Studies on the uses and dosage of cannabidiol

Throughout this article, you will notice that there are no specific dosage recommendations for every condition. It is extremely important to understand the complexities of each individual’s body and what that can mean when using CBD and establishing an exact dosage. Experts recommend starting with a small dose of CBD and increasing over time as you learn how your body responds. Some people choose to start with a dose of about 20 to 40 milligrams per day, divided into 3 administrations, morning, noon, and evening. at night. (As a point of reference, the doses applied by ingestion in clinical trials and recommended so far range from <1 to 50 mg/kg/d.) Just like the dosage, the formats can also vary depending on a person's needs and background preferences. We can find the following uses and their respective formats:

• Topic: CBD Oils, Creams, Balms, Ointments, etc.
• Ingested: Capsules, Gummies, etc.
• Inhaled: Vape liquids, Flowers.
• Transdermal patches

If you want to learn more about these different formats and their benefits, check out our article: What is the best way to use CBD?

How to use CBD for different pathologies (Studies and knowledge in research)

Finally, we will mention the side effects of CBD which include: drowsiness, dry mouth, headaches, loss of appetite and medical interactions. ATTENTION: It is extremely important to check if you are taking any medications to see if CBD could cause any medical interactions . If you need medical advice, check out our experts page to connect with qualified experts. You can also sign up for the Medical Cannabis Program's bi-monthly online meeting with Dr. Sarah Chinelo . The event is free and by signing up you can access two personal consultations, both of which will be attended by Dr. Sarah Chinelo at the following events.

Introduction to CBD

Cannabis is a plant-based product, or botanical, with origins dating back to the ancient world and, in recent years, has attracted much national attention as an alternative or complementary therapy. The Cannabis Sativa L plant contains a wide variety of Cannabinoids, including the most studied, CBD and THC. CBD, or cannabidiol , has come into the spotlight due to increased study of its ability to alleviate symptoms of a wide variety of pathologies that many patients suffer from. Its lack of psychoactive effects and safety profile have made it an interesting avenue for improving overall health and well-being through CBD’s ability to interact with our endocannabinoid system. The ECS (Endocannabinoid System) is an intercellular communication network that links our organs and our bodily systems to help regulate all sorts of processes , from how we sleep to how we feel, and much more in between. When CBD interacts with your endocannabinoid system, it can help regulate these processes . However, researchers are still unsure of how CBD interacts with our ECS. At this time, the most studied and promising therapeutic properties of CBD are the following:

• Anti-inflammatory [1]
• Anxiolytic [2] [3]
• Neuroprotective [4] [5]
• Antioxidant [5]
• Antitumor [6] [7]
• Anticonvulsant [8]
• Anti-craving [9]

Although CBD may be beneficial alone, some research suggests that taking CBD alongside THC and other compounds found in cannabis, such as terpenes and flavonoids, may enhance therapeutic effects. This phenomenon is often referred to as "the entourage effect." [11] [ (lat. Means in glass or in the glass) studies are performed with microorganisms, cells, or biological molecules outside of their normal biological context. (lat. Within the living) are those in which the effects of various biological entities are tested on whole living organisms or cells, usually animals, including humans, and plants, as opposed to an extract of dead tissue or organism. Not performed on humans. Includes in vitro and in vivo trials. Performed on animal models such as rodents. Performed on humans. Receptors that are part of the endocannabinoid system and that can only be activated by endocannabinoids or phytocannabinoids. Cannabinoid receptor found mainly in the central nervous system, especially abundant in the brain. CB1 receptors are found in areas related to cognitive functions (attention, memory, language, higher mental functions), emotional state, pain, sensory perception, visceral perception and motor coordination. They can also be found in areas of the peripheral nervous system. Cannabinoid receptor found mainly in the peripheral nervous system and are especially abundant in cells with immune function. Receptor found in the adrenal glands, digestive system, central nervous system and spleen. Involved in the regulation of blood pressure, inflammatory pain and metabolism or bone. Transient potential vanilloid receptors, present in all tissues and in the Central and Peripheral Nervous System. Also known as mediators of pain, inflammation, thermoregulation and muscle tone. Serotonergic receptors distributed mainly in the Central Nervous System. They are related to emotional and memory processes, influencing the tone of our mood. A response with a shape resembling a bell. On the Y axis we would have the dose and on the X axis the response, that is, how does the response change when we increase the dose, for example? More is not always better. A dose that is too low does not produce a noticeable response in the body, while a medium dose achieves the greatest effectiveness. But as we increase the amount, the body's response is not greater, but in fact, it decreases. That is why it is important to start with a quantity until you find the minimum effective dose. Neurons that secrete dopamine (a compound present in the body as a neurotransmitter and precursor of other substances, including adrenaline) in their synapses. The way in which a disease develops.

Acne

Acne is a long-term skin condition that occurs when dead skin cells and skin oil clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring. In healthy skin, sebaceous glands produce sebum that drains onto the skin's surface through a pore, which is an opening into the follicle. Keratinocytes, a type of skin cell, line the follicle. Normally, as the body sheds skin cells, the keratinocytes rise to the surface of the skin. When someone has acne, hair, sebum, and keratinocytes stick together inside the pore. This prevents the keratinocytes from shedding and stops the sebum from reaching the surface of the skin. The mixture of oil and cells allows bacteria that normally live on the skin to grow in the clogged follicles and cause inflammation, swelling, redness, heat, and pain. When the clogged follicle wall breaks, the bacteria, skin cells, and sebum spill out onto nearby skin, creating lesions or pimples. The resulting appearance can lead to anxiety, lowered self-esteem, and in extreme cases, depression. CBD has been shown to interact with the endocannabinoid systems of the skin and has been shown to be useful in disorders such as acne due to its anti-inflammatory effects (1,2) and through its regulatory effect on sebaceous gland functions (3). In acne-affected skin areas, hair follicles become clogged and due to this, the area becomes inflamed. By applying CBD-enriched ointments topically, the inflammation can be reduced and some relief can be found. On the other hand, acne is known to leave scars once the symptoms disappear and even when they are still present. However, different studies have found that CBD applied topically can reduce scar formation. (2) Human sebocytes (sebum-producing cells) actively participate in inflammatory processes in the skin by recruiting and communicating with immune cells. This interaction leads to the generation of cells, which could contribute to the pathogenesis of not only acne vulgaris but also of several inflammatory skin diseases. CBD appears to interact with sebocytes by preventing inflammation and regulating sebum production (3). In this context, CBD has been found to contribute to the maintenance of homeostatic sebaceous lipogenesis in these sebocytes. This means that it helps balance lipid production by sebocytes and can therefore regulate skin diseases such as acne (4).

1. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders Sudhir M Baswan , et al 2020.
2. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars . B Palmieri et al. 2019
3. Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. Attila Oláh , et al. 2014
4. Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System. Kinga Fanni Tóth , et al., 2020

Addiction

Drug addiction is a chronically relapsing disorder characterized by a compulsive desire to seek and use drugs with poor control over substance use, despite negative consequences. A limited number of preclinical studies suggest that CBD may have therapeutic properties on opioid, cocaine, and psychostimulant addiction, and some preliminary data suggest it may be beneficial in cannabis and nicotine addiction in humans (1). One of the studies analyzed in (1) shows how CBD decreases the reward-facilitating effect of morphine, without influencing motor function. Furthermore, the 5-HT1A receptor antagonist reversed the effect of CBD on the reward-facilitating effect of morphine (2). Combined, this shows how promising CBD may be for opioid addictions. At this point, it should be noted that other studies revealed (3) a synergistic effect when CBD was combined with THC, which reduced the withdrawal score to a greater extent than either of these compounds used separately. In the case of psychostimulants (i.e. cocaine or methamphetamine), CBD does not seem to have an impact on the rewarding effect of stimulants, but one study (4) suggests that it may influence addictive behaviors during the relapse phase (in synergy with THC). CBD has also been shown to be useful in tobacco addiction , with the results of one study (5) showing a significant reduction in the number of cigarettes smoked (40%) in the CBD inhaler group during the week of treatment, with a trend continuing to indicate a reduction after follow-up. More studies are needed to fully assess CBD’s potential as an intervention for addictive disorders. However, it has become clear that it is a useful tool, so it requires further study, especially around dosing (since it has already been shown to be effective) and for acceptance and common use among addicts, i.e. an accepted and recommended alternative by doctors.

1. Prud'homme M, Cata R, Jutras-Aswad D. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence . Subst Abuse . 2015.
2. Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol. 2013.
3. Hine B, Torrelio M, Gershon S. Interactions between cannabidiol and delta9-THC during abstinence in morphine-dependent rats. Life Sci. 1975;17(6):851–7.
4. Parker LA, Burton P, Sorge RE, Yakiwchuk C, Mechoulam R. Effect of low doses of delta9-tetrahydrocannabinol and cannabidiol on the extinction of cocaine-induced and amphetamine-induced conditioned place preference learning in rats. Psychopharmacology (Berl). 2004.
5. Morgan CJ, Das RK, Joye A, Curran HV, Kamboj SK. Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings. Addict Behav. 2013.
6. Yasmin L. Hurd , Ph.D. et al. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. 2019

Anxiety

There are many different types of anxiety disorders, and most are characterized by “intense, excessive, and persistent worry and fear about everyday situations” (Mayo Clinic). Anxiety is a multifaceted affliction that can stem from genetic traits, trauma, and underlying illnesses. Cannabidiol has been widely recognized for its anxiolytic effect and the way it interacts with our cannabinoid receptors (CB1, TRPV) and receptors outside of our endocannabinoid system such as 5-HT1A, our serotonin receptor, crucial for modulating our emotions (1). Studies are still inconclusive and have used doses ranging from 30 mg (2) to 800 mg (3) per day . The variability of different anxiety disorders and how different each person’s endocannabinoid system is makes it extremely difficult to find a one-size-fits-all dose. For more information, you can read our article written by neuropsychologist and phytotherapist, Tommaso Bruscolini. CBD and Anxiety

1. Esther M. Blessing et al. " Cannabidiol as a Potential Treatment for Anxiety Disorders ." 2015
2. Sublingual Cannabidiol for Anxiety . Mclean Hospital. Clinical Trial. 2019.
3. Cannabidiol for the Treatment of Anxiety Disorders: An 8-Week Pilot Study . McMaster University. 2020.

Osteoarthritis

Osteoarthritis, also known as OA, is an extremely common rheumatoid disease that affects bones, joints, and ligaments. Characterized by the wearing down of cartilage and joints, osteoarthritis is the most common type of arthritis in people over the age of 50. [1] Osteoarthritis can take such a toll on the body that it can lead to severe pain, inflammation, and even reduced mobility. Preclinical evidence in rats shows that cannabidiol and other cannabinoids can help patients improve their quality of life by reducing pain, inflammation, and even preventing nerve damage. [2] Most studies have looked at internal use of cannabidiol, but topical use may also be a complementary format for relieving localized pain and inflammation. For more information, you can read our article on OA written by neuropsychologist and phytotherapist, Tommaso Bruscolini. CBD and Osteoarthritis

1. What is osteoarthritis? National Institute of Arthritis and Musculoskeletal and Skin Diseases.
2. Philpott HT, O'Brien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis . Pain. 2017

Cancer

Cancer is a group of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. More than 100 types of cancers affect humans today. In cancer patients, cannabinoids have been used primarily as part of palliative care to relieve pain, alleviate nausea, and stimulate appetite . Furthermore, numerous animal and cell culture studies have shown anti-tumor effects of cannabinoids in various types of cancer. This opens up a whole new world of how we can medicate cancer patients. There are two ways in which CBD may be related to cancer. Either with the disease itself or with the side effects of the medications taken to treat the disease. Side effects:

• Pain: In total, 177 patients with cancer pain, who experienced inadequate analgesia despite chronic opioid dosing, entered a two-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Patients were randomized to THC:CBD, CBD extract, THC extract, or placebo. The primary analysis of change from baseline in mean pain score was statistically significant in favor of THC:CBD compared to placebo , while the THC group showed a nonsignificant change. Twice as many patients taking THC:CBD showed a greater than 30% reduction in baseline pain score compared to placebo. The number of responders in the THC group was similar to that in the placebo and did not reach statistical significance. This points to the great importance of CBD in terms of pain management. (1)
• Nausea and lack of appetite: Considerable evidence shows that manipulation of the endocannabinoid system regulates nausea, vomiting, and appetite in humans and other animals . (2)

Understanding how cannabinoids regulate essential cellular processes involved in tumorigenesis, such as progression through the cell cycle, cell proliferation and cell death, as well as the interactions between cannabinoids and the immune system, are crucial to improving existing and developing therapeutic approaches for cancer. (3).

1. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain Jeremy R.JohnsonMB et al 2010
2. Regulation of nausea and vomiting by cannabinoids Linda A Parker , 2011
3. Cannabinoids in cancer treatment: Therapeutic potential and legislation. Barbara Daris . 2019

Depression

Depression (also known as major depressive disorder or clinical depression) is a mood disorder that causes a persistent feeling of sadness and loss of interest. Depression affects how you feel, think, and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal daily activities, and you may even feel like life isn't worth living. A main symptom of depression is anxiety itself, so they are often discussed together. Overall, researchers from different in vivo and in vitro studies (1-6) agree that CBD has very promising anxiolytic and antidepressant effects. Results showed that a single dose of CBD dose-dependently induced an antidepressant-like effect (7 to 30 mg/kg) in mice (5). Others (4) showed an effective interaction between CBD and the 5-HT1A neuroreceptor (a key serotonin receptor in depression). All of these studies show extremely promising results. Regarding dosage, initial CBD studies showed conflicting results: high doses (100 mg/kg) were ineffective, while low doses (10 mg/kg) were anxiolytic. When tested across a wide range of doses in additional studies, CBD’s anxiolytic effects exhibited a bell-shaped dose-response curve, with anxiolytic effects observed at moderate but not higher doses (6). However, most studies are conducted in animal models, so researchers are calling for more direct research in humans, but their initial results are an essential step in establishing how CBD works in the body. It also holds promise as an alternative or complementary treatment with antidepressants and other pharmacological options.

1. Tambaro S, Bortolato M. Cannabinoid-related agents in the treatment of anxiety disorders: current knowledge and future perspectives . Recent Pat CNS Drug Discov . 2012.
2. Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders . Neurotherapeutics . 2015.
3. Khan AU, Falconi-Sobrinho LL, et al. Cannabidiol-induced panicolytic-like effects and fear-induced antinociception impairment: the role of the CB1 receptor in the ventromedial hypothalamus . Psychopharmacology (Berl). 2020.
4. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa Alexandre R de Mello Schier , Natalia P de Oliveira Ribeiro , Danielle S Coutinho , Sergio Machado , Oscar Arias-Carrión , Jose A Crippa , Antonio W Zuardi , Antonio E Nardi , Adriana C Silva 1 2014
5. Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex Amanda J. Sales1,2 & Manoela V. Fogac?a1,2 & Ariandra G. Sartim1,2 & Vitor S. Pereira3 & Gregers Wegener3 & Francisco S. Guimara?es1,4 & Sa?mia RL Joca. 2018
6. Cannabidiol as a Potential Treatment for Anxiety Disorders Esther M. Blessing , 1 Maria M. Steenkamp ,1 Jorge Manzanares ,1,2 and Charles R. Marmar 1 Neurotherapeutics . 2015 Oct; 12(4): 825–836.

Atopic dermatitis

Atopic dermatitis is an autoimmune disease characterized by chronic inflammation of the skin (dermatitis). It causes itching, redness, swelling, and cracked skin. Clear fluid may come from the affected areas, which often thickens over time – this is due to a leaky, impaired skin barrier. While the condition can occur at any age, it usually begins in childhood and its severity changes over the years. Cannabinoids have demonstrated anti-inflammatory, antipruritic, anti-aging, and antineoplastic properties through several mechanisms, including interaction with the endocannabinoid system found in the skin. Recent research has indicated the pivotal role of the endocannabinoid system in maintaining skin barrier function and homeostasis, and its dysregulation has been linked to various skin disorders such as atopic dermatitis (1). Each of these points shows how CBD can improve the quality of life of people with atopic dermatitis. A: by regulating the sebaceous glands B: boosting the immune system and preventing the onset of disease. C. Relieving the symptoms of the disease D. Helps deal with other problems arising from the disease A. Sebaceous glands: a. How does CBD help? CBD interacts with the skin's endocannabinoid system by balancing lipid production, in this case regulating it to combat dry skin, resulting from dermatitis. (2) B. Immune system – This is important as atopic dermatitis is an autoimmune disease. Some studies argue that the key to CBD’s success is its immune-boosting capabilities, which lead to antiviral and antibacterial effects. What CBD achieves here is to boost the immune system by boosting the endocannabinoid system to the point that it could alleviate the onset of the disease itself. C. Inflammation: Topical administration of CBD ointment is, according to new studies (2), a safe, effective, and noninvasive alternative to improve the quality of life in patients with some skin disorders, especially inflammatory disorders such as atopic dermatitis. One specific 2019 study found that a CBD ointment helped clear the skin and reduce the itching and loss of sleep it caused, specifically through reducing inflammation of the affected skin areas (3). Chronic inflammation and the resulting itching may be two of the main characteristics of this disease. Some studies argue that combating itching (which comes from skin inflammation) is the most promising role of CBD. D. Bacteria: It has been shown that it is common for bacteria such as Staph (Staphylococcus aureus, a common type of bacteria) to infect the skin of people with atopic dermatitis, triggering flare-ups and other complications. However, the antibacterial effect of CBD has been shown to limit those infections. (5) CBD therefore provides an alternative to traditional treatments.

1. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders Sudhir M Baswan , et al 2020.
2. Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System. Kinga Fanni Tóth , et al., 2020
3. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. B Palmieri et al. 2019
4. Jessica S. Mounessa, B.S., et al. The role of cannabinoids in dermatology JAAD. 2017
5. Cannabidiol is an effective helper compound in combination with bacitracin to kill Gram-positive bacteria. Claes Søndergaard Wassmann , et al. 2020

1. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders Sudhir M Baswan , et al 2020.
2. Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System. Kinga Fanni Tóth , et al., 2020
3. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. B Palmieri et al. 2019
4. Jessica S. Mounessa, B.S., et al. The role of cannabinoids in dermatology JAAD. 2017
5. Cannabidiol is an effective helper compound in combination with bacitracin to kill Gram-positive bacteria. Claes Søndergaard Wassmann , et al. 2020

Pain

Understanding the function of endogenous cannabinoids helps explain the effectiveness of exogenous cannabinoids, such as those found in the cannabis plant, in treating pain. CBD, for example, inhibits the breakdown of anandamide, a primary pain suppressor, thus acting in an analgesic manner. (1) For those living with chronic or acute pain, finding a safe and effective method of pain management is a key concern. Currently, within Europe alone, 95 million people live with chronic daily pain. Commonly used painkillers include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. However, many of these medications can have serious side effects and lead to dependency from long-term use. CBD is currently gaining ground as an alternative form of pain relief that can offer a better quality of life without the risk of addiction. It is believed that CBD can work to relieve pain by reducing inflammation in the body. It has been reported (2) that CBD relieves pain in rats through TRPV1 receptors, which control functions such as inflammation, body temperature, and pain perception. In this study, rats were given 10 mg/kg of CBD. They saw that CBD eliminated the abnormally heightened pain sensitivity to heat stimulus assessed by a test on the soles of their feet. All together, their results demonstrate that the TRPV1 receptor could be a molecular target of CBD’s antihyperalgesic action. What seems to be accepted among researchers is that CBD does relieve pain and it does so by reducing inflammation (3). Again, how CBD should be consumed and its dosage has not yet been officially established and may vary depending on the type of pain. For more information on how CBD can help chronic pain, check out our article, written by pharmacologist Jose Vazquez Luca de Tena. CBD and Chronic Pain

1. McDougle DR, Kambalyal A, Meling DD, Das A. Endocannabinoids anandamide and 2-arachidonoylglycerol are substrates for human CYP2J2 epoxygenase . J Pharmacol Exp Ther . 2014.
2. Vanilloid TRPV1 receptor mediates the antihyperalgesic effect of the nonpsychoactive cannabinoid, cannabidiol, in a rat model of acute inflammation. Barbara Costa ,* Gabriella Giagnoni , Chiara Franke , Anna Elisa Trovato , and Mariapia Colleoni .2004 Br J Pharmacol .; 143(2): 247–250.
3. Costa B, et al. Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. 2004 Naunyn Schmiedebergs Arch. Pharmacol.;369:294–299

Menstrual pain and symptoms

The multifaceted world of menstrual symptoms can include mood swings, pain, and inflammation. Cannabis has helped with menstrual pain since the beginning of human history. [1] The endocannabinoid system has a lot to do with regulating these symptoms. We can find a high concentration of cannabinoid receptors in the female reproductive system, especially the CB1 and CB2 receptors. Modulation of the ECS by CBD can help offer anti-inflammatory properties, pain relievers and mood regulators that can help relieve menstrual pain symptoms. [2] [3] [4] Although they lack concrete evidence, anecdotally, many patients use CBD and other cannabinoids such as CBG and THC, sublingually (for a global effect) and topically (for localized inflammation and pain) using creams or balms, to achieve muscle relaxation, reduce anxiety, and soothe inflammation and pain. For more information, please see our article, reviewed by Tommaso Bruscolini.

1. Russo, Ethan. Cannabis Treatments in Obstetrics and Gynecology: A Historical Review . 2002
2. Nida Noreen, et al. Is Cannabidiol a Promising Substance for New Drug Development? A Review of its Potential Therapeutic Applications . Critical Reviews™ in Eukaryotic Gene Expression. (2020)
3. Otrubova K, Ezzili C, Boger DL. The Discovery and Development of Inhibitors of Fatty Acid Amide Hydrolase (FAAH) . Bioorg Med Chem Lett. (2011)
4. Nagarkatti, P. et al. “ Cannabinoids as novel anti-inflammatory drugs .” Future medicinal chemistry 17 (2009).

Epilepsy

Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Seizures are brief or recurrent periods of vigorous shaking. There are many different types of epilepsy (which differ from the type of seizure to the origin of the disease), however, the most common type of epilepsy is epilepsy. Charlotte Figi’s story catapulted CBD into the mainstream of cannabinoid research in childhood epilepsy. Over the past 20 years, research has been increasing, but almost exclusively through in vitro and in vivo laboratory studies on isolated molecules, while human studies have focused mainly on terminal diseases and as a palliative treatment (including THC). Cannabidiol (CBD) and cannabidivarin (CBDV) have recently emerged among cannabinoids for their potential antiepileptic properties. A dramatic clinical improvement was observed, both in terms of decreased seizure frequency and recovery of cognitive functions, which could be paralleled by elevated plasma concentrations of CBDV. For this purpose, various cannabis preparations of different concentrations and contents are used. Recent changes in the legal environment have improved the availability of products with high concentrations of cannabidiol (CBD) and low concentrations of tetrahydrocannabinol (THC). What has radically changed the view on Cannabis and has driven the hundreds of studies on Cannabidiol is the story of Charlotte Figi, an American girl who from a few months of age suffered from Dravet Syndrome, a rare form of epilepsy, intense and frequent, which resists pharmacological treatments and causes up to 400 seizures per week and generally results in premature death. With Charlotte's lack of response to drugs and almost completely incapacitated, her family decided to give her CBD Oil, orally, and the result was unthinkable: the seizures were reduced to 3 or 4 per month without the need for further medication, and the girl began to walk, feed herself and develop her cognitive functions. In recent years, Charlotte has managed to live completely seizure-free. Charlotte's story led to an exponential increase in research on CBD which has led to the discovery, in addition to its anti-epileptic and antispasmodic properties, of its anxiolytic, anti-inflammatory, analgesic and neuroprotective effects. This history may be the reason for the most recent and comprehensive study conducted on epilepsy. To date, the largest exploratory study of CBD’s tolerability and anticonvulsant activity relates to a recent, physician-sponsored, expanded access program at 11 epilepsy centers in the U.S. (1). A total of 214 patients, 1 to 30 years of age, with severe epilepsy received a 99% pure CBD oil-based liquid formulation at a starting dose of 2 to 5 mg/kg/day, titrated to intolerance or a maximum dose of 25 mg/kg or 50 mg/kg per day, depending on the study site. There was a notable reduction in seizures recorded in patients with focal seizures (-55%) and atonic seizures (-54%). Interestingly, a reduction in motor seizures by 50% or more was observed in 51% of patients receiving clobazam (a common prescription drug for epilepsy), compared to 27% of those not receiving clobazam. Studies are much more advanced in this field, which led to the patent of Epidiolex, a cannabidiol-based drug prescribed for patients with certain types of epilepsy (LGS, Dravet syndrome or TSC).

1. Serena Silvestro et al. Molecules . 2019; 24(8): 1459. Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Safety in Clinical Trials
2. Perucca E. et al. Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? . J Epilepsy Res . 2017.

Multiple sclerosis

Multiple sclerosis (MS) is a debilitating autoimmune disease that damages the insulating coverings of nerve cells in the brain and spinal cord. This damage disrupts the ability of parts of the nervous system to transmit signals, resulting in a variety of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Specific symptoms may include double vision, blindness in one eye, muscle weakness, and problems with sensation or coordination. MS takes several forms, with new symptoms occurring in single attacks (relapsing forms) or accumulating over time (progressive forms). Between attacks, symptoms may disappear completely; however, permanent neurological problems often persist, especially as the disease progresses. While the cause is unclear, the underlying mechanism is thought to be destruction by the immune system or failure of myelin-producing cells. Proposed causes for this include genetic and environmental factors triggered by a viral infection. The aim of (1) was to determine whether a cannabis-based medicinal extract (CBME) benefits a variety of symptoms due to multiple sclerosis (MS). Study subjects were treated with a dose of 2.5-120 mg of each day, in divided doses. CBME was administered in the form of Sativex (it is an oral spray containing 1:1 THC:CBD and the first approved cannabis drug prescribed for MS). After CBME, the primary symptom score was reduced from 74.36 to 48.89 after CBME and from 74.31 to 54.79 after placebo. It is still unknown how CBD alleviates MS symptoms, but it seems likely that it is due to its neuroprotective and anti-inflammatory effects.

1. Derick T Wade et al., 2004, Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Pubmed.
2. Malfitano AM, Proto MC, Bifulco M. Cannabinoids in the management of spasticity associated with multiple sclerosis. Neuropsychiatr Dis Treat . 2008.

Fibromyalgia

Fibromyalgia is a condition that causes pain throughout the body (also known as widespread pain), sleep problems, fatigue, and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called abnormal pain perception processing. CBD is believed to activate serotonin receptors. It plays a role in: pain perception (1,2) maintain body temperature reduce inflammation (2) According to recent studies, CBD also: may possibly prevent symptoms of psychosis (1) These benefits are what make CBD an attractive alternative treatment for pain disorders like fibromyalgia. CBD has been found to relieve symptoms of chronic pain and reduce inflammation. It actually appears to reduce pain through its reduction in inflammation (2). It is therefore presented as an alternative to opioid prescriptions that can be addictive. In a clinical study, 367 patients received THC:CBD 1:1. The conclusion was that medical cannabis appears to be a safe and effective alternative for the treatment of fibromyalgia symptoms. (4)

1. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes J Manzanares , et al. 2006
2. COSTA B., et al. Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. 2004 Naunyn Schmiedebergs Arch. Pharmacol.;369:294–299
3. Tambaro S, Bortolato M. Cannabinoid-related agents in the treatment of anxiety disorders: current knowledge and future perspectives . Recent Pat CNS Drug Discov . 2012.
4. Safety and Efficacy of Medical Cannabis in Fibromyalgia Iftach Sagy et al. 2019

Cold sore

Cold sores are a type of infection (herpes simplex virus HSV-1) that primarily affects the lips and nose area. Symptoms typically include a burning pain followed by small blisters or sores. The first outbreak may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate, causing new outbreaks in the mouth, lips, and nose area. According to recent studies, CBD also:

• Helps relieve symptoms of cold sores
• It can prevent the appearance of cold sores

As mentioned above, CBD has a significant anti-inflammatory effect when applied topically, which has also been shown to relieve cold sore symptoms, especially inflammation and pain (1). However, CBD has also been shown to help prevent and heal cold sores. In a 2009 study, researchers concluded that CBD is effective at stimulating healthy cell growth and limiting the pain and inflammation that often occur during the healing process (2). In the longer term, CBD may also help prevent future HSV-1 outbreaks. Key to CBD’s success is its immune-boosting capabilities, which lead to antiviral effects. A properly functioning immune system can fight off active HSV-1 cells, and therefore future cold sore outbreaks, better than a weak immune system. The anti-inflammatory activity of cannabinoids may compromise host inflammatory responses to acute viral infections (in general), but may be beneficial in persistent infections, as found in a 2010 study. (3) As we show here, CBD is a very promising solution or at least a relief for cold sores and other skin diseases arising from viral infections.

1. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. B Palmieri et al. 2019
2. Prakash Nagarkatti, et al. Cannabinoids as novel anti-inflammatory drugs 2009
3. Carol Shoshkes Reiss et al. Cannabinoids and Viral Infections . 2010

Migraines

Cannabis has a long history of use for migraine treatment. Cited in Ethan Russo’s review, cannabis was a key treatment for migraines in ancient cultures (Chinese, Indian, Egyptian, Assyrian, Greek, and Roman) and later in the Industrial and Renaissance era in Europe. [1] In 2018 Ethan Russo, described in an article his findings on the concept of Clinical Endocannabinoid Deficiency (CED); a syndrome of a downregulated endocannabinoid system, and mentioned the possibility that migraines may be a result of CED. [2] We know that CBD has anti-inflammatory, analgesic and relaxing properties that can help treat migraines. However, the positive effect of CBD on our endocannabinoid system and the ability to slow down anandamide levels sheds light on how CBD can be an interesting alternative to classic treatments such as NSAIDs (ibuprofen, etc.). [3] If you want to learn more about the effects of CBD on migraines, check out our article written by Tommaso Bruscolini.

1. Russo, E. Hemp for headache: An in-depth historical and scientific review of cannabis in migraine treatment . Journal of Cannabis Therapeutics, 1(2), 21-92. (2001)
2. Russo EB. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinol Lett. 2004;25:31–39. (2018)
3. Cupini LM, Costa C, Sarchielli P, et al. Degradation of endocannabinoids in chronic migraine and medication overuse headache. Neurobiol Dis.;30:186-189. (2008)

OC (obsessive compulsive disorder)

Obsessive-compulsive disorder (OCD) is a disorder in which people have unwanted, recurring thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively or compulsively. Repetitive behaviors, such as handwashing, touching objects, or cleaning, can significantly interfere with a person's daily activities and social interactions. It is thought to affect 2 to 3 percent of the world's population, but is experiencing a huge increase in the current population, in part due to the global pandemic. The standard treatment for OCD is cognitive behavioral therapy and/or medication. Currently, the only FDA-approved medications to treat OCD are serotonin reuptake inhibitors (SRIs). About one-third of people do not experience a significant reduction in symptoms after undergoing these treatments. SRIs typically require about 6 weeks to have clinically significant effects. Currently, CBD’s ability to alleviate OCD symptoms is largely theoretical and anecdotal. That’s because there is a very limited amount of research examining CBD’s effectiveness for people with OCD. CBD has become relevant in this field of study for its anxiolytic and anti-compulsive effects. A handful of case reports describe people with OCD who experienced symptom improvement after being treated with CBD or other cannabinoids. But more large-scale clinical trials are needed to evaluate CBD's efficacy and safety. In a 2021 study (Dakota et al.2021), researchers examined the effects of medical cannabis on a group of 87 people with OCD. The researchers found that patients reported:

• 60% reduction in compulsions
• 49% reduction in intrusive thoughts
• 52% reduction in anxiety

The quantification of the dose applied in this study is a bit blurry and controversial. Individuals smoked Cannabis for a period of 31 days with concentrations of 14% THC and 4% CBD. In this case, as in many others, researchers found that the combination of THC and CBD was key to improving pathology, however, they did not analyze the exclusive use of CBD. Here we have to point out that cannabis with higher doses of CBD was found to lead to a greater reduction in compulsive behavior. A 2015 review of studies (2) found strong evidence that 300 to 600 milligrams of CBD taken orally reduces anxiety symptoms. It's plausible that a similar dose could be effective for treating OCD, but more research is needed to confirm this idea.

1. Acute Effects of Cannabis on Symptoms of Obsessive-Compulsive Disorder Dakota Mauzay 1 , Emily M LaFrance