The use of CBD oils may be increasingly in vogue when it comes to everything from anxiety relief to anti-inflammatory healing, the use of cannabis in medicine is no new phenomenon.
Cannabis is a plant-based or botanical product with a history dating back to the ancient world. The first convincing evidence that it was used as a medicine is from AD400 and in the US cannabis was extensively used as a medicine in the 19th and early 20th century.
However, in 1937 federal restriction on both the use and sale of cannabis was put in place and its use in medicine came to an end around 1942. Fast forward half a decade and in 1996, California was the first state to legalise the use of botanical cannabis under physician supervision.
As of 2019, more than 20 countries have legalised the use of medical cannabis and more than 30 states in the US alone.
How does CBD oil work?
In order to understand this, we first have to understand where these drugs work. Endocannabinoids (eCBs) and their receptors are found throughout the human body in places such as the nervous system, internal organs, connective tissues, glands and immune cells. The eCB system has a role better known as “eat, sleep, relax, forget and protect”.
There are two main components in cannabis- and cannabinoid-related products, the psychoactive component THC (tetrahydrocannabinol) and the non-psychoactive component CBD (cannabidiol). Due to CBD’s non-psychoactive effects, it has gained significant interest in the medical community and has shown a high potential for therapeutic use, including as an antiepileptic (treat epilepsy), anxiolytic (treat anxiety), antipsychotic (treat psychosis and mental health-related problems) and anti-inflammatory (treat pain and arthritis).
It also has neuroprotective effects and thus may have applications in diseases such as pain (chronic and neuropathic), diabetes, cancer and neurodegenerative diseases, such as Huntington’s disease. Alongside this, CBD – in combination with THC – has received regulatory approvals in several European countries and is under study in registered trials with the FDA.
CBD oils come in various dosages, but the most common consumption is between 20 and 40mg per day, depending on what you’re using it for. Oils tend to come with dropper caps or as sprays, so you can effectively measure dosage. It’s usually held under the tongue for 30 seconds to a minute in order to absorb.
What is medical marijuana licensed for in the UK?
Currently, medical cannabis products are licensed for three conditions (prescribed by a specialist):
- A severe and rare form of epilepsy called Dravet syndrome and Lennox-Gastaut syndrome (LGS), which classically does not respond to usual antiepileptics.
- Nausea and vomiting caused by chemotherapy, when other medications have not worked.
- Muscle stiffness and spasms in people suffering with multiple sclerosis (MS).
Are there unwanted or adverse effects from CBD oil?
Much of what is known about the adverse effects of medicinal cannabis comes from studies of recreational users of marijuana. An important consideration here is that street cannabis often contains a much higher THC content (and thus less CBD): this “skunk” is what the majority of UK cannabis users are using.
Short-term use of cannabis can cause impaired short-term memory, impaired motor coordination, altered judgment and paranoia or psychosis at high doses.
Long-term or heavy use of cannabis, especially in individuals who begin using it early (teenage years) can lead to addiction, altered brain development resulting in cognitive impairment with poor educational outcomes and significant effects on quality of life. It is also associated with chronic lung disease and an increase in psychosis-related health disorders, such as schizophrenia and variants of depression. It has also been recognised (in people with a predisposition to these conditions) to increase the risk of heart attacks and strokes.
In light of the reported risks of recreational cannabis use, a systematic review, published in the Canadian Medical Association Journal in 2018, examined 31 studies (23 randomised controlled trials and eight observational) looking at the adverse events associated with medical cannabis. The median exposure to cannabinoid products was two weeks (eight hours to 12 months) and despite more than 4,700 adverse events, 97 per cent of them were deemed not to be serious, with the majority being vomiting, dizziness, urinary tract infections and relapse of the underlying disease (multiple sclerosis).
Despite ongoing debate, the medical use of cannabis and cannabinoid-related products represents the revival of a plant with historical significance into modern-day healthcare. It is interesting that this appears to be parallel to controversies regarding the use and abuse of prescription opioids in the US (see my opioid crisis article). Ultimately, however, whether recreational or prescribed, cannabinoid products are a group of drugs with their own set of potential health benefits and risks.