Cannabis sativa L. (cannabis) contains hundreds of chemicals in different classes, however, the cannabinoid class is found uniquely in this species. Popularly known as marijuana, cannabis is the most consumed illicit drug in the world, with Δ9-tetrahydrocannabinol (Δ9-THC) being the main cannabinoid of toxicological interest, as it is responsible for most of the psychotomimetic effects caused and is associated with abusive use. of the plant. On the other hand, for some years, interest in scientific research with cannabis has been growing significantly, due to the important therapeutic effects that some cannabinoids have shown. Cannabidiol (CBD), for example, is a cannabinoid that, in addition to modulating the euphoric effects of Δ9-THC, has shown important pharmacological activities.



WHAT IS CBD OR CANNABIDIOL?

Cannabidiol (CBD) is a cannabinoid, a natural compound of the Cannabis Sativa L plant. Unlike THC, CBD has no psychotropic or addictive effects. It interacts with our endocannabinoid system, promoting the well-being and natural balance of our body.
 





Pure CBD. How is it obtained?

CBD can be obtained from cannabis seeds or flowers. To obtain CBD oil from cannabis, laboratories choose hybrid plants, whose floral resin usually has high proportions of CBD.
 



The extraction of this oil must be as intact as possible, with other cannabis compounds such as other cannabinoids, flavonoids and terpenes that give pure CBD a greater therapeutic character.



HOW DOES CBD WORK?

Endocannabinoid system

CBD acts on our body's endogenous cannabinoids, named for their similarity to compounds in the cannabis plant. These elements are part of the endocannabinoid system.

The endocannabinoid system plays an indispensable role in regulating the physiological processes that affect our daily life (mood, intestinal strength, energy level, blood pressure, immune activity, glucose metabolism, among others) and can improve endocannabinoid tone for slow down or stop the progress of some diseases.



WHAT IS THE CBD FOR?

CBD is used as a food supplement, topical remedy or pharmacological treatment to relieve chronic pain, intestinal or skin inflammation, depression, anxiety and seizures in refractory epilepsies. It is also used in symptoms of neurological diseases such as multiple sclerosis, Alzheimer's, Parkinson's or schizophrenia.



CBD BENEFITS AND PROPERTIES

More research is still needed to determine the other benefits and safety of cannabidiol. The most frequently used formula is oil, although we can also find CBD in extract, essential oil or oil-based capsule.

 




Serves as a treatment for Dravet syndrome

It is a genetic disease where the patient suffers from fever and convulsions due to high temperature. Over time, these symptoms can get worse until epilepsy develops.

According to clinical trials, it has been shown that while this syndrome reduces the patient's quality of life, CBD provides relief.


Treatment of Lennox-Gastaut syndrome

It is similar to Dravet syndrome where seizures occur during childhood, causing the muscles to contract.

Thanks to three clinical trials involving 516 patients suffering from LGS or Dravet, CBD oil (Epidiolex) was administered with other medications and these patients were found to experience fewer seizures compared to those who took a placebo.


Parkinson's disease analysis

After the successful use of CBD in seizures, it was determined to study its effectiveness in other diseases, such as Parkinson's. Some research has been done to verify its efficiency, although the results are still inconclusive.

So far, one study has been carried out on Parkinson's patients who were given a dose of CBD (between 150 and 400 mg/day) combined with classic medications for the disease. In some patients, the result was very positive. The downside is that the number of candidates in the study was small.


Potential effectiveness in other pathologies

CBD is an innovative drug, therefore clinical trials and studies continue to be conducted. There are also neurological studies where the effects of cannabis on patients with schizophrenia are evaluated, as well as its effects on pathologies such as diabetes, anxiety or multiple sclerosis. However, there is still a lack of scientific basis to consider its effectiveness in this type of patient.

Currently, we can find CBD creams in authorized pharmacies that relieve muscle pain and skin reactions such as inflammation or itching.



HOW IS CANNABIDIOL USED?

CBD oil, for example, is approved under the name Epidiolex for patients with epilepsy. Despite this, many laboratories have managed to create other presentations to treat joint pain-related problems.

In oil form, it can be taken sublingually (under the tongue) in drops or spray. On the other hand, CBD creams combine cannabidiol with other therapeutic compounds such as aloe vera, rosemary, arnica and others to be applied topically.



ARE CBD AND THC THE SAME?
 



CBD is not the only cannabinoid found in cannabis. Currently, there are 113 compounds in the plant, such as CBD, CBN, CBG or THC.

THC (tetrahydrocannabidiol) is a psychotropic substance that causes the well-known psychoactivity of marijuana. In contrast, CBD does not produce such psychoactive effects.

However, both components have great therapeutic power and their effects are effective when they work together, as they potentiate the analgesic effect. Likewise, CBD counteracts the psychoactivity of THC.



CBD BASED PRODUCTS

Currently, on the market we can find a wide variety of products made with cannabidiol, some of which are:

  • CBD supplements. Found in the form of gel capsules, tinctures or pills. Its effects are similar to those of food and whose concentration depends on the pathology to be treated.
  • E-liquid. They are used in e-cigarettes and vaporizers. They reduce anxiety, insomnia, depression, pain sensation. It usually contains 2.5% concentration of CBD.
  • CBD oil. It comes in drops, spray or capsules. They can be used topically and their concentration varies depending on the use, being 5% (pain and minor pathologies), 10% (acute pain) and 15% (chronic pain).
  • CBD creams. They are the most used in the form of balms, lotions, ointments and ointments. It has topical application where CBD levels range from 5% to 50%. They soothe pain, infections, inflammation and skin conditions.
  • crystals. CBD concentrations that do not contain THC, being obtained from the resin. Its effect is almost immediate and improves the effects of body and mind disorders.
     





WHAT IS THE DIFFERENCE BETWEEN CBD IN OIL AND IN CREAM?

There are differences between CBD oil and CBD and hemp-based types of creams, ointments and cosmetics. The most important thing would be that CBD oil has almost no diversity of ingredients, based on hemp seed oil and CBD extract. They are natural ingredients with low toxicity used sublingually.


On the contrary, CBD creams and ointments are cosmetic and topical products that, within their composition, have cannabidiol (oil or extract) and other natural supplements such as aloe vera, rosemary or others, for their absorption by the skin.



PROVEN EFFECTS OF CBD

CBD for medical use

Some of the therapeutic properties of cannabis come from THC, but also from its negative effects. This is why it is always used in combination with CBD for medicinal use, as CBD counteracts psychoactivity. Some of the proven effects it contains are:

  • Epileptic action: Epidiolex drug is the only CBD-based drug approved by the FDA so far.
  • Anxiolytic: In studies with small groups of patients, it has been shown that cannabidiol can be a powerful anxiolytic.
  • Anti-inflammatory and antioxidant action: Effective against types of pain associated with oxidative stress and inflammation, such as rheumatoid arthritis, inflammatory bowel disease and skin pain.

It can reduce itching or irritation in cases of hypersensitivity, eczema, and other skin conditions.



SECUNDARY EFFECTS

Like any medication, CBD is subject to side effects such as:

  • dry mouth
  • Loss of appetite.
  • Low blood pressure and dizziness.
  • Somnolence.
  • In high and usual doses it can cause liver damage.
  • As for topical use, there is still not enough information about the side effects it can cause.

 




CONTRAINDICATIONS AND SIDE EFFECTS

As with any medication, there are also contraindications in certain types of patients, as well as special precautions to consider:

  • Pregnancy: CBD is not safe during pregnancy or lactation.
  • Children: While Epidiolex may be for pediatric use, other forms of CBD may not be safe. It is better to consult the doctor first so as not to expose the child's health.
  • Pathologies: People with liver problems should not take high doses of CBD. In patients with Parkinson's, extensive use of cannabidiol is not recommended as it may worsen the pathology.
  • Herbs: Be careful when taking CBD with other herbs or supplements as it can cause drowsiness or dizziness.
     





FREQUENTLY ASKED QUESTIONS ABOUT CBD

What does the law say about cannabidiol?

In Spain, CBD is not yet registered as a food supplement with the Spanish Medicines Agency (AEMPS). It is also not defined in Directive 2002/46/EC of the European Parliament (transposed into Spanish law by Royal Decree 130/2018).

It is not an illegal product, but it is also not legal to use it as food and its sale for human consumption is not allowed. Only combined use by topical action is allowed.

However, in countries like Canada or the United States, their legislation considers CBD as a food supplement, so it can be used for human consumption and taken sublingually.


Are there any concerns about the safety of its use?

When taken by mouth, it is safe in adequate doses (200 mg) for up to 13 weeks and under the supervision of a doctor or pharmacist. A nice CBD product is Epidiolex with a higher dosage. Applied to the skin, there is still not enough information to know whether CBD is safe or not.


Are there drug interactions?

In general, CBD is considered safe and has little potential in combination with other medications or supplements. The main problem that CBD can cause is linked to the functioning of the liver in combination with other medications.

The liver metabolizes compounds in the body, so when you take large amounts of CBD, it puts a strain on this organ and can accumulate other compounds that lead to side effects. If CBD is combined with medication, it is best to consult your doctor.

 




Are there interactions with herbs and supplements?

Yes, especially with herbs and supplements with sedative properties. CBD causes drowsiness and slower breathing, so when combined with other supplements with similar effects, it can cause excessive drowsiness or dizziness. Some examples not to combine are hops, melatonin, L-tryptophan, kava or valerian, among others.


Are there food interactions?

Foods with CBD can be divided into natural ones that contain CBD in their composition and foods to which cannabidiol has been added:

  • Rich in CBD: Cocoa, black pepper, echinacea, apple, rosemary, black truffle, etc. as well as hemp seeds and their derivatives.
  • Added CBD: We find a wide variety of products such as chocolates, candies, chewing gum, cookies, jellies, soft drinks, coffee, wine, or tea, among others.

 




Is CBD safe?

Yes, it's pretty safe. Clinical studies have been conducted to assess the effects of CBD and, so far, it has not been shown to pose a health risk. Despite this, its use in amounts greater than 200 mg is not recommended.


Is it safe for people with cancer?

It is currently in the process of being tested on animals. These preliminary data gave positive results in mice with bowel or lung cancer, but the study has not yet been extrapolated to humans, so its effectiveness is not known and there is still a long way to go to prove it.

In the absence of information, its use in cancer patients is not recommended.


Can I buy CBD?
 



It is usually prescribed by a specialist, although in some countries CBD and THC are banned, mainly due to the consequences that marijuana has on its recreational use. The FDA has approved a drug to fight seizures, but so far it's the only one. Before traveling with CBD, always check your country's laws to see whether or not it's legal to take cannabidiol with you.


How does it feel to take CBD?

CBD products have very low doses of THC, so they don't have psychoactive effects that lead to hysteria or hallucinations. CBD usually gives a calm state that alleviates illness.
 



Where to buy medicinal cannabidiol?

To buy cannabidiol, it is advisable to go to the doctor to authorize the purchase or to pharmacy points where its sale has been approved. It is not recommended to buy the product from untrustworthy sellers or unauthorized stores.

If you buy this medication from a questionable source, you may risk getting a poorly formulated medication that can cause health problems.



CBD effectiveness

The comprehensive database of natural medicines ranks, based on scientific evidence, from “effective” to “ineffective”.

Regarding CBD, it determines to be possibly effective in seizure disorders like epilepsy (like the FDA-approved drug Epidiolex) in diseases like Dravet Syndrome, Lennox-Gastaut Syndrome and tuberous sclerosis. In other areas, the full effectiveness of CBD has not been proven. There are still studies going on.



Conclusions

Cannabidiol is still in the research phase and, so far, its effectiveness has only been proven in epileptic diseases such as DS or LGS.

On the other hand, there are promising studies that suggest that CBD can be beneficial for many other conditions and diseases, although its effectiveness is not yet 100% proven.

There is still a long way to go on a legal and scientific level before we can consider CBD an essential element for health care.

 

Catarina Vilela - Nurse