Prescribing CBD with THC for Patients

While CBD is known for its non-psychoactive therapeutic properties, THC is recognised for its psychoactive effects.

Recent studies and clinical practices suggest that a combination of these two cannabinoids can provide enhanced therapeutic benefits.

Here, we explore the reasons why it is important for doctors to consider prescribing CBD in conjunction with THC.

1. The Entourage Effect

The concept of the "entourage effect" refers to the synergistic interaction between various cannabinoids and terpenes found in cannabis. This phenomenon suggests that the combined effects of these compounds are greater than the sum of their individual effects.

A landmark study published in the British Journal of Pharmacology highlighted the enhanced therapeutic potential of whole-plant cannabis extracts over isolated cannabinoids . By prescribing CBD with THC, doctors can harness this entourage effect, leading to improved outcomes for patients.

2. Enhanced Pain Management

Chronic pain is a prevalent condition that significantly impacts the quality of life. While both CBD and THC independently possess analgesic properties, their combination has been shown to be particularly effective in managing pain.

A study published in the Journal of Pain Research found that a combination of CBD and THC provided greater pain relief for patients with chronic pain compared to CBD or THC alone . This is particularly relevant for conditions such as neuropathic pain, fibromyalgia, and arthritis, where conventional treatments often fall short.

3. Reduction of THC's Psychoactive Side Effects

One of the major concerns with THC is its psychoactive effects, which can include anxiety, paranoia, and cognitive impairment. CBD, on the other hand, has been shown to mitigate these adverse effects.

A study in the Journal of Psychopharmacology reported that CBD can reduce the anxiety and cognitive impairment induced by THC . Therefore, prescribing CBD alongside THC can make cannabis-based therapies more tolerable and safer for patients, particularly those who may be sensitive to THC's effects.

4. Improved Outcomes for Neurological Conditions

Neurological conditions such as epilepsy, multiple sclerosis (MS), and Parkinson's disease can be particularly challenging to treat. Research indicates that the combination of CBD and THC may offer superior therapeutic benefits for these conditions.

For instance, Sativex, a pharmaceutical-grade extract containing both CBD and THC, has been approved in several countries for treating spasticity in MS patients. Clinical trials have demonstrated its efficacy in reducing spasticity and pain, thereby improving the quality of life for MS patients .

5. Potential Anti-Cancer Properties

Emerging research suggests that cannabinoids may possess anti-cancer properties. A study published in Molecular Cancer Therapeutics found that the combination of CBD and THC could induce apoptosis (programmed cell death) in cancer cells and inhibit tumor growth more effectively than either compound alone.

While more research is needed in this area, these findings highlight the potential for CBD and THC to be used as adjunctive therapies in cancer treatment.

6. Enhanced Anti-Inflammatory Effects

Inflammation is a common underlying factor in many chronic diseases, including autoimmune disorders, cardiovascular diseases, and neurodegenerative conditions. Both CBD and THC have demonstrated anti-inflammatory properties.

A study in the European Journal of Pharmacology indicated that the combination of CBD and THC produced a more significant anti-inflammatory response than either cannabinoid alone . This makes the combination particularly valuable for treating conditions characterised by chronic inflammation.

7. Addressing Diverse Symptoms in Palliative Care

Palliative care aims to improve the quality of life for patients with serious illnesses by addressing a wide range of symptoms, including pain, nausea, and loss of appetite. The combination of CBD and THC can be particularly effective in this context.

For example, a study published in the Journal of Pain and Symptom Management found that patients receiving a combination of CBD and THC reported significant improvements in pain, nausea, and overall well-being . This underscores the importance of using both cannabinoids to provide comprehensive symptom relief.

Summary

Prescribing CBD alongside THC offers a multitude of benefits that can enhance the therapeutic efficacy of cannabis-based treatments. The synergy between these cannabinoids, known as the entourage effect, can lead to improved outcomes for pain management, neurological conditions, and inflammatory diseases, among others.

Additionally, CBD can mitigate the psychoactive side effects of THC, making the treatment more tolerable for patients. As research continues to unfold, the combination of CBD and THC is poised to become a cornerstone of personalised and effective medical cannabis therapies.

References

Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology, 163(7), 1344-1364.

Johnson, J. R., Burnell-Nugent, M., Lossignol, D., Ganae-Motan, E. D., Potts, R., & Fallon, M. T. (2010). Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC extract in patients with intractable cancer-related pain. Journal of Pain Research, 3, 7-14.

Englund, A., Morrison, P. D., Nottage, J., Hague, D., Kane, F., Bonaccorso, S., ... & Kapur, S. (2013). Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. Journal of Psychopharmacology, 27(1), 19-27.

Zajicek, J. P., Apostu, V. I. (2011). Role of cannabinoids in multiple sclerosis. CNS Drugs, 25(3), 187-201.

Torres, S., Lorente, M., Rodriguez-Fornes, F., Hernandez-Tiedra, S., Salazar, M., Garcia-Taboada, E., ... & Guzman, M. (2011). A combined preclinical therapy of cannabinoids and temozolomide against glioma. Molecular Cancer Therapeutics, 10(1), 90-103.

Carrier, E. J., Auchampach, J. A., & Hillard, C. J. (2006). Inhibition of an equilibrative nucleoside transporter by cannabidiol: a mechanism of cannabinoid immunosuppression. European Journal of Pharmacology, 536(1-2), 197-207.

Johnson, J. R., Lossignol, D., Burnell-Nugent, M., & Fallon, M. T. (2013). An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. Journal of Pain and Symptom Management, 46(2), 207-218.