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Epidiolex is the first FDA-approved treatment in the U.S. that contains a purified drug substance derived from marijuana -- CBD -- and the first treatment for Dravet syndrome. In September 2018 the FDA rescheduled cannabidiol from a C-I controlled substance to a C-V controlled substance, meaning it has a proven medical use but a low risk of abuse. This change allows Epidiolex to be marketed in the U.S.

Still, for many, cannabis has become a tonic to dull pain, aid sleep, stimulate appetite, buffer life’s thumps and shocks. Pot’s champions say it peels back layers of stress. It’s also thought to be useful as, among other things, an analgesic, an antiemetic, a bronchodilator, and an anti-inflammatory. It’s even been found to help cure a bad case of the hiccups. Compounds in the plant, some scientists contend, may help the body regulate vital functions—such as protecting the brain against trauma, boosting the immune system, and aiding in “memory extinction” after catastrophic events.


So far, though, there’s scant clinical evidence for the claimed benefits of CBD. In June, the Food and Drug Administration approved the first CBD drug, Epidiolex, for treating seizures associated with two rare forms of epilepsy. Otherwise, the FDA doesn’t consider CBD products to be dietary supplements—manufacturers can’t claim the products will diagnose, treat, or cure any diseases. Instead, CBD product literature contains phrases like “restore vitality,” “relax and recover,” and “may keep healthy people healthy.”
Cannabidiol (CBD) is a naturally-occurring constituent of industrial hemp (cannabis sativa) plants. It is the most abundant non-psychoactive cannabinoid found in cannabis and is being scientifically investigated for numerous reasons. Most people have heard of a cannabinoid called THC, which is the ingredient in cannabis that gets users high. Unlike THC, CBD (cannabidiol) is a non-psychoactive cannabinoid and does not cause a high.

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Based on history cannabis is believed to have originated from Central Asia. Cannabis is one of the oldest plant medicines known to man. It is difficult to trace the beginnings of cannabis use use by humans because it was cultivated and consumed long before the appearance of writing. According to archeological discoveries, cannabis has been known in China since the Neolithic period, around 4000 BC.

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He leads me through Mindful’s bustling front offices and into its interior corridors. In freezers Mindful stores seeds from all over—Asia, India, North Africa, the Caribbean. A world traveler who’s become something of a Johnny Appleseed for marijuana, Hague is extremely interested in the plant’s historical biodiversity, and his seed bank of rare, wild, and ancient strains is a significant part of Mindful’s intellectual property. “We have to recognize that humans evolved with it practically since the dawn of time,” he says. “It’s older than writing. Cannabis use is part of us, and it always has been. It spread from Central Asia after the last ice age and went out across the planet with man.”
Last year, the National Academies of Sciences, Engineering and Medicine released a nearly 500-page report on the health effects of cannabis and cannabinoids. A committee of 16 experts from a variety of scientific and medical fields analyzed the available evidence — more than 10,000 scientific abstracts in all. Because so few studies examine the effects of CBD on its own, the panel did not issue any findings about CBD specifically, but it did reach some conclusions about cannabis and cannabinoids more generally. The researchers determined that there is “conclusive or substantial evidence” supporting the use of cannabis or cannabinoids for chronic pain in adults, multiple sclerosis-related spasticity (a kind of stiffness and muscle spasms), and chemotherapy-induced nausea and vomiting. The committee also found “moderate” evidence that cannabis or cannabinoids can reduce sleep disturbances in people with obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis, as well as “limited” evidence that these substances can improve symptoms of Tourette’s syndrome, increase appetite and stem weight loss in people with HIV/AIDs, and improve symptoms of PTSD and anxiety.
"We still don't fully understand all of the mechanisms involved in CBD's actions," says Marcel Bonn-Miller, Ph.D, who studies CBD and its effects, primarily on PTSD. "We know some pieces but definitely not the whole story at this point. A lot of our understanding of the many potential benefits of CBD is rooted in work either on the cellular level or in preclinical models with rodents."
CBD does not appear to have any psychotropic ("high") effects such as those caused by ∆9-THC in marijuana, but may have anti-anxiety and anti-psychotic effects.[12] As the legal landscape and understanding about the differences in medical cannabinoids unfolds, it will be increasingly important to distinguish "medical marijuana" (with varying degrees of psychotropic effects and deficits in executive function) – from "medical CBD therapies” which would commonly present as having a reduced or non-psychoactive side effect profile.[12][57]
McGuire doesn’t advise buying CBD products. You need to differentiate, he says, between the extremely high doses of pharmaceutical-grade pure CBD that participants in the handful of successful studies were given and the dietary supplements available over the counter or online. “These may contain quite small amounts of CBD that might not have large enough concentrations to have any effects,” he says. “It’s the difference between a nutraceutical and a pharmaceutical.” These supplements aren’t allowed to make claims of any effects. “If you’re making creams or sports drinks with CBD, you can say anything you like as long as you don’t say it will do such and such,” he says.
Whether any of these CBD products will do anyone any good (or bad) is moot. “Cannabidiol is the hottest new medicine in mental health because the proper clinical trials do suggest it has clinical effects,” says Philip McGuire, professor of psychiatry and cognitive neuroscience at King’s College London. “It is the No 1 new treatment we’re interested in. But although there’s tons of stuff in the news about it, there’s still not that much evidence.” Large, long-term studies are needed; a 2017 review paper into the safety profile of CBD concluded that “important toxicological parameters are yet to be studied; for example, if CBD has an effect on hormones”.
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In the apparent rush to accept weed into the mainstream, to tax and regulate it, to legitimize and commodify it, important questions arise. What’s going on inside this plant? How does marijuana really affect our bodies and our brains? What might the chemicals in it tell us about how our neurological systems function? Could those chemicals lead us to beneficial new pharmaceuticals?

Zuardi, A. W., Crippa, J. A., Hallak, J. E., Bhattacharyya, S., Atakan, Z., Martin-Santos, R., … & Guimarães, F. S. (2012). A critical review of the antipsychotic effects of cannabidiol: 30 years of a translational investigation [Abstract]. Current Pharmaceutical Design, 18(32), 5,131–5,140. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22716160

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