids in managing nerve pain.

Importantly, there are many anecdotal reports with the same result. One patient, Tim, tried many things to cope with Trigeminal nerve pain that followed severe physical trauma from being jumped. Only cannabis was able to stop the pain and burning. Still others have successfully used THC in cannabis to manage chronic back pain or nerve pain from Type 2 diabetes.

The effective results could be because the central nervous system has a high concentration of CB1 receptors. Significantly, it is the receptor that has the greatest response to THC. In fact, in the animal model, mice that are genetically bred to lack CB1 receptors appear to feel pain more strongly.

Microdosing Cannabis for Pain

Patients looking for pain relief through THC, but wanting to avoid the high, can try microdosing. By taking small amounts of THC more frequently (versus large doses less frequently), patients can avoid the intoxicating effects of cannabis.

Vomiting & Nausea/Appetite Managed with THC

The antiemetic benefits of cannabis have been known since the 1970s. Specifically, the stimulation of CB1 receptors suppress vomiting and nausea. Additionally, it has become common for cancer patients undergoing chemotherapy to be prescribed THC cannabinoid therapy using cannabis or Sativex.

In a double-blind, placebo controlled study ^[5]P. Grimison, A. Mersaides, A. Kirby, N. Lintzeris, R.Morton, P. Haber, A. Walsh, I. MacGregor, Y. Cheung, A. Tognela, C. Hahn, K. Briscoe, M. Aghmesheh, P. Fox, E. Abdi, S. Clarke, S. … Continue readingpublished in the Annals of Oncology (2020), chemotherapy patients had significant improvement of nausea and vomiting following cannabinoid treatment with THC and CBD.

Cannabis, THC in particular, can also stimulate appetite by binding to the same receptors. In fact, THC is famous for inducing the munchies. Research suggests that the endocannabinoid system regulates eating behavior and studies have demonstrated THC’s ability to increase appetite levels.

Anti-Cancer Benefit of THC in Cannabis

It is well known that cannabis can help patients cope with the side effects of cancer treatments, but these molecules have also demonstrate anti-cancer benefit in the lab and in the animal body. As a matter of fact, over the  past two decades, research in this area has accelerated. A 2016 publication of Progress in Neuro-Psychopharmacology and Biological Psychiatry gives a good overview of the use of cannabinoids as anticancer agents. It states that:

• Cannabinoids can stress a part of the cancer cell (endoplasmic reticulum) that makes proteins, essentially resulting in autophagy (cancer-cell death).
• THC can stop angiogenesis. This is the process whereby new blood vessels are formed. A tumor must undergo angiogenesis in order to enlarge tumors and metastasize. Effectively, THC stops metastasis and reduces the growth of tumors.

The Special Case of Glioma

Unfortunately, Glioblastoma Multiforme (GBM) is an aggressive form of brain cancer. While these tumors don’t typically metastasize outside of the central nervous system, these are quick to spread throughout the brain and into the brain stem and cerebellum, and even to the spinal cord.

Explicitly, GBM is notoriously persistent and difficult to treat. One of the main chemotherapy drugs, Temozolomide (TMZ) can very quickly stop providing benefit. Glioma patients, while at first responding favourably, quickly develop resistance to Temozolomide (TMZ) treatments.

In a preclinical trial published in Molecular Cancer Therapeutics (2011), ^[6]Sofia Torres, Mar Lorente, Fatima Rodriguez-Fornes, Sonia Hernandez-Tiedra, Maria Salazar, Elena Garcia-Taboada, Juan Barcia, Manuel Guzman, Guillermo Velasco. (2011) A Combined Preclinical Therapy … Continue reading THC combined with TMZ was extremely effective at killing glioma cells. Further, scans indicated significant reduction in tumor size with combined treatment versus TMZ alone.

Additionally, growing evidence indicates that THC has potent anti-tumor capacity and may be used to successfully manage GBM ^[7]Dumitru CA, Sandalcioglu IE, Karsak M. (2018) Cannabinoids in Glioblastoma Therapy: New Applications for Old Drugs. Front Mol Neurosci. 2018 May 16;11:159. doi: 10.3389/fnmol.2018.00159.

Neuroprotective Function of Cannabis

There is evidence that THC may assist in, not only slowing the trajectory of brain injury as it happens, but also help repair the brain. When the brain is assaulted, whether that be through blunt force trauma or distruptions in blood flow, glutamate is activated. Glutamate is an excitatory neurotransmitter and its activation (due to reduced blood flow), results in further damage. THC stops that.

One early study published in the journal Molecular Neurobiology (2002), ^[8]Mario van Der Stelt, Wouter B. Veldhuis, Mauro Maccarrone, Peter R Bar, Klass Nicolar, Gerrit A. Veldink, Vincenzo Di Marzo, Johannes F G Vliegenthart (2002). Acute Neuronal Injury, Excitotoxicity, … Continue readingdetermined that through the activation of CB1 receptors, THC directly inhibits glutamatergic transmission. The result is a reduction of glutamate levels and scaling down of injury to brain tissue.

A secondary source of brain damage following injury is the inflammatory response of the body. Cell damage continues due to inflammation in the brain. THC appears to have a strong anti-inflammatory effect on microglia (a type of brain cells involved in immune/inflammatory response and that remove damaged neurons).

Research published in Frontiers in Neurobiology (2016), ^[9]Sabrina F. Lisboa, Felipe V. Gomes, Francisco S. Guimaraes, Alline C. Campos (2016). Microglial Cells as a Link Between Cannabinoids and the Immune Hypothesis of Psychiatric Disorders. Front … Continue reading indicates that THC “can inhibit microglial cell activation.” This makes is a potential therapeutic tool to reduce neural inflammation and thereby reduce damage to neuronal cells following brain injury.

Can THC in Cannabis Help Dementia?

Studies in the lab have shown that THC can break up amyloid plaques and may prevent their formation by interacting with the proteins that aggregate to form these plaques.. While these are performed at the cellular level (and not in the human body), it is promising for Alzheimer’s and THC research.

A further benefit of THC is that it has strong anti-inflammatory benefits. As mentioned, this may give further protection to the brain by reducing inflammation. It is believed that chronic inflammation increases the risk for developing Alzheimer’s disease.

Seizure Control May Require THC Too

Hyperexcitability of neurons in the hippocampus can lead to seizure activity. Cannabidiol (CBD) has long been the go-to for patients with retractable epilepsy. Interestingly, whole plant medicine, which includes THC in cannabis (not just hemp), is showing promise at controlling seizures. Some patients are trialling a switch between CBD-rich cannabis oil and then oil with higher levels of THC – to keep seizures at bay.

While the exact mechanisms behind neurotransmitter activity during seizures are still the subject of intense research, one important theory says TRPV1 receptors appear to play a big role. ^[11]Nazıroglu, M. (2015). TRPV1 Channel: A Potential Drug Target for Treating Epilepsy. Current Neuropharmacology, 13(2), 239–247. doi: 10.2174/1570159×13666150216222543 Studies show that when CB1 receptors are activated, ion channels at the TRPV1 receptor are turned off. Since THC has a strong affinity to CB1 receptors, this relationship could be why THC is showing promise in preventing seizures from even starting.

THC has medicinal importance on its own accord – as part of a whole plant medicine or as a stand alone extract. Patients should not be intimidated to try and, even if the feelings of ‘being high’ are intolerable, there are ways to comfortably work up to therapeutic dose.

Truthfully, cannabis can be viewed as a personalized medicine. This is because the terpene and cannabinoid ratios that work for one person may not work for another. The THC dose that makes one feel incapacitated will have zero effect on another. It’s important to work with a physician who understands cannabis medicine and is willing to help you navigate all fo the different possibilities available in finding relief.