Rebecca Bigornia 8 ppt CBD Presentation.pptxDownload PPTX • 860KBAPPE SCRIPT CBD Presentation Script (1).docxDownload DOCX • 17KB
Natalie Eshaghian & Donna Salib
Medical marijuana has become legal in many states in the US. Cannabis, also known as Marijuana, is growing in popularity in its efficacy in treatment of many different diseases. The cannabis plant consists of two main compounds: THC and CBD (cannabidiol). THC is responsible for the plant’s mood-altering and addictive quality, which makes it illegal in a few states, while CBD is not mood-altering, or addictive and is legal in all 50 states. CBD can be consumed as an oil, applied to the skin as an ointment, or inhaled as a vapor. Many patients use CBD for relief from anxiety, insomnia, inflammation, and more. To understand CBD’s benefits, we have to fully understand how cannabis works in the brain. Cannabis contains over 60 compounds called cannabinoids that act on the body’s endocannabinoid system which down-regulates stress-related signals that lead to inflammation and pain. There are two main receptors that cannabinoids bind to named CB1 and CB2. THC acts on the CB1 receptor and affects memory, concentration and coordination, while CBD does not act on CB receptors but instead acts on pain receptors that affect pain perception, anxiety and inflammation. (3) It is important to note that CBD is different from hemp products which contain CBD, or less than 0.3% of THC and several other cannabinoids while CBD products include only the CBD content from the cannabis plant, removing the THC and other cannabinoids. In 1970, the controlled substance act had banned marijuana, hemp and all related products such as CBD oil; it wasn’t until 2014 when the agricultural act, also known as the farm bill, legalized hemp for research purposes and designated it as a plant since it had less than 0.3% of THC. In the 2018 farm bill, more progress was made when hemp related products were made federally legal.
Increased interest rose in 2018 when the FDA approved a pure CBD oil called Epidiolex for a rare form of pediatric seizures, and it was found that it reduced the amount of seizures for these children. There was a study done in patients 1-18 years of age, and the study tested the safety of CBD in these patients, as well as any changes in seizure type, frequency, and seizure free days. They found that the adjunctive treatment of CBD in pediatric epilepsy was found tolerable at doses of up to 50mg/kg/day. There was a decrease in seizure frequency as well as increase in seizure free days in these patients. (2) Pediatric seizures are a difficult disease for a patient and a family to live with, with poor quality of life. Many families try to look into alternative medicines to try to help their child’s disease.
Another study was done to evaluate the effects of CBD ointment given twice a day for a duration of 3 months to treat chronic skin diseases such as psoriasis, atopic dermatitis, and scars. The results showed that there was a significant improvement on the symptoms of the skin diseases in all the patients. It was seen through before and after pictures of the patients that their scars or disease symptoms all decreased within the 12 week period. It was concluded that CBD ointment without THC is a safe and effective method of improving certain skin diseases and inflammatory conditions. (1) Psoriasis is a systemic skin disease that is growing in its treatment options available. In addition, atopic dermatitis (also known as eczema) and scars are another issue that many people live with and have minimal treatment options. CBD ointment can greatly help in finding a new and safe way to treat these diseases and provide these patients with a better quality of life.
Overall, CBD (cannabidiol) seems to be a safe and effective method to treat many different disease factors. CBD has been seen to be increasing in quantity and popularity over time, possibly due to the fact of its efficacious treatment. Many of these diseases that CBD helps are diseases with minimal treatment options and have a poor quality of life with their diseases. It is important for health care workers, especially pharmacists, to be educated on the topic of CBD and medical marijuana and the disease states that they aid in treating. Since CBD is found to work well in many of these populations, it is important to look more into CBD and its efficacies, as well as speak to medical professionals to see if CBD is an effective medication for a patient's disease.
Palmieri B, Laurino C, Vadalà M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Clin Ter. 2019;170(2):e93-e99. doi:10.7417/CT.2019.2116
Park YD, Linder DF, Pope J, et al. Long-term efficacy and safety of cannabidiol (CBD) in children with treatment-resistant epilepsy: Results from a state-based expanded access program. Epilepsy Behav. 2020;112:107474. doi:10.1016/j.yebeh.2020.107474
Baswan SM, Klosner AE, Glynn K, et al. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders. Clin Cosmet Investig Dermatol. 2020;13:927-942. Published 2020 Dec 8. doi:10.2147/CCID.S286411
Cannabidiol, otherwise known as CBD, is the second most abundant active ingredient in cannabis, and is classified as a phytocannabinoid. It is non-psychoactive and non-addictive, but still has widespread effects throughout the body. It is often seen as a miracle cure, without getting the “high” effects of inhaling or ingesting marijuana itself. CBD is a cannabinoid 1 receptor antagonist. These cannabinoid receptors function to maintain homeostasis in our bodies and they’re present throughout. Within this endocannabinoid system, many things are regulated like pain, memory, mood, appetite, stress, sleep, metabolism, immune function, and reproductive function. The cannabinoid 1 receptor is found in the peripheral nervous system, the hippocampus and the amygdala. These receptors regulate things like memory, fear and emotion. CBD specifically modulates these receptors thus reducing or regulating psychomimetic effects like mood, memory and anxiety. It has many other mechanisms and such a wide array of benefits explaining its use in so many different conditions.
The only FDA approved dug on the market is called Epidiolex which is a near pure form of CBD oil. It’s used for two severe pediatric seizure disorders: Lennox-Gastaut syndrome or Dravet Syndrome. It’s classified as a schedule V drug and is a highly expensive option that isn’t covered by insurance. The initial dose is 2.5 mg/kg twice daily which increases after one week. A major risk with this CBD formulation is hepatic toxicity and effects. This is why ALT, AST, and total bilirubin should be monitored at baseline and frequently during therapy. Side effects include decreases appetite, rash, diarrhea, somnolence and fatigue, but it is well tolerated overall. The exact antiepileptic mechanism of action of cannabidiol is unknown. Its onset of action is usually within 4 weeks and it has a very long half-life ranging up to 61 hours. Some important counseling points include telling the patient to take it at the same time every day in the same manner. That means if they have been taking it with food, to continue doing so, but if they have been taking it on an empty stomach instead, to not randomly take it with food a certain day. This is because food does have an effect on the absorption of cannabidiol.
While it only has these two FDA approved indications, CBD oil is being studied in a plethora of conditions such as Parkinson’s, schizophrenia, diabetes, multiple sclerosis, anxiety, depression, insomnia, arthritis, and inflammatory and neuropathic pain. Many people chose to purchase CBD oil and use is as an adjunctive therapy to conditions like cancer, chronic pain or anxiety. There are other formulations of CBD like candles, spray, serum, lip balm, etc. It has been found to be effective in both studies and life, used in both humans and pets. Many people go to CBD as a safe option or an alternative to medications.
1. Cannabidiol (Lexi-drugs). Hudson, Ohio. Lexicomp, Inc. Jan 2021.
Cannabis is a popular plant in society that may be used for a wide variety of functions. With its two active ingredients, cannabidiol (CBD) and tetrahydrocannabinoid (THC), it garnered the attention of its use for therapies in neurodegenerative diseases. Cannabidiol, a phyto-cannabinoid, is a cannabinoid-1 (CB1) receptor antagonist and primarily affects the nervous system. Cannabidiol works on the endocannabinoid system (ECS) to produce physiological and homeostatic effects through the CB1 and CB2 receptors. Regulatory functions of the ECS include cognition, analgesia, and appetite control. Because of the wide range of possible therapies for this substance, many studies are being conducted to observe the effects it has on Parkinson’s disease (PD) and Alzheimer’s disease (AD). This is due to the neuroprotection that CBD had on animal studies when being treated for PD and AD. These studies are being investigated on how CBD can control motor and non-motor symptoms in both diseases.
Alzheimer’s disease is the leading cause of dementia and the most common neurodegenerative disease. It is described as deposits of amyloid β-senile plaques in the extracellular space and intracellular neurofibrillary tangles made up of tau protein. There are four genetic mutations that can contribute to the onset of AD: mutation in the β-amyloid precursor protein, ApoE allele mutations, and presenilin 1 and 2 mutations. One of the AD animal studies compared the levels of expression of CB1 receptors in mice dependent upon age. Observations demonstrated that expression of the CB1 receptors were increased with older models as well as increased in the later stages of AD. The exact mechanism that CBD has on AD and its mutations is not known. Some studies have shown contradictory effects of CBD. For example, one study demonstrated the reducing effects of Aβ protein expression. Another study argued that CBD had no effect on the soluble and insoluble Aβ (40, 42) proteins. The study, however, did state that CBD has the potential of being a long-term prevention therapy for AD due to the positive results that patients experience with social disengagement and loss of face recognition.
Parkinson’s disease is a motor disease and is the second most common neurodegenerative disease. It is described as the reduction in dopamine located primarily in the substantia nigra, and the accumulation of intracellular Lewy bodies caused by a mutation in the α-synuclein. Most of the studies that included CBD treatment in patients with PD were used with animal models. However, there was no study that investigated the chronic effects of CBD and failed to show the permanent cessation of neurodegeneration. There have been reports of serious adverse effects of the cannabis plants on patients with PD and AD such as toxic effects on the brain that led to fatalities. More studies have shown that rather than using CBD alone for neuroprotection, more evidence points to the combination for the use of THC-CBD as being a better neuroprotective agent.
Although some studies show the potential of what CBD can do for patients with AD and PD, it is difficult to make therapies for these patients if the direct mechanism of CBD is not well understood. Therefore, more studies done on the molecular level need to be a higher priority.
Cooray, R., Gupta, V., & Suphioglu, C. (2020). Current Aspects of the Endocannabinoid System and Targeted THC and CBD Phytocannabinoids as Potential Therapeutics for Parkinson's and Alzheimer's Diseases: a Review. Molecular neurobiology, 57(11), 4878–4890. https://doi.org/10.1007/s12035-020-02054-6.
Cannabidiol (CBD) has become an increasingly popular ingredient in natural products used for various types of symptoms including pain, epilepsy, and anxiety. CBD is one of over a hundred phytocannabinoids found in cannabis. CBD is a naturally occurring cannabinoid from cannabis that gives therapeutic actions. Tetrahydrocannabinol, or THC, is best known for its psychoactive effects. Therefore, the use of CBD products does not cause any psychoactive effects because there is no THC in CBD. CBD is most popular due to its non-psychoactive and non-addictive therapeutic profile.
Cannabidiol is a cannabinoid-1 receptor antagonist. These receptors are a part of the endocannabinoid system whose function is to maintain our body’s homeostasis in response to changes in the environment. Cannabinoid receptors are present across the entire body, including the brain, nerves, skin, immune cells, bone, fat tissue, liver, muscle, blood vessels, kidneys, and the GI tract. The endocannabinoid system serves many functions including pain, memory, mood, appetite, stress, sleep, metabolism, immune function, and reproductive function.
There is currently only one cannabidiol medication that is FDA approved on the market. Epidolex is an almost pure CBD oil with indications for Lennox-Gastaut syndrome and Dravel Syndrome, two severe pediatric seizure disorders. Although there is an FDA indication for an almost pure CBD oil, the DEA still considers CBD itself as a schedule 1 medication. Due to the high expense of the medication, off-label studies are not easily done to identify other indications for this medication. CBD is still being studied for the treatment of other disease states including Parkinson’s, schizophrenia, diabetes, multiple sclerosis, anxiety, depression, insomnia, arthritis, and inflammatory and neuropathic pain.
According to the American Epilepsy Society, the effectiveness of CBD wanes in children and adults with treatment-resistant epilepsy due to tolerance over time. Tolerance was defined as the need to increase the dose by 30% to achieve the same benefit or 30% less of a response to the medication being administered. In a study done to show the decreased effectiveness of CBD in the human population, 17 of the 53 patients developed tolerance after an average of 7.3 months.
According to the World Health Organization, CBD is generally well tolerated with a good safety profile. The most reported adverse events may be due to drug-drug interactions between CBD and other medications a patient can be on. There is a long list of drug interactions for CBD therefore, the pharmacist needs to check these drug interactions if it is known that the patient uses CBD to treat their health conditions. It is important to note that CBD can potentially decrease the breakdown of medications in the liver, therefore it is important to note what medications are metabolized by the liver because an overdose of medication can occur from the accumulation within the body. CBD should also be used cautiously with over the counter vitamins and supplements.
“Cannabidiol (CBD): MedlinePlus Supplements.” MedlinePlus, U.S. National Library of Medicine,
Commissioner, Office of the. “What to Know About Products Containing Cannabis and
CBD.” U.S. Food and Drug Administration, FDA, www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.
Corroon, Jamie, and Rod Kight. “Regulatory Status of Cannabidiol in the United States: A
Perspective.” Cannabis and Cannabinoid Research, Mary Ann Liebert, Inc., Publishers, 27 Sept. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6154432/.
CBD has become very popularized in the recent years through its increased use in the general population. However, CBD has not been studied extensively in clinical trials to actually explore its benefits to the body, leaving many skeptical of its actual use. Cannabidiol (CBD) is an active ingredient within marijuana (cannabis). CBD is non psychoactive and non-addictive leading some to believe it is okay to use recreationally aside from prescription drug use. CBD itself is a cannabinoid 1 receptor (CB1) antagonist that is located in the brain and nervous system. CBD is thought to exhibit widespread systemic effects throughout the body because the CB1 and CB2 receptors are located all over the body, including in the gut. Recently, there has been a prescription strength for cannabidiol oil called Epidiolex used and FDA approved in Lennox Gastaut syndrome and Dravet syndrome. It is currently being evaluated in benefits in Parkinson’s, diabetes, arthritis and inflammatory bowel disease including Crohn’s Disease and Ulcerative Colitis. The CBD products on the market are thought to moisture and soothe skin, relieve discomfort and help with anxiety. CBD itself when used as supplementation is not regulated and is not approved for other than the Epidiolex use. CBD can cause sleepiness and drowsiness so if used, it should be used with caution with sleep inducing and sedating medications like benzodiazepines. However, CBD is not risk free. In animal studies, adverse effects included developmental toxicity and embryo-fetal mortality. It is unknown if CBD can produce these effects in humans. Human studies for CBD use in epilepsy and psychiatric conditions reported some drug-drug interactions, diarrhea, fatigue and vomiting- all common side effects. CBD may have some anti-inflammatory and antioxidant properties that is associated with many autoimmune conditions like arthritis and inflammatory bowel diseases including Crohn’s disease and ulcerative colitis. This inflammation in the bowel is due to certain inflammatory cytokines being activated in Crohn’s and ulcerative colitis. In animal studies it was found that the presence of these pro-inflammatory cytokines such as TNF-a was decreased when CBD was tested. Therefore, there has been some speculation in the effect of CBD on the gut neuro-immune axis since it has been theorized to have some effect on inflammation. In a study focusing on CBD use in Ulcerative Colitis patients showed from biopsies that CBD administration significantly reduced the expression of S100B, paralleling a decrease in the severity of intestinal inflammation. S100B is considered a marker of glial cells which are responsible for the release of pro inflammatory cytokines. Aside from all these speculations, there has not been proven significant clinical evidence in order to get CBD approved for gastrointestinal disorders. Further studies need to be conducted and further research must be explored in regard to the benefits of CBD to get FDA approval for another clinical indication. Through repeated clinical trials it is important to explore the use of CBD as it definitely does have an effect on the patient’s body, but it needs to be explored if the effect is actually beneficial to the patient.
Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardò FP. Cannabidiol Adverse Effects and Toxicity. Curr Neuropharmacol. 2019;17(10):974-989. doi:10.2174/1570159X17666190603171901
De Filippis D, Esposito G, Cirillo C, et al. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One. 2011;6(12):e28159. doi:10.1371/journal.pone.0028159
CBD or the cannabis plant of the Cannabaceae family contains more than eighty biologically active chemical compounds that can have beneficial therapeutic effects in treating certain severe conditions. The more commonly known products in CBD include THC, which creates the “high” feeling associated with marijuana, as well as CBD which is known as cannabidiol. Currently, the FDA has only approved one CBD product as a prescription to treat two rare and severe forms of epilepsy. However, CBD has only a limited safety profile and the risk for taking CBD needs to be considered before using it for any indicated condition. CBD is known to cause certain side effects such as liver injury, male reproductive toxicity, changes in mood, as well as some drowsiness or sleepiness. In addition, CBD can cause several drug interactions between other medications and dietary supplements that may be unaware to patients and physicians yet. The FDA is actively working to learn more about the safety of CBD as an alternative medication.
According to the Henry J. Kaiser Family Foundation, there were over 4 billion prescription drugs filled at pharmacies in the United States in 2016, and roughly 6.3 million Americans using drugs for non-medical reasons. CBD would be a better alternative for patients who need a safer and more natural way to manage pain, seizures, and anxiety. Since CBD is non-psychoactive, it doesn’t cause users to experience a high, so patients can go about their daily lives without feeling impaired or different from their medication. A double-blind, placebo-controlled study was done on the effects of cannabidiol for the treatment of drug resistant seizures in the Dravet syndrome for a 14-week treatment period. This study treated 120 children between the ages of 2 and 18 years of age who remained resistant to traditional epilepsy treatments. At the end of the study, the participants seizure frequency had dropped by an average of 39 percent with CBD. The average frequency of monthly convulsive seizures decreased from about 12 to 6 with CBD, and three of the participants had their seizures stop entirely. The participants did experience certain side effects such as vomiting, fatigue and fever.
Another study done by researchers of Colorado Anschutz Medical Campus investigated the effects of CBD for the treatment of psoriasis, eczema, and inflammatory skin disease. This study found that eight of the 21 patients with severe itching or pruritus were able to ease the itching and treat their skin condition by applying a CBD cream twice a day for three weeks. The anti-inflammatory properties of cannabinoids make them beneficial for skin conditions. CBD and THC have shown to interact with the endocannabinoid system’s CB2 receptors to stimulate an anti-inflammatory response. They do not cause any psychotropic effect because they are all topical products and they do not reach the bloodstream in the same one as a systemic drug does. When looking at alternative treatments for traditional drugs that don’t seem to help patients, CBD can be a great option in treating certain severe conditions.
“Figure 2f from: Irimia R, Gottschling M (2016) Taxonomic Revision of Rochefortia Sw. (Ehretiaceae, Boraginales). Biodiversity Data Journal 4: e7720. Https://Doi.org/10.3897/BDJ.4.e7720.” doi:10.3897/bdj.4.e7720.figure2f.
Devinsky, O., Cross, J. H., Laux, L., Marsh, E., Miller, I., Nabbout, R., . . . Wright, S. (2017). Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. New England Journal of Medicine,376(21), 2011-2020. doi:10.1056/nejmoa1611618