Scientific, Legal, and Regulatory Considerations for Cannabidiol
Robert E.C. Wildman, Richard S. Bruno in Handbook of Nutraceuticals and Functional Foods, 2019
Both marijuana and hemp are produced from the same species of plant, Cannabis sativa, though different varieties are cultivated for specific characteristics. Cannabidiol (CBD) is one of over 100 naturally occurring cannabinoids found in both marijuana and hemp. Although both marijuana and hemp come from Cannabis sativa, hemp typically has a much lower concentration of delta-9 tetrahydrocannabinol (THC), the psychoactive chemical found in marijuana that produces a “high” when consumed.1 The World Health Organization's Expert Committee on Drug Dependence discussed CBD during its 39th meeting, which took place in November 2017 in Geneva, Switzerland. The World Health Organization reported that when consumed by humans, pure CBD does not exhibit the effects indicative of abuse, dependence potential, or any public health-related problems.2 Although pure CBD does not produce a “high” or cause dependence in users, the legal status of CBD in the United States has been mired in an intricate web of regulatory and legal considerations that are worthy of examination.
Cannabis
G. Hussein Rassool in Alcohol and Drug Misuse, 2017
Cannabis is derived from a bushy plant, Cannabis Sativa, and the part that contains the ‘psychoactive’ substance is found primarily in the flowers (buds) due to the presence of the cannabinoid substance THC (Δ9-delta-9-tetrahydrocannabinol) and CBD (Cannabidiol). THC is the main active chemical in cannabis and there are also 60 different cannabinoids in the cannabis plant. The psychoactive elements are much less found in the seeds, leaves and stems of the plant. Cannabidiol is a cannabis compound that does not produce euphoria or intoxication but has significant medical benefits. In fact, it can actually counteract the psychoactivity of THC. Research evidence has shown CBD to have therapeutic value for a number of conditions including anti-seizure, antioxidant, neuroprotective, anti-inflammatory, analgesic, anti-tumor, anti-psychotic and anti-anxiety properties (Volkow 2015).
Medical cannabis in mental health–substance use
David B Cooper in Ethics in Mental Health–Substance Use, 2017
Cannabidiol (CBD) is a CB1 and CB2 antagonist (Pertwee 2008) that is present is some cannabis strains. Interestingly, it has been suggested that THC and CBD may have opposite properties: THC produces psychotic-like and anxiogenic effects in humans (D’Souza et al. 2004, D’Souza et al. 2005, D’Souza et al. 2008), while CBD might modulate THC’s euphoric (Dalton et al. 1976), appetitive (Morgan et al. 2010), anxiogenic, and other psychological/physical effects (Karniol et al. 1974, Nicholson et al. 2004, Zuardi et al. 1982). CBD may also have anti-seizure properties and a large clinical trial is currently underway in treatment resistant epilepsy in children (NCT02397863). CBD also showed great promise as an antipsychotic drug in pre-clinical and human studies as it was associated with fewer extrapyramidal side effects than conventional antipsychotics (Fakhoury 2016).
Expectancies about the effects of cannabidiol products on anxiety symptoms
Published in Journal of Substance Use, 2023
Brianna R. Altman, Maha N. Mian, Luna F. Ueno, Mitch Earleywine
Furthermore, nearly 94% of participants endorsed lifetime cannabis use, followed by high rates of average use. This high prevalence of cannabis use is noteworthy, as individuals who hold strong beliefs about cannabis-based products might have overstated CBD’s potential positive effects. While no significant correlations appeared between anxiety and CBD use, results revealed a weak association between cannabis intoxication and anxiety symptoms. The self-medication hypothesis, which states that individuals attempt to reduce symptoms through substance use, might support this finding (Khantzian, 1987). Prior research demonstrates a high comorbidity of anxiety and cannabis use (Crippa et al., 2009). Individuals might consume cannabis to cope with intense anxiety. Alternatively, individuals under the influence of cannabis might experience heightened feelings of anxiety; this might be especially true for those who do not use regularly or after consuming highly potent products (Crippa et al., 2009; Hall & Solowij, 1998). More research is needed to elucidate the complicated relations between cannabis use and anxiety. Still, our results did not find significant relations between cannabis use and CBD’s impact on anxiety symptoms. Perhaps because cannabidiol is non-intoxicating, individuals’ experiences with cannabis intoxication did not generalize to their CBD expectancies.
Current and future pharmacotherapy options for drug-resistant epilepsy
Published in Expert Opinion on Pharmacotherapy, 2022
Samia Elkommos, Marco Mula
Cannabidiol is only available as an oral solution and requires twice daily divided dosing. It is highly protein bound with low oral bioavailability. Importantly, cannabidiol undergoes extensive hepatic metabolism through the CYP3A4 and CYP2C19 enzymes and, therefore, has several interactions. The most pertinent is with clobazam whereby cannabidiol can increase clobazam levels by 60% on average, and subsequently increase the concentration of clobazam’s active metabolite N-desmethylclobazam, therefore requiring a reduction in clobazam dose [47,48]. In a study of cannabidiol in people with LGS, combining cannabidiol with clobazam showed a greater anti-seizure effect [49]. Cannabidiol may also lead to an increase in liver enzymes, especially in combination with sodium valproate, and monitoring of liver functional tests is therefore advised before initiating treatment with cannabidiol and at 1, 3 and 6 months after starting treatment.
Cannabidiol drug interaction considerations for prescribers and pharmacists
Published in Expert Review of Clinical Pharmacology, 2022
Myfanwy Graham, Jennifer H Martin, Catherine J Lucas, Bridin Murnion, Jennifer Schneider
There has been a surge in public interest and research into using cannabidiol as a medicine. Cannabidiol is one of the two major phytocannabinoids in cannabis. Its pharmacodynamic profile at both cannabinoid and non-cannabinoid receptors is different to that of the other major cannabinoid, tetrahydrocannabinol, although they are both lipids and require metabolism for excretion [76]. Cannabidiol has been used to treat many different clinical conditions, including rare types of epilepsy, managing pain, anxiety, and sleep disorders [77]. Since cannabidiol is commonly added to existing drug regimens, interactions between cannabidiol and other co-administered drugs may occur. The extent of interaction between drugs depends on the plasma drug concentrations of each drug and the systemic exposure measured by the AUC. Plasma drug concentrations and AUC are determined by the dose, dosing regimen, formulation, route of administration, and drug pharmacokinetics. Additional variability may be conferred by pharmacogenomic diversity.
Related Knowledge Centers
- Anxiety
- Cannabis
- Cognition
- Dietary Supplement
- Tetrahydrocannabinol
- Cannabinoid
- Movement Disorder
- Route of Administration
- Vaporizer
- Oral Administration