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Does cannabidiol protect against the negative effects of THC?

  • Cécile Henquet (a1) and Rebecca Kuepper (a1)
Abstract
Summary

A recent study by Morgan and colleagues found that cannabidiol attenuates the acute cognitive effects of delta-9-tetrahydrocannabinol (THC). This is of interest as THC has been associated with the detrimental effects of cannabis on mental health in at-risk users, and the potency of cannabis is increasing across Europe.

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Copyright
Corresponding author
Cécile Henquet, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, PO Box 616 (Vijverdal), Maastricht, The Netherlands. Email: cecile.henquet@sp.unimaas.nl
Footnotes
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See pp. 285–290, this issue

We thank the Dutch Medical Research Council (VENI and OOG) for funding research that led to this editorial.

Declaration of interest

None.

Footnotes
References
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1 Morgan, CJA, Schafer, G, Freeman, TP, Curran, HV. Impact of cannabidiol on the acute and psychotomimetic effects of smoked cannabis: naturalistic study. Br J Psychiatry 2010; 197: 285–90.
2 Potter, DJ, Clark, P, Brown, MB. Potency of delta 9-THC and other cannabinoids in cannabis in England in 2005: implications for psychoactivity and pharmacology. J Forensic Sci 2008; 53: 90–4.
3 Di Forti, M, Morgan, C, Dazzan, P, Pariante, C, Mondelli, V, Marques, TR, et al. High-potency cannabis and the risk of psychosis. Br J Psychiatry 2009; 195: 488–91.
4 Morgan, CJA, Curran, HV. Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis. Br J Psychiatry 2008; 192: 306–7.
5 Bhattacharyya, S, Morrison, PD, Fusar-Poli, P, Martin-Santos, R, Borgwardt, S, Winton-Brown, T, et al. Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology 2009; 35: 764–74.
6 Leweke, M, Schneider, U, Radwan, M, Schmidt, E, Emrich, HM. Different effects of nabilone and cannabidiol on binocular depth inversion in Man. Pharmacol Biochem Behav 2000; 66: 175–81.
7 Pertwee, RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. Br J Pharmacol 2008; 153: 199215.
8 Zuardi, AW, Crippa, JA, Hallak, JE, Moreira, FA, Guimaraes, FS. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res 2006; 39: 421–9.
9 Leweke, FM, Koethe, D, Pahlisch, F, Schreiber, D, Gerth, CW, Nolden, BM, et al. Antipsychotic effects of cannabidiol. European Psychiatry 2009; 24 (suppl 1): S207.
10 Henquet, C, van Os, J, Kuepper, R, Delespaul, P, Smits, M, á Campo, J, et al. Psychosis reactivity to cannabis use in daily life: an experience sampling study. Br J Psychiatry 2010; 196: 447–53.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Does cannabidiol protect against the negative effects of THC?

  • Cécile Henquet (a1) and Rebecca Kuepper (a1)
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eLetters

Does cannabidiol protect against the harms of THC?

H. Valerie Curran, Professor of Psychopharmacology
15 November 2010

We read with interest the recent lucid Editorial by Henquet and Kuepper1 discussing our empirical paper2 showing that cannabidiol (CBD) protects against the acute memory impairing effects of THC in naturalistically smoked cannabis.

Henquet and Kuepper raise the issue of an individual’s preference fordifferent strains of cannabis. They cite di Forti et al’s3 study suggesting that many patients with first episode psychosis say they preferskunk or sinsemilla (with negligible CBD content) over resin or traditionally grown herbal strains typically containing more CBD. Di Fortiet al question why: “those already experiencing prodomal and/or psychotic symptoms should choose a cannabis type (sinsemilla) likely to exacerbate their symptoms”.

Henquet and Kuepper suggest that Morgan et al “found no evidence thathealthy controls with elevated schizotypy scores show a preference towardsthe high-THC/low-cannabidiol variants.” In fact, we reported no data on preference. Instead, we explored possible relationships between schizotypyscores and assayed THC/CBD in their cannabis. However, we had also asked our participants which type of cannabis they preferred and present this data here to contribute to the current debate.

In our sample, 66% of participants classified their own cannabis as skunk; 21% traditional herbal; 13% resin/hashish. The profile of preferences differed: 34% skunk, 24% traditional herbal, 18% resin/hashishand 24% no preference. Comparing psychosis proneness in groups with preferences for differing varieties we found no significant difference (p=0.168).

One aspect of cannabis use varies with varieties available on the market. In 2008, 81% of samples taken during UK police arrests were skunk (an increase from 15% in 2002 and 55% in 2005), 15% resin and very few traditional herbal4. The mean THC content of skunk was 16%, CBD <0.1%; resin 6% THC, 3.5% CBD. The proportion of skunk to resin/herbal in these samples was higher than in our naturalistic study, perhaps reflecting a traditional type of home grown product rarer in samples from arrests. Although 42% of our sample preferred herbal/resin, when these were unavailable they smoked skunk.

In a related study, attentional bias towards cannabis-cues was significantly greater in those acutely smoking lower than higher CBD strains5. This modulation of the incentive salience of drug cues by CBD suggests that those smoking low CBD strains are at increased risk of addiction. Other mental health consequences are likely to be more marked when individuals smoke low CBD strains, especially for those who have other vulnerability factors.

Acutely, cannabis increases psychosis-like experiences more in healthy individuals who are higher in psychosis-proneness. We found that psychosis-proneness levels did not differ between those smoking cannabis high or low in CBD or between those groups who preferred skunk to other varieties. Levels of psychosis–proneness in healthy cannabis users are clearly lower than first episode patients or most prodromal individuals. This may be one factor influencing why patients in di Forti’s study expressed a preference for skunk. It is now important to investigate how objectively measured THC/CBD content of cannabis affects symptoms of thoseat risk of and those diagnosed with a psychotic disorder.

References

1. Henquet C. & Kuepper R (2010) Does cannabidiol protect agains the negative effects of THC? British Journal of Psychiatry, 197: 259-260.

2. Morgan CJA, Schafer G, Freeman TP. & Curran HV (2010a) Impact of canabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study. British Journal of Psychiatry, 197: 285- 290.

3. Di Forti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, et al. (2009) High-potency cannabis and the risk of psychosis. BritishJournal of Psychiatry, 195: 488–91.

4. Hardwick S & King LA (2008) Home Office Cannabis potency study2008. Home Office Scientific Development Branch.

5. Morgan CJA, Freeman TP, Schafer GL & Curran HV (2010b) Cannabidiol attenuates the appetitive effects of Ä9-tetrahydrocannabinol in humans smoking their chosen cannabis. Neuropsychopharmacology, 35:1879 -1885.
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Conflict of interest: None Declared

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