Cannabis oil

Cannabis oil is a plant-derived preparation extracted from the Cannabis sativa or Cannabis indica plant, containing varying concentrations of cannabinoids, primarily cannabidiol (CBD) and tetrahydrocannabinol (THC). It is used both medicinally and recreationally, depending on formulation, cannabinoid ratio, and legal jurisdiction. Cannabis oil may refer to several types of oils depending on cannabinoid composition and extraction method:

• CBD oil (non-psychoactive)

• THC-rich cannabis oil (psychoactive)

• Full-spectrum cannabis oil (contains a broad range of cannabinoids)

• Rick Simpson Oil (RSO) (high-THC extract)

This profile details the pharmacology, medical applications, dosing, legal considerations, contraindications, side effects, interactions, and special precautions related to cannabis oil in its therapeutic use.

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Pharmacological Classification

• Therapeutic Class: Cannabinoid-based medicine / Analgesic / Anxiolytic / Anticonvulsant

• Pharmacologic Class: Phytocannabinoid compound

• ATC Codes (depending on active ingredient):

  • N02BG10 (Cannabidiol)

  • N02BG10 (Dronabinol – synthetic THC analogue)

• Legal Classification: Varies by country (prescription, over-the-counter, or controlled substance)

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Types of Cannabis Oil

CBD Oil

• Derived from hemp (≤0.3% THC) or marijuana

• Does not produce euphoria or intoxication

• Legal in many countries as a supplement or medicine

THC-Rich Oil

• High in tetrahydrocannabinol

• Produces psychoactive effects (euphoria, altered perception)

• Classified as a controlled substance in most jurisdictions

Full-Spectrum Cannabis Oil

• Contains CBD, THC, terpenes, flavonoids, and other cannabinoids

• Offers the “entourage effect” (potential synergy among compounds)

Broad-Spectrum Oil

• Similar to full-spectrum but without THC

Rick Simpson Oil (RSO)

• Potent extract with very high THC concentrations

• Advocated for cancer (anecdotally), not clinically approved

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Active Components

• CBD (Cannabidiol):

  • Non-psychoactive

  • Anti-inflammatory, antiepileptic, anxiolytic, neuroprotective

• THC (Tetrahydrocannabinol):

  • Psychoactive

  • Analgesic, antiemetic, appetite-stimulating, muscle relaxant

• CBN, CBC, CBG: Minor cannabinoids with emerging therapeutic roles

• Terpenes (e.g., myrcene, limonene): May enhance effect via the entourage mechanism

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Mechanism of Action

Cannabinoid Receptor Binding

• CB1 Receptors (central nervous system):

  • THC binds strongly → psychoactive and analgesic effects

• CB2 Receptors (peripheral tissues, immune cells):

  • Modulate inflammation and immune responses

CBD Mechanism

• Low affinity for CB1/CB2; modulates receptor activity indirectly

• Acts on 5-HT1A, TRPV1, GPR55, PPARγ

• Modulates inflammatory cytokines, intracellular calcium, and neurotransmitter release

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Medical Indications

Approved Uses (based on jurisdiction and product)

• Epilepsy (especially Lennox-Gastaut, Dravet syndromes) – CBD (e.g., Epidiolex)

• Multiple Sclerosis spasticity – Sativex (nabiximols; contains THC+CBD)

• Chemotherapy-induced nausea/vomiting – synthetic THC (dronabinol, nabilone)

• Cancer pain – palliative adjunct

• Anorexia in HIV/AIDS – appetite stimulant

• Chronic neuropathic pain

Off-label / Investigational

• Anxiety disorders

• Depression

• Autism spectrum disorder

• Parkinson’s disease tremors

• Alzheimer’s agitation

• Post-traumatic stress disorder (PTSD)

• Inflammatory bowel disease

• Glaucoma

• Migraine prophylaxis

• Sleep disorders

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Dosing and Administration

CBD Oil (oral)

• Starting dose: 5–20 mg/day

• Titration: Increase gradually over days to weeks

• Therapeutic dose range: 10–100 mg/day (sometimes higher in epilepsy)

• Maximum: Up to 20 mg/kg/day for severe epilepsy

THC Oil (prescription, e.g., Sativex)

• Titrated in sprays (each delivers ~2.7 mg THC, 2.5 mg CBD)

• Typical dosage: 1–12 sprays/day depending on indication

Rick Simpson Oil (RSO)

• No standardized dosing; high concentrations of THC

• Typically used without medical oversight; caution advised

Routes

• Sublingual (fast absorption)

• Oral ingestion (slower onset, longer effect)

• Vaporization (rapid relief for acute symptoms)

• Topical (for localized pain/inflammation)

• Rectal (anecdotal use; variable absorption)

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Pharmacokinetics

• Absorption: Oral bioavailability 6–20%; enhanced by fatty foods

• Onset of action:

  • Oral: 30–90 minutes

  • Sublingual: 15–45 minutes

  • Inhaled: 5–10 minutes

• Peak plasma levels: 2–4 hours (oral)

• Duration: 4–12 hours depending on dose and route

• Metabolism: Hepatic (CYP3A4, CYP2C9, UGT enzymes)

• Excretion: Biliary and renal routes

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Contraindications

• History of psychosis or schizophrenia (THC)

• Severe liver impairment (CBD caution)

• Pregnancy and breastfeeding

• Hypersensitivity to cannabinoids

• Uncontrolled cardiovascular disease

• Substance use disorders (THC caution)

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Adverse Effects

CBD Oil

• Generally well tolerated

• Mild drowsiness

• Diarrhea

• Appetite change

• Elevated liver enzymes (especially with valproate)

• Dry mouth

THC-Rich Cannabis Oil

• CNS/Psychiatric: Euphoria, dysphoria, paranoia, hallucinations, sedation

• Cognitive: Impaired memory, reduced concentration

• Cardiovascular: Tachycardia, orthostatic hypotension

• GI: Nausea, vomiting

• Dependence/Withdrawal: With chronic use; symptoms include irritability, sleep disturbance

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Drug Interactions

Metabolic Interactions

• CYP3A4 and CYP2C19 inhibitors/inducers may affect levels of CBD/THC

  • E.g., ketoconazole, clarithromycin (increase effect)

  • Rifampicin, carbamazepine (decrease effect)

Increased CNS Depression

• Benzodiazepines, opioids, alcohol, barbiturates

Increased hepatotoxicity risk

• With valproate or clobazam (CBD-induced elevation in transaminases)

Additive effects with serotonergic agents

• Potential for serotonin syndrome (rare, more theoretical)

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Legal and Regulatory Status

United Kingdom

• CBD oil: Legal as a supplement if THC <1 mg/container; not a licensed medicine

• THC/cannabis oil: Controlled substance (Schedule 2)

• Prescribable THC+CBD: Sativex for MS; Epidiolex for epilepsy

United States

• CBD from hemp: Legal federally (<0.3% THC), state laws vary

• THC-containing oils: Controlled substances (Schedule I) unless via state medical programs

• FDA-approved: Epidiolex (CBD), Marinol (THC), Cesamet (nabilone)

European Union

• Legal status varies widely

• CBD generally permitted; THC products require special authorization

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Use in Pregnancy and Lactation

• Not recommended during pregnancy due to fetal neurodevelopmental risks (THC)

• CBD crosses placenta and may impact neurodevelopment

• THC detected in breast milk, with potential long-term effects on infant cognition and behavior

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Use in Special Populations

• Pediatrics: CBD approved for specific epilepsies; THC generally avoided

• Elderly: Use with caution due to altered pharmacokinetics, fall risk

• Hepatic impairment: CBD and THC metabolism reduced; dose adjustment may be necessary

• Psychiatric disorders: Avoid THC; monitor mood and cognition

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Patient Counseling Points

• Begin with low doses, titrate slowly

• Do not drive or operate machinery if drowsy or impaired

• Monitor for mood changes, paranoia, or hallucinations (with THC)

• Avoid alcohol and other sedatives concurrently

• Ensure product is from a reputable source and is lab-tested

• Check legal status in your region before purchasing or traveling

• Store in a cool, dark place, away from children and pets