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Many parents lacked the resources and connections they had. Everyone should have access to the drug that had so helped Sam, they thought. But that meant the F. For that to happen, real trials had to take place. And given the fraught political history of cannabis in the United States and the skepticism they would most likely face, Jacobson knew she would need top epilepsy experts to conduct those trials. The D.
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Much of the research into its therapeutic potential comes from other countries, including Brazil. Later studies by Zuardi and his colleagues showed that a large dose of CBD, when given to volunteers who feared public speaking — that is, who suffer from social anxiety — blunted the flight-or-fight response, measured by increases in heart rate, blood pressure and skin conductivity, prompted by having to address others. These were small studies, and the amount of CBD involved, which was milligrams in the social-phobia study, is greater than what users might consume these days in some CBD gummies, for example, but relieving anxiety is nonetheless one of the most widely reported reasons people use CBD.
CBD may also have antipsychotic properties. In susceptible individuals, its sister cannabinoid THC can, in high doses, induce psychotic symptoms, and heavy marijuana use early in life has been linked to an increased risk of developing psychotic disorders, possibly because it alters brain development. The scientists are now testing CBD as a prophylactic to prevent schizophrenia from even emerging.
A single milligram dose of CBD given to these patients, scientists at Kings College London have found , can partially normalize regions of the brain that have been shown in fMRI visualizations to become dysfunctional during schizophrenic episodes. A follow-up study will prophylactically treat a large group of these patients thought to be teetering on the edge of psychosis.
Current schizophrenia treatments merely attempt to manage the disorder once it has already emerged. A medicine that slows or prevents the disease from taking root altogether, almost like a vaccine, would address a huge unmet need. And precisely because the proportions between the two cannabinoids have become so skewed — the ratio of THC to CBD has risen to 80 to 1 from 14 to 1 in two decades — lots of modern cannabis is potentially much more toxic for the brain, says Hurd, who is the director of the Addiction Institute at Mount Sinai.
Now she studies how CBD could help opioid addicts kick the habit. THC may also have therapeutic uses, particularly in treating the pain that often puts people on a path leading toward opioid addiction. And opioid-related deaths have declined in states that legalized medical cannabis , suggesting that people who have access to less-addictive options for pain management may not be as likely to become hooked on opioids.
Other possible applications of plant-derived cannabinoids could be just as groundbreaking. Israeli scientists have found that CBD can lessen the incidence of graft-versus-host disease in bone-marrow transplant patients , presumably because the cannabinoid calms the immune system and deters it from attacking the patient. How could one family of molecules help so many maladies? The most obvious response is that they might not; all this research is preliminary and might not pan out. But scientists often propose a counter-explanation: Many chronic disorders, even though they seem distinct, are characterized by dysfunction in the same few pathways.
Inflammation and oxidative stress, for example, occur in schizophrenia, metabolic disorders, heart disease and other ailments. The therapeutic magic of CBD and, in some cases, THC — and maybe some of the more than other cannabinoids in cannabis — may come from the ways that, by tweaking the endocannabinoid system, they push the body away from disease toward the unruffled state scientists call homeostasis.
There are other examples of a single drug being able to help meliorate a variety of conditions. We know aspirin as a treatment for fever and headache, for example, but in low doses it is also used to reduce the risks of stroke, heart attack and pre-eclampsia in pregnant mothers; it even figures as an adjunct treatment for schizophrenia.
Aspirin has its own downsides — an elevated risk of bleeding, for instance — but like CBD, its broad utility may be partly explained by its anti-inflammatory effects. Like CBD, aspirin is derived from a plant. The active ingredient in aspirin, salicylate, was first extracted from willow bark and was a folk remedy for thousands of years before scientists finally made a pill from it in the late 19th century.
In early , just a few weeks after Sam Vogelstein returned from Britain, Catherine Jacobson organized a brainstorming session at N. The neurologists who ran the trials included Orrin Devinsky from N. In June , just five years after that meeting — an instant in drug-development time — the F.
And three months later the D. The drug, called Epidiolex, is not the first cannabis-related drug on the market. Marinol, used to suppress nausea and stimulate appetite, contains THC.
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But Epidiolex is the first drug that contains only CBD and the first one derived directly from the cannabis plant itself. The THC in Marinol is synthetic. Epidiolex is also noteworthy for its unusual history. Drugs are typically developed in the lab and go through trials before reaching patients. But in the case of Epidiolex, two mothers of epileptic children experimented on their own sons and then helped push a version of what they discovered into the F. Because so many people already use cannabis and think it helps, patients might be, in effect, pioneering new uses through self-experimentation.
Users, meanwhile, look to the published literature as Jacobson did for guidance on how to use cannabinoids. The end result is that cannabis science and vernacular cannabis use exist in an uneasy symbiosis.
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CBD is generally considered safe, even at the high doses tested so far — and the quantities in chocolates, teas and other edibles tend to be far below the concentrations tested experimentally. Still, many who have direct experience with CBD, including a few scientists, do not think it should be available only by prescription. They point out that long before the Controlled Substances Act, which made marijuana illegal, people used the plant medicinally.
Cannabis should not only take its place as an F.
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It should also reclaim its role as a folk remedy. If there is a Patient Zero in the vernacular cannabis movement, that person is a girl in Colorado named Charlotte Figi. Doctors diagnosed Dravet syndrome, in her case caused by a spontaneous genetic mutation. By the time she was 5, she was wheelchair-bound, receiving sustenance through a feeding tube, seizing about times per week, and on several occasions she had to be shocked back to life after her heart stopped.
Doctors once recommended a medically induced coma just so her body could rest. Medical cannabis has been legal in Colorado since The seizures almost entirely disappeared. Word of this success spread through the network of medical-marijuana professionals, and early in , someone called on behalf of the CNN medical correspondent Sanjay Gupta. Gupta, who is a neurosurgeon, had previously argued against the legalization of medical cannabis, but he now wanted to do a show on it. After much discussion, Paige Figi and Joel Stanley, the Boulder-based cannabis grower who had produced the extract for Charlotte, decided to invite Gupta to tell their story.
If it came from a skeptic of his standing, people might actually believe it. Gupta visited the Figi home, watched old videos of Charlotte seizing, looked at family photos, and saw the Charlotte before him as a playful little girl of 6. At one point, Paige Figi told me, Gupta, who has daughters of his own, requested that the cameras be turned off, and cried. Figi fed them. Some stayed a few nights. One family ended up living with them for a year. A community began to coalesce in Colorado Springs, made up of epileptic children and their families.
This was also a period of some tension and confusion. He kept long waiting lists of hopeful parents. Figi and Stanley eventually left Realm of Caring to avoid conflicts of interest.
In , the F. Both say they updated their websites. Where Jacobson and Nussenbaum saw their role as helping a cannabis-derived drug get F. Figi, who says she switched her party affiliation from Republican to Democrat after Donald Trump was elected president, even considered running for elected office and making access to CBD part of her platform. And that access should not depend on whether recreational cannabis is also legal. Why hold them hostage?
One reason some physicians look askance at the vernacular cannabis movement is that it can, in its sometimes quasi-religious devotion to the plant, seem almost cultlike. She had no data at that point on its efficacy and did not recommend it. The Epidiolex trials have provided some evidence of effectiveness, Park told me, but she still frets over the phenomenon. Sometimes parents of patients refuse established epilepsy treatments in favor of cannabis products, she says, because these are perceived as somehow natural and thus superior to standard medicines.
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Nor are most drugs completely free of side effects. In the standard drug-approval process, observed side effects are noted on the packaging. If new ones show up after F. CBD has known side effects. These issues might be caused by different cannabinoids or terpenes, another type of biologically active molecule produced by plants. CBD can also interfere with how quickly the body breaks down other medications. The greatest concern, however, and one I heard repeatedly from parents and physicians, is quality control.
It sent out a flurry of letters warning companies not to make medical claims. Two years later, a study published in JAMA documented that, in 84 products sold online, 26 percent had less CBD than advertised and 43 percent had more. And the cannabis plant can absorb toxic substances like heavy metals or pesticides as well as carry infective agents. Marcia Yudkin.