CBD and THC: Does the market reflect therapeutic dosing?

Inhaled cannabis has been shown to reduce chronic pain, however its intoxicating effects present a clinical limitation. Several studies support the popular notion that CBD (cannabidiol) can reduce THC (trans-Δ⁹-tetrahydrocannabinol) subjective effects, yet multiple other studies demonstrate that CBD can actually enhance THC's intoxicating effects. These discrepancies are dependent upon the two cannabinoids’ ratios and concentrations. We hypothesize that the majority of medical cannabis products with THC and CBD will have ratios capable of producing significant acute intoxication, similar to recreational products. This study subsequently aims to characterize cannabis products available from dispensaries within ratio and concentration categories, and evaluate whether the probable effects of products labeled as recreational differ from those labeled as medical to determine their potential utility for chronic pain. We collected THC and CBD content from cannabis products offered by 653 dispensaries online from nine states (CA, CO, ME, MA, NH, NM, RI, VT, WA). A total of 8,505 herbal cannabis products were recorded, with 6,293 offering information on CBD content. The 72.8% of products containing CBD (>0%) fall into four clinically meaningful categories: CBD can enhance THC effects (THC:CBD ratios ≥ 1:1), CBD has no significant effect on THC effects (ratios ∼1:2), CBD can either have no effect or is protective against THC effects (ratios 1: >2<6), or CBD is protective against THC effects (ratios ≤ 1:6). In line with our hypothesis, the majority of both medical and recreational products with CBD fall into the foremost listed category (e.g., 66.7% medical, and 67.7% recreational in CO), with CBD likely potentiating THC effects; and products likely to provide CBD mitigation of THC effects make up the smallest category (e.g., 6.7% medical, and 9.2% recreational in CO). Patients seeking medical cannabis with CBD content for chronic pain are therefore at substantial risk of amplifying THC acute effects. Department of Anesthesiology - Wake Forest School of Medicine Funds.