Welcome back to the TRUCE MEDICAL MINUTE, and Part 2 on the psychoactive effects of medical cannabis. After some positive feedback I stuck with the Alex Grey artwork. This one is called “Cannabacchus” and I think is a pretty special piece of art. If interested, details are at the end of the post.

After covering cannabis and euphoria (in Part 1) with a great deal of positive feedback, today I will cover some of the negative aspects of the psychoactivity of cannabis (cue the fart sound). Yes, readers, unfortunately there are potential negatives too. If you missed part one (link in comments) please read it to understand that I am by no means opposed to patients feeling good from cannabis. In fact I encourage it. But for some, its not their cup of tea.

What does “psychoactivity” mean? It is an ability of a drug/substance to change brain function, resulting in alterations in perception, mood, consciousness, cognition, or behavior. Cannabis has the wonderful ability to produce some desired psychoactive effects. These may include euphoria, anxiolytics (decreased anxiety), relaxation, and somnolence. Not all of these are favorable and some are flat out undesirable to may patients.

Cannabis can also cause problematic effects. Unsettling symptoms like impaired memory, confusion, anxiety, paranoia, disorientation, dizziness, somnolence (if undesired) can be real enough issues that patients turn away from the medication. If they occur on the first time using they will almost certainly scare the patient away from ever going back to cannabis and gaining benefit. They are often related to excessive dose of THC with factors in the “set and setting” of the cannabis use…but they can be avoided with the right type of medicine, dosing and timing.

How can we get away from these effects?
1. Staying with low dose THC, even after widening the therapeutic window (more about this widening in a future post)
2. Keeping the CBD:THC ratio under 3:1
3. Use acid forms of cannabinoids
4. Topical delivery systems
5. Careful with edibles, especially the first time (just ask Dion Waiters!)

My general goal for most of my chronic pain patients is more than simply decreasing pain. It is to improve their lives by increasing their functionality. This may be by helping them to be able to work. It could be to help them to be able to fulfill the role they desire: of a parent, a spouse, a sibling or a friend, etc. Or it could simply be to help get out of bed each day and live. At any rate, many patients who become too densely stoned from cannabis are not able to do these things effectively, or any better than they could without it. So we work together on strategies to help them gain medical benefits from cannabinoids without feeling high. It can be done, but requires more time and effort from me, lest anybody think that is my target. My goal is to help improve my patients’ lives and we achieve that by working together. Every patient is different.

Utah is a unique state. Many of my patients who are in the more “conservative resident” cohort tend to strongly desire avoidance of any psychoactive effects, let alone euphoria. Even Utah Legislators and Prop 2 opponents went as far as to suggest that we needed nothing more than isolated CBD for patients as its is “not psychoactive”. This statement is a fallacy, even without discussing the flaws in the argument for CBD-only. CBD has significant anxiolytic effects, which indeed fall under the definition of psychoactivity as it alters brain function. Instead CBD is a “non-euphoriant” by definition, but it certainly is not non-psychoactive. So let’s agree to stop calling it that.

Finally, another topic that falls under the negative effects of cannabinoid’s psychoactivity and the perceived reward it can provide is the idea of “Cannabis Use Disorder” (CUD). This will be covered in a future TMM blog as it will take too long to discuss.

If there are any specific subjects or questions that you’d like to see covered, please comment here or message TRUCE privately if preferred. We’ll make every effort to discuss your submissions. As always, comments and questions specific to each column are encouraged.

We are always actively seeking TMM blog contributors among our readers who are willing to share their unique perspectives and medical ideas. There is no commitment required.

Andrew Talbott, MD
TRUCE Medical Advisor
Board Certified in Anesthesiology and Pain Medicine

Image “Cannabacchus” is copywrited by Alex Grey. For full size image or to purchase a copy of this print click here: https://www.amazon.com/Alex-Grey-Cannabacchus-…/…/B075SPRPK8

Apologies to Mr. Grey on the cropping and added text.