The Potential of Cannabidiol (CBD) for Therapeutic Purposes

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Article by: Nora Volkow, Director, National Institute on Drug Abuse

Three weeks ago I had the opportunity to testify before the Senate on cannabidiol, or CBD — one of the main active ingredients in the marijuana plant, and a compound around which there is a growing amount of interest from the public as well as the scientific and medical communities. The intent of the hearing was to explore ways we can reduce obstacles to research on CBD, given that all chemicals in the marijuana plant are currently in the most restricted category of the Drug Enforcement Administration’s schedule of controlled substances — schedule I. This category is reserved for substances that have a high potential for abuse and no scientifically supported medical use. Medical research can and is being done with schedule I substances; however, there are strict regulations and administrative hurdles associated with this status.

The chemical in marijuana that causes the high (and many of its other effects) is delta-9 tetrahydrocannabinol, or THC. But there are over 100 other cannabinoid chemicals in the plant; CBD is one of those. Different cannabinoids can have very different biological effects; CBD, for example, does not make people high and is not intoxicating (please see Bergamaschi et al. 2011). And, there is reason to believe it may have a range of uses in medicine, including in the treatment of seizures and other neurological disorders. In the impassioned, often emotional debates these days over medical marijuana, CBD is often cited as one of the main reasons restrictions on marijuana should be loosened.

A basic understanding of the way cannabinoids affect the body and the brain is helpful to making sense of some of the confusing and contradictory claims made by partisans on either side of those debates. Most cannabinoids (including THC) interact with specific targets on cells in the body, the CB1 and CB2 receptors. CB1 receptors are found mainly in the brain and are important for learning, coordination, sleep, pain, brain development, and other functions; CB2 receptors are found mostly in the immune system. The fact that chemicals in marijuana can speak the body’s chemical language (and cause both beneficial and harmful effects) is not surprising and does not make marijuana special. Many plants, including the opium poppy, tobacco, and coca are similar in that regard. Extracting and amplifying the medicinal benefits of such plants and minimizing their potential harms can lead the way to effective medications, but are also a major scientific challenge.

In marijuana’s case, future medicinal uses will most likely lie in drugs based on cannabinoid chemicals or extracts with defined concentrations that can be reliably produced. There are very few precedents for a whole plant being approved as a drug (only two “botanical drugs” are currently approved in the U.S.). This is because creating a standardized plant medicine poses major difficulties — especially in a case like marijuana where there are countless, widely varying strains and large numbers of chemical components about which little is yet known. Marijuana has over 500 chemicals in total, including the 100 or so cannabinoids, so we will still be learning about this plant for years to come. However, we are quickly learning a lot about THC and CBD, and because of its unique properties, CBD, especially, may be poised to make great inroads into our pharmacopoeia.

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