Undecarboxylated cannabis oil is more energising, but takes longer to make; decarboxylated oil is more sedating and takes less time to make. The best way is to experiment and see what suits you best.
Try to become your own doctor, because food is medicine, and cannabis is food. It is great fun to experiment with eating cannabis, as well as boosting your endocannabinoid system at the same time. Enjoy!
However, many have adopted a policy of decriminalisation to make simple possession a non-criminal offense (often similar to a minor traffic violation). Others have much more severe penalties such as some Asian and Middle Eastern countries where possession of even small amounts is punished by imprisonment for several years. Countries that have legalised recreational cannabis are Canada, Georgia, South Africa, and Uruguay, plus eleven states and the District of Columbia in the United States and the Australian Capital Territory in Australia. Legality varies in these countries and subnational jurisdictions when it comes to commercial sale. A policy of limited enforcement has also been adopted in many countries, in particular Spain and the Netherlands where the sale of cannabis is tolerated at licensed establishments.
Countries that have legalised the medical use of cannabis include Argentina, Australia, Canada, Chile, Colombia, Croatia, Cyprus, Germany, Greece, Israel, Italy, Jamaica, Lithuania, Luxembourg, North Macedonia, Norway, the Netherlands, New Zealand, Peru, Poland, Switzerland, and Thailand. Others have more restrictive laws that only allow the use of certain cannabis-derived pharmaceutical drugs, such as Sativex, Marinol, or Epidiolex. In the United States, 33 states and the District of Columbia have legalised the medical use of cannabis, but at the federal level its use remains prohibited for any purpose.
โThe ancient Chinese knew of cannabis pain-relieving and mind-altering effects, yet it was not widely employed for its psychoactive properties; instead it was cultivated as hemp for the manufacture of rope and fabric. Likewise, the ancient Greeks and Romans used hemp to make rope and sails. In some other places, however, cannabis intoxicating properties became important. In India, for example, the plant was incorporated into religious rituals. During the Middle Ages, its use was common in Arab lands; in 15th-century Iraq it was used to treat epilepsy; in Egypt it was primarily consumed as an inebriant. After Napoleonโs occupation of Egypt, Europeans began using the drug as an intoxicant. During the slave trade, it was transported from Africa to Mexico, the Caribbean and South America. cannabis gained a following in the U.S. only relatively recently. During the second half of the 19th century and the beginning of the 20th, cannabis was freely available without a prescription for a wide range of ailments, including migraine and ulcers,
There is a maximum sentence for each drug offence set by law, but in practice they arenโt used very often.
Sentencing for drug offences is mainly set out in the Sentencing Councilโs Definitive Guideline for Drug Offences. The Court takes steps to decide on how serious the offence is and what the starting sentence point is for an offence. From the starting point the sentence can go up if there are things that make your offence more serious (aggravating factors), or down if there are things that make it less serious (mitigating factors), within a lower and upper range. You can also get a lower sentence if you plead guilty โ the amount of discount will depend on how early you say you are guilty.
There is no statutory right to a discount for an early guilty plea. Section 144 of the Criminal Justice Act 2003 states that it remains down to the discretion of the Court. It was in R v Buffrey (14 Cr. App. R (S) 511) that the Court detailed general percentages for certain early guilty pleas. For example, one third for pleading guilty on first opportunity. There is no guarantee that an early guilty plea will result in a specified reduction in sentence, but in practice they usually do.
There are some outcomes which are given outside of the court. For more information on the Cannabis Warning Scheme please see the Cannabis Law section in our Drugs A-Z.
The following is about the sentencing of adults for drug offences โ for information on sentencing of young people below the age of 18 please see the section below.ใ
In practice, the first time you are caught in possession of a small amount of any drug for personal use you may get a formal caution. Cautions are dealt with at the police station and you must admit that you are guilty of the offence to get one. This is not a conviction, but is recorded as part of a criminal record and can affect education, employment and travel. It is possible to get another caution if you are arrested another time. Cautions can have conditions added to them, such as drug treatment, but most donโt.
You might be charged with possession if you have had cautions or convictions for similar offences before, or if you have more than a small amount of drugs on you. There is no set amount of drugs where the police will decide to charge instead of giving a caution. It is possible to challenge a police decision to charge you instead of giving a caution. For advice on this please call the Release helpline or email us.
If it is your first offence, the Court can give you an absolute or conditional discharge. An absolute discharge is no punishment at all, but you will still have a criminal record. A conditional discharge means that if you are convicted of another offence within a certain time (normally 12 or 18 months) you can be sentenced for the new and old offence.
You are most likely to get a fine at court for drug possession (sometimes you will also get a discharge) if it is a first offence, or it has been a long time since your last conviction. A fine is expected to be paid straight away but if you get benefits or have a low income you can make an arrangement to pay in instalments. The least amount that a court will accept is ยฃ5 per week.
If you have previous convictions for possession of drugs or other drug offences, the worse the sentence will be. It is possible to go to prison for a few weeks or months for simple possession. You will get a harsher sentence if you were in possession of drugs in or near a school, or in a prison. You will get a lesser sentence if you have no previous convictions or if you are charged with cannabis possession and are using it to help relieve the symptoms of a medical condition.
The Sentencing Council’s detailed tables for this offence can be viewed here at page 30.
For most other offences the Court decides a sentence based on a range of factors. As a starting point the Judge or Magistrates will look at the defendantโs โculpabilityโ and the โharmโ associated with the offence.
Culpability is decided by considering the type of role that the defendant undertook; for example, did they make a profit? Did they have control over others involved in the supply chain? Was it solely for their own use? Or, did they provide drugs to friends for no money? These types of questions will determine what type of role the Court considers applicable to the offence. There are three possible roles that a court can consider:
Depending on the type of offence the court will consider different things to determine which role a person falls into. Normally if you are working alone, have no knowledge and/or influence over what other people might be doing, or are being pressured or exploited in some way then you will be thought to be in the ‘lesser role’. As soon as you are controlling/managing in some way, or there is a financial gain, there is a risk of falling into the ‘significant role’. You will be classed to be in the โleading roleโ if you are organising an operation that could be at a commercial level.
The Court will determine the level of harm by the quantity of drugs seized. For most offences there are four categories, with Category 4 dealing with the smallest quantity and Category 1 the largest.
By matching your role (โculpabilityโ) with the level of harm the Court will reach a starting point for your sentence and also an upper and lower range that it must stay between. These will be different for each different class of drug. Your sentence might go up if you have previous convictions for the same/similar offence, if violence or weapons were used/threatened, or if the drugs had a high purity. Your sentence might be less if you have no previous convictions, are vulnerable in some way or committed the offence because of your own drug use. If you plead guilty to an offence your sentence can be reduced by up to a third of what it would have been, depending on if you have said that you are guilty at an early or late stage. Personal factors can also cut a sentence. The Court can depart from the guidelines if it is in the interests of justice to do so.
These offences can be very serious and you are at risk of getting a prison sentence if convicted. However, because supply can range from simply passing some drugs to a friend (technical supply) right through to selling drugs on a very large scale, the sentences can also be very different. At the lower end of the scale if you are only supplying a small amount of a Class C drug it is possible to get a fine, but otherwise you should expect to get at least a community order and/or a suspended prison sentence.
A community order is supervised by a probation officer and can be made up of a number of different things, including drug treatment and unpaid work. At the other end of the scale, supply of 5kg of cocaine could see a starting sentence of 14 years’ imprisonment in circumstances where the defendant was considered to have a ‘leading role’. This demonstrates the huge variation in possible sentences for this offence.
The Sentencing Council’s detailed tables for this offence can be viewed here at page 11.
These offences are also taken very seriously and a prison sentence is a real risk if you are convicted. Production can range from growing a few of cannabis plants through to producing large amounts of cocaine on a commercial scale. If you have only grown one or two cannabis plants it is possible to get a caution at the police station. However, normally you will be charged and if convicted then you will be sentenced at court. Community orders, suspended sentences and prison sentences are often given for these offences.
The difference between production and cultivation is that if you are convicted of production you can also have a case against you for proceeds of crime. These hearings happen after you are convicted and sentenced. You can be ordered to pay back an amount of money that the Court says you made from your criminal activity. If you do not pay this you can be given another prison sentence.
The Sentencing Council’s tables for this offence can be viewed here at page 18.
If you are convicted of importing or exporting drugs a prison sentence is likely; however, there are exceptions. If the quantity of the controlled drug is equal to or less than the amount specified in Category 4 of the sentencing guidelines regardless of the class of drug, the Judge or Magistrate will refer directly to the starting point and ranges for possession or supply offences depending on the intent of the individual in undertaking the export/import.
If treated as an import/export offence the purity of the drugs will affect the seriousness of the offence and may make a sentence longer or shorter.
The Sentencing Council’s tables for this offence can be viewed here at page 5.
The Court decides the sentence for this offence a bit differently. Instead of a role they look at how responsible you are for what happened to determine culpability, which will be classed as either higher or lower. There are then two levels of harm โ greater and lesser โ which are based on how often drug-taking has happened at the address and/or the amount of drugs involved. The Court matches up the level of culpability and harm to fit you into one of three categories and get a sentence starting point and range. Each class of drug has different sentences, but generally you can expect a fine and/or a community order. It is possible to get a prison sentence for this offence, especially if there is a lot of drug activity at the address, it has been going on for a long time, or children are present. A lesser sentence might be given if you have been threatened or forced to allow people to use your property.ใ
The Sentencing Council’s detailed tables for this offence can be viewed here at page 24.
For information on how cannabis possession is dealt with for people under 18 go to the Cannabis Law section in our Drugs A-Z.ใ
If you are under 18 and it is your first offence you will normally be given a youth caution (formerly called reprimands and final warnings) which is not a conviction, but does stay on your criminal record forever and can affect education, employment and travel. It is possible to get another youth caution if you are arrested another time.
You might be charged and have to go to the Youth Court if you have youth cautions or convictions for similar offences before, or had more than a small amount of drugs on you. There is no set amount of drugs where the police will decide to charge instead of giving a youth caution. It is possible to challenge a decision to charge you instead of giving a youth caution. For advice on this please call the Release helpline or email us.
If it is your first offence, and you plead guilty, the Youth Court can give you an absolute or conditional discharge. An absolute discharge is no punishment at all, but you will still have a criminal record. A conditional discharge means that if you are convicted of another offence within a certain time (normally 12 or 18 months) you can be sentenced for the new and old offence. The Court do not have to give you a discharge and often sentence young people to referral orders for their first conviction if they are pleading guilty (they ignore any absolute or conditional discharge you may have been given before). A referral order will be for between three and 12 months and will be managed by the local Youth Offending Team โ you will need to meet with them regularly and they can make you do lots of different things, such as drug treatment and work in the community.
You might be given a youth rehabilitation order if the Court thinks the offence is serious enough. You can be made to do a number of different things, including drug treatment and work in the community.
Prison sentences are a last option for young people, but if the offence is extremely serious then you might get a detention and training order. For part of this you will be in a Young Offenderโs Institution, and the rest of it will be supervised in the community.
Under the โSlip Ruleโ the Crown Court can alter a sentence/order made by the Crown Court up to 56 days since it was made. Usually this rule is not used; however, it may be relevant when the Court overlooked a statutory provision or new evidence relevant to sentencing comes to light.
In sentencing, if there is a disagreement with regards to the facts of the case, in circumstances where the defendant has plead guilty, either side can call evidence to support their position. This would be undertaken through a Newton Hearing, established in the case of R v Newton (1983) (77 Cr.App.R.13). This will necessitate a hearing in front of the Judge about the disputed facts; for example, in a case involving supply of a controlled drug the defence may not accept the prosecution’s evidence as to the value of the drugs seized and wish to bring independent expert evidence to support their assertion.
A Judge may also decide in sentencing that it is appropriate to make an ancillary order. These can include things such as drinking banning orders, or football banning orders. It will be the prosecution advocateโs duty to apply for appropriate ancillary orders and the Judge to determine whether they are necessary.
You already know what terpenes are because youโve experienced them all your life. Simply put, terpenes are what gives an orange its citrusy smell. They give pine trees their unique aroma. Theyโre even responsible for the relaxing effects in lavender. They are chemicals that determine how things smell.
But wait. You thought that cannabinoids were the compounds in the cannabis plant that caused healing, right? Yes, but itโs been discovered that terpenes can play a big role in that as well. In fact, cannabinoids and terpenes work together in something called the entourage effect.
The entourage effect simply means that cannabinoids such as THC and CBD, along with the hundreds of other compounds, along with the terpenes, are meant to work together. Itโs the whole plant that does the best job, not just a single compound. While relief does come from using a CBD oil or a THC oil, whole plant therapy has been the most common use. Utilizing all the compounds and terpenes in the plant may just be the best way after all.
Terpenes can intensify or downplay the effects of the cannabinoids. Have you ever noticed how two similar strains can produce profoundly different effects? One may leave you with couch lock and the other may energize you? Thatโs another aspect of the entourage effect, which is driven by both cannabinoids and terpenes.
Currently, there are at least 20,000 different terpenes in existence and the cannabis plant has more than 100 of these terpenes. Many terpenes that are produced by the cannabis plant are also found elsewhere in nature. However, there are a couple of terpenes that are in high concentrations in cannabis plants. Here are the ones to know.
Myrcene, which can also be found in mangoes, is the primary terpene found in cannabis plants. In fact, some plants can have up to 65 percent of their terpene profile made up by myrcene alone. The presence of myrcene often determines whether a specific strain can be considered an indica or sativa. Plants with more than 0.5 percent myrcene are said to be indica. Myrcene is responsible for giving marijuana its distinctive aroma. Myrcene has relaxing properties as well as anti-inflammatory properties. Strains that are high in myrcene are Skunk XL, White Widow, and Special Kush.
The second most abundant terpene found in cannabis, limonene can also be found in various citrus fruits and is responsible for the citrusy smell. However, it may not be present in all cannabis strains. Limonene has powerful anti fungal and antibacterial properties, and its great smell means that it is a common additive in household cleaning and cosmetic products. Limonene can also help to bust stress and enhance mood. Strains high in Limonene include Sour Diesel and OG Kush as well as Super Lemon Haze.
This terpeneโs name says it all, really. Pinene is found most abundantly in the pine tree and is what gives pine needles its distinctive smell. Found in two varieties, alpha, which is responsible for that wonderful pine aroma, and beta, which has a scent like rosemary, dill, or parsley. Pinene is a strong bronchodilator, but also has strong anti-inflammatory and antiseptic effects that have been used for centuries in herbal medicines. Pinene can be found in strains like Strawberry Cough and Blue Dream.
If youโve ever used lavender for its relaxant effects, then youโre familiar with the terpene linalool. Linalool is widely known for the stress-relieving, anti-anxiety, and anti-depressant effects. Linalool can help to balance out the anxious side effect sometimes produced by THC and this makes it an ideal terpene for the treatment of anxiety. Linalool is present in strains like Special Kush, Amnesia Haze, and OG Shark.
This terpene, which has a spicy, woody, peppery scent, is also found in black pepper and cinnamon. Studies indicate that this one small terpene is capable of performing the big job of treating anxiety, depression, and inflammation. Caryophyllene is found in such strains as Super Silver Haze, Skywalker, and Rock Star.
While many other strains help to increase appetite, which is beneficial to those who have conditions which nausea and loss of appetite are a factor, strains that contain humulene may actually help to decrease appetite. Found in hops, cloves, and basil, humulene has also shown anti-inflammatory and antibacterial properties in research. Strains which contain humulene include Liberty Haze, Girl Scout Cookies, and Sour Diesel.
As said, cannabis contains some 100 known terpenes, all of which produce their own effects. Combined with the cannabinoids and other terpenes, the future of cannabis may just be in the cultivation of strains rich in certain terpenes and cannabinoids to create strains tailored to produce certain effects.
Carbonization destroys many of the terpenes, just like it destroys many of the cannabinoids. Because of this, using a portable vaporizer with temperature control is probably the best way to get the most out of the terpenes found in cannabis. Like cannabinoids, terpenes have their own individual optimal temperature, and these temps can vary widely. Researching the various temperatures at which the terpenes you desire to be released is key in achieving the desired effect.
Terpenes and cannabinoids are two compounds found in cannabis that when used together help produce a synergistic effect. Selecting strains based upon the terpenesโ effects can help you to achieve the result you desire.
Michael Jacobs is a marketing and creative content specialist at GotVape.com.
It may take five years or even longer for the prohibition to be fully lifted but it is an utter fallacy to suggest this country will resist the inexorable trend that has taken hold in the United States, Canada, Spain and other western countries.
Legalisation is coming, no matter what Irish policymakers may say about the prospect now.
Doctors and campaigners and those who work in criminal justice will argue it out. But they are not the only ones driving the agenda. Once blue-chip international capital begins swirling around an issue โ and this has already begun here โ the die is basically cast.
Thatโs a grubby truism, but a truth nonetheless. Companies lobby, they fund major studies to sway opinion, they promise jobs and taxes.
Cannabis is already fully legal for all types of use in Canada. It is a burgeoning industry there funded by Wall Street investors such as Blackrock, Vanguard Group and Morgan Stanley. It is legal for, wink wink, medicinal use in about 33 US states, and recreational use in 11, including big hitters such as California and Illinois. The US is the biggest honey pot for cannabis capitalists.
Cannabis is the next-best thing to legal in Portugal; itโs legal in private in Spain, once you donโt annoy people in public; possession is decriminalised or consumption is effectively tolerated in private in countries such as Israel, the Netherlands, parts of Australia, Austria, and much of Latin America.
New Zealanders will vote on making it legal next year. So it is obvious where global opinion is moving.
Despite the health risks and the fallacious โgateway drugโ debate, more solid civil liberties arguments are winning out in country after country. This trend will continue because there are few compelling arguments to reverse it. There are many good arguments for why people should not smoke cannabis or why they should consume it rarely. But they are weak arguments for maintaining legal prohibition in free societies.
The development of neural circuits in youth, at a particularly important time in their lives, can be heavily influenced by external factors โ specifically the frequent and regular use of cannabis โ leading to compromised cognitive control.
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), reports that alterations in cognitive control โ an ensemble of processes by which the mind governs, regulates and guides behaviours, impulses, and decision-making based on goals are directly affected.
The researchers found that these brain alterations were less intense in individuals who recently stopped using cannabis, which may suggest that the effects of cannabis are more robust in recent users. Additional findings from the study also suggest greater and more persistent alterations in individuals who initiated cannabis use earlier, while the brain is still developing.
Lead author Marilyn Cyr, PhD, said: โMost adults with problematic substance use now were most likely having problems with drugs and alcohol in adolescence, a developmental period during which the neural circuits underlying cognitive control processes continue to mature.
โAs such, the adolescent brain may be particularly vulnerable to the effects of substance use, particularly cannabisโthe most commonly used recreational drug by teenagers worldwide,โ added the postdoctoral scientist in the Division of Child and Adolescent Psychiatry at the New York State Psychiatric Institute, Vagelos College of Physicians & Surgeons, Columbia University, New York.
The findings are based on functional magnetic resonance imaging (fMRI) data acquired from just 28 adolescents and young adults (aged 14-23 years) with significant cannabis use and 32 age and sex-matched non-using healthy controls.
Participants were scanned during their performance of a Simon Spatial Incompatibility Task, a cognitive control task that requires resolving cognitive conflict to respond accurately.
The authors also examined the degree to which fluctuations in activity in relation to conflict resolution is synchronised across the different regions comprised in this frontostriatal circuit, that is, to what extent are regions functionally connected with each other.
Although circuit connectivity did not differ between cannabis-using and non-using youth, the research team found an association between how early individuals began regularly using cannabis and the extent to which frontostriatal regions were disrupted, suggesting that earlier chronic use may have a larger impact on circuit development than use of later onset.
โThe present findings support the mission of the Adolescent Brain and Cognitive Development study, a longitudinal study aimed at understanding the developmental trajectory of brain circuits in relation to cannabis use,โ said Dr Cyr. โIn addition, these findings are a first step towards identifying brain-based targets for early interventions that reduce addiction behaviours by enhancing self-regulatory capacity.
โGiven that substance use and relapse rates are associated with control processes, interventions based on neural stimulation, such as transcranial magnetic stimulation (TMS), and behavioural interventions, such as cognitive training, that specifically target the brain circuits underlying these control processes may be helpful as adjunct intervention strategies to complement standard treatment programs for cannabis use disorder.โ
The organisation behind the cannabis trials
NICE guidelines and their impact on Twenty21
The National Institute for Health and Care Excellence (NICE) published their guidance to clinicians on the 11th of November 2019 regarding the prescribing of Cannabis-Based Medicinal Products (CBMPs).
Drug Science welcomes this news from NICE as it shows the start of a more rational approach to medical cannabis. However, it must be emphasised that this is just the start of a long process and not the answer to the needs of the hundreds of thousands of patients who use illegal cannabis for medicinal purposes every day. The reason that these guidelines are inadequate is two-fold:
Firstly, the NICE decision relates to just two illnesses โ MS and severe childhood epilepsy โ a small fraction of the total number of patients. The Drug Science Twenty21 initiative has already had requests from over 3500 patients. The majority have chronic pain syndromes and many others have disorders such as PTSD for which neither Sativex nor Epidiolex has an indication.
Secondly, both Sativex and Epidiolex are fixed doses โ a Sativex dose is a roughly equal mixture of about 3mg each of Delta-9-Tetrahydrocannabinol and Cannabidiol whereas Epidiolex is purely a strong dose of Cannabidiol. Many of the patients we have spoken to have tried these already and found them ineffective or they have not tolerated them and prefer the flexibility of dosing that other forms of medical cannabis offers. Twenty21 will attempt to deliver this more flexible dosing approach and allow titration to optimise each patientโs case.
Furthermore, the guidance did allude to two promising recommendations:
“The committee discussed the importance of collecting data on the treatment, clinical outcomes and adverse events experienced by people prescribed cannabis-based medicinal products, to inform future guidance and use. They noted the ambition to develop a UK register outlined in NHS England and NHS Improvement’s barriers to accessing cannabis-based products for medicinal use on NHS prescription.” This registry is something that the Drug Science team are creating right now to bolster NHS clinicians confidence in prescribing CBMP’s through the NHS.
“Some evidence identified the need for training and further education for prescribers”. This recommendation is something that Drug Science are very aware of. The roll-out of medicinal cannabis in the UK is dependant on prescriber confidence. Drug Science is creating a set of educational materials for current medical students, an online space for prescribers to ask questions to cannabis experts and a series of seminars devoted to cannabis education.
Using this information, the Drug Science team are continuing to fight for patients that need access to medicinal cannabis. As you might imagine, this is not a speedy process, however, we urge all of you that have signed up to be a part of this registry to stay tuned as we expect to have some exciting updates coming soon!
Best wishes
The Drug Science team
More than 60 percent of CBD users were taking it for anxiety, according to a survey of 5,000 people. Does it help?
The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm.Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when โfreaking outโ over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewartโs French bulldog partakes, too.
Cannabidiol, or CBD,is the lesser-known child of the cannabis sativaplant; its more famous sibling, tetrahydrocannabinol, or THC, is the active ingredient in pot that catapults usersโ โhigh.โ With roots in Central Asia, the plant is believed to have been first used medicinally โ or for rituals โ around 750 B.C., though there are other estimates too.
Cannabidiol and THC are just two of the plantโs more than 100 cannabinoids. THC is psychoactive, and CBD may or may not be, which is a matter of debate. THC can increase anxiety; it is not clear what effect CBD is having, if any, in reducing it. THC can lead to addiction and cravings; CBD is being studied to help those in recovery.
Cannabis containing 0.3 percent or less of THC is hemp. Although last yearโs Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administrationโs oversight of products derived from cannabis.
CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep. Part of CBDโs popularity is that it purports to be โnonpsychoactive,โ and that consumers can reap health benefits from the plant without the high (or the midnight pizza munchies).
Just as hemp seedlings are sprouting up across the United States, so is the marketing. From oils and nasal sprays to lollipops and suppositories, it seems no place is too sacred for CBD. โItโs the monster that has taken over the room,โ Dr. Brad Ingram, an associate professor of pediatrics at the University of Mississippi Medical Center, said about all the wild uses for CBD now. He is leading a clinical trial into administering CBD to children and teenagers with drug-resistant epilepsy.
,CBD
Facts about wellness.
Will these trends change your life โ or
take your money?
โItโs promising in a lot of different therapeutic avenues because itโs relatively safe,โ said James MacKillop, co-director of McMaster Universityโs Michael G. DeGroote Center for Medicinal Cannabis Research in Hamilton, Ontario.
Last year, the F.D.A. approved Epidiolex, a purified CBD extract, to treat rare seizure disorders in patients 2 years or older after three randomized, double-blind and placebo-controlled clinical trials with 516 patients that showed the drug, taken along with other medications, helped to reduce seizures. These types of studies are the gold standard in medicine, in which participants are divided by chance, and neither the subject nor the investigator knows which group is taking the placebo or the medication.
While there is hope for treating other conditions with the plant extract, Epidiolex remains the only CBD-derived drug approved by the F.D.A. Most of the research on cannabidiol has been in animals, and its current popularity has outpaced science.โWe donโt have the 101 course on CBD quite figured out yet,โ said Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.
For students with generalized social anxiety, a four-minute talk, with minimal time to prepare, can be debilitating. Yet a small experiment in the journal Neuropsychopharmacology found that CBD seemed to reduce nervousness and cognitive impairment in patients with social anxiety in a simulated public speaking task.
However, a double-blind study found healthy volunteers administered CBD had little to no change in their emotional reaction to unpleasant images or words, compared to the placebo group. โIf itโs a calming drug, it should change their responses to the stimuli,โ said Harriet de Wit, co-author of the study and a professor in the University of Chicagoโs department of psychiatry and behavioral neuroscience. โBut it didnโt.โ
Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.
โOur top therapies attempt to break the association between reminders of the trauma and the fear response,โ said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the studyโs principal investigator. โWe think that CBD, at least in animal models, can help that process happen a lot faster.โ While large clinical trials are underway, psychologists say there isnโt compelling evidence yet as to whether this is a viable treatment.
Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. โIf you are looking for new treatments for sleep, that may be a clue,โ he said.
But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasnโt been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.
[Stressed-out parents are giving it a shot.]
A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. โOver all, we did not find that it panned out as a useful treatment for sleep,โ said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.
Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD,according to a review in Journal of Chemical Neuroanatomy. โSurprisingly, CBD seems to act faster than conventional antidepressants,โ wrote one of the authors of a new review, Sรขmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor atthe University of Sรฃo Paulo in Brazil, in an email interview. Of course, itโs difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.
But without clinical trials in humans, psychologists say CBDโs effect on depression is still a hypothesis, and not an evidence-based treatment.
โIf you take pure CBD, itโs pretty safe,โ said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvaniaโs Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.
Recently, the F.D.A. sent a warning letter to Curaleaf Inc. about its โunsubstantiated claimsโ that the plant extract treats a variety of conditions from pet anxiety and depression to cancer and opioid withdrawal. (In a statement, the company said that some of the products in question had been discontinued and that it was working with the F.D.A.)
Dr. Smita Das, chair of the American Psychiatric Associationโs Council on Addiction Psychiatryโs cannabis work group, does not recommend CBD for anxiety, PTSD, sleep or depression. With patients turning to these to unproven products, she is worried that they may delay seeking appropriate mental health care: โIโm dually concerned with how exposure to CBD products can lead somebody into continuing to cannabis products.โ
Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100 percent natural CBD extracts. They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.
Earlier research found fewer than a third of 84 products studied contained the amount of CBD on their labels. Some users of CBD have also failed drug tests when the product contained more THC than indicated.
This year, 1,090 people have contacted poison control centers about CBD, according to the American Association of Poison Control Centers. Over a third are estimated to havereceived medical attention, and 46 were admitted into a critical care unit, possibly because of exposure to other products, or drug interactions. In addition, concern over 318 animals poured into the American Society for the Prevention of Cruelty to Animalsโ Animal Poison Control Center.
A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. Thatโs when someone believes a drug is working and symptoms seem to improve.
โCBD is not a scam,โ saidย Yasmin Hurd, director of the Addiction Institute of Mount Sinai in New York Cityย who led aย double-blind studyย of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using. โIt has a potential medicinal value, but when we are putting it into mascara and putting it into tampons, for Godโs sake, to me, thatโs a scam.โ
A version of this article appears in print onย Oct. 20, 2019,Byย Dawn MacKeen
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