Disclosures
Agenda
Introduction
The Cannabis Plant
CBD and the Endocannabinoid System
CBD Binding
CBD's Impact on THC's Psychoactive Effects
Effects on Non-Endocannabinoid Signaling Systems
Is CBD Psychoactive?
CBD Conversion to THC
Drug Interactions, CBD Pharmacology, and CBD Products
Metabolism
Drug: Drug Interactions
CBD and Warfarin
CBD and Methadone
CBD and Anti-epileptic Drugs
Initiating CBD Anti-epileptic Therapy
CBD and Hepatic Impairment
CBD and Fatty Foods
Discontinuing CBD Anti-epileptic Therapy
Adverse Effects of Oral CBD
Forms of CBD
Common Modes of Administration
Full Spectrum, Broad Spectrum, CBD Isolate & Whole Plant CBD
Topical CBD
MedWatch
Accuracy of CBD Labels
Clinical Applications of CBD Therapy
Treatment Resistant Epilepsy and CBD
Prescribing Epidiolex (CBD)
Notifying the DEA
Mechanism of Action of Epidiolex
Treatment Resistant Epilepsy and CBD with THC
National Approval of CBD Products
Autism Spectrum Disorder
Parkinson’s Disease
Cancer Treatment
Arthritis
Depression
Pretreatment with CBD
CBD Research
Human vs. Animal Studies
CBD in Clinical Care Quizzes - Quiz 3 of 4
Some patients want to try CBD
Are the Medical Claims Valid?
Quality Control
Crossing the Border
CBD in Clinical Care Quizzes - Quiz 4 of 4

CBD and the Endocannabinoid System

Although CBD and THC have the same chemical formula (C21 H30 O2), the two phytocannabinoids differ structurally. CBD has a hydroxyl group where THC has a closed ring. This one structural difference between the two phytocannabinoids leads to significantly different phytocannabinoid receptor binding capacities. (Casajuana Köguel, Crippa, Ligresti, Mechoulam, Zuardi)

Reproduced with permission under the Creative Commons Attribution License from Calapai et al.
Preclinical and Clinical Evidence Supporting Use of Cannabidiol in Psychiatry Evidence-Based Complementary and Alternative Medicine Volume 2019, Aug 2019Article ID 2509129, 11 pages https://doi.org/10.1155/2019/2509129

CBD influences binding at cannabinoid-1 (CB1) and cannabinoid-2 (CB2) receptors in multiple ways, but unlike THC, CBD’s mechanisms of action do not involve the direct binding to CB1 or CB2 receptors; CBD has a very low affinity for the cannabinoid receptors. (Devane, Ligresti, Bisogno)

References

  • Casajuana Köguel C, López-Pelayo H, Balcells-Olivero MM, Colom J, Gual A. Psychoactive constituents of cannabis and their clinical implications: a systematic review. Adicciones 2018; 30(2):140–151.
  • Crippa JA, Zuardi AW, Hallak, JE, et al. Oral Cannabidiol does not convert to delta 8 or delta 9 THC in humans: a pharmacokinetic study in healthy subjects. Cannabis and Cannabinoid Research. Published Online: 4 Oct 2019; https://doi.org/10.1089/can.2019.0024 Accessed October 2020
  • Ligresti A, De Petrocellis L, Di Marzo V. From phytocannabinoids to cannabinoid receptors and endocannabinoids: pleiotropic physiological and pathological roles through complex pharmacology. Physiol Re 2016; 96 (4):1593–1659.
  • Mechoulam R, Shani A, Edery H, Grunfeld Y. Chemical basis of hashish activity. Science Aug 7, 1970; 169 (3945):611–612.
  • Zuardi AW, Shirakawa I, Finkelfarb E, Karniol IG. Action of cannabidiol on the anxiety and other effects produced by delta 9-THC in normal subjects. Psychopharmacology(Berl). 1982; 76(3):245–250.
  • Devane WA, Hanus L, Breuer A, Pertwee RG, Stevenson LA, Griffin G, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992; 258(5090):1946–1949.
  • Bisogno T, Hanus L, De Petrocellis, L Tchilibon S, Ponde DE, Brandi I, et al. Molecular targets for cannabidiol and its synthetic analogues: effect on vanilloid VR1 receptors and on the cellular uptake and enzymatic hydrolysis of anandamide.  J. Pharmacol  2001; 134 (4), 845–852.