CBD Pharmacology

On Nate Silver’s renowned political prediction site fivethirtyeight.com, Christine Aschwanden writes an interesting and compelling piece “Does CBD Really Do Anything?” In this piece, she examines the evidence surrounding CBD and other cannabinoids. The author examines a number of sources about the evidence behind CBD and also places it in the context of a booming marketplace that is willing to sell CBD to the public regardless of evidence or, in many cases, purity. Although much of her criticism of the evidence surrounding CBD and other cannabinoids is well justified, there is some good science and evidence for its effects as well.

Many manufacturers selling CBD products fail to test their products and some are selling products that are either adulterated or do not contain CBD at all. At LeafLine Labs, we tested many of the CBD products on the market and most did not contain CBD but contained CBD-A, the chemical precursor to CBD with lesser effects. Of those that did contain CBD, the concentration did not necessarily match the labeled dosage. Out of the broad number of samples we tested, in fact, only one product actually contained CBD. These manufacturers are either unaware that you have to decarboxylate CBD for it to be active at its greatest potential, or they are selling product that has not gone through the process to save money on manufacturing costs.

There are few double-blinded, placebo-controlled trials on CBD and its use as a medication. GW Pharmaceuticals is one of the few companies to have conducted serious trials in the cases of Epidiolex and Sativex. However, much of this this is due to the scheduling of cannabis as schedule I by the FDA and DEA prohibiting its use and study. This makes it impossible to prove that it is medically useful to the standards that the FDA requires, thus ensuring it will never be removed from schedule I status. In addition, a negative bias exists with regards to cannabis that is reinforced when no medical school, pharmacy school, or nursing school in the United States has curricula teaching about the endocannabinoid system, despite it being one of the key physiological feedback systems governing almost every system in our body. There is a wealth of information on what the endocannabinoid system does physiologically and what cannabinoids do pharmacologically speaking in animals and cellular experiments.

That being said, there are many studies which have examined the pharmacology of THC and CBD and show significant evidence for CBD’s use as an anti-inflammatory, an anxiolytic, and anti-epileptic, and for certain types of pain (e.g. neuropathic). I recommend reading “Cannabinoid Pharmacology: The First 66 Years,” and “From Phytocannabinoids to Cannabinoid Receptors and Endocannabinoids: Pleiotropic Physiological and Pathological Roles Through Complex Pharmacology”, especially for a good deep dive into the known pharmacology. These are two good examples of the depth and wealth of pharmacologic knowledge available regarding cannabinoids. There is ample enough proof embedded in them to prove that cannabis and cannabinoids have medicinal use. There is also ample evidence of the relatively low abuse and harm potential of cannabis in comparison to existing drugs such as benzodiazepines, opiates, amphetamines, and even alcohol or tobacco.

To obtain the clinical trial level of evidence, we must first take cannabis off of the schedule I list. It is impossible to conduct the needed studies without doing that first. We also have to start teaching our future medical professionals about the endocannabinoid system and how it works or their will be no one in place in medicine or regulatory bodies with the knowledge to evaluate efficacy. As of now, very few medical professionals have even a passing knowledge of the endocannabinoid system and therefore have no means by which to evaluate the evidence. We need to change that by including the endocannbinoid system and cannabinoid pharmacology in curricula.

So although Christine Aschwanden poses good points and brings valuable scrutiny into the Wild Wild West of Cannabis, we first need to change the schedule status and educate our professionals before we can expect any serious scientific evaluation of cannabis’ medicinal potential.

Ethan Carruthers