Despite having to battle through prohibition, stigmatisation and strict regulatory restrictions, the legal cannabis market is rapidly emerging in various jurisdictions around the world. The key driver of this market is the medical cannabis sector, which is quickly gaining traction thanks to a growing body of scientific and clinical research that supports the efficacy of medical cannabis.
The term medical cannabis, also known as medical marijuana or MMJ, is used to describe any plant-based medicine that has been created using extracts from the cannabis plant and is prescribed by medical practitioners. The therapeutic benefits of the cannabis plant are largely associated with molecules called cannabinoids which are pharmacologically active compounds found within the cannabis plant.
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The average cannabis plant contains over 120 different cannabinoids in addition to a range of other phytochemicals that have displayed therapeutic potential. The two most well-known cannabinoids are CBD and THC.
Uses & benefits of CBD
While there are a variety of different medical cannabis products that can be found on the market, the ones that contain CBD are the most common. CBD-based products are associated with a wider range of therapeutic benefits and less undesirable side-effects when compared to other medical cannabis products, such as a dry flower.
If you haven’t heard of CBD before, then you may be confused by what it is and what it means. CBD is an acronym for cannabidiol, which is classed as a cannabinoid. CBD specifically is a phytocannabinoid, meaning that it is a cannabinoid extracted from a plant, as opposed to an endocannabinoid, which are naturally produced within our bodies.
CBD isn’t just specific to the cannabis plant, it can also be extracted from hemp plants. Hemp contains high concentrations of CBD, while containing only trace amounts of THC (less then 0.3%), which is found in abundance in cannabis plants. This is one of the main reasons why some manufacturers prefer to extract their CBD from hemp, as products that contain more than 0.2% THC are illegal in most jurisdictions.
The interest in CBD as a pharmaceutical and a nutraceutical is rapidly growing, with high consumer demand for these products. This largely stems from manufacturer claims regarding CBD’s health benefits in addition to a growing body of scientific evidence that outlines CBD’s medical applications.
One such medical application is pain relief, which is a major reason why many consumers are turning towards CBD. Patients who suffer from chronic pain, neuropathic pain and inflammatory pain can all utilise CBD to help manage these conditions. The main way CBD relieves pain is by inhibiting the release of inflammatory proteins, making it an alternative treatment option for those suffering from arthritis and other joint-related pain conditions.
Patients with anxiety and insomnia may also find CBD helpful in treating some of the symptoms associated with these conditions. Research suggests that CBD has some anxiolytic properties and ingestion of CBD may cause a reduction in anxiety symptoms.
In contrast, CBD’s effects on sleep are not yet fully understood but it has proven to be an effective sleep aid for some consumers. An explanation as to why this may occur lies in CBD’s ability to treat some of the conditions which are comorbid with insomnia, with pain and anxiety being high among them.
There has also been a lot of research into CBD’s ability to alleviate the symptoms of epilepsy, particularly in young children. Although the exact mechanism of action is still under investigation, CBD has displayed the ability to reduce the frequency and duration of seizures. Lennox-Gastaut syndrome and Dravet syndrome are two seizure conditions that have a CBD medication (Epidiolex) approved by the FDA.
Some other potential benefits that have appeared in different studies are tumour inhibition, acne management and neuroprotective effects. These products are available in a wide range of formulations, such as CBD oils, tinctures, capsules, topicals, gels, edibles and vape juices. As such, CBD can be consumed in a number of different ways, which means you’ll be able to find a product that’s exactly right for your needs.
CBD and its effects are becoming more well-known by mainstream consumers, as the compound is the focus of medical research, popular media and cannabis legislation. Commercially available CBD continues to pop up on shelves across the globe.
Although there is plenty of positivity surrounding CBD and its health claims, there is also lots of misinformation out there. Whether you’ve heard about CBD from family members, friends, health professionals or manufacturers, the information you receive can be different every time.
With more and more consumers turning to CBD for medical or wellness purposes, clarity around the associated health claims is more important than ever to ensure the safety of consumers and viability of cannabis-based medicines. CBD is a compound surrounded by many myths and misconceptions, so let’s explore some of the main ones that you’re likely to encounter.
[1] CBD is for medical purposes while THC is for recreational purposes
As mentioned earlier, there are many claims that CBD can improve a wide range of health conditions. Some of these claims include CBD’s ability to treat conditions such as chronic pain, anxiety, insomnia, various forms of epilepsy and even acne.These claims are backed up by the testimonies of CBD product manufacturers and consumers alike and are further supported by a significant body of research and clinical evidence.While CBD gets all the recognition for being the main therapeutic compound extracted from cannabis, there is another major phytocannabinoid that doesn’t receive the same level of medical appreciation. Similar to CBD, tetrahydrocannabinol (THC) is the other major cannabinoid found within cannabis that is attributed with producing many of the plant’s physiological effects.In most jurisdictions, medicinal cannabis products may only contain trace amounts of THC or THC-containing products are banned completely. In the United States, the limit for these products is no higher than 0.3% THC and in the European Union, the limit is 0.2% THC.The main reason for these precautions is due to concerns over THC’s psychoactivity and long-term effects. The psychoactive effects of THC are largely responsible for the producing the ‘high’ that cannabis is associated with. Because of this, THC has a reputation of only being used for recreational purposes, with CBD having a reputation of use for medicinal purposes.This is a false dichotomy, as THC actually has many medicinal benefits, with numerous clinical trials detailing some remarkable and medically-relevant properties. Some of these include relief from the symptoms of pain, insomnia and nausea, amongst others.But what about the opposite? While CBD clearly has some health benefits, not many consumers would utilise the compound for recreational purposes as it does not produce a ‘rewarding’ or pleasurable effect. CBD is not typically associated with euphoric effects, craving or any drug abuse potential.Although CBD doesn’t produce any type of euphoria, it might allow the consumer to feel more relaxed, focused and relieved of stress in social settings. CBD doesn’t only need to be taken to treat serious medical conditions – it can also be enjoyed socially or to improve certain activities.
THC is the main psychoactive compound in cannabis plants and is responsible for producing the cannabis ‘high’. CBD does not contribute towards this high in any way, which is one of its main marketing points. Manufacturers are quick to point out that consuming CBD will not alter the consumer’s consciousness or offer any mental impairments, with some referring to CBD as ‘non-psychoactive’.
However, this is not the case – CBD is psychoactive. CBD has been proven to impact our psyche but often in beneficial ways, with studies finding the compound to have anxiolytic, antipsychotic, anti-craving, alerting and mood-elevating properties. Even in very high doses, CBD does not impair mental and physical functioning in most consumers.What certain manufacturers mean when they refer to CBD as ‘non-psychoactive’ is that it won’t produce any type of ‘high’. Some more informative and truthful terms to describe the actions of CBD are non-intoxicating or non-impairing.
[3] Cannabis is a scheduled drug so no CBD research has been conducted
Although prohibition has certainly hindered cannabis research in the past, it is a fallacy to concur that no adequate research has been done on CBD and its effects. In the United States, cannabis is classified as a Schedule 1 drug, however, many universities and organisations throughout the country have been permitted to conduct research on the plant.For example, the University of San Diego in California is currently conducting clinical trials to determine whether cannabidiol can be of use to children with autism. There are very few treatments that are effective in reducing the severe behavioural problems associated with autism so the hope is that Epidiolex, a FDA-approved CBD solution, may reduce these problematic behaviours.This is just one example of the countless studies being conducted on CBD, and they are not just restricted to North American institutions. In fact, Israel was the first country to properly investigate cannabidiol and you can now find a range of studies being conducted on the compound in various countries around the world.In the UK, a 2018 study showed promising results in using CBD to treat ulcerative colitis. In Italy, a 2014 study suggested that CBD can inhibit the growth of cancerous cells in colon cancer. In Brazil, a study from 2017 found that people who took CBD prior to public speaking experienced less anxiety than the control group.While this may not mean that CBD is the definitive cure for ulcerative colitis, colon cancer and anxiety, it is proof that credible CBD studies are being conducted. Nearly all of these studies are available on PubMed, which has over 20,000 citations regarding the endocannabinoid system (ECS) and phytocannabinoids such as cannabidiol.Keep in mind that a lot of this research has been conducted on cell cultures and various animal models but not many have been conducted on humans. An exception to this is the research that has been conducted on young children with rare genetic seizure disorders, however, further research needs to be conducted on CBD’s efficacy in the treatment of pain, anxiety and insomnia in order to support the marketing claims.
It is true that many of CBD’s reported benefits, such as its analgesic, anxiolytic and anti-cancer effects require further investigation. Currently, CBD has not been approved as a treatment for conditions such as chronic pain, anxiety, insomnia, migraines and IBD despite clinical and anecdotal evidence supporting its efficacy.
But this doesn’t mean that CBD hasn’t been approved for any other specific conditions. In June 2018, the Food and Drug Administration (FDA) approved Epidiolex, an orally-administered CBD solution, for Lennox-Gastaut syndrome and Dravet syndrome. These conditions are seizure disorders which predominantly affect children and were difficult to treat prior to the approval of Epidiolex.Epidiolex is the first cannabis-derived (and CBD-based) medication to receive FDA approval since cannabis became a Schedule 1 narcotic in 1970. This was a monumental achievement, as the US federal government once deemed that drugs belonging to the Schedule 1 class had no medical value.There are also numerous clinical trials being conducted on the efficacy of CBD for the treatment of certain health conditions, so it is likely that the compound will be approved for more of these conditions in the near future.As it stands, many consumers are currently utilising CBD for conditions it has not yet received approval for. Only time and further research will determine how many of CBD’s reported health benefits are medically relevant.
[5] CBD works by activating cannabinoid receptors
The endocannabinoid system (ECS) is a collection of cannabinoid receptors that are located throughout the body, with higher concentrations being present in the brain and spinal cord. It is a complex signalling system that’s main function is to maintain homeostasis, which is the balance of internal, physical and chemical conditions within the body.This system helps us to respond to illness and injury, restore balance at a cellular level and is constantly maintaining the wellbeing of our organs and tissues. When fully activated, the ECS can influence things such as appetite, sleep, emotions, memory, body temperature, nociception, the immune system and nervous system.The efficacy of medical cannabis and its associated products in the treatment of neurologic, inflammatory, gastrointestinal, psychiatric, infectious, and metabolic conditions is largely due to their interactions with the ECS.THC, the main intoxicating (and therapeutic) compound found within cannabis, exerts its effects by activating the CB1 receptors of the ECS. This stimulates a range of different cellular activities that restore physiological balance, with some of the resulting therapeutic benefits being pain and stress relief, mood elevation and anti-inflammation.One would assume that CBD acts in a similar manner to THC as they are structurally similar. However, as confusing as it may be, this is not the case. In fact, CBD doesn’t directly stimulate either CB1 or CB2 receptors at all.Instead, CBD interacts with the ECS in two known ways: by encouraging your body’s natural production of endocannabinoids, and by dampening the activity of some cannabinoid receptors, rather than activating them. This dampening effect is also the main reason why CBD is used by some consumers to counteract the psychoactive and anxiety-inducing effects of THC consumption.
[6] All CBD is the same
The cannabidiol molecule is the same regardless of whether it was originally extracted from cannabis and hemp or artificially created in a lab. While the CBD molecule always remains the same, commercially available CBD-containing products can vary greatly.Take CBD oil, for example. It is a naturally complex product that can contain a diverse range of additional phytochemicals that have been extracted from the cannabis plant, such as terpenes, flavonoids and other cannabinoids, such as THC. Products that contain CBD in addition to these compounds are referred to as full-spectrum CBD extracts.It is thought that full-spectrum extracts provide more benefits than CBD consumed by itself, largely due to a phenomenon known as the ‘Entourage Effect’. This effect describes the way in which these compounds work together synergistically to provide additional health benefits to the ones they provide when consumed alone.For example, THC can enhance the benefits of CBD on pain and inflammation, while terpenes such as limonene can provide antibacterial and anxiolytic effects. This is why CBD oils from different vendors can contain very different molecules, even if they both contain the same milligram dosage of CBD.In contrast, CBD isolate products are purified CBD. These products are typically found in powder or crystal form and are usually ingested either directly or as a food additive. CBD isolate can also be infused into carrier oils, such as olive oil, to create your own CBD oils or skin-safe oils to create your own CBD topicals.Regardless of their composition, a large number of commercially available CBD products are actually mislabelled. In a 2017 study, researchers purchased 84 various CBD products online and found that only 26 had been labelled correctly (i.e. contained CBD within 10% of the claimed amount). 36 of these products contained more CBD than stated on the packaging and 22 contained less.Purchasing CBD can be tricky, especially online, and it can be hard to know which retailer to trust. However, it is imperative to do a bit of research prior to buying a new CBD product, to ensure legitimacy and safety. Consumers should find third-party tested brands from licensed and reputable labs, and CBD products that contain whole-plant extracts, as these offer the best safety profile and medical benefits.
For CBD products that contain little to no THC, high doses are recommended more often than not. Why is this? Milligram for milligram, CBD is much less potent than THC at relieving symptoms. For example, someone who experiences pain or stress relief with 3-5mg of THC may require 30-200mg of CBD in order to achieve the same results.The effects of CBD are only noticeable if it is consumed daily and in large doses. The research in this area has been remarkably consistent. Studies that have utilised pharmaceutical-grade CBD to treat anxiety, schizophrenia and epilepsy have required hundreds of milligrams of CBD per dose.In studies that have used rodents, children and sometimes adults as test subjects, an effective dose of CBD typically ranged between 10-20mg per kilogram of weight, to be consumed daily. For a 70kg adult, this equates to taking a dose of CBD between 700-1400mg per day. Unfortunately, this is simply unaffordable for most consumers.
In saying this, low doses of CBD can provide mild benefits. If being utilised to treat occasional inflammatory pain, the recommended dosage is 25-50mg per day. Those that suffer from seizures, Parkinson’s, ALS and chronic pain will require a much higher dose of CBD.
[8] A lot is better
Although high doses of CBD may be more effective, consuming too much may not necessarily be better. This may seem contradictory to the previous point but there are some explanations for this.CBD isolate in particular has a peak effective dose, where higher and lower doses on either side start to become ineffective. Unfortunately, studies have found this therapeutic peak to be narrow and difficult to pinpoint.Because of this, it appears that CBD isolate products may offer less health benefits than full-spectrum CBD products. This is due to the other cannabinoids, terpenes, flavonoids and other phytochemicals present in these extracts providing additional therapeutic effects.Some clinical trials have also reported that very high doses of CBD (e.g. 1000mg per day for a 70kg adult) can also increase the risk of side-effects. While lowering the dose of CBD may reduce its therapeutic effectiveness, it also mitigates the occurrence of any adverse effects.There is currently no ideal dose of CBD for any given patient or condition. With numerous CBD products already on the market and more constantly in production, chances are there won’t be any standardised guidelines anytime soon. Contact your medical practitioner or consult an online guide to help find the optimal dose of CBD that works for you.
With all of the reported health benefits of CBD consumption and positive news around the CBD industry, you may be excused for thinking that the compound doesn’t have many side-effects or none at all. This is not the reality. Any CBD product manufacturer telling you otherwise is not looking out for your best interests.Like most medications, CBD isn’t right for everyone and it can come with some potential side-effects, particularly when consumed in high doses. One of the most important ones to consider is how CBD interacts with other prescription medications.CBD can alter the way our body metabolises certain medications, particularly the ones that come with warnings about consuming grapefruit. CYP3A4 is a vital enzyme found in the gut which is responsible for the metabolism of many drugs. Any consumption of grapefruit or its juice can inhibit this enzyme, resulting in too much medication floating around in the bloodstream.CBD acts in a similar manner to grapefruit juice in this regard and can inhibit CYP3A4 as well as another enzyme called CYP2D6. The medications to avoid when also consuming CBD include blood thinners such as warfarin, anti-convulsants, HIV antivirals, cholesterol-lowering statins, some hypertensive drugs and certain anti-cancer agents, amongst others.Some other side-effects that have been reported with CBD use by some consumers are nausea, fatigue and irritability. While these side-effects can present themselves, it is often only after taking large doses of CBD, as seen in some studies, or in conjunction with other prescription medications.If you’re a CBD consumer and are experiencing adverse effects, then consult with a medical practitioner to discuss whether CBD is the right choice for you and that you are purchasing your supply from a reputable source. If any problems persist, consider lowering your CBD dose or ceasing use entirely.
[10] CBD is a marketing scam / shady industry
The wellness industry is a large market, reaching a value of $4.5 trillion USD in 2018 which accounts for 5.3% of the global economic output. The sheer size of this industry requires constant consumer interaction and product innovation to maintain strong revenue growth.As a result, any new and excited compound with numerous health claims (e.g. CBD) can be unnecessarily included in a range of cosmetic and wellness products. Although some of CBD’s applications in any given product can appear to be unnecessary, it doesn’t mean that ALL of CBD’s applications are unnecessary.Whenever these opportunities present themselves to businesses within the industry, they will attempt to include these compounds in their products if there is enough consumer interest and demand. This may seem like a marketing scam but it is simply a way for these businesses to bump up the price of these products, because they claim to provide additional health benefits.However, this doesn’t change the fact that CBD has those reported health benefits. While it is correct that CBD doesn’t need to be in most of the products that it winds up in, this doesn’t diminish the fact that CBD itself has legitimate medical applications. Don’t let the over-saturation of CBD-infused wellness products fool you into thinking that this compound is merely a fad.As we touched on earlier, a large portion of the CBD-infused products that can be found online are mislabelled. Epidiolex is currently the only FDA-approved CBD medication, so critics of the CBD industry are justified in highlighting the quality issues that stem from mislabelled.It would be a mistake though to conflate low-quality CBD products with high-quality CBD products. Even though some shady manufacturers can label CBD products incorrectly, legitimate and well-sourced CBD products can provide numerous benefits to medical cannabis consumers worldwide. This is why it is important for every prospective CBD consumer to do their own research on what a quality CBD product looks like and what is legal in their part of the world.
With all the misinformation surrounding CBD, it is super important that you do your due diligence when looking to purchase CBD-based products. This involves doing your own research and trying to source reliable and responsible CBD information.
There are a few important things to keep in mind.
Firstly, the medical potential of CBD as a therapeutic compound should never be confused with issues surrounding the CBD industry, such as unregulated quality standards and unproven health claims. Similarly, be mindful that although some of CBD’s therapeutic benefits are backed up by scientific evidence, they are still under investigation, with only Epidiolex receiving FDA approval for the treatment of different seizure conditions.
Secondly, remember that not all CBD products are the same. It is important to know where the CBD in your products has been sourced from as well as being aware of any additional compounds present and what effects they may have. Lastly, only purchase products from reputable brands and sources unless you have done a fair amount of research on the product you have chosen.
Anastasiia Myronenko
Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.