Whether you call it ganja, weed, Mary Jane, or Devil’s Lettuce, you likely have a story involving direct or indirect effects of America’s most popular illicit drug: marijuana. A 2018 survey of teenagers (8th to 12th graders) found that while 14% of 8th graders indicated marijuana use, that number ballooned to 44% by the time they reached their senior year of high school. It’s likely these rates are underestimated, given that asking youth to self-report illicit drug use leads to underreporting. The anecdotal evidence for marijuana’s use in medicine has been staggering, but empirical evidence has been hard to come by (for a number of reasons). Recently, there has been a push towards the use of cannabidiol (CBD) as a means of treating numerous ailments. CBD has been found in drinks, lotions, topical oils, and strangely enough, suppositories. But, before we decide these are ideas we can get behind, one must ask: What exactly is CBD and what does the law say about it?
What is CBD and is it Legal?
CBD is the second most prevalent of the active ingredient in Cannabis plants. It’s derived directly from the hemp plant, not the marijuana plant. Legally speaking, marijuana plants are prohibited by the DEA. Scientifically speaking, hemp and marijuana belong to the same genus but are of a different species. The most important difference between the two is tetrahydrocannabinol (THC) content. THC is the foremost active ingredient in marijuana and is the compound responsible for the altered state of consciousness (aka getting high). By comparison, hemp plants contain no more than 0.3% (by dry weight) of THC, meaning that you won’t be able to get high off hemp plants. Any cannabis plant with over 0.3% THC content will produce a high and is illegal on the federal level. Any cannabis plant with under 0.3% THC content is a hemp plant, will not produce a high, and is not illegal on the federal level. Due to the lack of uniformity of marijuana law on a federal and state level, please refer to the Marijuana Policy Project’s state policy map, as well as NORML’s law database.
It’s important to note that the 2018 Farm Bill removed legal restrictions on CBD if it’s derived from hemp plants. Previously, all cannabis plants were considered the same, and thus, banned entirely. The hemp provisions removed hemp from the definition of marijuana, and even though THC is a Schedule I controlled substance, an exception was created specifically for THC in hemp. What remains to be seen is how the Food and Drug Administration (FDA) will regulate CBD moving forward. On June 16th, the FDA released a document stating that adding CBD to a food or labeling CBD as a dietary supplement is currently illegal under federal law. As Laura Reiley of the Washington Post notes, “so far, the FDA has looked the other way for intrastate commerce in CBD foods, but interstate sales are thornier.”
With the rapid influx of CBD-infused products, it’s important to ask how exactly CBD can address so many ailments at once. Depending on the ailment, that answer differs greatly. A Harris Poll conducted in April showed that the top 3 reasons U.S. adults say they have tried CBD is for “relaxation”, “stress/anxiety relief”, and “improved sleep”, but the uses for CBD extend far beyond those listed. A review published in Molecules, a peer-reviewed chemistry journal, found that CBD may have some effect on serotonin receptors, which would provide some relief to those suffering from depression and/or anxiety. This same review found that CBD is a “suitable candidate for advanced nanosized drug delivery systems”, essentially meaning that CBD can help deliver compounds as needed to ensure they are achieving their desired effect. This, combined with data showing that CBD can help medications cross the blood-brain barrier in mouse brains, shows promising potential for aiding in drug delivery. More data published in the American Society for Microbiology found that CBD is active against Gram-positive bacteria (think: MRSA, S. pneumoniae, and S. aureus), with potency similar to that of established antibiotics.
To date, the only FDA-approved cannabis-derived drug available for prescription in the U.S. is Epidiolex. Epidiolex is an oral solution used to treat seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Research about the medical benefits of cannabis has been scarce because the status quo has been fearful of this plant and the criminalization of its use. If new research is conducted displaying the efficacy of CBD in treating medical conditions, companies may be more likely to pursue research and development of cannabis-derived drugs.
Using CBD to treat autism has also been gaining steam within many social circles. Researchers in Israel conducting a follow-up study on anecdotal evidence found that CBD in autism spectrum disorder patients (ASD) “appears to be well tolerated, safe, and an effective option to relieve symptoms associated with ASD.” Autism has not been added as an Approved Medical Condition on any state’s medical marijuana lists. For what it’s worth, Ohio considered adding anxiety and autism as qualifying conditions for medical marijuana use, although this decision was delayed to give new board members a chance to review over 2,000 pages of data. Researchers at the University of California San Diego are conducted a clinical trial involving 30 children, each diagnosed with autism and severe symptoms. The intent of this study is to better understand how CBD interacts with or alters neural activity, as well as measuring if CBD effectively and safely alleviates some of the more problematic symptoms of ASD, such as aggressive behaviors, self-injurious behaviors, hyperactivity, and social/communicative deficits.
The Limitations of CBD Use
With all the discussion regarding the potential benefits of CBD, it would be irresponsible not to highlight the limitations we currently face related to CBD use. First and foremost, more empirical data needs to be gathered. Due to the rather confusing federal policy on marijuana, it will be primarily up to the private sector and the states to fund meaningful CBD research. Anecdotal evidence may be enough to sell a product, but it will not be enough to convince institutions to support CBD as an alternative or supplemental therapy.
Regulation of CBD products needs to happen on a federal level, due to the wildly inaccurate labeling practices of CBD extracts sold online. A study published in the Journal of the American Medical Association found that of the 84 products from 31 companies that they tested, 43% of the products were under labeled (contained more CBD than labeled). 26% over labeled (contained less CBD than labeled) and 31% were accurately labeled. Vaporization liquid was the most frequently mislabeled, and oil was most frequently labeled accurately. THC was detected in 21% of samples. On both the federal and state level, there are no standards for manufacturing and production, meaning there is no minimum or maximum dosage for CBD. This leads to products that may not have enough CBD to produce the desired effect, or products that have entirely too much CBD for the desired effect. Standardization needs to happen, but more research is necessary to determine a reasonable standard for most people.
State regulations involving testing and manufacturing standards may alleviate some of the burden caused by labeling inaccuracy, but when products come from a state with little-to-no regulation into a state with a regulatory framework, inconsistencies will arise without the existence of a basic federal framework.
Finding a way to incorporate medical marijuana (including CBD) into the training of physicians may prove beneficial moving forward. Only 9% of U.S. medical schools have clinical cannabis content in their curricula. Due to the emergence of clinical cannabis as a treatment for many conditions, it would be irresponsible and ill-advised for physicians not to seek knowledge regarding the potential benefits of clinical cannabis. It is imperative that every outlet is explored to best prevent and treat debilitating medical conditions.