Over the past few years, increasing public and political pressure has supported legalization of medical marijuana. One of the main thrusts in this effort has related to the treatment of refractory epilepsy—especially in children with Dravet syndrome—using cannabidiol (CBD). Despite initiatives in numerous states to at least legalize possession of CBD oil for treating epilepsy, little published evidence is available to prove or disprove the efficacy and safety of CBD in patients with epilepsy. This review highlights some of the basic science theory behind the use of CBD, summarizes published data on clinical use of CBD for epilepsy, and highlights issues related to the use of currently available CBD products.
CBD is the major non-euphorigenic component of Cannabis sativa. Some research is beginning to show that CBD is different than other well-studied cannabinoids. All cannabinoids function as ligands, meaning they dock onto the binding site of a protein and have the ability to modulate a receptor’s behavior. CB1 receptors are widely distributed, but are particularly abundant in areas of the brain, including those concerned with movement, coordination, sensory perception, emotion, memory, cognition, autonomic and endocrine functions.
In fact, CBD is therapeutic in nature, and will work to manipulate bodily systems at the cellular level to return afflicted organ systems, tissue systems, and even chemical systems in the central nervous system back to a state of health and homeostasis. This is precisely why it has been capable of treating conditions such as depression and anxiety, to chronic physical ailments such as pain, inflammation, arthritis, and more.
Social media is blasting this one out lately, showing that different parents have been treating their children illegally (in states that are not classed as medical states) to help prevent their children from having seizures or deal with epilepsy. While there has been limited scientific evidence on the topic, 2016 was a major turning point for the plant as a major study was conducted by Orrin Devinsky, a neurologist at New York University Langone Medical Center, showing profound results.
CBD is well tolerated in humans with doses up to 600 mg not resulting in psychotic symptoms (15). In the few small placebo-controlled studies performed, no significant CNS effects were noted. Oral CBD undergoes extensive first-pass metabolism via CYP3A4, with a bioavailability of 6%. Following single doses in humans, the half-life of CBD when taken orally is about 1 to 2 days.1 In vitro studies have shown that CBD is a potent inhibitor of multiple CYP isozymes, including CYP 2C and CYP3A (16, 17). Whether these in vitro observations are relevant at plasma concentrations likely to be seen in patients is unclear. In addition, given its metabolism via CYP3A4, clinical trials of CBD in patients receiving enzyme-inducing AEDs, such as carbamazepine or phenytoin, will require detailed pharmacokinetic studies.
Oils: CBD oils are the most potent and unprocessed form of cannabidiol. CBD oil is removed directly from the flowers, stalks and seeds of the hemp plant during the extraction process. The most effective CBD oils are full spectrum, which means that they include all compounds found naturally in the plant, including the cannabinoids (with trace amounts of THC), terpenes and essential oils. You can find CBD oils in a bottle with a dropper. This allows you to ingest the oil by using it by mouth.
So when people began touting the benefits of CBD for pain, it was a big deal. A non-addictive substance that can ease pain without making you feel high or groggy? It’s easy to see why CBD has been making so many waves. In fact, cannabis plants have a long history as a pain reliever. Whether or not it’s true that Queen Victoria took CBD-rich cannabis to help with menstrual cramps, it is certainly true that her royal physician, Sir J. Russell Reynolds, listed cannabis as “one of the most valuable medicines we possess.” Victorian doctors aside, there are also ancient Assyrian and Ayurvedic manuscripts that recommend cannabis for pain.