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Advocacy: Medical Cannabis CBD

While not everyone with epilepsy should or would consider medical cannabis or cannabidiol (CBD) as a treatment option, some people living with uncontrolled seizures have reported beneficial effects and reduced seizure activity when using medical cannabis, especially strains rich in CBD. Further research is needed on the effects of medical cannabis on epilepsy, but when recommended by a treating physician, medical cannabis may be the best alternative for some individuals living with drug-resistant epilepsy and uncontrolled seizures.

Access to medical cannabis will support increased research efforts and allow individuals who have failed to gain seizure control an option for treatment.

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Position

The Epilepsy Foundation is committed to supporting physician-directed care, and to exploring and advocating for all potential treatment options for epilepsy, including cannabidiol (CBD) oil and medical cannabis. We support safe, legal access to medical cannabis and CBD if a patient and their health care team feel that the potential benefits of medical cannabis or CBD for uncontrolled epilepsy outweigh the risks.

We also support breaking down barriers to research to better understand the potential therapeutic benefits and harms of cannabis. The Epilepsy Foundation does not have a policy position on adult use recreational cannabis programs – however, under these laws, individuals and their physicians are able to work together to access cannabis to control seizures when medically appropriate.

Status

As of November 2020, 48 states and the District of Columbia have legalized either the recreational or medical use of cannabis on the local level. Under federal law, cannabis remains a Schedule I controlled substance, and illegal to use, buy, sell, or possess. The restrictive Schedule I status also creates a significant barrier to conducting medical research on the benefits or harms of cannabis as a treatment option for epilepsy and seizures as well as other complex, chronic conditions.

During the November 2020 elections, Arizona, New Jersey, South Dakota, and Montana residents approved ballot measures to allow for the adult recreational use of cannabis. Mississippi and South Dakota residents approved ballot measures to allow for the medical use of cannabis as well. The Arizona law will take effect on November 30, 2020 when election results are certified, and public sale of cannabis could begin as soon as March 2021. New Jersey’s constitutional amendment takes effect January 1, 2021 and will issue regulations and licenses for cannabis businesses in the coming months. On February 2, 2022, Mississippi became the 37th state to adopt medical cannabis laws when Governor Tate Reeves signed SB 2095 into law.

CBD: Concern, or no Big Deal?

You’ve probably heard of THC (delta-9 tetrahydrocannabinol), the cannabis compound that is responsible for the “high” with cannabis use. But, THC is just one of 80 different “cannabinoids,” or natural chemical compounds in the cannabis plant that interact with the body’s central nervous system. Perhaps the second most well-known cannabinoid is CBD (cannabidiol).

But, what is CBD? We’ve weeded through the evidence to tell you some of what’s known so far.

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Unlike THC, CBD does not cause a high or intoxication. Some data suggest that it may actually offset some of the intensity and unwanted psychoactive effects of THC, such as anxiety, paranoia, memory loss, and euphoria.

Research on the medicinal uses of CBD is ongoing, but little is currently known. The Food and Drug Administration recently approved the first cannabis-derived CBD drug (Epidiolex) for treatment of seizures in patients age 2 years and older. Beyond that, pre-clinical (cell and animal) studies suggest that CBD may be therapeutically useful by containing antioxidant, neuroprotective, anti-inflammatory, analgesic, anti-psychotic, and an anti-anxiety properties. However, these effects are only just beginning to be more broadly studied in humans.

Commercial CBD products aren’t well researched. Products containing CBD are sold by retail cannabis stores, supermarkets, and health stores as tinctures, edibles, sprays, capsules, lotions, and more. Since little is known about how to dose CBD for various potential medicinal effects, we don’t know if these commercial products contain the right amount of CBD to produce any medicinal effects. Currently, Epidiolex is the only CBD-based product approved by the FDA for medical use in the U.S., and it is only approved for treatment of seizures.

Commercial CBD products aren’t well regulated. There are a lot of different CBD products out there, and those that are found outside of a licensed cannabis retail shop are unregulated and may not be tested. This means product quality is uncertain; some commercial CBD products may contain contaminants, other dangerous chemicals, or synthetic CBD oil, and the concentrations of CBD in the products may not be reliable.

CBD can interact with other drugs. It can cause the body to metabolize some drugs differently, which may result in an adverse reaction. Drug interactions can occur, for example, with a number of commonly used medications including steroids, antihistamines, calcium channel blockers, immune modulators, benzodiazepines, antibiotics, anesthetics, antipsychotics, antidepressants, anti-epileptics, and beta blockers.

A CBD-infused gummy a day does not keep the doctor away. Here’s the bottom line: CBD may eventually prove to have medical benefits, but there is still a lot that we don’t know. While research catches up on its uses, correct dosage, and long-term effects, it’s important to consider potential risks. People who are interested in trying CBD should talk to their healthcare providers first, and should purchase products from a licensed retail cannabis store.

Sources and Resources:
  • World Health Organization: Cannabidiol (CBD) Pre Review Report
  • Harvard Health Blog: Cannabidiol (CBD) – what we know and what we don’t
  • Partnership for Drug-Free Kids: What parents should know about kids using CBD
  • NIDA: FDA Approves First Drug Derived from Marijuana
  • NIDA: The Biology and Potential Therapeutic Effects of Cannabidiol

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5 thoughts on “ CBD: Concern, or no Big Deal? ”

Although this article is short, I think it provides a good foundation of what CBD is, the uses, and concerns–something that I wanted to learn about since I know some of my friends that use CBD products for its therapeutic effects. It is obvious that CBD needs to be researched more to discover the long term effects and the correct dosages to feel the therapeutic effects. The CBD market reminds me a lot of the vitamin industry in that there is a lack of regulation and proof of what is ~really~ in such products. For people who take supplements everyday, I would recommend checking out labdoor.com where they test over-the-counter vitamins and supplements to check for how true their products match up to their labeling and other important factors.

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CBD really has a great potential in treating numerous health problems, but it is true, that commercial CBD products aren’t well regulated, especially on Amazon, where they found out that a product was labeled as 1000mg CBD, but it cointained only 8mg of CBD in it. It is always recommended to ask for COA (certificate of analysis) before buying CBD products or maybe even get them analysed by yourself.
In one study (with synthetic CBD) they found out that it metabolizes through liver enzymes, Cytochromes P450, as well as numerous medicines do. This can lead to “unpredictable” effects of medicines as its effects can be enhanced, diminished or can stay the same.
Many people think off CBD as a magic cure for everything, but that is definitely not the case. It can help ease, prevent and even cure some diseases, but it definitely isn’t a miracle compound as many would like to hear.

This is a really interesting article that highlights the current state of CBD. I have seen CBD on the rise lately, particularly on social media. I recently watched an Instagram story of a popular “influencer” squirting CBD oil in her mouth, claiming it helped her anxiety. I was a bit skeptical about this, so I did some research and found much of the same that you reported in this article. There were a lot of mixed opinions on the effectiveness of CBD and much of the “evidence” was anecdotal. I totally agree with you that there isn’t a lot of research on CBD and more needs to be done. The lack of regulation is also a huge issue, especially with the large market online. I do look forward to seeing what the FDA does with CBD oil in the future as I think it may have potential to help certain issues, but at this time there is too much uncertainty around the product to make a definitive claim about it.

On another note, I recently saw in the news that Kim Kardashian West had a CBD-themed baby shower. It will interesting to see just how much celebrity influence has on the use of CBD even without clear scientific benefit. We will have to see.

Great informative article!

The current state of CBD in the US is very interesting as highlighted by this post. Though it is unregulated and there is wide discussion regarding “proper” dosage, the therapeutic effects described by those who use CBD are undeniable. A common argument of those who disagree with the use of CBD is that its effects are placebo. In my opinion, this is best case scenario for users of CBD. If CBD truly has no effects, the users are perceiving beneficial effects with no risk of true dependency.

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While I do agree that continued CBD research is necessary, I also think that there are minimal reasons for concern of users in terms of public health. Research can help steer us in the direction of the most effective way of dosing CBD for a desired effect, but if it gets adopted by big pharmaceutical companies it may become the antithesis of what it seeks to remedy – affordable relief from anxiety, restlessness, and the like.

This was a very interesting and short read on the quick facts on CBD. The main idea that I retrieved from this post was that there is not a lot of regulation on CBD products in general. With that being said, I would advise consumers and patients to purchase and use CBD products with caution as mentioned in the post due to low levels of research. Medicinal effects are not certain, but a lot of people still use it to help to relieve some of their symptoms and other prominent health issues. CBD oil affects many neurotransmitter receptors that help reduce pain. It also counteracts the effects of THC, the chemical in marijuana that makes someone high or intoxicated, by inhibiting the receptor’s affinity to bind to THC. Furthermore, it stimulates the 5-ht1A receptor which triggers responses to help with anxiety, addiction, sleep, pain, nausea and vomiting. I can go on and on with the effects of CBD, but the extent to which it actually relieves these symptoms will vary from person to person since the dosage has not been identified for the best benefit. The only exception is Epidiolex, the CBD-derived prescription only medication to treat seizures.
I work in a pharmacy and our store sells over the counter CBD products. Occasionally, we would have customers coming in and asking about those products. For which health concern, I am not sure. I personally know someone who uses CBD oil to help regulate her sleeping behavior. She tends to take a long time to fall asleep at night and these cycles are usually inconsistent due to her working schedule. After taking some CBD oil, she was able to fall asleep much quicker. She told me that she uses that CBD oil product periodically to assist her with sleep and that she no longer takes melatonin. For some people, it may work, but I would still encourage the public to be careful when purchasing CBD products, especially online because scammers and risk of getting the wrong product is higher with uncertified websites who may mask their identity.