CBD: How Exactly Does It Work?

From A4M Partner Pharmacy Podcast Network‘s Magazine
By Todd S. Eury

The controversy surrounding CBD’s use as a treatment option for pain and other medical conditions hasn’t stopped it from skyrocketing to fame.

Today, CBD is one of the fastest growing industries globally with a projected market value of $23.7 billion by 2023. Last year, 14% of Americans admitted to using CBD, while 64% of seniors who tried CBD said it helped somehow. Let’s take a closer look at what CBD is and how it works:

What is cannabidiol?

The World Health Organization defines cannabidiol (CBD) as “one of the naturally occurring cannabinoids found in cannabis plants. It is a 21-carbon terpenophenolic compound which is formed following decarboxylation from a cannabidiolic acid precursor, although it can also be produced synthetically.”

Cannabis sativa or hemp is the primary source of CBD. This herbaceous plant is native to central

and western Asia, but it is cultivated worldwide for medicinal purposes and for its natural textile fiber.

The terms “hemp” and “marijuana” have been mistakenly used interchangeably and have evolved and grouped under an umbrella term, cannabis. In actuality, hemp and marijuana are varieties of Cannabis sativa, a species of the genus Cannabis in the Cannabaceae family. As language continuously evolves, the term cannabis has now drifted from its taxonomical classification as the genus Cannabis to an umbrella term, cannabis, used in today’s culture to refer to anything related to hemp or marijuana4. Taxonomically, the genus Cannabis incorporates the following species: Cannabis sativa, Cannabis indica, Cannabis ruderalis2.

Out of more than 400 chemical compounds found in the cannabis plant, there are about 60 cannabinoids, including CBD, which is not psychoactive.

Although cannabis has been used in treating pain for centuries, CBD started to gain popularity when in 2018, the U.S. Food and Drug Administration approved Epidiolex oral solution for treating seizures associated with two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome.

According to FDA Commissioner Scott Gottlieb, M.D., “This approval serves as a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies. And, the FDA is committed to this kind of careful scientific research and drug development.”

How does cannabidiol work?

The exact mechanism of action for cannabidiol, particularly its anticonvulsant and antiepileptic effects, are still not fully known. However, cannabinoids are known to interact with cannabinoid receptors that form the body’s endocannabinoid system.

Endocannabinoids are dispersed throughout the body in various targets. Such receptors can be found in the CNS, spleen, internal organs, testes, retina, glandular organs, connective tissue. The endocannabinoid system is responsible for modulating neurotransmitters to “relax, sleep, eat, and protect”.

The body produces two types of receptors: CB1 and CB2. CB1 receptors are found throughout the body, with the largest concentration in the brain, as they help coordinate activities like emotion, pain, appetite, mood, movement, and memory.

CB2 receptors, on the other hand, are found mostly in the immune system, where they

trigger the responses of pain and inflammation.

THC, the psychoactive compound found in marijuana, usually targets the CB1 receptors, causing myriad different effects on brain-related activities. CBD, on the other hand, stimulates both CB1 and CB2 receptors, resulting in agonist and antagonist effects depending on concentration and other factors.

Several research studies conducted about CBD have revealed that it could produce an antagonistic effect against GPR55, which is a type of Gprotein-coupled receptor that has effects on some parts of the brain.

It could also produce an inverse agonistic effect on GPR3, GPR6 and GPR12. However, CBD’s exact mechanism of action is yet to be discovered, demanding further studies.

Is CBD a form of marijuana?

Harvard University https://www.health.harvard.edu/newsletter_article/cbd-products-are-everywhere-but-do-they-work answers this controversial question with a yes and no.

Dr. Donald Levy, assistant clinical professor of medicine at Harvard Medical school, explains that CBD does not give you the “high” related to using marijuana because it doesn’t contain tetrahydrocannabinol (THC).

He says, however, that the idea of CBD not being psychoactive could be a misconception, “It does change your

consciousness. You feel mellow, experience less pain, and are more comfortable.”

He added that some CBD products on the market today could contain small amounts of THC, which is why it’s imperative to impose clear regulations regarding the development of CBD.

Aside from marijuana, CBD can also be derived from hemp containing 0.3% of THC or less. In 2018, Congress

passed the Farm Bill, which legalized hemp in all 50 states and hemp-derived CBD legal. This deregulated CBD from a Schedule I substance, as long as it contains less than 0.3% THC. The controversy lies primarily in CBD’s use derived from marijuana, which is still under debate today.

The legality of marijuana-derived CBD depends on what state you live in. Some states allow the use of marijuana for both recreational and medical purposes, while others only allow it for medical use.

Still, there are some states where the use of marijuana for any purpose is entirely illegal.

What are the uses of CBD?

Over the years, CBD has been used to address more ailments and medical conditions.

A study in 2018 notably revealed that CBD use could help with arthritis or joint pain, chronic pain, sleep disorders, anxiety and depression, cluster headaches, migraine, nausea, post-traumatic stress disorder

(PTSD), multiple sclerosis, epilepsy, Alzheimer’s disease, and Parkinson’s disease. Nonetheless, the most substantial evidence for CBD’s benefit is in treating two of study in 2018 notably revealed that CBD use could help with arthritis or joint pain, chronic pain, sleep disorders, anxiety and depression, cluster headaches, migraine, nausea, post-traumatic stress disorder (PTSD), multiple sclerosis, epilepsy, Alzheimer’s disease,

and Parkinson’s disease.

Nonetheless, the most substantial evidence for CBD’s benefit is in treating two of the worst childhood epilepsy syndromes resistant to antiseizure medications mentioned earlier, known as Dravet and Lennox-Gastaut syndrome. This led to the approval of Epidiolex, which is touted as the first cannabis-derived medication to be legalized by the FDA.

Is CBD safe?

The safety of CBD products has been proven in adults, although some may experience mild side effects like irritability, nausea, and fatigue. CBD may also interact with some medications, which is why it’s highly advised to consult a doctor before using it.

However, Dr. Levy from Harvard advises against the use of CBD products in children and teenagers, “I don’t suggest that anyone under age 21 use marijuana regularly. It’s also not clear what the appropriate CBD dose is for children, and more research is needed in this area.”

The bottom line

Like any other new drug in the market, CBD is expected to undergo some scrutiny until its benefits are proven through sufficient scientific research and clinical trials.

Those who already experienced CBD products’ benefits in assisting with their medical conditions would say that CBD has changed their lives. Thus, the CBD industry’s future is still looking bright despite the controversies, and it won’t be long until its efficiency is proven.