cbd oil cannabidiol for pain and anxiety

New data back use of medical cannabis for epilepsy, pain, anxiety

Two new studies offer positive news about medical cannabis, suggesting that marijuana products improve physical and cognitive symptoms, boost quality of life, and rarely produce signs of problematic use.

In one study, patients with epilepsy who used medical cannabis were nearly half as likely to have needed an emergency department visit within the last 30 days as was a control group. In the other study, 3 of 54 subjects who used medical cannabis showed signs of possible cannabis use disorder (CUD) over 12 months.

The findings show that “there is improvement in a range of outcome variables, and the adverse effects seem to be minimal, compared to what we might have hypothesized based on the bulk of the literature on the negative effects of cannabis on health outcomes,” cannabis researcher Ziva Cooper, PhD , of the University of California at Los Angeles, said in an interview. Dr. Cooper moderated a session about the studies at the virtual annual meeting of the College on Problems of Drug Dependence.

In one study, cannabis researcher Ryan Vandrey, PhD , of Johns Hopkins University, Baltimore, and colleagues compared medical cannabis users (number, 808; mean age, 38; percentage female, 63%) to a control group of people who were interested in medical cannabis (n, 468; mean age, 35; percentage female, 62%).

In both groups, 79% were White. The groups had similar levels of primary medical conditions, such as neurologic (38% and 36%, respectively, for the medical cannabis group and control group) and chronic pain (25% and 23%, respectively.)

The wide majority of those in the medical cannabis group – 58% – were cannabidiol (CBD) users, relying on a component of cannabis (marijuana) that does not make people high. Fewer than 20% used tetrahydrocannabinol (THC), which does make people high, or a combination of both CBD and THC.

Most of those in the medical cannabis group used the drug as an adjunct (39%) to other treatments or last-resort (29%) treatment instead of first line (11%) or second line (18%).

In patients with epilepsy, about 45% of controls reported a past-month ED visit, compared with about 25% of medical cannabis users. The gap in past-month hospital admissions was even wider, at about 35% for the controls and about 15% for the medical cannabis.

After an initial survey, the researchers followed subjects prospectively; some either started or stopped using medical cannabis. From baseline to follow-up, those in the medical cannabis group improved more, compared with those in the control group on a variety of measures of quality of life, anxiety, and depression.

“Folks who were in the control condition at baseline and then initiated cannabis use started to look more like the baseline cannabis users,” Dr. Vandrey said. “The folks who were cannabis users at baseline and then stopped for whatever reason started to look like the controls. And the controls [who never started using medical cannabis] stayed the same.”

As for adverse effects, two-thirds of medical cannabis users reported no problems; the highest number, 14%, reported high cost.

As for limitations, Dr. Vandrey reported missing data, a reliance on self-reports, and poor follow-up with about a third of participants agreeing to complete follow-up assessments. “We are continuing to collect data on this,” he said, “and we’re hoping we’ll be able to drill down more as we get bigger.”

The study was funded by the Realm of Caring Foundation.

In the other study, led by cannabis researcher Staci Gruber, PhD, of McLean Hospital in Belmont, Mass., and Harvard Medical School in Boston, researchers tracked 54 subjects (mean age, 49; 20 male and 34 female; 48 white) for up to 2 years after they began medical cannabis use. Most had pain (36) or anxiety/PTSD (31), and all had to have abstained from recreational cannabis use for at least 1 year.

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At follow-ups, the users reported improved mood and anxiety via various measures, and they saw some improvement in quality of life. “We did not see worsening cognitive performance,” Dr. Gruber said. “In fact, we saw improved performance or no change on measures of executive function, in contrast to what we see in the literature.”

Research has suggested that as many as 30% of recreational cannabis users develop cannabis use disorder (CUD), Dr. Gruber said. But only 3 of the 54 patients showed signs of possible CUD at 12 months, she said, even though frequency of use jumped substantially vs. baseline.

Information about study funding was not available.

Dr. Cooper disclosed relationships with FSD Pharma, Beckley Canopy Therapeutics, and Insys Therapeutics. Dr. Vandrey disclosed work with Zynerba Pharmaceuticals, Canopy Health Innovations, and FSD Pharma. Dr. Gruber reported no disclosures.

CBD oil as medicine: The promise and the risks

Metro Atlanta resident Becky Ferguson says she started using non-addictive cannabis oil because she hoped it would ease her chronic pain.

The result was not quite what she expected.

“It might have helped a little bit [with the pain], but I am getting a tremendous reduction in anxiety,” says Ferguson, who is in her late 50s.

Ferguson says she’s calmer and better able to deal with stress than she has ever been in her life. “I have a much higher quality of life,” she says.

Yet there are also health warnings about CBD oil (cannabidiol) and hemp-derived products.

When it comes to hemp and cannabis, there is much confusion among the public about labels, because of how science and the law define these substances. For the average person, it’s almost like having too many cousins with the same first name.

Another source of confusion is that recreational use and medical use of marijuana — though they are different things — are both gaining legal and social acceptance in the United States.

CBD oil like CBD oil beauty products is derived from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (cannabis), it does not make a person “high.”

People generally can obtain it easily in stores across the country. You might want to visit sites like https://deltamunchies.com/delta-8-vape-pens/ so that you can order one online. There are also Medical Cannabis Extracts and edibles like Delta-8 Candies for those who don’t like smoking CBD products.

Some researchers differentiate hemp from marijuana by pointing to THC, which is the psychoactive ingredient in marijuana. (In other words, it’s what causes the high.) Cannabis plants that produce THC at a concentration higher than 0.3% are labeled “cannabis,” while those that produce less than that are labeled “hemp.”

The nationwide legal status of CBD, such as CBD Oil, changed fairly recently. The Hemp Farming Act of 2018 proposed to remove hemp from the Schedule 1 list of controlled substances, making it an ordinary agricultural commodity. The act’s provisions were incorporated into the Farm Bill that became law last December.

Do you know what you’re getting?

Hemp is a promising product for farmers.

A 2018 Forbes article said that spending on legal cannabis worldwide is expected to hit $57 billion by 2027. The adult-use (recreational) market will cover 67 percent of the spending, and medical uses will take up the remaining 33 percent.

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U.S. Senate Majority Leader Mitch McConnell, who is from the largely agricultural state of Kentucky, ensured that the federal Farm Bill passed. In Georgia, another state where farming is very important, Gov. Brian Kemp supported the recent Hemp Farming Act. It allows for the production and sale of hemp products, but only by “licensed farmers.” Every state is making its own farming rules.

CBD oil is selling well in Georgia, but all of it on the market here now comes from other states. Once Georgia creates regulations, CBD can be manufactured in the state by farmers who receive a hemp growing license, which costs $50 per acre annually, the AJC reported.

As of now, Georgia’s Department of Agriculture says no licenses have been issued. The state’s hemp rules are still being developed.

In the meantime, plenty of CBD items, like CBD moonrocks, are for sale in Georgia. People can buy cannabis products from such vendors as convenience stores, mall kiosks and hardware stores, as well as from smoke shops and online vendors.

But with no regulations on these sales, what’s safe?

Buyers have little protection

Today, it’s a “buyer beware” market.

Ferguson, who lives in DeKalb County, says she found a third-party reputable laboratory to verify the contents of her CBD product. She says it’s important to research companies before making a buying decision.

Atlanta pharmacist Ira Katz says, he, too, recognized the importance of CBD for several reasons, “but only if it’s coming from a reputable company.”

As a pharmacist, Katz looks for companies with stellar reputations. And for now, he’s settled on a few products. “You can’t go to a convenience store and talk to the clerk with questions like: ‘Can I take it? How much should I take? Is it safe?’ ”

Katz also reminds his customers to beware of potentially unsafe products. Reputable pharmacists, says Katz, take the time to ask about the quality of products before ordering them, and they make recommendations based on a patient’s medical history.

Hemp products are not for everyone, and they are not the cure-all that some advertisers may suggest, Katz says. But he adds that “the beauty of it [CBD] is that it really doesn’t seem to have interactions.”

“Many people are taking sleeping products with addictive properties and far too many [take] addictive pain medications,” he says.

There are certain circumstances for which Katz might suggest a legal hemp product. For example, it can be beneficial to patients who have been on opioids for pain management to lessen their daily intake, and hemp products may enable them to do that.

A seller with a mission

“My mom had cancer when I was in my 20s,” says Joe Salome in an interview at his Sandy Springs store. Salome says he watched his mom receive relief from her medicinal cannabis years ago.

Salome believes in these products. As far as he’s concerned, “all marijuana use is medical use at the end of the day.”

“Whether we know it or not [you can call] it medical or recreational.” That’s why many states that have legalized cannabis get rid of the medical cannabis category completely as they transition, says Salome.

Salome is a partner in the Georgia Hemp Company. He says he’s seen how cannabis can help people.

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Once a medical marijuana law was passed in Georgia under previous Gov. Nathan Deal, Salome went from an online distributor to a merchant with a brick-and-mortar location where he could talk to concerned consumers.

“For the most part,” said Salome, “the people that visit our store are looking for some type of relief from pain, anxiety or sleep [issues].”

“What we find is that the majority of people out there don’t want a product with even a little bit of THC — even the legal limit — because of the taste, the stigma or whatever — they don’t necessarily want it.”

“As shop owners, we are going after what CBD does about the inflammation, anxiety, pain and those types of things,” said Salome. He hopes other companies are just as concerned as he is. He also wishes find more CBD Oil products that effectively work to relieve chronic pain.

Limited oversight

Federal government officials, meanwhile, have raised concerns about these products.

The FDA has issued several warning letters to firms that market unapproved new drugs allegedly containing CBD. As part of these actions, the FDA tests the chemical content of cannabinoid compounds.

Some were found not to contain the levels of CBD that their makers claimed on the packaging. “These products are [also] not FDA-approved for the diagnosis, cure, mitigation, treatment, or prevention of any disease,” states the FDA.

The Federal Trade Commission sent warning letters to three companies selling oils, tinctures, capsules, “gummies” and creams. In the letters, the FTC urged the companies to review all claims made for their products, including consumer testimonials, to ensure they are supported by competent and reliable scientific evidence.

In the interim, it’s the buyer taking the risk.

Physician hopeful but cautious

Dr. Cheryl McGowan, a family medicine physician who lives in Alpharetta, says that while “some of the early research appears promising,” she’s not ready to recommend CBD just yet.

McGowan says some side effects are minor, such as fatigue, nausea and diarrhea. Others, like liver toxicity and interaction with medications, such as the blood thinner Coumadin, have the potential to be severe.

Like many other health practitioners, McGowan cautions, “Right now, we really don’t know, other than some small studies, many of which were conducted in the lab or in animal models, exactly how CBD use affects humans long-term. And what dosages are optimal for different patients and different conditions.”

Meanwhile, stores selling CBD oil are popping up all over.

Breana Holmes in her store. Photo credit: Marietta Daily Journal

The Marietta Daily Journal recently reported that Canton resident Breana Holmes had struggled with the widespread pain of fibromyalgia for years when a friend let her try some of the cannabis-derived CBD products he was selling at his newly opened CBD shop.

The results changed her life, she says.

Holmes, who said she also suffers from anxiety, said the pain she felt regularly was finally manageable and she was able to relax, the Daily Journal reported. So, she said, she set out to open her own shop, and in February, Holmes became an owner of a Your CBD Store franchise location in Smyrna.

And there are now four Your CBD Store locations in Cobb County alone, the Daily Journal reported.

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

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