Ever since cannabis was analyzed with modern technology, there has been astronomical growth in the amount of published research data about the plant. The synthesis of cannabinoids and the discovery of our endocannabinoid systems have led to a new age of understanding anatomy and physiological functions of the body. What have also taken place are simultaneous exploitations not only of the plant’s benefits, but also questionable practices and motives to ultimately generate profit.
We invite you to take a deeper look as we provide evidence-based information about data behind cannabinoid based products while also giving considerations to public health and health literacy.
Science: An Always-Expanding Field of Complexities
Before we go into examples of evidence and interpretations it is important to remind ourselves that the scientific model itself is based in fundamentals, yet is always evolving. This notion is based on the reality that two things can be true at the same time. For example, the way researchers conduct studies using different methodologies has of course changed over the decades. In modern times, all types of studies exist from self-reported surveys and case studies to meta-analyses and placebo-controlled clinical trials. While there can be valuable information found at each level of research, it is only in the weight of all evidence that conclusions should drive policies and recommendations. In order for this to occur, a trained eye must decipher the key takeaways of any study. Here is a helpful resource on ways to spot bad science or research of questionable quality.
Because different studies inherently hold contrasting intentions, insights that are offered should therefore be used in accordance with that information. For example, when a study discusses how synthetic cannabinoids operate within the brain using specific ligand structures, it cannot be denied that researchers may have found important areas for future pharmacological work. At the same time, in this example, experiments were conducted in a highly-specified, controlled environment which requires massive amounts of resources and comes with limitations. To be clear, this is not to say such information is lacking in overall importance or in helping understand how a particular function works. However, when compared to real-world longitudinal studies, open label clinical trials or comprehensive systematic reviews, more specialized works often provide narrowly applicable levels of information. For this reason, open access of research results is another critical topic for consideration. Granted people must be compensated fairly and make a living at the work they do, but if data only reside behind paywalls we must ask ourselves, “How is it benefitting humanity and the common good?”
Evaluating Research on CBD
While explorations continue, conclusions about cannabinoids (specifically CBD) are now made based on available information which have been replicated and expanded upon over time. According to the World Health Organization Report on CBD, its Expert Committee on Drug Dependence stated that “CBD is generally well tolerated with a good safety profile” and “In humans, CBD exhibits no effects indicative of any abuse or dependence potential.” The report goes on to say that there may be possible contraindications in some populations with drug-drug interactions, however – as both can be true simultaneously - this certainty does not negate the previous definitive statement on cannabidiol’s proven safety profile.
Data research that intends to build upon previous works can generally provide helpful information. In the example of a recent study published in Elsevier’s Epilepsy & Behavior Journal, the long-term efficacy and safety of CBD was evaluated. Through their methods and analyses researchers studied demographic and baseline characteristics of patients, which included seizure frequencies over time. What was found is that in children with treatment-resistant epilepsy, “results of this study support and extend those from previous research on the safety and tolerability of CBD, demonstrating that CBD was generally well tolerated as a long-term treatment in doses up to 50mg/kg/day…[and] also appeared to support a reduction in major seizure frequency and an increase in total seizure-free days for many patients.”
In a related review example, researchers concluded that “CBD is an effective treatment for patients with Dravet and Lennox-Gastaut syndromes”, but goes on to say, “The role of CBD in the treatment of drug-resistant epilepsy is adjuvant and often overstated.” These statements, while seemingly conflicting, do provide a more complete perspective with regards to growing social acceptance of CBD, and complexities of individualized treatment options that challenge a traditional “one size fits all” approach.
Many products used in controlled research settings originate from proprietary development, as in the case of Epidiolex and GW Pharmaceuticals. The industry as a whole is now seeing an overwhelming expansion of products available to consumers. This trend is expected to continue at least until the FDA provides clear regulatory parameters for cannabidiol as a supplement or nutraceutical, and guidance on its regulatory plan for a cannabis-derived product pipeline.
Opportunistic or Providing Value?
Since March, citizens living in the United States have seen dozens of articles about cannabis-derived products and the coronavirus (COVID-19.) Now more than ever it is critical for sources to publish fact-based and comprehensive information, especially pertaining to such matters of public health. One way to spot bias in publications is by sensationalized headlines. News and media outlets tend to gravitate towards catchy phrases or enticing hooks that draw people in to increase readership. This is done using persuasive tactics and provocative or sometimes misleading language.
As communities continue to deal with the impacts of this deadly global crisis, a recent study review does provide an example that strikes a more fair balance. In the study, “Could Cannabidiol Be a Treatment for Coronavirus Disease-19-Related Anxiety Disorders?” researchers set out to assess available data on the specific issue of anxiety. In reviewing their conclusions, one can effectively make two interpretations. The first one being that the typical call for future research is warranted and the second being that consideration for CBD as a treatment option include the aforementioned disclaimer about contraindications.
“Symptoms of anxiety and post-traumatic stress are going to be prevalent as a consequence of the COVID-19 pandemic, particularly in those most closely affected by the disease, and in those with pre-existing anxiety conditions. Unlike CBD, current antianxiety medications possess significant unwanted side effects, and delayed onset of action, limited efficacy in some patients, strong drug dependence, and withdrawal syndromes. Unlike THC, studies have shown that CBD lacks any rewarding effects of its own given that it fails to induce conditioned place preference or enhance the reinforcing effects of electrical brain self-stimulation. CBD is already being evaluated as a potential treatment during the active coronavirus disease phase, and we suggest that the pre-clinical and clinical evidence base supports the hypothesis that CBD could be a novel pharmacological option for treating COVID-related anxiety disorders that merits testing through well-designed clinical trials. CBD could be more preferable compared with some of the medicines currently available with respect to its safety and side effect profile, although prescribers need to be aware of potential drug interactions with concomitant medication because of the effect of CBD on liver enzymes.”
A headline such as, “Study Shows CBD Can Cure Covid” is borderline irresponsible and at best provides false hope, yet at its worst can be detrimental in multiple ways if taken literally or out of context. Articles written from a panacea framework or “cure-all” fashion plays on audiences’ emotions to drive profit, and often leave people misinformed about real public health benefits and potential risks. A more responsible, nuanced approach will reveal that more a cautiously optimistic and objective perspective is preferred by consumers, medical providers and those actively working in data science.
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