By: Dr. Leigh Vinocur
If you’re exploring medical cannabis for the first time, you’re not alone and you’re also not wrong to feel a little overwhelmed. Cannabis is not a one-size-fits-all medication. It’s not even a “one-size-fits-most.” Instead, it’s a personalized journey guided by biology, your medical history, and a bit of patience. It’s important not to go it alone. Medical cannabis, while generally safe, is a real medicine that interacts with your body and potentially your other medications. That means you need medical guidance, and not from friends or well-meaning dispensary attendants. In fact a recent study has shown that over 54% of these customers are relying on dispensary staff to answer medical questions about the use of medical cannabis, while only about 3% of those patients have asked for input from their medical provider. And this is problematic, because despite knowledge of their products in the dispensary and perhaps their own personal experience, dispensary attendants cannot and should not be giving medical advice.
You need to start with a cannabis clinician, who can be a physician, nurse practitioner (NP), physician assistant (PA) or pharmacist (PharmD). A good cannabis clinician should take the time to review your medical records, discuss how it may help your specific medical condition, and make sure you will not have any drug interactions with your other medications. They should be willing to follow up with you and be available to answer your questions once you start using medical cannabis.
There should be a discussion on the endocannabinoid system, which is our own internal cannabinoids that our body produces to maintain our internal balance (homeostasis) and handle various stressors. They should explain how phyto-cannabinoids (the plant cannabinoid compounds) interact with our endocannabinoid system, as well as a simplified explanation of the pharmacology of cannabis. Typically, inhaled cannabis kicks in faster (within minutes) and wears off quicker, whereas oral cannabis (like gummies and tinctures) can take longer to work — about 30 minutes to 2 hours and can last up to 12–24 hours. If you are cannabis naïve, it is especially important to “start low and go slow.” That means start at a low dose and then slowly increase the dose over time, every 3-5 days.
Additionally, you should record everything, such as your dose, timing, and how you felt. There are apps or even simple handwritten log sheets that can help you and your cannabis physician to find your optimal personalized regimen.
How cannabis can affect your mental health
We know that our endocannabinoid system (ECS) plays a critical role in our mental health. Our internal endocannabinoids attach to our cannabinoid receptors (CB1 and CB2) in the brain to regulate our central nervous system. These compounds, such as anandamide, which is our “bliss molecule,” have been found to have anti-anxiety and antidepressant effects. And there are abundant CB1 receptors in areas of the brain that control emotions, mood, and fear. A 2016 review study published in Nature discusses how our endocannabinoid system regulates and buffers stress in these parts of our brain.
Studies also find that dysfunction in our ECS can affect our mood and contribute to anxiety and depression. We have another internal endocannabinoid called 2-Arachidonoylglycerol (2-AG). A study found that women with lower levels of this endocannabinoid were more likely to have major depression. The same researchers also found that depressed patients who had lower blood circulating levels of anandamide were also more likely to report anxiety. In fact, these mental health conditions might indicate how a dysfunction or deficiency of our internal endocannabinoid system, affects disease.
THC and CBD, the main plant cannabinoids, interact with our endocannabinoid receptors. And they can also interact with other brain neurochemical receptors that have been found to have a role in anxiety and depression, such as serotonin. With respect to THC a 2005 study found that low doses can have anti-anxiety and antidepressant effects, while high doses can actually trigger anxiety. An older study from the 1980s found that CBD can have anti-anxiety properties in both low and high doses and can mitigate anxiety produced from THC as well as its intoxicating effects. But it is very important not self-medicate with cannabis. Please talk with a physician or mental health professional if you are having symptoms of anxiety and depression.
What is Clinical endocannabinoid deficiency syndrome (CECD)
Famous cannabis clinician and researcher, Dr. Ethan Russo coined the term Clinical Endocannabinoid Deficiency (CECD) to describe many hard-to-treat medical conditions that may be a dysfunction or deficiency of our internal endocannabinoid system.
The autism spectrum disorder is a prime example of a condition that at present, offers few great medicinal treatment options. It is an especially complex neuro-developmental disorder affecting communication and behavior. Recent studies in Israel and the US found that children with autism-spectrum disorder do have lower levels of these important endocannabinoids. In fact, researchers from the US study done at Stanford University remarked that a direct correlation could almost predict how severe these children were on with spectrum, just by looking at their anandamide levels.
By using the plant cannabinoids, in theory, may re-balance their dysfunction. A small study looking at CBD use as an additional therapy in children on the spectrum with severe behavioral problems, found a 61% reduction in behavioral outbreaks, a 47% improvement in communication, and a 39% decrease in anxiety. Almost one-quarter of these children ended up stopping other medications. But again, it is important to work with a knowledgeable clinician.
While medical cannabis therapeutics are promising, much of this research is still emerging and somewhat limited due to cannabis’ federal illegality and its “Schedule I” status. It’s also a very personalized medicine and variability can even exist within the same product, at different times due to how plants grow and respond to their environment. Medical cannabis is not a miracle cure, however, it is an additional tool with real therapeutic potential, especially when used thoughtfully, patiently, and under medical supervision.
Dr. Leigh Vinocur is a board-certified emergency physician, national spokesperson for the American College of Emergency Physicians, and a sought-after medical expert with over 20 years of frontline experience. She has held senior leadership roles, including Chief Medical Director for a multi-state healthcare system serving more than 150,000 patients annually.
A founding member of the Dr. Oz Show Medical Advisory Board, Dr. Leigh is a trusted voice in national media, with appearances on the TODAY Show, CNN, Fox News, Inside Edition, and more. She blends clinical expertise with warmth and humor to break down complex health topics for everyday audiences.
Dr. Leigh also holds a Master’s in Medical Cannabis Science and Therapeutics from the University of Maryland and is the founder of Ananda Medical Practice.
