Everything You Need to Know About Cannabis

Rachel Jacoby Zoldan
Photo credit: Illustrations By Brett Ryder

From Oprah Magazine

You can smoke it, vape it, sip it, or spritz it. You can bake it into brownies. You can find it in lotions and potions to rub on your skin, tinctures to drop under your tongue, capsules to swallow, or oils that have been added to your latte or ice cream. Cannabis is everywhere these days, and to hear its proponents talk, it’s the fix for everything that might ail you. But is it? And do you need a degree in medicinal plant studies (yes, that exists) to know your CBD from your THC?

What exactly is cannabis?

The cannabis plant contains more than 100 chemical compounds, known as cannabinoids, some of which can affect how we feel and think. The most famous are tetrahydrocannabinol (THC), which produces a euphoric feeling and alters sensory perception, and cannabidiol (CBD), which is non-intoxicating but may be potent in other ways. Both hemp and marijuana are varieties of cannabis, but hemp has a very low concentration of THC, while marijuana’s is, no pun intended, much higher. The type and amount of cannabinoids in any given plant vary widely depending on the plant’s strain and how it’s grown; they help determine whether a cannabis product will perk you up, settle you down, or land you somewhere in between.

How do you consume cannabis?

Smoking pot leads to an almost- immediate high; in edible form, effects are delayed for 30 minutes to an hour but may be more intense, longer lasting, and, in some cases-especially if you overindulge-decidedly unpleasant (nausea, paranoia, even hallucinations).

Of course, cannabis has the potential to do much more than alter your consciousness. Yet because the plant’s longtime illegal status (see “Canna-Busted?,” right) stunted medical research, there’s still a lot to learn about its effectiveness. We’ve rounded up some of the most common cannabis claims to see which are solid and which may be as wispy as smoke.

Does cannabis actually relieve chronic pain?

The facts: When no less an authority than the National Academies of Sciences, Engineering, and Medicine (nasem) released a 2017 report reviewing the health effects of cannabis, it included evidence to validate the plant’s efficacy in treating several health conditions; chronic pain was in the top three.

A comprehensive review published in JAMA in 2015, analyzing 79 trials with 6,462 patients, found evidence that cannabis worked for chronic pain-which is “encouraging,” says Raphael Mechoulam, PhD, head of the medicinal chemistry lab at Hebrew University of Jerusalem and one of the world’s foremost cannabis researchers.

There is real promise that cannabis could help adults with chronic pain.

Daniele Piomelli, PhD, co-director of the Center for the Study of Cannabis at the University of California, Irvine, is also optimistic: “There is real promise that cannabis could help adults with chronic pain, though we need a few more studies to say that conclusively.” Because cannabis has a negligible risk of overdose, experts have suggested that medical cannabis could even be a way to help address the country’s opioid problem.

We have less evidence for the CBD-only panaceas we’re seeing everywhere from bars to bodegas to boutiques: the oils, vapors, topicals, and tinctures. There are tantalizing studies on CBD for pain, but they’ve been done on lab animals, and a rat needs a far lower dose of a drug to see effects than a 150-pound woman.

Medical cannabis could be a way to help address the country’s opioid problem.

Furthermore, the amount of cannabidiol that your body can get from an oil is relatively low. “My feelings on CBD products isn’t that they don’t work, but that they can’t be effectively used by humans because the dose would need to be so high,” says Jordan Tishler, MD, a Harvard Medical School–trained internist who’s president of the Association of Cannabis Specialists.

The caveats: An October 2018 paper found that more than one in ten frequent marijuana smokers who gave up their habit experienced cannabis withdrawal syndrome, which could include symptoms such as feelings of anger, irritability, or aggressiveness; abdominal pain; fever; chills; sweating; headache; or tremors or shakiness.


Photo credit: Illustrations By Brett Ryder

Is cannabis legal?

The laws regulating cannabis-and their enforcement-are changing by the day. Here’s where things stand right now.

Marijuana has been effectively illegal under federal law since 1937. Today it’s still federally prohibited, but individual states have their own laws regarding growth, sale, and possession (for instance, 46 states permit some form of medical use of marijuana; ten of them also permit recreational use).

46 states permit some form of medical use of marijuana; 10 of them also permit recreational use.

Hemp, on the other hand, was federally legalized last year. But as of press time, CBD, even if derived from hemp, is still federally prohibited. Although CBD is widely marketed as a health and wellness aid, the FDA considers it a drug, not a supplement, and does not allow the sale of CBD-laced products.

The FDA considers CBD a drug.

Some states, like Maine, have even started cracking down on the sale of CBD-infused food products. Does this mean the feds will come after you for your CBD gummies? Unlikely. In February 2017, then–Attorney General Jeff Sessions said in an interview that the Justice Department wasn’t planning to take on “small marijuana cases”-like yours. True, Sessions is no longer AG, but federal policing of individual consumption is still unlikely to become a priority.


Does cannabis help with sleep?

The facts: There’s moderate evidence that cannabis can help some people snooze better, according to the nasem report. And a 2017 research review suggests that CBD may have therapeutic potential for the treatment of insomnia. THC may also help people nod off faster, says Mechoulam. But on the flip side, it might cause sleep to be less restful, canceling out some of its benefits.

The caveats: The way cannabis helps or hampers sleep depends on many factors, including the levels of CBD and THC, the dose, the method, the length of time you’ve been taking it, and the existing sleep issues. In addition, most of the studies on cannabis and sleep have been done on people with chronic pain issues. And even if THC does put you out, there’s a risk that the effects will wear off with regular use. But if you’ve tried everything else, talk to a doctor about cannabis. “Insomnia is, like pain, a condition for which conventional medications don’t work very well,” says Tishler, who notes that cannabis is a promising option with a low risk of negative side effects.

And how about gastrointestinal issues?

The facts: While a preliminary 2017 study showed that a non-intoxicating form of THC called THC-A had an anti-inflammatory effect when applied to cells taken from people with inflammatory bowel disease (IBD), experts are still uncertain whether cannabis can have the same effect in patients. Tishler says that cannabis use can improve IBD symptoms including the debilitating stomach pains IBD is known for, but it’s not a proven cure. “The evidence for treatment of symptoms of IBD is clear,” he says. “Whether that’s based on changes in how a patient perceives their symptoms or on improving the pathology of the disease is less than clear.”

The caveats: THC-A has been tested only in human tissue, not humans themselves. While Tishler has recommended the compound to some of his patients, he says that “most dispensaries aren’t hip to the medical value of THC-A” and don’t carry these types of products.

But cannabis can mitigate anxiety, right?

The facts: Studies have supported the stoner movie stereotype of the uptight worrywart who is mellowed out by a joint. But studies have also supported that other stereotype, of the paranoid pothead: Anxiety and panic reactions are the most commonly noted acute effects of being high. This is because THC appears to decrease anxiety at lower doses and increase anxiety at higher doses.

THC appears to decrease anxiety at lower doses and increase anxiety at higher doses.

There is less anecdotal and scientific evidence regarding CBD, though it appears to ease anxiety at all doses that have been tested. “My impression is that low levels of THC and high levels of CBD cause positive effects by enhancing mood,” notes Mechoulam. However, he adds, the therapeutic window for CBD and the precise mechanisms by which it works are yet to be determined.

The caveats: Considering the number of people who use marijuana to treat anxiety, there’s a surprising dearth of rigorous research on how it affects mental health conditions. Given the federal prohibition of cannabis, most studies looking at its effect on mood have involved little control or standardization of treatment type or dose. THC and CBD may help anxiety in the short term, but so do exercise and cognitive-behavioral therapy, and the evidence suggests long-term use isn’t recommended (the effects may wear off, or users could become dependent on this treatment).

Now for the biggest caveat of all. Use of marijuana is linked to an increased risk of schizophrenia in those with a genetic vulnerability, and the risk goes up the more you use. So if you’re going to partake, do so in moderation. And keep in mind that, as every expert will tell you, what we don’t yet know about cannabis far outweighs what we do. But if it turns out to have even half the therapeutic benefits it’s said to possess, it will prove to be a wonder drug indeed.

Photo credit: Illustrations By Brett Ryder

How is cannabis grown?

Sure, cannabis is a leafy plant, but that doesn’t mean it’s necessarily green. In fact, over the decades, pot’s illegal status has led to some decidedly eco-unfriendly acts. To make space for clandestine greenhouses and secret fields in the woods, cannabis farmers often fragmented forests by clear-cutting trees.

They diverted creeks and rivers to help irrigate the thirsty plant (which needs about six gallons of water per day), then doused it with pesticides. Fertilizer runoff drained into streams. Illicit operations sometimes relied on polluting diesel generators to stay off the power grid. Even now, growing the plant indoors (legally or not) requires high-intensity lights and ventilation equipment; these types of operations alone account for 1 percent of total annual U.S. electricity use, according to a 2012 study in the journal Energy Policy.

Commercial cultivation of hemp was recently made legal under federal law; 31 states allow for the commercial growth of medical marijuana, according to cannabis consulting firm Quantum 9. Environmentalists, medical experts, and entrepreneurs generally agree that legalization is beneficial for the planet and its people. For example, “regulators in many states are establishing clear rules that limit pesticide usage, as is done with other commercial crops,” says Daniele Piomelli, PhD, co-director of the UCI Center for the Study of Cannabis. And growers who no longer need to hide from the law can focus on implementing earth-friendly agricultural practices.

Some groups already encourage growers to scale up sustainably: Clean Green Certified and Certified Kind assess cannabis cultivators and award stamps of approval to those using organically based practices (Clean Green, which is more established, has certified 108 farms). Washington recently became the first state to start its own certification program and is likely to verify its first crops within the next year. Front Range Biosciences, an agricultural biotech company, is taking a different tack: It sells seeds bred to be disease-resistant, high-yielding plants, which lowers growers’ reliance on pesticides.

Gauging the greenness of CBD-laced products is trickier, since it’s difficult to ensure that the extract came from an American growth operation-as opposed to one in China-let alone a sustainable one. However, these brands tout their eco-friendly practices: Charlotte’s Web, which sells hemp-derived CBD oil, uses ladybugs as a pesticide and relies on cover crops like oats and rye to help slow land erosion. And the California-based Humboldt Apothecary, known for its THC and CBD tinctures, works with some operators who use farming methods that restrict irrigation. While states consider ways to clean up cannabis, we can all help by urging the government to study pot’s impact on the environment, and pushing to find out where that Acapulco Gold, Maui Wowie, or Panama Red really comes from and how it was grown. -R.J.Z.