In some instances, CBD can be used to treat epileptic seizures.
In 2018, the Food and Drug Administration (FDA) approved the use of CBD under the brand name Epidiolex to treat seizures resulting from Lennox-Gastaut syndrome and Dravet syndrome—two rare forms of epilepsy—in patients at least 2 years old.
2. Treat Select Epilepsy Syndromes
The results were interesting, although not entirely conclusive. On one hand, those treated with CBD did not experience much change in pain when compared with placebo patients. On the other hand, there were statistically significant differences between the group receiving the 250-milligram dose and the placebo group when measuring the average weekly improvement of their worst pain levels and their WOMAC (Western Ontario and McMaster Universities Arthritis Index) physical function rating. Additionally, men seemed to benefit from CBD more significantly than women in this test.
Margaret Rajnic, a doctor of nursing practice experienced in medical cannabis and CBD, emphasizes the importance of using therapy in tandem with any type of cannabis or CBD for PTSD. “There is an amount of therapy that is needed for PTSD,” she says. “But CBD will give you that little bit of decreased anxiety.”
A 2006 study found that Sativex—a CBD-based botanical drug approved in the United Kingdom in 2010—promoted statistically significant improvements in quality of sleep, pain during movement and pain at rest in patients with rheumatoid arthritis when compared to a placebo. It was the first controlled trial of Sativex as a treatment for rheumatoid arthritis, involving 58 patients. CBD was found to have a pain-relieving effect, as well as an ability to suppress disease activity.
Even more-standardized products, from pharmaceutical companies or the government, can vary in form and purity. “We’re not dealing with a single molecule, in known amounts, as it would be with standard pharmaceutical agents,” Russo says. That means that aside from the two government-approved medications, doctors cannot necessarily look to clinical trials to find the right dose to prescribe a patient, who might get the product from a different source.
The lack of reliable data on dosing means that some clinical trials might fail not because CBD doesn’t help, but because they didn’t use the right amount. Other trials may land on a dose that’s OK, but doesn’t maximize benefit while minimizing side effects.
Whatever the indication, the best approach is to start with a low dose and raise it slowly over up to two weeks, says Ethan Russo of Vashon, Washington, director of research and development for the International Cannabis and Cannabinoids Institute in Prague.
Dearth of data
There are some in the scientific community who believe that the myriad chemicals in cannabis extracts might be a good thing. The additional compounds can create a sort of synergy known as the “entourage effect.” In fact, one review found that CBD-rich extracts, compared to purified CBD, worked against epilepsy at lower doses and with fewer side effects. Using such extracts could result in more effective, less expensive medications, Russo suggests. On top of all that, CBD trialists must also consider drug-drug interactions. Like grapefruit juice, CBD can block liver enzymes that break down other drugs.
“It’s a bit scary, really, isn’t it?” Martin says. “There’s not really much evidence to tell us how much better it [CBD] is than other therapies that we’ve currently got, how much better it is than placebo, and also what dose we should use.”
When Martin searched the literature for CBD dose-guidance equations for a recent review, she, like Millar, came up short. She couldn’t find even one paper that met her criteria: intravenous dosing and reporting of individual patient bloodstream concentrations. In contrast, 12 studies were available for THC, which has a longer clinical history.
When the intern returned with all the literature she could find, it was a short stack: only a couple of dozen papers. The scientists were stunned. They’d expected more from a molecule receiving so much attention from the biomedical world and consumers. As they surveyed the scant literature, they wondered: is this all there is?
Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting. If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.
CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.
Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
The bottom line on cannabidiol
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CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?