This has been the year medical cannabis hit the mainstream. The government has announced that it is relaxing laws on when cannabis medicines can be prescribed by doctors, following high-profile cases such as that of Billy Caldwell, the 13-year-old boy hospitalised by his epileptic seizures after he was denied legal access to the cannabis oil that helps control them. Meanwhile a new generation of cannabis medicines has shown great promise (both anecdotally and in early clinical trials) in treating a range of ills from anxiety, psychosis and epilepsy to pain, inflammation and acne. And you don’t have to get stoned to reap the health benefits.
In a series of placebo-controlled studies involving 15 healthy volunteers, Fusar-Poli et al. investigated the effects of CBD and THC on task-related blood-oxygen-level dependent functional magnetic resonance imaging activation, specifically the go/no-go and fearful faces tasks [109, 110]. The go/no-go task measures response inhibition, and is associated with activation of medial prefrontal, dorsolateral prefrontal, and parietal areas . Response activation is diminished in PTSD and other anxiety disorders, and increased activation predicts response to treatment . CBD produced no changes in predicted areas (relative to placebo) but reduced activation in the left insula, superior temporal gyrus, and transverse temporal gyrus. The fearful faces task activates the amygdala, and other medial temporal areas involved in emotion processing, and heightened amygdala response activation has been reported in anxiety disorders, including GAD and PTSD [113, 114]. CBD attenuated blood-oxygen-level dependent activation in the left amygdala, and the anterior and posterior cingulate cortex in response to intensely fearful faces, and also reduced amplitude in skin conductance fluctuation, which was highly correlated with amygdala activation . Dynamic causal modeling analysis in this data set further showed CBD reduced forward functional connectivity between the amygdala and anterior cingulate cortex .
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Furthermore, THC and CBD oils also differ in the nature and effect of their Cannabinoid content. Cannabinoids typically bind to receptor sites located in the brain, called CB-1, and various parts of the human body called CB-2. But different cannabinoids produce different effects depending on which type of receptor they bind to. THC mostly binds to receptors in the brain, but CBD unlocks the receptors scattered throughout the body, making it far more useful for healing properties.
CBD’s potential usefulness in treating certain conditions is yet another argument in favor of legalizing the entire cannabis plant. Removing cannabis from the federal list of Schedule I narcotics that are illegal under the Controlled Substances Act would allow scientists to research its full medical potential and pharmaceutical companies in the United States to develop marijuana-based drugs and submit them for FDA approval. Government-regulated labs could test products like CBD oil to ensure safety and quality. Doctors could prescribe marijuana- based medicines with full knowledge of potential side effects and drug interactions, and without fear of losing their medical licenses or being thrown in jail.
Yet the DEA has stated unequivocally that it considers CBD to be illegal under the Controlled Substances Act. “CBD derived from the cannabis plant is controlled under Schedule I of the CSA because it is a naturally occurring constituent of marijuana,” Joseph Rannazzisi, the deputy assistant administrator of the DEA, told a congressional panel in June. “While there is ongoing research into a potential medical use of CBD, at this time, CBD has no currently accepted medical use in the USA.” Moreover, DEA spokesman Eduardo Chavez told the New Republic that Medical Marijuana, Inc.’s in-house opinion with regards to CBD has no merit. “The bottom line,” Chavez said, “is the oil is part of the marijuana plant, and the marijuana plant is currently a Schedule I controlled substance under federal law.”
I found I was too groggy during work hours if, on a typical day, I took CBD in the morning and at night. A dose of 25 milligrams an hour before going to bed, plus occasional topical use, has become my norm. The main exception is after an especially long or hard weekend run, when I have an additional 25 milligrams if I’m planning to mostly lounge about the house.
In a study whose findings have not yet been published, he and a colleague, Daniel Friedman, found that patients receiving CBD in addition to their usual medicines had 39 percent fewer convulsive seizures than patients who remained on their normal drug regimen. Given that the study included only the most treatment-resistant patients, this is an “excellent response,” Devinsky says.
CBD oil isn’t legal everywhere. In the United States, some states allow it for only specific medical purposes and some don’t. You may need to get a license from your doctor to be able to use CBD. If cannabis is approved for medical use in your state, you may be able to purchase CBD oil online or in special cannabis stores or clinics. As research on CBD continues, more states may consider the legalization of cannabis products.
Cost is another consideration. Most CBD oils are sold in concentrations of 300 to 750 mg, although this may range from less than 100 mg to more than 2,000. A good indicator of price-point is the cost per milligram. Low-cost CBD oils usually fall between five and 10 cents per mg; mid-range prices are 11 to 15 cents per mg; and higher-end oils cost 16 cents per mg or higher. Given these varying per-milligram costs, a bottle of CBD oil may be priced anywhere from $10 or less to $150 or more.
Several studies point to the potential benefits of CBD for anxiety. For generalized anxiety, the National Institute on Drug Abuse says that CBD has been shown to reduce stress in animal studies. Study subjects were observed as having lower behavioral signs of anxiety. Their physiological symptoms of anxiety, like increased heart rate, also improved.
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To determine the effects of each substance, physiological measures were collected along with symptom ratings approximately 1, 2, and 3 hours post-administration. Post-trial assessment of physiological measures indicated that compared to placebo and CBD, administration of THC caused anxiety, dysphoria, positive psychotic symptoms, neurophysiological sedation, and elevated heart rate. Strikingly, there appeared to be no significant differences between CBD and placebo on physiological or symptomatic measures.
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"The data supporting efficacy and dosing are specific to one product: Epidiolex," Bonn-Miller says. "That's not necessarily translatable to 'Joe Bob's CBD Blend.'" A CBD extract you buy online or in a dispensary will almost certainly have less CBD in it, he explains, and will contain other cannabinoids—meaning that it will work differently and will need to be dosed differently. "This is not to say that 'Joe Bob's CBD Blend' definitely isn't going to be effective for pediatric epilepsy, but it means that we need to study it before we know."
A wealth of marketing material, blogs and anecdotes claim that cannabis oils can cure whatever ails you, even cancer. But the limited research doesn't suggest that cannabis oil should take the place of conventional medication, except for in two very rare forms of epilepsy (and even then, it's recommended only as a last-resort treatment). And, experts caution that because cannabis oil and other cannabis-based products are not regulated or tested for safety by the government or any third-party agency, it's difficult for consumers to know exactly what they're getting.
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