Dan Frey, a physical therapist in Portland, Maine, says that his patients report the most success using CBD to treat long-term trouble spots rather than acute injury sites. Frey, who doesn’t prescribe medication or supplements, says his conversations about CBD are initiated by patients. Many also tell Frey they find it helps with pain management, especially when used in conjunction with other treatments such as massage and a targeted strengthening and mobility program.
The side effects and risks involved with consuming marijuana-based products aren't clear, either, Bonn-Miller said. It's important to "determine cannabinoids that are useful therapeutically while understanding and using cannabinoids that are associated with less risk," he said. At least with CBD, he said, it doesn't appear to have the potential for addiction. That's different from THC, which has been associated with addiction, he said, and negative side effects, including acute anxiety.
Prescription medicine (Schedule 4) for therapeutic use containing 2 per cent (2.0%) or less of other cannabinoids commonly found in cannabis (such as ∆9-THC). A schedule 4 drug under the SUSMP is Prescription Only Medicine, or Prescription Animal Remedy – Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.
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Cannabidiol is currently a class B1 controlled drug in New Zealand under the Misuse of Drugs Act. It is also a prescription medicine under the Medicines Act. In 2017 the rules were changed so that anyone wanting to use it could go to the Health Ministry for approval. Prior to this, the only way to obtain a prescription was to seek the personal approval of the Minister of Health.
But it’s Guzmán’s brain tumor research that has captured headlines—and the interest of pharmaceutical companies. Through his years of research he has ascertained that a combination of THC, CBD, and temozolomide (a moderately successful conventional drug) works best in treating brain tumors in mice. A cocktail composed of these three compounds appears to attack brain cancer cells in multiple ways, preventing their spread but also triggering them, in effect, to commit suicide.
Topical solutions also vary greatly in potency. For example, Prevail Botanical’s salve contains 1,000 milligrams of CBD in 2.2 ounces. Floyd’s of Leadville cream has 700 milligrams in a 30-gram (1.05 ounce) container. These deliver higher amounts of CBD than other topicals I tried, such as PlusCBD’s balm (100 milligrams in 1.3 ounces) and Medterra’s cream (750 milligrams in 3.4 ounces). Remember, more isn’t necessarily better.
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As a consumer, you can look at the manufacturer's website to see whether they batch-test their products, or ask them directly. You could also send a sample of your CBD oil to a testing facility yourself, something Bonn-Miller says he would do if he were trying to treat someone with a severe issue such as epilepsy. Testing can also determine whether the product contains pesticides, heavy metals, or other toxins.
Those warning letters aside, there’s not a lot of federal oversight right now over the claims being made or the products that are being sold. Cohen warned against buying CBD products online, because “there’s a lot of scams out there.” Yet his clinic sells CBD, and he admits, “I say ‘Don’t buy online,’ but ours is worth doing, because we know what we’re doing. We ship all over.”
The oil may be further refined by 1) alkali washing, or removing the heavy aromatic carboxylic acids with antibiotic properties, which may cause heartburn, gallbladder and pancreas irritation, and resistance to hemp antibiotics; 2) conversion of CBD to THC. Process 1) consists of dissolving the oil in a nonpolar solvent such as petroleum ether, repeatedly washing (saponifying) with a base such as sodium carbonate solution until the yellow residue disappears from the watery phase, decanting, and washing with water to remove the base and the saponified components (and evaporating the solvents). This process reduces the oil yield, but the resulting oil is less acidic, easier digestible and much more potent (almost pure THC). Process 2) consists of dissolving the oil in a suitable solvent such as absolute ethanol containing 0.05% hydrochloric acid, and boiling the mixture for 2 hours.
“CBD coupled with stretching, icing, and foam rolling is a common treatment plan for tendonitis injuries about the knee, such as iliotibial band syndrome,” says Charles Bush-Joseph, M.D., a professor of orthopedics at Rush University Medical Center in Chicago. “Many patients like the fact that CBD is a natural substance. While specific research on the use of CBD in this instance is lacking, many believe that it helps prevent muscle and collagen breakdown.”
Although hemp and marijuana are essentially different cultivars of the same plant – Cannabis sativa L – marijuana has been cultivated to concentrate high levels of THC (frequently as much as 18%), in the plant’s flowering tops, whereas hemp, which is primarily grown in Europe to make clothing, paper, biofuels, bioplastics, nutritional supplements, cosmetics, and foods, contains less than 0.3% THC.
Numerous diseases — such as anorexia, emesis, pain, inflammation, multiple sclerosis, neurodegenerative disorders, epilepsy, glaucoma, osteoporosis, schizophrenia, cardiovascular disorders, cancer, obesity and metabolic syndrome-related disorders — are being treated or have the potential to be treated by cannabis oils and other cannabinoid compounds. Although studies are limited due to strict government guidelines, a growing number of pediatric patients are also seeking symptom relief with cannabis or cannabinoid treatment.
It's a little more uniform when the product is absorbed by smoking or vaping the oil, Ward said. But, "there are obvious concerns about smoking something." A 2007 review published in the journal JAMA Internal Medicine found that smoking marijuana resulted in similar declines in respiratory system health as smoking tobacco. A similar review published in 2014 in The American Journal of Cardiology found that marijuana smoke inhalation can increase the chances of heart attack or stroke. Neither review analyzed the effects of vaping cannabis oil alone, so it's unclear if it has the same health risks as smoking other marijuana products.
Typically, pharmaceutical companies making cannabis-based medicines have sought to isolate individual compounds from the plant. But Mechoulam strongly suspects that in some cases those chemicals would work much better in concert with other compounds found in marijuana. He calls this the entourage effect, and it’s just one of the many cannabis mysteries that he says require further study.
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