There seems to be a general excitement that new medication is available as a treatment for many chronic conditions. The use of cannabidiol oils is sweeping the country and we need to stop and ask: what are they and what can they treat?
There are two main cannabinoids found in the cannabis sativa species of plants: cannabidiol (CBD) and 9-tetrahydrocannabinol (THC). The psychoactive properties of THC are what makes cannabis the most common substance of abuse worldwide.
CBD is derived as a concentrated extract from cannabis flowers or leaves which are dissolved in an edible oil, such as sunflower, hemp or olive oil.
CBD oils may contain a variety of concentrations of pure CBD, THC and other minor cannabinoids depending what variety of cannabis plant was used.
In most instances, hemp plants are the preferred source of CBD as they have regulated amounts of THC, usually around 0,3%. Hemp is still grown primarily for its fibres but the increasing demand for CBD oil is opening-up a new market.
Where it began – epilepsy
In 2013, a family, in Colorado, USA, wanted to find an alternative treatment for their daughter who suffered from a severe form of epilepsy, causing her to have seizures over 40 times per day.
When the child was started on a CBD-enriched cannabis (later named Charlotte’s Web), the seizure rate was reduced by 98%. As more epileptic patients began using CBD, the regulatory authorities began to examine the products available. Of concern, the United States Federal Drug Agency (FDA) found that a third of the products being sold did not even contain CBD oils. An approved formulation, called Epidiolex, is now available. Initial studies are encouraging; severe seizure disorders do seem to be responding. Though, further research is ongoing to establish any safety concerns.
Fastest growing field in psychopharmacology
The active ingredients of cannabis act on the endocannabinoid system in the body. Cannabinoid receptors are found centrally in the brain, in the blood, and peripheral nervous system.
We do not, yet, completely understand the varied functions of this system. Research into it has increased dramatically and it’s now the fastest growing field in psychopharmacology.
The endocannabinoid system seems to be involved in basic functions, such as appetite, metabolism, immune regulations, reproduction and pain control. Due to these widespread actions, CBD seems to have effects on so many conditions.The reported pharmacological benefits occur in:
- Anxiety disorder
- Depression
- Inflammatory conditions, such as arthritis
- Schizophrenia
- Parkinson’s disease
- Diabetes and obesity
- Sleep disorders
- Cancer
- Chronic pain
Take note of the type of studies
It’s very important to be aware that a great deal of evidence of the efficacy of CBD oils in the above conditions comes from animal studies (so not yet proven in humans) and anecdotal evidence.
There is increasing observational evidence being gathered from regular cannabis users and a few small clinical trials. This lack of reliable, long-term data is not such an issue if the CBD is being used in reasonably healthy adults, but the oil is being marketed for people, especially the elderly and children, with quite complex diseases.
Availability and side effects
CBD oils are widely available now; both in large retail pharmacies and online. These are derived mainly from hemp seeds. Hemp oil is itself a good nutritional supplement as it’s high in protein, unsaturated fats and several vitamins and minerals.
These CBD oils can, however, cause nausea, fatigue and irritability. Since they are sold as a food supplement, there is no regulation of its safety and purity, or how much active product is in a bottle. There is also no evidence what the dosing schedule should be for manufacturers to follow guidelines.
CBD has no psychoactive effects and is not addictive. A recent report, from the World Health Organisation, found “no public health risks or abuse potential” for CBD.
There is no doubt that some conditions like intractable, chronic pain, respond better to the higher THC containing, psychoactive cannabis. For this reason, people around the world have been campaigning for the legalisation of all cannabis products. This is now the debate at the level of the United Nations; although many countries, including South Africa, have now started that process themselves.
SA ruling
On 18 September 2018, the Constitutional Court of South Africa ruled that it’s now legal to use and cultivate cannabis in a private space. The Constitutional Court has given 24 months to have the cannabis laws in South Africa amended. It’s important to remember that even though private use of cannabis has been decriminalised, the buying and selling of cannabis, cannabis oil and cannabis seeds remains illegal.
The Department of Agriculture, Forestry and Fisheries (DAFF) has teamed up with other departments such as Health, Trade and Industry and Environmental Affairs to start working on a new regulatory framework for the cultivation of the different strains of cannabis with specific THC and CBD composition.
The medicinal effects have become increasingly recognised and valued and the change in regulation will allow research and development to improve the quality and reliability of CBD oils and related products in years to come.
MEET OUR EXPERT
Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She is part of the Netcare Sunward Park Bariatric Centre of Excellence and has a busy diabetes practice.