The Goldilocks Principle: Medical cannabis in general and CBD in particular have consistent anxiety relieving effects. But sometimes you have to play with them a bit to get just the right amount

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We have a verdict: “The overall pattern of human clinical data supports . . . CBD [as having] a consistent anxiolytic [anxiety reducing] effect,” says the most comprehensive literature review to date on the ability medical cannabis (MC) to relieve anxiety. Even more good news: A ton of people are able to completely replace (61%) or reduce (72%) their prescription meds with MC. Those are very encouraging findings as pain, anxiety & depression are the 3 main reasons people are increasingly turning to MC (MC = CBD, THC, or a combination of the two, often called whole plant cannabis, taken to relieve a troublesome condition).

But it’s not one size fits all. As the authors point out, there’s a number of variables that determine how well MC will work for you, and knowing what they are allows you to fine tune how you take MC.

Here’s the general rule: CBD, by itself, shows consistent anxiety-reducing effects; THC does the exact opposite, it’s anxiety-inducing (anxiogenic), and they both do so strongly. For example, a study looking at social anxiety disorder found that CBD “significantly reduced anxiety, cognitive impairment and discomfort, and significantly decreased hyper-alertness.” Conversely, in another study, THC “was found to have a profound anxiogenic effect, with participants stating that they felt increasingly more tense, jittery and less in control as the dose was increased;” and, similar found that subjects reported “near panic.”

Thus, when taking whole plant cannabis the relative concentrations of CBD to THC matter; the more of the former and the less of the latter the greater the anxiety reduction. Especially since whole plant cannabis contains other cannabinoids and compounds that reduce anxiety; the terpenes, for example, have shown “significant anxiolytic action.”

But there’s an important carve-out for some THC users: People who are naturally anxious and are longtime users report anxiety reduction; conversely, if you’re a naïve THC user and generally non-anxious to beging with, the stronger the THC the more likely you are to freak out. (If you find yourself in that position studies show that taking CBD will bring you back down to earth.)

Other variables: Age; gender (men have reported greater headache relief from MC than women); how you take it (oral administration delays the effect but it lasts longer); and, the big catch-all – dosage, where sometimes a lower dose works better to relieve anxiety, hence the adage ‘start low and go slow.’

Importantly, all this can sound more complicated than it actually is. As UCSF oncologist Donald Abrams, MD, puts it:

Medical cannabis is a different kind of medicine. Patients are able to work out for themselves what works best.

I [don’t] say take this strain, this much, this many times a day. I don’t think cannabis is a medication that needs a package insert. Most people can probably figure out how much to use it. Every patient is different, every strain is different – I think the best recommendation is ‘start low, go slow.’

While Abrams’ approach may seem counterintuitive, it deserves a very careful look because when it comes to MC he’s as good as it gets. Aside from being in the trenches for 40 years using MC to treat cancer and AIDS patients – witnessing what works and what doesn’t – he’s quite the scholar and researcher. Educated at Stanford, he teaches and researches at UCSF, has a clinical practice at San Francisco General Hosp, co-edited the cancer textbook Integrative Oncology, was named a ‘Top Cancer Doctor’ by Newsweek, and was on the committee that wrote the seminal book on medical cannabis, The Health Effects of Cannabinoids: The Current State of the Evidence, on behalf of the National Academies of Sciences, Engineering and Medicine.

Abrams’ perspective is simply the Goldilocks Principle applied to MC: Sometimes you have too much, sometimes you have too little – what you’re after is just the right amount.

The good news is he has watched his patients successfully figure that out for over 40 years.

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