dosing of cbd oil for teen with anxiety

Marijuana Facts for Teens

NIDA. “Marijuana Facts for Teens.” National Institute on Drug Abuse, 1 Dec. 2017, https://archives.drugabuse.gov/publications/marijuana-facts-teens.

NIDA. Marijuana Facts for Teens. National Institute on Drug Abuse website. https://archives.drugabuse.gov/publications/marijuana-facts-teens. December 1, 2017.

Want to Know More? Some FAQs about Marijuana

What is marijuana?

Marijuana is a mixture of dried, shredded flowers of the cannabis plant, Cannabis sativa. It goes by many different names, such as weed, pot, herb, and grass. Marijuana can be smoked, used to brew tea, and mixed in foods (edibles). Stronger forms include sinsemilla (sin-seh-me-yah), hashish (hash for short), and hash oil.

The main mind-altering chemical in marijuana is THC. Marijuana contains more than 500 chemicals, including more than 100 compounds that are similar to THC. The amount of THC in marijuana determines its potency, or strength, and how it can affect the body. Marijuana growers have been increasing the THC content of marijuana over the past few decades.

“I used to smoke pot until I had an anxiety attack and thought I couldn’t breathe . . . I was wheezing, and I got really paranoid.”

“There are a million things to do that are more fun than smoking some unknown grass. Go to the beach, go to the movies, go to the gym—you’re not missing anything.”

– Comments submitted to NIDA’s blog for teens

How does marijuana work?

Marijuana is psychoactive. In other words, it changes how the brain works. Marijuana affects specific sites in the brain called cannabinoid receptors. These receptors send messages to different nerve cells throughout the nervous system. They affect brain areas that impact learning and memory, appetite, coordination, and pleasure so interfering with these receptors can have significant effects on your body.

What happens if you use marijuana?

Marijuana affects each person differently depending on their biology, the plant’s potency, previous experience with drugs, the way a person uses the drug, and the use of alcohol or other drugs at the same time. Some people feel nothing at all when they use marijuana. Some feel relaxed or high. Others suddenly get anxious and paranoid; this happens especially when a person uses stronger marijuana, takes too much, or isn’t used to taking it. We’re still learning about how marijuana affects the brain and how long the effects will last—especially after someone stops using the drug.

What are common effects of marijuana on the body, brain, and behavior?

Regular marijuana use has also been linked to memory and relationship problems, poorer mental and physical health, lower salaries, and less career success. 6

Short-term effects (while using or right after using)

  • learning, attention, and memory problems
  • distorted perception (sights, sounds, time, touch)
  • poor coordination
  • increased heart rate
  • anxiety, paranoia
  • psychosis (not common)

Effects that last longer than the short term (a few days) but may not be permanent

  • learning and memory problems
  • sleep problems

Long-term effects (effects of repeated use)

  • risk of marijuana addiction
  • long-term learning and memory problems if heavy use begins during youth
  • risk for chronic cough, bronchitis
  • risk of schizophrenia in some people with higher genetic risk
  • in rare cases, risk of recurrent episodes of severe nausea and vomiting

How does smoking marijuana affect the lungs?

“I was lazy a lot. I didn’t want to do things. I was depressed. I felt like I was always in a rut. I was always feeling bad about myself, where I was standing in life.”

— from Alby’s story, on smoking marijuana daily

Someone who smokes marijuana regularly may have many of the same breathing and lung problems as people who smoke tobacco. For example, marijuana smokers can develop a daily cough or have a higher chance of getting a lung infection. Like tobacco smoke, marijuana smoke has a toxic mix of gases and tiny particles that can harm the lungs. Although we’re still learning if marijuana causes lung cancer, many people who smoke marijuana also smoke cigarettes, which do cause cancer. Also, smoking marijuana can make it harder to quit smoking cigarettes.

What are the effects of inhaling secondhand marijuana smoke?

Here’s what we know about secondhand marijuana smoke:

  • If you inhale secondhand marijuana smoke, it’s unlikely you would fail a drug test, but it is possible.
  • Secondhand marijuana smoke is more likely to give someone a high if they’re in an enclosed space with others smoking marijuana with high THC levels.
  • A recent animal study showed that secondhand marijuana smoke can affect heart and blood vessels as much as secondhand tobacco smoke.
  • More research is needed, but we do know that marijuana smoke can especially affect children and people with asthma.

Is vaping marijuana safer than smoking it?

Marijuana affects the brain—altering memory, judgment, and coordination.

Some people think that vaping is a safer way to use marijuana because you’re not inhaling smoke. But you’re still inhaling various chemicals when using a vaporizer. A study of some vaporizer products found the vapor contains toxic chemicals and possibly toxic metal particles from the device itself. 7 Scientists continue to study the risks of vaping.

Can marijuana lead to psychosis?

People who have taken large doses or used marijuana with high THC content may experience brief psychosis. Psychosis can affect the mind and make it hard for a person to understand what’s real and what isn’t. A psychotic reaction usually goes away as the drug’s effects wear off, but disturbing memories can remain. Some people have a gene that may increase the chance of long-lasting psychotic disorders, such as schizophrenia (a severe mental disorder that affects thoughts, feelings, and behavior), when they repeatedly use marijuana.

Can you overdose on marijuana?

While there are no reports of someone dying directly from marijuana use, it can still cause serious health problems. Some people have psychotic reactions that can lead to dangerous behaviors. Others may have uncomfortable side effects from marijuana, such as shaking, leading them to seek care in an emergency room.

How long after use can marijuana show up on a drug test?

The effects of marijuana usually last from 1 to 3 hours, but marijuana can stay in the body for days or even weeks after use. Organs in the body have fatty tissues that absorb the THC in marijuana. In general, standard urine tests can detect THC several days after use. In people who use heavily, however, urine tests can sometimes detect THC for several weeks.

Does marijuana use lead to other drugs?

Research suggests that teens usually try alcohol, tobacco, and marijuana before most other drugs. But most people who use marijuana don’t go on to use other drugs. Here are a few theories about why some do:

  • Someone who is more likely to use other drugs may use marijuana first because it’s easier to get.
  • Someone who is using marijuana is likely to be in contact with users and sellers of other drugs, increasing the chances of trying them.

What is K2 or Spice and how does it affect the brain?

The chemicals in many products sold as K2/Spice are unknown. Some varieties could cause dramatically different effects than the person might expect.

K2 or Spice refers to plant materials that have been coated with chemicals similar to the chemicals found in marijuana. Some people mistakenly think K2/Spice and marijuana are the same thing, but they’re not. Sellers advertise K2/Spice as both a “safe” and “legal” substitute for marijuana. Neither is true. Although labels on K2/Spice products often say that they contain “natural” material from plants, their active ingredients are made in labs. These chemicals act on the same brain areas as THC. However, some chemicals in K2/Spice may produce much more powerful, unpleasant, and unpredictable effects, such as extreme anxiety, paranoia, and hallucinations.

Is it safe to smoke marijuana if you are pregnant or breastfeeding?

Doctors advise pregnant women not to use marijuana because it could harm the fetus. Studies suggest that children of mothers who used marijuana while pregnant may be more likely to have trouble with problem-solving skills, memory, and attention. Mothers are also advised not to use marijuana while breastfeeding. Research suggests that moderate amounts of THC are excreted into breast milk. We’re still learning how this affects a baby’s developing brain.

Can marijuana produce withdrawal symptoms when someone quits using it?

TJONES1 — JUNCTION CITY HIGH SCHOOL, OREGON:

If you’re dating someone who uses marijuana, does that increase your chance of using it?

NIDA: Great question! Research shows that people who have friends who use drugs are more likely to use drugs themselves. But we don’t really know why this is the case. It could be that by hanging out with people who use drugs, you have more chances to try them. Certainly, you can choose not to try drugs if offered, but this can be a challenge. Another approach would be to see if your friend will stop using marijuana — for your benefit and theirs.

– from NIDA’s Chat Day

Yes, it can. The symptoms can include irritability, problems sleeping, anxiety, and marijuana cravings, and peak a few days after regular marijuana use has stopped. Withdrawal symptoms can make it hard for someone to stay off marijuana.

What if a person wants to quit using marijuana but it’s too hard?

If people find it hard to stop using, they might have a marijuana use disorder. The severe form of a marijuana use disorder is also known as addiction. Marijuana use disorder is complex but treatable. No single treatment is right for everyone. Addiction treatment can help a person stop using drugs, rebuild relationships with family and friends, and restore their productivity at work, at school, and in society. Current treatment programs for marijuana focus on counseling and support groups. There are also programs specially designed to help teenagers. Researchers are testing different ways to help people stay off the drug, including some medications.

Is marijuana legal?

Federal law says marijuana in any form (e.g., smoked or edible) is not legal for medical or recreational use. However, some states have made marijuana use legal for medical use, and a few have even legalized it for recreational use (for adults only). Check your state website to learn if your state has medical or recreational laws.

What’s the latest on medical marijuana?

Scientists continue to investigate safe ways that patients can use THC and other marijuana ingredients as medicine.

Research has shown that some chemicals in marijuana including THC and cannabidiol (CBD) could have medical uses. Clinical trials are ongoing to develop and test medications that contain THC and/or CBD for pain relief or seizure disorders. The Food and Drug Administration (FDA) will evaluate the results to determine if these medications are safe and effective for treating these conditions. There are currently three FDA-approved medicines containing THC or THC-like chemicals that treat nausea from chemotherapy and increase appetite in patients with AIDS. These include two forms of a medicine called dronabinol, available as a capsule or an oral liquid, as well as a medicine named nabilone sold as capsules.

Many researchers, including those funded by the National Institutes of Health, are continuing to explore the possible uses of THC and other cannabinoids to treat symptoms of illness and other conditions such as:

  • cancer
  • HIV/AIDS
  • multiple sclerosis (MS)
  • inflammation
  • pain
  • seizures
  • addiction
  • mental health, including disorders such as post-traumatic stress disorder (PTSD)

Sativex ® , a mouth spray containing THC and CBD (another chemical found in the marijuana plant) is available in several countries outside the United States. It’s used to treat muscle spasms and nerve pain caused by multiple sclerosis. Epidiolex ® , a CBD-based liquid drug to treat certain forms of childhood epilepsy, is being tested in clinical trials.

Dosing of cbd oil for teen with anxiety

Chris Aiken, MD

Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC.

Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Your patient comes in with a new medication on his list: CBD oil. He started taking it for anxiety and wants to know if it’s safe. You hedge, explaining that there is limited information available on unregulated products, but the patient is persistent. He says CBD oil is available as a prescription, and wonders if you could write one for it.

Cannabidiol, or CBD, is a derivative of marijuana that has recently become available as a prescription drug, Epidiolex. It is FDA-approved for two rare forms of childhood epilepsy, Lennox-Gastaut and Dravet syndromes, and was fast-tracked for that indication because of the dire need for treatment in children with these intractable seizures. Meanwhile, the same drug has been available as a supplement for the past decade, called CBD oil. Many patients take this oil for its rumored mental health benefits, and you’ll need to know the basics when they request prescriptions for it.

Table: Cannabinoids From CBD to THC

CBD vs THC
Marijuana (cannabis) is a blend of over 100 cannabinoids, only one of which is tetrahydrocannabinol (THC), the cannabinoid that is most responsible for the high people get from consuming pot. CBD, on the other hand, does not cause a “high,” although many people consider it to be somewhat tranquilizing. CBD also does not cause some of the problems seen with THC, such as cognitive impairment, anxiety, and (more rarely) psychosis. Those dangers are particularly relevant to adolescents, where the latest data show that marijuana triples the risk of psychotic disorders (Jones HJ et al, JAMA Psych 2018;75(3):240–246). CBD has neuroprotective properties, and it may actually lower the risk of psychosis and anxiety with THC. For more information, see the table “Cannabinoids From CBD to THC” above.

CBD in psychiatric disorders
In one of the most paradoxical clinical findings in recent memory, it turns out that CBD, far from causing psychosis, may actually be an effective treatment for psychosis. So far, 5 out of 7 controlled trials of CBD’s antipsychotic effects have been positive, and the latest of these is reviewed in this issue (Epidemiol Psychiatr Sci 2018;27(4):327–335). Another prescription CBD product, Arvisol, is undergoing phase I clinical trials in schizophrenia.

In addition to psychosis, there are a couple of small, placebo-controlled trials of CBD in social anxiety disorder. These looked at the drug’s acute effects when taken before a stressful social situation in 34 subjects. Compared to placebo, CBD had a significant effect, bringing anxiety down to the same levels reported by healthy controls (Blessing EM et al, Neurotherapeutics 2015;12(4):825–836).

Somnolence is the main side effect with CBD, but studies in sleep are mixed. Tolerance can develop to its sedative effects, and low doses (below 160 mg) can be stimulating (Babson KA, Curr Psychiatry Rep 2017;19(4):23). CBD does not appear to help bipolar mania or the cognitive impairments of schizophrenia.

CBD oil or Epidiolex?
Are CBD oil and Epidiolex really the same drug? They are both CBD, short for cannabidiol, but where they differ is in their purity and regulatory status. Epidiolex is a Schedule V prescription drug, the lowest level of regulation for a controlled substance. CBD oil is an ­over-the-counter supplement. It is legal in all states as long as it’s extracted from the hemp plant, a variety of cannabis that contains little THC and produces no high.

In terms of purity, CBD oil is a gamble. In a study of 84 online products, only 30% contained the amount of CBD on the label, and 21% contained THC (Bonn-Miller MO et al, JAMA 2017;318(17):1708–1709). The FDA keeps a running tally of unacceptable products at www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm. Another good source is Consumer Labs, which tests products for purity and integrity. Among their recommended options, the best-priced oils are available at elixinol.com and bluebirdbotanicals.com.

The dosages used in psychiatric research range from 300 mg/day for anxiety to 800–1,200 mg/day for schizophrenia. The epilepsy dosage, 10–20 mg/kg/day, adds up to around the same amount used in schizophrenia for most adults. Cost is an issue with CBD, prescribed or not. A 300 mg dose is $20–50/day in the over-the-counter form and around $35/day for the prescription when paying out of pocket.

CBD, Marinol, and medical marijuana
CBD is in a very different category than dronabinol (Marinol) and nabilone (Cesamet), the other prescription cannabinoids. These are synthetic isomers of THC (Δ-9-THC) and are under tighter regulation than CBD (Schedule III vs Schedule V). They are only approved for nausea during chemotherapy and, in the case of dronabinol, anorexia in AIDS. As pure THC compounds without the protective effects of CBD, they may have even more psychedelic effects than marijuana (Bhattacharyya S et al, Neuropsychopharm 2010;35(3):764–774). “Medical marijuana” can refer to any marijuana component, such as CBD, or to the plant itself. It usually refers to the plant, which is legal with a prescription in 33 states and Washington DC. Each state has its own list of conditions that medical marijuana is approved for.

Side effects and drug interactions
The World Health Organization concluded that CBD has “a good safety profile” (WHO, 2018). Somnolence is its main side effect, and the PDR warns of elevated liver enzymes. On drug screens, CBD can cause a false positive for THC.

CBD may raise the levels of psychiatric medications through inhibition at UGT2B7 (lamotrigine, lorazepam) and CYP2C19 (diazepam and several SSRIs and antipsychotics). CBD itself is metabolized by CYP3A4 and CYP2C19.

Risks vs benefits
The FDA fast-tracked the approval of Epidiolex (CBD) because its risk-benefit profile is favorable for rare forms of epilepsy that are difficult to control with current anticonvulsants. The bar is higher for disorders with existing treatments, like psychosis and anxiety, and the data in these conditions are scarcer.

While we sort out these dilemmas, patients will no doubt experiment with the readily available CBD oil, so what should we do in the interim? We recommend the following commonsense approach.

TCPR Verdict: We don’t have much evidence to endorse or warn against CBD. Though it’s premature to prescribe CBD, we should guide patients to safer products if they are getting it on their own. That’s harm reduction, like suggesting to casual drinkers that red wine is safer than vodka