Fact Checked

CBD: Is it Worth All the Hype?

The triumphant stories of many novel medications can be rooted in someone’s misfortune. Such was the story of 5-year old Charlotte Figi, who back in 2013 had as many as 50 seizures a day. 

Charlotte was diagnosed with a very rare form of epilepsy called Dravet Syndrome. She had cognitive and motor delays, had a feeding tube inserted, and struggled with daily activities all because of the number of seizures she had each day.

As stories go, there was a moment of hope. Charlotte’s mother stumbled upon a story of a child in California who used medical marijuana for a similar issue. She was quick to research marijuana’s anti-seizure effects in the scientific literature. The literature specifically pointed to cannabidiol (CBD), a non-psychoactive component of the Cannabis plant as the probable anti-seizure compound.

The Figi family lives in Colorado, where medical marijuana has been legal since the year 2000. They identified a strain of Cannabis at a local dispensary that contained just the right amount of CBD and no trace of the psychoactive compound delta-9-tetrahydrocannabinol (Δ9-THC; commonly known just as THC). 

With the blessings of the state of Colorado and Charlotte’s doctors, the parents began using purified CBD from the unique Cannabis strain. To everyone’s surprise, after a few weeks of increasing the CBD to an effective dose, Charlotte was finally seizure-free for as much as an entire week. 

Charlotte went from having 50 episodes a day to only about 2-3 episodes a month. Her story received recognition via a documentary called “Weed”

How Does CBD Work to Control Seizures?

Charlotte’s story sparked countless other sufferers of epilepsy to try CBD… and many reported more control over their seizures. 

It has to be noted that these patients, including Charlotte, continued to take at least one other medication from their original epilepsy treatment regimen. CBD was an addition to therapy, not a single therapeutic agent. 

Following Charlotte’s story and subsequent scientific studies, the FDA approved a specific oil-based solution of CBD called Epidiolex® in 2018. 

  • Epidiolex® is pure CBD extracted directly from the Cannabis plant 
  • It is the first natural product to be approved by the FDA for the treatment of rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome

We surprisingly still know very little about how CBD specifically works to prevent seizures. Scientists know that it likely has nothing to do with cannabinoid receptors found throughout the central nervous system; although, some alternative ideas are emerging

More research is needed to better understand this new use of CBD and its potential for other medical conditions. 

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Other Health Effects of CBD

Humans have used cannabis for millennia. We know this because Egyptians, Assyrians, and multiple Asian cultures left ancient texts that describe the use of Cannabis

We know that the cannabis plant originated somewhere in Central Asia and was first cultivated there, possibly in present-day Mongolia

Cannabis was used throughout human history for:

  • Religious ceremonies 
  • Medicinal purposes 
  • Making of textiles 
  • Euphoric effects 
  • Consumption

The emergence of new technologies capable of extracting individual ingredients from Cannabis helped spread the use of these compounds. Thanks to such developments, we know that THC is the key molecule that is psychoactive, while CBD is not. 

CBD was first identified in 1930, but it remained fairly unpopular until Charlotte Figi used it to control her seizures. Questions are multiplying around CBD’s other health effects. Naturally, there are already countless claims pointing to CBD’s almost magical properties. 

But - are they backed up by science? 

There is currently insufficient or inconsistent evidence to make a definite recommendation on most of these claims, but the most promising studies pertain to: 

  • Movement disorders 
  • Insomnia
  • Peripheral neuropathy
  • Social anxiety disorder

Clinical studies use very precise doses ranging from 2.5 mg per kilogram of body weight twice daily, to a fixed-dose of 600 mg; so, each studied result is tied to a very specific dose. A higher dose will also not translate to a higher benefit. Instead, the higher the dose, the higher the likelihood of experiencing adverse effects; the desired effect usually levels off much sooner. 

We know that CBD can damage the liver thanks to the studies that put Epidiolex® on the market. Patients with baseline liver disease should not use Epidiolex®. Since Epidiolex® is pure CBD, one should expect that this recommendation extends to any CBD product. 

CBD can cause some other problems:

  • Somnolence 
  • Decreased appetite
  • Diarrhea 
  • Fatigue 
  • Multiple drug interactions
    • Clopidogrel, clobazam, and warfarin are examples of such interactions 
    • More interactions are being identified, as more information is collected
    • Another problem with CBD is that it can cause birth defects, so pregnant women should avoid CBD.

Why Can I Buy CBD in a Store, but Not THC?

A person can purchase CBD without a prescription anywhere in the country, thanks to the Farm Bill of 2018

The bill changed the way we define “marijuana,” which itself is defined as any part of the Cannabis plant. Any Cannabis plant with less than 0.3% of THC is referred to as hemp and can be used for agricultural purposes.

Marijuana is still an illegal substance in the eyes of the federal government, while THC is restricted. CBD in the form of Epidiolex® is also restricted because it is made from non-hemp Cannabis. CBD found on store shelves is made from hemp. 

Finding the Right CBD Products.

There has been some controversy regarding CBD products: 

There are some steps you can take to ensure you’re getting the right product with the right amount of CBD:

  • Good quality products will often have a certificate of purity given by an independent lab that verifies how much CBD is in the bottle that you are purchasing. 
  • This way, you will also be able to know whether your product contains any impurities or toxins like pesticides

The question on many people’s minds is, “should I spend money on this and will it even help?”

Importantly, what is “it” that you are trying to improve? Since we still lack good quality studies, there is no proof “it” will be improved. Also, many CBD products can be pricey, which is not limited to those with purity certificates. Another important factor to remember is that many CBD products contain different strengths of CBD. 

Lastly, as with all-natural products, before making a purchase, it is a good idea to ask these two questions:

  • Will it help? 
  • Will it cause harm?

Conclusion

We will continue to learn much more about CBD as research grows. So far, we can name a few specific positive and negative effects of this compound. For Charlotte and her family, the positive effects outweigh any potential side effects as the number of her seizures fell significantly. 

With time, we will learn more about CBD’s benefits and side effects. Until then, CBD should be used with caution and vigilance. Be aware of new evidence and, before you take or use any CBD; make sure you consult your healthcare provider first. Afterward, if you decide to acquire CBD products, always get your product from a trusted source. 

Reference List

1. Maa E, Figi P. The case for medical marijuana in epilepsy. Epilepsia. 2014;55(6):783-786. doi:10.1111/epi.12610

2. Sanjay G. Why I changed my mind on weed. CNN. August 8, 2013. Accessed July 22, 2020. https://www.cnn.com/2013/08/08/health/gupta-changed-mind-marijuana/index.html

3. Gray RA, Whalley BJ. The proposed mechanisms of action of CBD in epilepsy. Epileptic Disord. 2020;22(S1):10-15. doi:10.1684/epd.2020.1135

4. Zuardi AW. History of cannabis as a medicine: a review. Braz J Psychiatry. 2006;28(2):153-157. doi:10.1590/s1516-44462006000200015

5. Pisanti S, Bifulco M. Medical Cannabis: A plurimillennial history of an evergreen. J Cell Physiol. 2019;234(6):8342-8351. doi:10.1002/jcp.27725

6. VanDolah HJ, Bauer BA, Mauck KF. Clinicians' Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019;94(9):1840-1851. doi:10.1016/j.mayocp.2019.01.003

7. What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding. U.S. Food and Drug Administration. Accessed July 22, 2020.
https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding

8. Hemp Production and the 2018 Farm Bill. U.S. Food and Drug Administration. July 25, 2019. Accessed July 22, 2020.

https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019

9. FDA, FTC warn company marketing unapproved cannabidiol products with unsubstantiated claims to treat teething and ear pain in infants, autism, ADHD, Parkinson’s and Alzheimer’s disease. U.S. Food and Drug Administration. October 22, 2019. Accessed July 22, 2020.
https://www.fda.gov/news-events/press-announcements/fda-ftc-warn-company-marketing-unapproved-cannabidiol-products-unsubstantiated-claims-treat-teething

10. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. U.S. Food and Drug Administration. Accessed July 22, 2020.
https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

Published August 17th, 2020 by Dr. Tomasz Jurga, PharmD, BCPS, BCACP, CDCES
Fact Checked by Chris Riley

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