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Uh Oh: Politicians Formerly Against Medical Marijuana Now Singing Praises of Cannabidiol

Don't sacrifice the plant for one of its healing compounds.
 
 
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State lawmakers who have steadfastly opposed the legalization of medical marijuana are suddenly singing the praises of cannabidiol. What gives?

Lawmakers in a growing number of states, including Alabama, Florida, Georgia, Utah, and Wisconsin, are saying no to medical cannabis but yes to cannabidiol, a naturally occurring compound in the plant. But is this new direction in the best interest of patients?

Cannabidiol, also known as CBD, is one of an estimated 100 unique, biologically active compounds present in the marijuana plant. First discovered in 1940 (though its specific chemical structure was not identified until 1963), CBD is the most studied cannabinoid after delta-9-THC. Like THC, the compound acts on the endogenous cannabinoid system to stimulate a variety of potentially beneficial therapeutic effects. (Some of these more notable effects include anti-anxiety, anti-convulsant, anti-inflammatory, and anti-cancer activities.) Unlike THC, cannabidiol is not psychoactive. Therefore, it does not trigger the so-called marijuana high. In fact, studies show that CBD tempers THC’s psychoactivity.

It is this latter effect that has gotten the attention of lawmakers, many of whom have steadfastly opposed any liberalization of medical marijuana access but are now pushing to legalize strains of cannabis and extracts high in CBD content. Even career prohibitionists, like Project SAM’s Kevin Sabet, have begun to acknowledge CBD’s therapeutic qualities while continuing to dismiss the notion that the plant itself possesses any therapeutic value. But is sacrificing the whole plant in lieu of a single compound—even one as promising as CBD—an ideal alternative for patients? Not by a long shot. Here's why.

Despite compelling anecdotal reports of young children successfully using CBD to offset symptoms of otherwise intractable pediatric epilepsy such as Dravet Syndrome, no controlled clinical studies have been concluded as of yet documenting the compound’s efficacy for this condition in this specific patient population. There are, however, a limited number of controlled trials performed assessing the use of CBD in adults with more conventional forms of the disease. Specifically, a pair of controlled trials published in 1980 reported the substance possesses some moderate effectiveness as an anti-convulsant. But those studies involved only 16 total subjects, and no additional controlled trials have replicated these preliminary findings.

This is because cannabidiol is classified as a Schedule I substance, making it exceedingly difficult for researchers to study in controlled clinical settings. As a result, most of the nearly 1,200 papers available on CBD focus on the substance’s effects in animals or in a petri-dish. As for the handful of human trials assessing CBD in isolation, these are primarily studies of the compound’s safety, not efficacy. (Two notable exceptions are a 2012 German study which found CBD administration limited psychotic episodes in patients with acute schizophrenia on par with the drug amisulpride, but possessed a markedly superior side-effect profile, and a 2011 Brazilian study reporting that CBD reduces anxiety in subjects with social anxiety disorder.)

By comparison, there is a far greater pool of controlled clinical studies documenting the efficacy of either whole plant marijuana and/or THC. A 2012 review of a series of recently conducted trials by the University of California to evaluate the effectiveness of whole smoked marijuana in hundreds of patients concluded that sufficient clinical research has now been performed to validate the plant’s therapeutic efficacy. “Based on evidence currently available the Schedule I classification is not tenable,” the authors determined. “[I]t is not accurate that cannabis has no medical value.”

Could investigators draw a similar conclusion acknowledging the medical value of CBD alone? It’s possible they could, but far from certain. That is because at this time the compound’s therapeutic efficacy has yet to be consistently documented in controlled clinical settings involving a significant number of people—a situation that exists largely because, until now, clinical researchers have been uninterested in studying its effects in humans and the federal government has made it cumbersome to conduct such studies.

 
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