Cannabis activists have come to expect not getting a fair hearing when discussing the medicinal benefits of the herb, which has been accused of causing mental health issues, reducing motivation and being a gateway to hard, addictive drugs. While no one can deny that abusing cannabis rich in psychoactive THC is likely to bring about problems, the same applies to any substance.
Thankfully, the therapeutic properties of cannabidiol (CBD), another important cannabinoid found in cannabis, cannot be shunned by the naysayers so easily. Since the early 1960s when CBD was isolated from the rest of the plant and had its chemical structure defined by Israeli researchers, a number of potential uses have emerged. As have safer ways of using cannabis – instead of damaging the lungs by smoking, near-instant relief is now possible with CBD vape oil and e-liquid.
But firstly, let’s look at why CBD does not have the drawbacks which have prevented THC’s progression as a mainstream medicine.
CBD – cannabis without the downsides
CBD and THC are just two compounds out of more than 400 which make up the entire cannabis plant. Most of these have barely been studied, but research has been extensive on these two since they are typically the most-abundant compounds in the herb. Both CBD and THC are cannabinoids, a set of more than 100 chemicals which function in a giant network of neurotransmitters, receptors and enzymes which make up the endocannabinoid system (ECS).
The differences in effects between CBD and THC, despite them both being cannabinoids, come from how they interact with the ECS. THC, in comparison to its endogenous analogue anandamide, is very potent and instigates significant alterations to mood and appetite when binding with the CB1 receptor. As a psychoactive substance, THC also causes changes to consciousness, behavior and perception of reality. These effects can be pleasurable in a recreational context, inducing temporary euphoria and reducing inhibitions, which helps with social bonding – hence why cannabis is so popular. However, a negative trip tends to make users paranoid and anxious. For those with a predisposition to schizophrenia and psychosis, THC can be a trigger.
But while THC is an agonist of the CB1 receptor, CBD is an antagonist, and therefore does not make such wild changes to mood and behavior. In fact, research shows that CBD decreases the binding affinity of this receptor, moderating the psychoactive effects of THC. This explains why recreational users often seek as high a THC to CBD ratio as possible. Several studies now attest to the anti-anxiety properties of CBD, which come from enhancing levels of GABA neurotransmitters and partially agonising the 5HT1-A receptor in the serotonin system, a common target receptor for drugs treating anxiety.
Is CBD the answer to inflammation?
One area where CBD looks to have huge therapeutic potential is inflammation. Many conditions are a result of irregularities in the immune system, such as inflammatory bowel disease (IBD), rheumatoid and psoriatic arthritis, some types of depression and even acne, the world’s eighth-most prevalent disease.
Inflammation remains a big problem in the 21st century because medical researchers have struggled to develop treatments that effectively reduce it, without causing side effects. Non-steroidal anti-inflammatory drugs (NSAIDs), for example, have been linked to liver and kidney problems, and a 2018 study published in the New England Journal of Medicine found that aspirin may even be harmful for the elderly.
In contrast, the side effects from taking CBD are minimal, and the cannabinoid looks to manage inflammation surprisingly simply, and naturally, through indirect activation of the CB2 receptor. The ECS is not just found in the central nervous system, but also the peripheral nervous system and specifically in the body’s immune tissues – this is where CB2 receptors reside, indicating that the ECS has an immunomodulatory role.
CB2 receptors are mostly activated by anandamide, and another endocannabinoid called 2-Arachidonoylglycerol (2-AG). CBD stops degradation of the former and is believed to do the same with the latter. Studies have found that CB2 receptor activation tends to reduce inflammatory cell activation. Researchers are currently looking to enhance CB2 receptor signalling and also find new agonists of the receptor.
Since CBD poses no risk to the user, some have already tried products to treat acne and other inflammatory issues and shared their success stories online. CBD seems more effective than many acne treatments as it also has a sebostatic effect – this prevents the skin from drying out when reducing aggravation in sebaceous glands, as sebum production is regulated, rather than stopped completely. CBD creams target the cannabinoid receptors in the immune tissues of the skin, which can help accelerate healing for cuts and wounds, and with managing swelling.
Could we all benefit from CBD?
The ECS needs certain levels of anandamide, 2-AG and lesser endocannabinoids to function as it should – while we don’t understand all of the system’s mechanisms, its influence and the importance of homeostasis is not in doubt. A group of researchers, headed by neurologist Dr Ethan Russo have been investigating deficiencies in the ECS since the 2000s, and have come up with some remarkable findings.
They argue that some unexplained illnesses, notably migraines and fibromyalgia, are a result of low endocannabinoid levels. For example, a lack of anandamide causes a lower mood, increased sensitivity to pain, appetite issues, fatigue and cognitive problems. Then we look at the main symptoms of fibromyalgia: depression, pain, weight loss or weight gain, disabling fatigue and cognitive issues (or “fibro fog).
Research in this department is lacking, besides the research of Russo and co on their concept of Clinical Endocannabinoid Deficiency (CECD), but a 2018 study of 30 fibromyalgia patients found that all enjoyed an improvement in symptoms after taking medical cannabis, and that more than half were able to stop taking their current medication. Almost one-third reported “very mild adverse effects.” A recent study also found cannabinoid treatment as therapeutic for migraines as existing anti-migraine drugs.
However, low mood, fatigue, cognitive impairment and out-of-control inflammation are problems that many of us experience at various points in life. Cannabis has been an integral part of medicine in many civilizations dating back thousands of years and was likely used prior to recorded history – the ECS could have been present in primitive animals as long as 600 million years ago. It’s evident, therefore, that the connection between humans and cannabis is a strong one. Now, thanks to science and technology, we can enjoy the regulatory properties of the herb without getting high.
The potential for medical cannabis seems limitless right now, given the wide range of uses and the holes in current research. In the coming years, our knowledge of CBD and THC will deepen further, and we’ll also learn more about how other cannabinoids affect the ECS and the rest of the body. From there, cannabinoid products with specific uses will become a reality.
For example, a potent neuroprotective treatment looks possible with CBD and cannabichromene (CBC) – both cannabinoids help stimulate growth in the hippocampus, which is responsible for forming and storing long-term memories. Meanwhile, CBD and cannabigerol (CBG) support bone growth, which could be effective for osteoporosis patients. What does seem certain is that CBD will be a staple in products that make use of multiple cannabinoids.