CBD has been in the news before, as a possible treatment for epilepsy. Research is still in its early days. Researchers are testing how much CBD is able to reduce the number of seizures in people with epilepsy, as well as how safe it is. The American Epilepsy Society states that cannabidiol research offers hope for seizure disorders, and that research is currently being conducted to better understand safe use.
Advantages of CBD oil treatment
Other studies find CBD helpful in reducing various psychiatric and medical symptoms like anxiety, insomnia and pain in patients with substance use disorders, indicating that CBD may be an effective treatment for opioid addiction. However, further studies are necessary.
Research suggests people with ALS can benefit from the entourage effect created by the combination of THC and CBD, similar to people with PTSD. In a 2019 study, patients received a combination of THC and CBD in varying doses depending on their needs and preferences. Those with mild, moderate or severe spasticity (muscle tightness and stiffness) due to ALS reported high levels of satisfaction with the treatment, and those with moderate to severe spasticity reported higher satisfaction rates than those with mild spasticity.
Arthritis involves the deterioration of the tissues in and around your joints. There are several types of arthritis, and symptoms include pain, stiffness and loss of motion. Arthritis treatment usually targets pain relief and improved joint function.
In 2018, in a study of more localized treatment, researchers administered a synthetic CBD gel in either 250-milligram or 500-milligram doses daily or a placebo to patients with knee pain due to osteoarthritis. Patients also stopped taking any other anti-inflammatory medications or painkillers, with the exception of acetaminophen, before and during the study period.
Meyer T, Funke A, Münch C, et al. Real world experience of patients with amyotrophic lateral sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD). BMC Neurol. 2019;19(1):222.
Blake DR, Robson P, Ho M, Jubb RW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology. 2006;45(1):50-52.
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Although researchers are cautiously optimistic that CBD may be helpful in the treatment of some types of pain, especially when combined with THC, more high quality studies are needed to determine its effectiveness in pain management.
Epidiolex, a prescription cannabidiol product, was approved for use by the FDA in 2018 for the treatment of seizures associated with two severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.
In 2020, Epidiolex received FDA approval for the treatment of seizures caused by tuberous sclerosis complex, a rare genetic disease that causes benign tumors to grow in the brain and other areas of the body (23).
Another study that included 26 healthy men found that treatment with 600 mg of CBD for 7 days led to significant reductions in blood pressure in the short term compared with a placebo group. However, the effect was lost after 7 days (26).
Currently, the only CBD product approved by the Food and Drug Administration is a prescription oil called Epidiolex. It's approved to treat two types of epilepsy. Aside from Epidiolex, state laws on the use of CBD vary. While CBD is being studied as a treatment for a wide range of conditions, including Parkinson's disease, schizophrenia, diabetes, multiple sclerosis and anxiety, research supporting the drug's benefits is still limited.
Laux LC, Bebin EM, Checketts D, et al. Long-term safety and efficacy of cannabidiol in children and adults with treatment resistant Lennox-Gastaut syndrome or Dravet syndrome: Expanded access program results. Epilepsy research. 2019;154:13-20. doi:10.1016/j.eplepsyres.2019.03.015
The renewed interest in the therapeutic effects of cannabis emanates from the movement that began 20 years ago to make cannabis available as a medicine to patients with a variety of conditions. It was in 1996 that Arizona and California first passed medicinal cannabis legislation, although Arizona later rescinded the approval, so it would be California that paved the way. At the time that this report was written, in 2016, 28 states and the District of Columbia had legalized the medical use of cannabis; 8 states had legalized both medical and recreational use of cannabis; and another 16 states had allowed limited access to low-THC/high-CBD products (i.e., products with low levels of THC and high levels of CBD) (NCSL, 2016). A recent national survey showed that among current adult users, 10.5 percent reported using cannabis solely for medical purposes, and 46.6 percent reported a mixed medical/recreational use (Schauer et al., 2016). Of the states that allow for some access to cannabis compounds, cancer, HIV/AIDS, multiple sclerosis, glaucoma, seizures/epilepsy, and pain are among the most recognized qualifying ailments (Belendiuk et al., 2015; NCSL, 2016). There are certain states that provide more flexibility than others and that allow the use of medical cannabis for the treatment of any illness for which the drug provides relief for the individual. Given the steady liberalization of cannabis laws, the numbers of these states are likely to increase and therefore support the efforts to clarify the potential therapeutic benefits of medical cannabis on various health outcomes.
Five good- to fair-quality systematic reviews were identified. Of those five reviews, Whiting et al. (2015) was the most comprehensive, both in terms of the target medical conditions and in terms of the cannabinoids tested. Snedecor et al. (2013) was narrowly focused on pain related to spinal cord injury, did not include any studies that used cannabis, and only identified one study investigating cannabinoids (dronabinol). Two reviews on pain related to rheumatoid arthritis did not contribute unique studies or findings (Fitzcharles et al., 2016; Richards et al., 2012). Finally, one review (Andreae et al., 2015) conducted a Bayesian analysis of five primary studies of peripheral neuropathy that had tested the efficacy of cannabis in flower form administered via inhalation. Two of the primary studies in that review were also included in the Whiting review, while the other three were not. It is worth noting that the conclusions across all of the reviews were largely consistent in suggesting that cannabinoids demonstrate a modest effect on pain. For the purposes of this discussion, the primary source of information for the effect on cannabinoids on chronic pain was the review by Whiting et al. (2015). Whiting et al. (2015) included RCTs that compared cannabinoids to usual care, a placebo, or no treatment for 10 conditions. Where RCTs were unavailable for a condition or outcome, nonrandomized studies, including uncontrolled studies, were considered. This information was supplemented by a search of the primary literature from April 2015 to August 2016 as well as by additional context from Andreae et al. (2015) that was specific to the effects of inhaled cannabinoids.
The majority of studies on pain cited in Whiting et al. (2015) evaluated nabiximols outside the United States. In their review, the committee found that only a handful of studies have evaluated the use of cannabis in the United States, and all of them evaluated cannabis in flower form provided by the National Institute on Drug Abuse that was either vaporized or smoked. In contrast, many of the cannabis products that are sold in state-regulated markets bear little resemblance to the products that are available for research at the federal level in the United States. For example, in 2015 between 498,170 and 721,599 units of medical and recreational cannabis edibles were sold per month in Colorado (Colorado DOR, 2016, p. 12). Pain patients also use topical forms (e.g., transdermal patches and creams). Thus, while the use of cannabis for the treatment of pain is supported by well-controlled clinical trials as reviewed above, very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States. Given the ubiquitous availability of cannabis products in much of the nation, more research is needed on the various forms, routes of administration, and combination of cannabinoids.
Cancer is a broad term used to describe a wide range of related diseases that are characterized by an abnormal, unregulated division of cells; it is a biological disorder that often results in tumor growth (NCI, 2015). Cancer is among the leading causes of mortality in the United States, and by the close of 2016 there will be an estimated 1.7 million new cancer diagnoses (NCI, 2016). Relevant to the committee's interest, there is evidence to suggest that cannabinoids (and the endocannabinoid system more generally) may play a role in the cancer regulation processes (Rocha et al., 2014). Therefore, there is interest in determining the efficacy of cannabis or cannabinoids for the treatment of cancer.
The committee did not identify any good-quality primary literature that reported on cannabis or cannabinoids for the treatment of cancer that were published subsequent to the data collection period of the most recently published good- or fair-quality systematic review addressing the research question.
Clearly, there is insufficient evidence to make any statement about the efficacy of cannabinoids as a treatment for glioma. However, the signal from the preclinical literature suggests that clinical research with cannabinoids needs to be conducted. 2ff7e9595c
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