Cannabidiol:
Written By: Natalia Loomis
Marijuana refers to the dried leaves, flowers, stems, and seeds from the cannabis sativa or cannabis indica plant. When it comes to this plant, most people think of stoners, Woodstock, hallucinations, and getting high. There is way more to this plant, what people with the stigmas against marijuana is just THC (the cannabinoid responsible for the “high effect”) Moreover, there are many other cannabinoids found in marijuana including cannabidiol (CBD). CBD is the second most prevalent active ingredient in cannabis which does not exhibit any “high” effects.
CBD has grown in popularity recently and has been tested in various countries for its therapeutic properties. CBD is being researched and marketed as an alternative method of treatment to certain pharmaceutical agents that contain harsh side effects. This can be used as an aid in relief to chronic pain, anxiety, inflammation, depression, and other conditions. There are a wide range of diseases in which CBD is thought to be beneficial such as: autoimmune diseases (inflammation, rheumatoid arthritis), neurological conditions (Alzheimer’s, dementia, Parkinson’s, multiple sclerosis, epilepsy, Huntington’s chorea, traumatic brain injury), metabolic syndrome (diabetes, obesity), neuropsychiatric illness (autism, ADHD, PTSD, alcoholism), gut disorders (colitis, Chron’s), cardiovascular dysfunction (atherosclerosis, arrhythmia), and skin disease (acne, dermatitis, psoriasis).
In a double blind multi-centered controlled trial, patients with schizophrenia were randomized in a 1:1 ratio to receive CBD (1000 mg/day; N=43) or placebo (N=45) alongside their existing antipsychotic medication. Participants were assessed before and after treatment using the Positive and Negative Syndrome Scale (PANSS), the Brief Assessment of Cognition in Schizophrenia (BACS), the Global Assessment of Functioning scale (GAF), and the improvement and severity scales of the Clinical Global Impressions Scale (CGI-I and CGI-S). After 6 weeks of treatment, compared with the placebo group, the CBD group had lower levels of positive psychotic symptoms (PANSS: treatment difference=-1.4, 95% CI=-2.5, -0.2) and were more likely to have been rated as improved (CGI-I: treatment difference=-0.5, 95% CI=-0.8, -0.1) and as not severely unwell (CGI-S: treatment difference=-0.3, 95% CI=-0.5, 0.0) by the treating clinician. Patients who received CBD also showed greater improvements that fell short of statistical significance in cognitive performance (BACS: treatment difference=1.31, 95% CI=-0.10, 2.72) and in overall functioning (GAF: treatment difference=3.0, 95% CI=-0.4, 6.4). CBD was well tolerated, and rates of adverse events were similar between the CBD and placebo groups. These results mean that CBD has beneficial effects in patients with schizophrenia and the effects do not depend on dopamine receptor antagonism that the other treatments rely on.
Greenwich biosciences has marketed CBD under the name Epidiolex, resulting in the 1st and only FDA-Approved Rx of CBD. Currently, it is approved to treat seizures associated with lennox-gastaut syndrome (LGS), Dravet syndrome, or tuberous sclerosis complex (TSC) in patients 1 year of age and older. Epidiolex is an oral solution of 100mg/ml and it is taken twice daily with meals. Even though CBD on its own is legal and sold over the counter, there are many benefits to having a prescription version. Since it is FDA approved, it undergoes strict regulation such as being grown without GMO, heavy metals, or pesticides, resulting in higher quality, safety, and efficacy of the drug. Additionally, the guidelines for CBD such as the quantity, grade, and precautions are clearly listed on the label, resulting in consistency and stability. Non-FDA approved CBD does not have to contain what might be on the label.
In conclusion, as the world transitions to breaking the stigma against parts of the marijuana plant. It is my hope that we continue to research the health benefits and provide better treatment to our patients.
References:
EPIDIOLEX® (cannabidiol). EPIDIOLEX.com. https://www.epidiolex.com/about-epidiolex. Accessed June 7, 2021.
Epidiolex(package insert). Carlsbad, CA. Greenwich Biosciences. 2020
McGuire P, Robson P, Cubala WJ, et al. Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. Am J Psychiatry. 2018;175(3):225-231. doi:10.1176/appi.ajp.2017.17030325
National Institute on Drug Abuse. Marijuana DrugFacts. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/marijuana. Published June 4, 2021. Accessed June 7, 2021.
