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The Benefits of CBD: Reality or Fiction?

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Claims about the therapeutic potential of CBD are ubiquitous online. The World Health Organization, like others, has confirmed the good safety profile of CBD, which does not pose a risk of abuse. More and more people around the world are asking their doctor if CBD could be a useful treatment for them. From capsules and oils to topical cream and oral atomizers, the passion for CBD has taken off.

A recent study by Santé Cannabis suggests, however, that medical cannabis treatments rich in CBD alone lead to only a modest improvement in symptoms.

Does evidence of the effectiveness of CBD support media hype?
LIMITED EVIDENCE OF SYMPTOM RELIEF

Cannabidiol, or CBD, is the main cannabinoid present in hemp, and is generally the second most common cannabinoid in the cannabis plant. More recently, under the Canadian Medical Cannabis Access Program, cannabis varieties and medical cannabis products have been developed to contain primarily CBD, although traces of THC and other cannabinoids are present.

CBD is known for its antiepileptic and anxiolytic effects supported by clinical and preclinical evidence. Several studies have also shown anti-inflammatory, immunomodulatory, antipsychotic and neuroprotective effects. However, the mechanisms of the effects of CBD remain poorly understood and the lack of evidence supporting many of its potential therapeutic properties is proving to be a barrier to its clinical use.

Seizures associated with refractory epilepsy are the symptoms for which there is most evidence to support the use of CBD. Epidiolex®, the first CBD-based drug product, was approved by the U.S. Food and Drug Administration (FDA) in 2018 as an anticonvulsant in the treatment of Lennox-Gastaut syndrome and Dravet syndrome. It was also approved by the European Medicines Agency in 2019, but is not available in Canada at this time.

Results from 5 randomized controlled trials also suggest moderate evidence that CBD can help reduce symptoms of psychosis.

While there is limited evidence to support CBD as an anti-anxiety drug, Cannabis Health clinicians have seen good results using CBD-rich treatments to relieve anxiety symptoms. A recent increase in the number of high-quality, long-term studies on CBD and anxiety may offer more conclusive results in the coming years. However, mental disorders such as anxiety currently account for only about 6% of Cannabis Health patients.

There is also limited evidence that CBD could be used as a treatment for withdrawal symptoms and cravings associated with substance use disorders.

The popularity of CBD has increased in part due to its good safety profile and the fact that it does not cause the psychoactive effects generally associated with THC.

These characteristics have to some extent contributed to the impression that CBD has a greater medical and therapeutic value than THC. In some countries, authorities have even launched medical cannabis access programs that rely exclusively on CBD treatment plans.

However, Santé Cannabis’s latest clinical study suggests that CBD-rich treatments actually produce only limited improvements in symptom management compared to treatment plans that combine both CBD and THC.

In some settings, the use of THC may sometimes be necessary for patients to benefit more from their medical cannabis treatment.

The Cannabis Health study was to be presented at the annual symposium of the International Society for Cannabinoid Research and will be published later this year.

It was conducted with patients who began medical cannabis treatment at one of our four clinics in Quebec between 2017 and 2019. The study followed two groups during this period: a group of 715 patients who were prescribed CBD-rich treatments and a group of 380 patients who were prescribed both THC and CBD treatments.

Treatment effectiveness was assessed using a standardized medical questionnaire and validated assessment tools such as the Edmonton Symptom Assessment Scale (ESAS), Brief Pain Inventory (BPI) and Initial EQ5D (BL), as well as 3-month follow-up (FUP1) and 6 months (UFP2).

The study found that patients whose treatment plan was based solely on CBD-based products reported fewer improvements and benefits than those who incorporated both THC and CBD into their treatment. The group of patients receiving CBD and THC showed a greater improvement for almost all the items assessed, by a statistically and clinically significant margin.

Additional data and further investigation are still needed to further validate these results and to control potential biases.

In the meantime, in the absence of results from other studies, it is probably best to approach CBD with caution and perhaps a dose of skepticism. Health Cannabis, however, remains keen to continue clinical research on the subject in cooperation with other participants in the scientific, pharmaceutical and medical fields of cannabis.

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