It’s no secret that cannabis has a long and controversial history. In fact, it’s the most commonly cultivated, trafficked, and abused illicit drug in the world. It’s also the drug in which both public attitudes and political debate are most polarised.
Over the last 20 years, there has been a huge resurgence in scientific interest in using the cannabis plant to treat a vast range of illnesses. You’ve probably noticed that CBD has become an ‘it’ ingredient within the health and wellness space, often advertised in drinks, haircare, skincare, supplements, and its pure form oil. But like all things, there is a level of scepticism surrounding CBD: is it just a passing phase or does science prove that CBD is here to stay?
In honour of today, August 8th, also dubbed National CBD Day, we’re going to dive into a number of scientific studies to understand the true extent of CBD as a treatment and how it could reshape the future of medicine.
First off, let's unpack what CBD actually is...
CBD is one of the main cannabinoids found in the cannabis Sativa plant. It doesn’t have any psychoactive properties like its companion THC (the other primary cannabinoid), so when taken alone it won’t induce the ‘high’ or euphoria that is often associated with smoking cannabis.
So, does that mean CBD is legal?
The laws surrounding not just CBD, but cannabis in general, are always evolving and changing. In the UK, CBD (and CBD only) is legal as long as it comes from an approved industrial hemp strain that contains less than 0.2% THC. If it goes above the 0.2% mark, it then becomes illegal because it is classed as a psychotropic product.
Although the UK is still coming to grips with talking comfortably about cannabis and its derived substances, other countries tend to have more explicit legislation on the subject. In Europe, most countries recognise that CBD is non-intoxicating and therefore allow CBD products, although all marketed products must respect a regulatory dose of THC – usually less than 1% in concentration.
Over the other side of the pond in the US, as of the time of writing (August 2022), 38 states have legalised the medical use of cannabis to varying degrees. CBD is legal in all 50 states, however, the laws dictating what type of product can be used and which is prohibited differ from state to state.
How is the effectiveness of medical CBD assessed?
CBD has been said to treat a number of conditions, and although it’s become so widespread, in order to be medically approved, there is a protocol that must be abided by. Typically, in controlled clinical studies, patients are randomly assigned to receive CBD, a placebo, no treatment, or another active treatment for their condition.
The results of these trials must demonstrate that the drug is more effective than a placebo or another currently used medicine in relieving the symptoms of the condition. Evidence must also show that any potential harms CBD can cause are outweighed by the benefits of taking it.
And now to answer the burning question: What illnesses does CBD really treat?
1. Epilepsy Syndromes
In 2018, the FDA approved the first-ever drug derived from cannabis: Epidiolex.
Epidiolex was initially developed by GW Pharmaceuticals, but in 2021, Jazz Pharmaceuticals acquired the drug for a handsome amount of money. The CBD-based medicine is used to treat seizures resulting from Lennox-Gastaut syndrome and Dravet syndrome – two rare forms of epilepsy – in patients at least two years old.
With 36,000 people suffering from the two syndromes in the US alone, three well-vetted studies took place to test out the drug. In these trials, 516 patients suffering from Lennox-Gastaut or Dravet syndrome were given Epidiolex or a placebo. It was found that when Epidiolex was taken alongside other prescribed medications, it significantly decreased the frequency of patients’ seizures.
After going to market and winning mega success stateside, with its first quarter racking up sales of $33.5 million (double the analyst expectations), the EMA also gave the drug the green light under the slightly different name, Epidyolex.
Since it’s been available to patients, each year sales have grown substantially meaning more people are being treated for Lennox-Gastaut syndrome and Dravet syndrome. So, with that in mind, it's fair to say that in this particular case CBD isn’t going anywhere anytime soon!
2. Opioid Addiction
Over the last decade, the widespread use of heroin and prescription opioids in the US has resulted in an unprecedented epidemic. In 2020 alone, there were more than 91,000 opioid-related deaths. Sadly, there are very few treatments currently available for heroin use disorders, and of the medications that are offered, they’re often underutilised and difficult to access.
On a more positive note, emerging research suggests that CBD could be used to help treat people who are dependent on opioids. In one study, researchers tested whether the CBD-based medicine, Epidiolex, could reduce heroin users’ cue-induced cravings. Of the 42 participants, each was randomly assigned to receive either 400 milligrams of CBD, 800 milligrams, or a placebo once daily for three days. Over the course of the three days, the participants were exposed to drug-related and neutral cues.
The study found that the CBD medication significantly reduced participants’ cue-induced cravings such as withdrawal anxiety, salivary cortisol levels (stress response), and resting heart rate. It was also reported that no serious adverse effects were found.
Similar studies in this area have learned that CBD also helps reduce various psychiatric and medical symptoms, such as anxiety, insomnia, and pain, in patients with substance use disorders.
It might seem somewhat strange to relieve an opioid addiction with a drug derived from cannabis due to its widely disputed reputation, however, CBD is proven to be non-addictive as it's not psychoactive. What's more, since current treatments for opioid use disorders are difficult to obtain, there is a gap in the market for alternative medicines, and the results of studies such as these only further indicate that CBD may be an effective treatment for opioid addiction.
3. PTSD Symptoms
CBD’s calming effect is perhaps the main reason its use has become so widespread. With an ever-increasing number of people suffering from mental health issues, it’s not surprising that CBD has been tested as a form of therapy. As research develops, several studies point toward the potential benefits of CBD as a treatment for multiple different kinds of anxiety.
PTSD, or post-traumatic stress disorder, is a chronic psychiatric condition that can develop after experiencing a traumatic event. It affects around 10% of people, meaning it has a huge social and economic impact. The disorder can manifest itself in many different ways, from sleep disturbances to changes in cognitive ability to social skills.
Even though so many people suffer from the illness, many pharmacological therapies for PTSD (such as antidepressants) have been found to be inefficient and can produce considerable side effects. As more people look towards CBD as alternative medicine, there have been multiple studies that have established that CBD can help with PTSD symptoms.
In 2018, the Journal of Alternative and Complementary Medicine conducted a small study of 11 people all suffering from PTSD. Over 8 weeks, along with routine psychiatric care, all patients received doses of CBD. The recordings found that 10 out of the 11 patients experienced a notable decline in their PTSD symptoms.
Worldwide, many people suffering from all types of anxiety have decided to opt for CBD as a treatment. However, when it comes to PTSD, Dr. Margaret Rajnic (who’s experienced in medicinal cannabis and CBD) emphasizes that it is of vital importance to use CBD alongside therapy and not as a replacement, commenting, “there is an amount of therapy that is needed for PTSD, but CBD can give you that little bit of decreased anxiety”.
Diabetes is a chronic condition that affects a person’s blood glucose regulation. There is currently no cure for diabetes, but a person can control the condition with medications such as insulin, biguanides, and alpha-glucosidase inhibitors.
As you probably know, CBD is not a regulated treatment for diabetes. Remarkably though, tests on human cells found that CBD helps reduce the effects of high glucose levels on other cells in the body, which typically precedes the development of diabetes and various complications.
In one small study, researchers tested 13 patients with type 2 diabetes who weren’t on insulin treatment. All participants received both CBD and a placebo in lieu of insulin. In comparison to the patients’ baselines before they started the test, researchers found that CBD reduced their levels of resistin (which causes resistance to insulin, the protein that regulates sugar levels) and enhanced their levels of glucose-dependent insulinotropic peptide (a hormone that ensures a sufficient release of insulin from digested food).
The results from this study suggest that CBD could be a natural treatment for diabetes by helping the body regulate insulin-related hormone levels.
Although research between diabetes and CBD is ongoing, GW Pharmaceuticals, the giants who developed Epidiolex (mentioned above) and Sativex (a cannabis spray that helps treat muscle spasms in multiple sclerosis), are currently in the process of developing another spray that could aid blood sugar control in type 2 diabetes. From this point of view, it looks like CBD-related therapies are only on the rise for diabetes patients!
5. ALS Symptoms
ALS, or Amyotrophic Lateral Sclerosis, is a progressive neurodegenerative disease that causes nerve cells in the brain and spinal cord to deteriorate, resulting in loss of muscle control that worsens over time. It’s not yet understood what exactly causes ALS to occur, although in some cases it can be hereditary.
At present, there is no known cure for ALS and there are only two FDA-approved medications on the market to treat ALS symptoms. Nevertheless, research suggests that people suffering with ALS can benefit from the ‘entourage effect’ created by combining CBD and THC.
The ‘entourage effect’ refers to the theory that when CBD and THC work together, they complement each other’s benefits and potency. For example, taking the same dose of THC and CBD together will soften the ‘high’ from the THC. By the same token, if a small dose of THC is paired with a larger dose of CBD, it enhances the effects of the CBD.
A 2019 study saw patients with ALS receive a combination of CBD and THC in varying doses depending on their needs and preferences. Patients reported high levels of satisfaction with the treatment, but it is worth noting that those with moderate to severe spasticity (muscle tightness and stiffness) due to ALS reported higher satisfaction than those with mild spasticity. This is encouraging news for ALS patients, however, more research in this area is definitely necessary.
There are many more conditions that CBD is said to help treat including chronic pain, cancer pain, depression, sleep disturbances, and neurological disorders (to name a few!). Although current research can be limited in these areas, it seems promising that these eye-opening studies will promote more research into CBD as a treatment and result in positive outcomes for both patients and practitioners.