Empowered and Informed

Cannabidiol

Cannabidiol

 
 

What is Cannabidiol (CBD)?

First identified in 1963, cannabidiol (CBD) is a non-psychoactive cannabinoid compound contained in the hemp plant Cannabis sativa. CBD is one of over 100 cannabinoids found in hemp. Another important cannabinoid in hemp is tetrahydrocannabinol (THC), CBD’s psychoactive cousin. THC is the active ingredient in marijuana. However, THC exists in a different variety of hemp from CBD. Both CBD and THC have a major impact on the body’s endocannabinoid system.

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

Your Endocannabinoid System (ECS)

The endocannabinoid system (ECS) is part of the body’s nervous system first identified in 1992 by researchers exploring THC.  While experts are still trying to fully understand the ECS, so far we know it plays a role in regulating a range of functions such as sleep, mood, appetite, memory, reproduction and fertility.  The ECS exists and is active in your body even if you don’t use cannabis!

The ECS produces its own brand of CBD called endocannabinoids.  Endocannabinoids carry messages to locations throughout the body.  The purpose of these messages is to stabilize your body’s internal environment.  For example, if an outside force such as pain from an injury or a fever, throws off your body’s homeostasis, your ECS kicks in to help your body return to its ideal operation. 

To carry messages, endocannabinoids connect (or bind) to receptors throughout the body.  Experts have identified two types of receptors, CB1 and CB2. 

  • CB1 receptors are mostly found in the central nervous system.

  • CB2 receptors are mostly found in the peripheral nervous system, especially immune cells.

https://www.healthline.com/health/endocannabinoid-system

 
cdb_diagram_endocannabinoid.png

What Does CBD Do?  

CBD works by interfering with the body’s ECS.  In one case CBD blocks an enzyme which degrades one type of endocannabinoid, causing a prolonged effect.  In another case CBD enhances the production of one type of endocannabinoid, augmenting its effect. 

In addition, CBD binds to non- CB1 and CB2 receptors in the body.  For example, CBD binds to serotonin receptors in the brain, affecting mood, appetite, sleep patterns, pain reception, and anxiety.  CBD also binds to receptors in the nervous system which may provide some relief from pain and arthritis.  CBD blocks some brain receptors and activates other brain receptors, the effects of which are not completely understood. 

Types of CBD

There are three types of hemp-derived CBD.

  1. Full spectrum CBD hemp is derived from the whole hemp plant matter. That means taking the roots, stems, flowers and leaves and pressing, pulverizing, or power washing them to extract the oils from the plant. This will produce a full spectrum of cannabinoids.  While full spectrum CBD hemp extract is mostly CBD, it contains a small amount of THC and a smattering of other compounds. 

  2. Broad spectrum CBD hemp is created from the same process as full spectrum CBD, but the THC compound is chemically removed.  Many people find they cannot have any THC in their system, so broad spectrum products are becoming more popular.

  3. Isolate is a single CDB compound chemically extracted from the plant.  Through this process the oils, chlorophyll, plant material and all other compounds are removed leaving behind a 99% pure CBD product.

https://kchempco.com/blogs/news/types-of-cbd

Methods of CBD Delivery

CBD is a fat-loving (lipophilic) compound like vitamin D.  Effective delivery should occur in a lipid-friendly environment, the best being sub-lingual (under the tongue) as CBD oil (tincture) drops.  

In addition to oil CBD comes in pill form as capsules.  Other forms include edibles (gummies, chocolates, drinks) and topical (balms, patches, lotions, and roll-ons).  While these forms are generally less effective at being absorbed compared to oil, consistency and convenience may make the non-oil forms more attractive.  Oral delivery should occur with a high-fat meal to achieve maximum absorption. 

Are All CBD Products the Same? 

One of the issues with CBD is that it is not regulated by the federal government (e.g., FDA).  Currently CBD is classified as a supplement, the same as vitamins, herbs, tinctures, and infusions, and not a medication.  This means that claims shown on labels may or may not be accurate.  There is also concern that some CBD products contain contaminants such as pesticides, heavy metals, molds, and aflatoxins.  Also, we don’t know the most effective therapeutic dose of CBD for any particular medical condition.  Thus, caution is urged should you choose to use CBD. 

If considering CDB, always read the Supplement Facts panel on the package.  Ensure the product,

  • Is made from non-GMO hemp. 

  • Is produced and packaged in a FDA-registered facility

  • Has third party testing under Good Manufacturing Practices (GMPs)

  • Has certification analysis (C of A) to ensure labeled components are present. 

Third party test companies include ConsumerLab.com, NSF International, and U.S. Pharmacopeia (USP).  Some CBD packages have a QR code with a lot number.  The code directs the purchaser to lab test details of that specific batch.  Some specific CDB brands’ test results are shown on third party test company websites. 

https://www.consumerreports.org/supplements/how-to-choose-supplements-wisely/

 

CBD Health Benefits

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, which typically don’t respond to antiseizure medications. Recently the FDA approved the cannabis-derived medicine for these conditions, Epidiolex®, which contains CBD.

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.

CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed to substantiate these claims.

Is CBD Safe?

Currently there are over 1,700 products containing CDB.  Over 70% of these CBD products are adulterated.  CBD also has side effects such as nausea, fatigue, irritability and at high dosages, diarrhea.  CBD can increase the level of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit.  A significant safety concern with CBD is that it is primarily marketed as a supplement, not a medication.  Some brands claim unproven medical benefits.  We also don’t know the most effective therapeutic dose of CBD for any particular medical condition. 

CBD Dosing

It is recommended to begin a CBD regimen under the guidance of a knowledgeable medical provider or pharmacist.  One local pharmacist starts his patients at 10-15 mg CBD.  He then increases 5 mg every third day.  Patients are to hold the oil in their mouth for 3 minutes.  The average dosage to his patients ranges from 10-50 mg per day.  It has been shown that increased dosages have a declining efficacy. 

https://www.eaze.com/article/how-much-cbd-should-i-take-a-guide-to-proper-dosing

Summary

While CBD hemp has earned one approval from the FDA, other uses for the product have not been rigorously tested and thus, lack sufficient efficacy and safety evidence.  Dosages for a given medical condition are heuristic at best.  And because CBD is currently marketed as a supplement, there is a lack of adequate labeling, quality control, and potential drug interactions.  If you do choose to give CDB a try, please be cautious, review labeling, and seek guidance from a knowledgeable medical provider or pharmacist. 

 
 
 
 

Resources

What  You Need to Know (and What We’re Working to Find Out) About Cannabis or Cannabis-derived Products, Including CBD. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis Updated July 17, 2019.

Cannabidiol (CBD)- what we know and what we don’t. Harvard Health Publishing- Harvard Medical School. Written by Dr. Peter Grinspoon. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476 Published August 24, 2019. Updated August 27, 2019.

PowerPoint on Medical Cannabis:  side effects, drug reactions, safety profile. Department of Health- District of Columbia. https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Cannabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf

FDA Regulation of Cannabis and Cannabis-Derived Products: Questions and Answers. U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-questions-and-answers Updated April 2, 2019.

Abuse Potential Assessment for Cannabidiol (CBD). U.S. Food and Drug Administration. Presented by Katherine Bonsone, Pharmacologist on April 19, 2018. Slides: 37-63. https://www.fda.gov/media/112947/download

Scheduling of Cannabidiol. Drug Enforcement Administration. https://www.deadiversion.usdoj.gov/fed_regs/rules/2018/fr0928.htm

Warning Letters and Test Results for Cannabidiol-Related Products. U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/warning-letters-and-test-results-cannabidiol-related-products Updated July 24, 2019.