Mapping cannabis potency in medical and recreational programs in the United States

Abstract

Cannabis related online searches are associated with positive attitudes toward medical cannabis, particularly when information is obtained from dispensaries. Since pain is the main reason for medicinal cannabis use, information from dispensary websites has the potential to shape the attitude of pain patients towards cannabis. This is relevant because cannabis has demonstrated efficacy in neuropathic pain with low tetrahydrocannabinol (THC) concentrations (< 5-10%), in contrast to potent cannabis (>15% THC), which is highly rewarded in the recreational realm. The role of CBD in pain is not clear, however it has gained popularity. Thus, we hypothesize that the potency of medical cannabis that is advertised online is similar to the cannabis advertised for recreational purposes, which would potentially create a misconception towards medical cannabis. The current lack of knowledge surrounding advertised potencies in the legal cannabis market limits the ability to generate clear policies regarding online advertising to protect patients that are willing to use cannabis for their condition. Thus, we evaluated the advertised THC and CBD content of cannabis products offered online in dispensaries in the United States to determine products' suitability to medicinal use and compare the strength of products offered in legal medical and recreational programs. We recorded THC and CBD concentrations for all herb cannabis products provided by dispensary websites and compared them between or within states. Four Western states (CA, CO, NM, WA) and five Northeastern states (ME, MA, NH, RI, VT) were included. A total of 8,505 cannabis products across 653 dispensaries were sampled. Despite the clear differences between medicinal and recreational uses of cannabis, the average THC concentration advertised online in medicinal programs was similar (19.2% ±6.2) to recreational programs (21.5% ±6.0) when compared between states with different programs, or between medicinal and recreational programs within the same states (CO or WA). Lower CBD concentrations accompanied higher THC products. The majority of products, regardless of medicinal or recreational programs, were advertised to have >15% THC (70.3%-91.4% of products). These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain. This data is consistent with reports in which THC and CBD in products from legal dispensaries or in

CBD and THC: Do They Complement Each Other Like Yin and Yang?

“…34 These results combined indicate that CBD can actually exacerbate the intoxication caused by THC when consumed under Arkell's paradigm: inhaled in a 1:1 variety (11% THC: 11% CBD), a common presentation in the legal US market. 26,34 Another article by Solowij and colleagues seems to support the idea that CBD can augment THC effects. 32 For their study, 36 frequent and infrequent cannabis users completed 5 different experimental sessions, with a week between each session, in order to test the acute effects of vaporized THC and CBD alone and in combination.…”

“…33 These findings are indicative of a complex interaction between the two prominent cannabis components: CBD must be modulating THC pharmacokinetics, and drug pharmacokinetics influence clinical effects. 33 This is particularly relevant given the lack to segmentation between products for medical usage and recreation usage, 26 as those seeking cannabis for medical purposes are presumably novice cannabis users.…”

“…24,32 It is noteworthy that, in general, CBD reduces psychotropic effects of THC when the latter was administered at very low doses 19,28,32,33 (Table 1) that are less likely to be found in herbal products from the U.S. legal market. 26 Another factor that seems to skew the results is whether CBD was administered simultaneously with THC or in a method involving pretreatment with CBD. The exact cause of this discrepancy is unknown; however, it has been suggested that CBD inhibits THC's metabolism to the potent psychogenic metabolite 11-hydroxy-THC.…”

Cannabis and work: Need for more research

“…39 Furthermore, in a 2019 survey of nearly 700 medical dispensaries in eight states, medical cannabis was found to have a similar THC concentration (19.2% ± 6.2%) to that found in cannabis sold for nonmedical purposes (21.5% ± 6.0%). 40 Relative to typical flower products, concentrated THC products such as oil, shatter, dab, and edibles have higher THC levels-from 60% 41 to 80%. 42 Some dispensaries list concentrates with THC potencies of 90% or more.…”

Cannabis in the Time of Coronavirus Disease 2019: The Yin and Yang of the Endocannabinoid System in Immunocompetence

“…15 This dose is significantly less than recreational dosing and miniscule compared to 75 mg/kg (used in the aforementioned mouse study). 16 This translates to a human equivalent dose of 360 mg for a 60 kg individual. Clearly, THC dose is a critical factor in assessing clinical impact.…”