The COVID-19 pandemic has brought a lot of changes including in the cannabis industry where sales in legal states have spiked enormously. Rates of cannabis use is such states as Oregon, Washington State, Colorado and California have increased from a high of 20% to a high of 54% depending on the state surveyed in the time period from April 9th to April 25th, 2020. Cannabis is clearly helping some people cope with the woes of the new panadrama unfolding in the ranks of the global public health scene.
The Start of the COVID-19 Pandemic-Timeline
On January 7th China announced its first coronavirus death and on January 13 the first death outside of Thailand was reported due to the novel coronavirus. On January 30th, the World Health Organization (WHO) declared a global health emergency. On February 2nd the first coronavirus death outside China was declared in the Philippines. On February 8th, the first death of a U.S. citizen occurred in Wuhan, China. On February 8th, the death toll in China surpassed that of the SARS epidemic with 811 deaths recorded. On February 11th WHO gave the new novel coronavirus syndrome the name COVID-19. On February 29th, the U.S. reported the first COVID-19 death on its soil. On March 11th WHO declared the outbreak a pandemic. On March 26th U.S. reported more cases of COVID-19 than anyplace in the world. Come March 31st more than 1/3 of the world was on protective lockdown. On April 7th 95% of Americans were now on lockdown.
May is seeing the first economic loosening of stay at home orders and lockdown efforts with cautious opening up of businesses as the public health statistics are scrutinized to take care that we do not open up Pandora’s box for a “second wave” of viral attacks. Many states have extended the “stay at home” order past May 1st despite demonstrations and a concerned economic public.
Predictions are that the epidemic may last a good two years, and a vaccine will not be ready for quite some time. Even if all stopgaps are removed, a vaccine will not be ready for human trials until the end of this year.
What is COVID-19
Acute infection of the highly infectious virus that causes COVID-19 is characterized by a cytokine superstorm which is the cause of the symptoms of fever, cough muscle pains, and in severe cases, pneumonia. Infection is contagious via droplets from the respiratory tract and entrance via the eyes, nose, mouth.
The virus may live on metal for up to 5 days and may hang in the air for at least 3 hours. It is more infective in certain ethnicities, in those with other medical conditions and in those over 60. In its simplest form you may not know you have it and in the severest cases you may face death. The average infected person infects another 2-2.5 people making it one of the most contagious viruses on the planet.
Lockdowns and the Start of a Panadrama of Stress and Isolation
As the public health crises grew rapidly and out of control there seemed to be no other solution than to send everyone home to stop infecting each other confined to their homes and able only to venture out to get “necessities” like food, water, gas and medication. House to house visits were banned and non-essential stores were closed, and the workers sent home to collect unemployment or face a jobless future many with no savings or other source of livelihood. Even when venturing outside to perform necessary errands people were ordered to stay 6 feet from each other (social distancing) and eventually, to wear masks.
Needless to say, with everyone ordered to stay confined to their homes feelings of isolation increased and a new social distancing drama started to unfold. On top of the isolation of social distancing and confinement came the stress of unemployment and a lack of income. It was a pandemic drama of isolation and stress or the panadrama of COVID-19.
The Rise in the Use of Cannabis During COVID-19
States where cannabis is legal have reported a dramatic increase in cannabis sales. Grow shops have noted a distinct increase in sales just prior to the “stay at home” order. Marijuana stores were declared an “essential” business by executive order and allowed to stay open by delivery or curb-side pickup in many legal states. People began to hoard their weed.
Interviews with users indicated that they wanted to “stock up.” Like toilet paper, cannabis had become a household necessity, one that indicated a need for “hoarding.”
Cannabis Use During a Time of Crises
Medical cannabis users can be the most vulnerable population served in the marijuana community as many are immune compromised. Businesses will need to go the extra mile to protect the vulnerable users in this group during the pandemic. Cannabis should be treated as any other medicine including those that harvest, grow and produce it and safety measures need to be in place to protect the workers and the public. It does not help someone already immunocompromised to get bud that someone with COVID-19 sneezed on. Masks should be required for all cannabis employees from seed to harvest along with social distancing, infection control and containment practices.
Cannabis as an Essential Business
Many legal states have kept cannabis stores open as essential businesses since they serve medical marijuana patients. One of the changes that needs to occur is with the onboarding of new cannabis business staff. In many states it takes 30 days to get a new employee’s background check done, fingerprints processed and get staff ready to work. In an environment with social distancing, quarantine requirements due to the pandemic, self-isolation, hospitalizations, and illness from the virus businesses need to be more flexible and get employees working more quickly than is possible right now. This requires cooperation with the states.
Further, dispensary agent cards only allow an employee to work at one location, often a particular location. With employees getting sick it would be advantageous to be able to move employees around from one business franchise location to another without penalty.
Cannabis is an essential business for non-medical card holders as well. The public deserves a way to destress without necessarily turning to pills or alcohol should they so choose. This is especially true for a substance that does not have the negative side effects of a hangover, aggression, or domestic violence. Furthermore, many non-medical card holders are using cannabis medicinally, they just cannot afford the $300.00 or so that it takes to become a registered card holder. Cannabis stores were allowed to remain open in 30 states where stay- at home orders were in place during the pandemic allowing for curb side pick-up and/or delivery.
Getting one’s cannabis from a licensed essential business or caretaker is far safer than buying it illegally where toxins and weed killers run rampant potentially damaging the lungs or at least making it unsafe to use during a respiratory epidemic. Dispensary cannabis needs to be tested and should contain a certificate of analysis to verify its purity.
Role of Cannabis in Stress and Anxiety
Using cannabis to cope with today’s panadrama of confinement, stress and anxiety requires some knowledge and restraint. THC, for example, in low doses can ease anxiety but in high doses will cause the opposite effect of increasing anxiety. CBD appears to decrease anxiety at all levels. In fact, CBD modulates the anxiety producing effects of THC so if higher THC is consumed it should be combined with CBD to offset any anxious side-effects from overindulging in THC.
The use of cannabis entails the administration of one or more phytocannabinoids such as THC or CBD, terpenes, other cannabinoids, or any combination thereof. While THC is considered psychoactive, CBD is not but has effects on anxiety, depression, schizophrenia, sleep, and other disorders, disorders common in a pandemic atmosphere. CBD often tones down the negative effects associated with excessive THC administration including heart palpitations, excess anxiety, and sedation. Human studies show that administration of 300-600 mg of oral CBD reduces anxiety in individuals and is useful in social anxiety disorders.
The top ten CBD products for stress related disorders can be found here.
Individual variations in objective and subjective effects of cannabis have been well documented and depend on the individual, variety/strain of the bud/flower, dosage, route of administration, personality, degree of tolerance and other factors. Acute marijuana intoxication is usually thought of as associated with euphoria, relaxation, a feeling of calm, having increased sensory awareness and experiences coupled with a craving for sweet and salty foods, a lack of focus, and a gaining of interpersonal insight.
Role of the Endocannabinoid System in Anxiety
The endocannabinoid system (ECS), brought into play by cannabis consumption, is expressed in all brain regions that are crucial for the processing of anxiety, fear and stress and plays a vital role in how we respond to these situations. Clearly it is vital for coping with the stressors of the COVID-19 panadrama we are embroiled in. Both for memory and fear the ECS is thought to serve as a buffer for our emotional responses.
Like social interaction and exercise, marijuana intoxication produces a sought-after state of calmness or centeredness that is mediated by a lack of anxiety and stress which is caused by the rewarding effects of elevated dopamine and oxytocin receptor activation. On the other hand, cannabis withdrawal is associated with the release of stress hormones and a decreased dopamine response.
Cannabis and the Treatment of Anxiety
A plethora of research is available on the use of cannabinoids in the treatment of anxiety related disorders. Anxiety is defined as emotional and maladaptive responses to a potentially dangerous or threatening situation such as we have with COVID-19.
Originally introduced in Chinese medicine during the third millennium BC, cannabis became a popular remedy in Asia and Europe in the centuries following. It gained a stable reputation in the Roman Empire and the Arabic world for its medicinal qualities. THC activates most psychological and behavioral effects of hemp products through activation of what we call the CB1 receptors in the brain and central nervous system. The high rates of anxiety relieving properties of THC and the effect on retrograde memories are one reason cannabis is so effective in treating post-traumatic stress patients.
The chemotype of cannabis or the chemical profile of the product being consumed largely determines the effects achieved. We have found that the percentage of THC, CBD and the terpene profile act by an entourage effect synergistically working together to create a specific therapeutic window. Some chemotypes are energizing whereas others are more sedating and appropriate to reduce anxiety.
The majority of users have reported that an intake of modest amounts of cannabis and CB1 receptor stimulants have resulted in euphoria, relaxation, heightened perception, sociability and creativity; moderate to high doses have been reported to cause phobia, agitation, panic, dysphoria, psychosis and mental confusion.
CB1 receptors such as the ones THC attaches to have been associated with regulation of most neurochemical substrates of anxiety including the neurotransmitters serotonin, norepinephrine, and acetylcholine in addition to stress hormones and opioid peptides.
Cannabis, CBD, and Anxiety
CBD has been found to reduce the anxiety and improve the sensation of wellbeing induced by an acute, high THC dose. However, these behavioral effects on anxiety are not limited by the interaction between CBD and THC. Recent studies have shown that CBD exerts anxiety reducing effects both in animal and human models by other routes as well. Only low or modest but not high doses have been associated with this reduction of anxiety.
CBD has anti-panic capabilities and has been shown to reduce responses to fearful stimuli. It was shown to reduce fear of public speaking engagements at a dose of 300-600 mg. Other studies have shown a dose of 10 mg/kg to be effective. The mechanism for these actions is still unclear. Toxic effects have not been noted and doses of up to 1500 mg have been well tolerated. CBD has also been found to help with sleep- something many are not getting enough of due to worries and stresses about the present crises.
The top ten CBD products for anxiety can be found here.
Cannabis, CBN and Anxiety
CBN is one of the 100 or so different cannabinoids in the cannabis plant. It is gaining notoriety as a therapeutic agent all its own accord. It is one of the first cannabinoids to be identified. CBN is produced in greater quantities as the cannabis plant ages. CBN can also be produced from THC.
A study by Steep Hill Labs shows that CBN can be one of the most sedative cannabinoids yet identified. Consumption of just 2.5 – 5 mg of CBN is about equal to 5-10 mg. of diazepam. Furthermore, the study conducted by this lab suggests that CBD and CBN work together in synergy to create a combined anxiety reducing effect and effect on sedative properties.
Some of the other health benefits of CBN include:
- Pain Relief– it alters the pain signals sent to the brain
- Antibacterial – it has been shown to be effective against MRSA
- Anticonvulsant
CBN is regarded as a sedative compound with anxiety reducing effects that may relieve pain as well. More research is needed to extrapolate on its benefits and mechanisms.
What About the Downside of Smoking?
Smoking can cause lung irritation and avoiding lung irritation is the first line of defense against this illness. Cannabis smoke can cause visible lung irritation and microscopic injury to the lining of the respiratory tract. Exposing the lung tissue to vape aerosols like e-cigarettes can increase the release of inflammatory cytokines, macrophages, neutrophils, and lymphocytes. Most healthy individuals recover from this but right now reducing your exposure to irritants might be best, particularly for those with secondary health conditions like heart disease or asthma.
Bronchitis is another side-effect of cannabis smoke. While these symptoms are usually temporary, they are not something you want to endure during a respiratory pandemic. Cannabis smokers inhale 66% more smoke than cigarette smokers and hold it in four times longer.
If you use a flower vaporizer, the key to a healthier draw is temperature control. A joint burns at around 950 degrees. Vaporization occurs at 350-400 degrees and the sweet spot is around 390 degrees. That temperature variance makes a big difference in protecting fragile lung tissue.
Avoiding dust, aerosols, cleaning solutions, pollution and controlling allergies are all potential steps to reducing lung irritation in addition to avoiding secondhand smoke.
An oxymoron is that CBD can cause a decrease in lung inflammation and has antimicrobial properties. The question has not been answered as to the benefits of smoking CBD as opposed to full spectrum cannabis.
Is There a Medical Use for Cannabis or CBD?
A 2020 study suggested that a mouthwash high in CBD extract might prove beneficial as a barrier against the SARS-CoV2 virus thus decreasing susceptibility to infection. Such a gargle has not been developed yet, but this study presents some interesting marketing potentials as a possible COVID-19 prevention strategy.
Conclusion
Clearly cannabis plays a role in the current high stress environment of COVID-19 and states have recognized this. While smoking in the midst of a respiratory infection outbreak may not be the best route to take, there are always capsules, tinctures, medibles, THC candy, THC gummies, bath bombs, CBD drinks/beverages and topical tonics to turn to should inhaling seem too risky for medically compromised patients such as asthmatics.
Medical Disclaimer: This information is not offered as medical advice but only as educational content. It has not been reviewed by the Food and Drug Administration.
