CBD, miracle therapeutic virtues, really?
Can CBD really be useful in the treatment of various disorders, from chronic pain to sleep problems or mental health? In view of the growing public interest in these issues, Canal Détox is looking at the subject, with an interest in what lies behind this scientific name and the effects of CBD on certain disorders that have been researched.
Until now, cannabidiol (CBD) has received less media coverage than THC, the main psychoactive molecule of cannabis. Shops dedicated to the sale of cannabis products and rich in CBD, herbal teas prepared to fight against insomnia or even oils to ingest against anxiety and dried flowers of cannabis to smoke or vaporize… Many very varied products are now available on the market.
While France has just launched an experiment on cannabis for medical use (with products composed of both THC and CBD) and the enthusiasm for CBD-based products continues to grow, it seems relevant to look at what the science is saying right now.
What does the scientific evidence to date show? Can CBD really be useful in the treatment of various disorders, from chronic pain to sleep problems or mental health?
In view of the growing public interest in these issues, Canal Détox is looking at the subject, with an interest in what lies behind this scientific name and the effects of CBD on certain disorders that have been researched.
CBD, THC: some benchmarks
Cannabis (or hemp) is a plant native to equatorial regions. Several species exist. Those consumed for their psychotropic properties, that is, capable of modifying the functioning of our central nervous system, are from the Cannabis sativa family. About 500 plant compounds are known, including about 60 cannabinoids.
The main psychoactive compound in cannabis is the tetrahydrocannabinoid (commonly known as THC). Cannabidiol (CBD) is also present in large quantities in the plant, and is not regulated as a psychotropic although it also has psychoactive effects through interaction with the serotonin system. This would explain the “soothing” effect promoted by sellers to help people with anxiety, sleep difficulties and chronic pain.
It should be noted that products sold commercially under the CBD label are in the form of natural extracts of flowers or whole flowers of cannabis. They contain mainly CBD but still a little THC (even if it is sometimes present in minute amounts). This is reduced to “CBD products” in common language but does not reflect the reality and complexity of the composition of products sold and consumed.
Over the past decade, the scientific community has become increasingly interested in CBD, as it is suspected of being involved in some of the potential therapeutic effects of cannabis. However, much of the data available to date comes not from extensive rigorous clinical trials, but from the recognition by scientists that CBD could act on many biological targets in the body.
Severe epilepsy in children
It is a documentary by the American channel CNN that put the CBD in the spotlight for the first time, in 2013. The film told the story of Charlotte, a girl with Dravet syndrome, a rare form of epilepsy. In the absence of effective treatment for the hundreds of seizures she suffered each week, these parents turned to an alternative solution: a cannabis oil particularly rich in CBD.
Today, while medical cannabis use is permitted in many countries, the only CBD-based pharmacological treatment that has been rigorously tested in clinical trials in the United States and has received FDA approval is Epidiolex, indicated in the treatment of pediatric epileptic seizures.
In France, HAS has supported reimbursement only when it is prescribed in the context of epileptic seizures associated with Dravet syndrome or Lennox-Gastaut in persons over two years of age and under medical supervision.
Chronic pain, anxiety… various disorders but little data
Beyond epilepsy, CBD is widely used in self-medication for a range of disorders. In particular, the opioid crisis in the United States and Europe helped to renew interest in this molecule. Given the magnitude of the problem, researchers have indeed worked to identify alternative solutions to relieve patients with chronic pain. In this context, medical cannabis has been regularly presented as a potentially effective and non-addictive treatment, and CBD, a molecule considered to have fewer adverse effects than THC, has been particularly highlighted.
But CBD is also regularly used by many individuals …
But CBD is also regularly used by many individuals to reduce stress and anxiety, to help oncology patients cope better with chemotherapy, or to help people with sleep disorders.
Why do users self-medicate with CBD?
To highlight the diversity of disorders for which CBD is used by consumers, a study published in JAMA Open Network in 2020 focused on the most frequently cited reasons for self-medication use.
More than 300 testimonies were examined. As a result, more than 63% of Internet users in the study reported using CBD to relieve symptoms related to anxiety, depression or autism spectrum disorders. More than 26% of them used it to fight orthopedic pain and nearly 15% to improve their sleep.
Studies to confirm the efficacy of the molecule in these different contexts are rare and often methodologically limited. Thus, unlike epilepsy, there are still no major rigorous trials comparing CBD to placebo in large samples of patients.
Moreover, most of the work carried out in the medical field is concerned with “medical cannabis” without distinguishing between its different compounds. It is therefore sometimes difficult to determine what effects can actually be attributed to CBD, especially since the mechanisms of action of this molecule are still not well known. Its therapeutic virtues are actually assumed from pharmacological mechanisms and results of preclinical studies. It will therefore be a few years before large-scale trials can answer the question of its clinical utility in the management of pain and psychiatric diseases.
And beyond efficacy, there are still questions about the safety of CBD-rich products, even if the people who market them claim that the molecule is safe and has not yet shown a potential for dependence resulting in excessive consumption, unlike THC-rich products.
Among the adverse effects that have been documented are mainly drowsiness, decreased appetite, digestive disorders, fever, fatigue and vomiting.
In the absence of a greater knowledge of the different biological mechanisms or of conclusive data from clinical trials, caution is therefore required regarding the consumption of CBD in self-medication. Especially since the dosages of CBD-based products are not standardized and some of them may interact with other drugs prescribed to individuals, cancel their effects or slow down their elimination. It can also be pointed out that taking these products increases the risk of positivity at a roadside check due to the systematic presence of THC, especially in cases of regular use.
[1] These products may contain other phytocannabinoids and terpenes (a class of hydrocarbons), in varying proportions depending on the variety of cannabis used and the method of extraction. There is no minimum threshold for CBD to be considered “CBD-rich”.