CLINICAL CUSTOMIZATION WITH HEMP EXTRACTS
Hemp extract products offer broad spectrum wellness. However, they can be customized via unique modalities depending on desired therapeutic effects and individual response.
Optimizing delivery of broad spectrum CBD means using the lowest effective dose that produces benefits for a desired duration without causing unwanted side effects. Although vaporization and inhalation provide rapid effects, most patients prefer other administration methods:
- Sublingual: 15- to 60-minute onset; systemic effects that last less than 6 hours.
- Oral: 60- to 90-minute onset; systemic effects that last 4-12 hours.
- Topical: 20- to 40- minute onset; localized effects that last up to 4 hours.
- Transdermal: 20- to 40- minute onset; localized and systemic effects lasting up to 6 hours.
- Liposomal: liposomes significantly accelerate onset and increase bioavailability across the aforementioned administration methods.
The potential biphasic effects of dosing, coupled with an individual’s unique metabolism and endocannabinoid tone, mean administration method and dosing are often highly subjective. The figures provided are estimates.
There are 113 known cannabinoids and hundreds of terpenoids (flavor/aroma molecules) . In what is known as the entourage effect, these chemicals synergize to amplify therapeutic effects beyond a single isolated compound . Broad spectrum CBD extracts are more effective against epilepsy symptoms and inflammation compared to purified CBD isolate [3,4].
It may be that controlling ratios of select cannabinoids and terpenes provoke specialized, targeted responses. Russo (2011) suggests that unique combinations of cannabinoids and terpenes can result in novel treatment modalities for wide-ranging illnesses such as depression, dementia, and dermatological conditions .
Cannabinoids also have different physiological effects. Cannabigerol (CBG), for example, is a potent GABA uptake inhibitor, while cannabinol (CBN) has been shown to activate TRPV2 receptors [5,6]. Given that this field is still relatively new, research has not yet isolated and confirmed divergent synergy between specific compounds – with the notable exception of THC and CBD.
Clinical customization at this stage is likely a matter of hypothesis, trial, and subjective reporting. If a patient finds that a tincture with relatively high CBG and limonene provides relief while a tincture with relatively high CBN, and linalool does not, adjustments can be made as necessary.
Most products contain ingredients beyond broad spectrum CBD; tinctures, for example, are seated in carrier oils. Essential oils are commonly used to amplify topical therapeutic effects. Pharmaceutical-grade products are rigorously tested and usually free of allergens, but patients and practitioners should be aware of potentially beneficial or harmful extra ingredients.
Currently, clinical customization of hemp extracts is more art than science. The practitioner must listen carefully and evaluate administration method and cannabinoid/terpene content in light of the patient’s history and needs. The consumer can journal to help track effects and discuss results with their practitioner.
- Aizpurua-Olaizola O., et al. (2016). Evolution of the cannabinoid and terpene content during the growth of cannabis sativa plants from different chemotypes. Journal of Natural Products,79(2), 324-31. doi:10.1021/acs.jnatprod.5b00949
- Russo E.B. (2011). Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology,163(7), 1344-64. doi:10.1111/j.1476-5381.2011.01238.x
- Pamplona, Fabricio A. et al. (2018). Potential clinical benefits of CBD-rich Cannabis extracts over purified CBD in treatment-resistant epilepsy: Observational data meta-analysis. Frontiers in Neurology, 9:759. https://doi.org/10.3389/fneur.2018.00759
- Gallily R. et al. (2015). Overcoming the bell-shaped dose-response of cannabidiol by using cannabis extract enriched in cannabidiol. Pharmacology & Pharmacy,06(02), 75-85. doi:10.4236/pp.2015.62010
- Turner C.E. & Elsohly M.A. (1981). Biological activity of cannabichromene, its homologs and isomers. The Journal of Clinical Pharmacology,21(1). doi:10.1002/j.1552-4604.1981.tb02606.x
- Qin N, et al. (2008). TRPV2 is activated by cannabidiol and mediates CGRP release in cultured rat dorsal root ganglion neurons. Journal of Neuroscience,28: 6231–238.