CBD oil and other cannabis products are becoming popular treatments for a range medicinal treatment and used with caution until the individual has achieved. Before we proceed, I have to stress that both THC and CBD produce the biggest health benefits when combined with each other and with. How to calculate how much CBD and THC is in your cannabis oil factor for Peace Naturals' cannabis oils better reflects the amount of dried flower we use work together synergistically to yield the desired therapeutic effect.
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CBD, on the other hand, is being used to treat inflammation, stress, depression and anxiety, while also being used to combat cancer, epilepsy, schizophrenia, multiple sclerosis, migraines, arthritis, and the side effects of cancer treatments. The Crime Rate Perception Gap. Mapping America's Biggest Employers. Visualizing the Future of the Pharma Market. Foreign Direct Investment by Country. Visualizing Corruption Around the World. A World of Languages. Visualizing 40 Years of Music Industry Sales.
The Coming Opportunity in Infrastructure. The World's Largest 10 Economies in Visualizing the World's Busiest Ports. Visualizing the 4, Year History of Global Power. Mapping the Largest Employers in the U. Visualcap 17 hours ago. THC has been linked to the development of schizophrenia, and a contributor to neurodevelopment deficits in adolescents. Dating back as far as BC, hemp plants had been used for various medicinal and industrial purposes.
In , the United States Pharmacopeia USP classified marijuana as a legitimate medical compound and many physicians supported its use for conditions such as epilepsy, chronic migraines, and pain. In the s, political propaganda sought to associate marijuana use, specifically by minority and low-income populations, with psychosis, addiction, and violent crime. Many believe this was influenced by several prominent businessmen in competing synthetic fiber industries in attempts to reduce the size of the growing hemp industry.
Despite opposition from the American Medical Association AMA and physicians who believed in the medical efficacy of marijuana, by , all cannabis preparations were removed from the USP and National Formulary. In the s and early s, marijuana soon became associated with recreational use by anti-establishment groups further adding to the stigma associated with its usage. By , the CSA labeled cannabis as a Schedule 1 substance.
This relatively short era of recreational marijuana use has influenced how the public perceives the drug. Since that time, there have been repeated unsuccessful attempts to reconsider its Schedule 1 status to allow for easier investigation.
The AAP also supports further research into the indications and correct dosage for cannabinoids in addition to developing policy around how to verify purity and formulations. Recommendations from the American Academy of Pediatrics 8.
To date, however, 8 states and the District of Columbia have passed legislation to legalize recreational marijuana use, with an additional 20 states allowing for some form of medical cannabis. Fourteen nonmedical marijuana states have specific legislation regarding CBD Figure.
Discussion about the safe and efficacious use of these products in a responsible way that protects vulnerable populations, including pediatrics, is necessary. Similar to endogenous opioids, a human's central nervous system is impregnated with cannabinoid receptors and endocannabinoids. In the early s, 2 receptors were discovered, cannabinoid type 1 CB1 and cannabinoid type 2 CB2. Both CB1 and CB2 are G-coupled protein receptors located presynaptically and control the release of neurotransmitters at both inhibitory and excitatory synapses.
CB1 is mostly expressed on presynaptic peripheral and central nerve terminals and is believed to be responsible for psychologic effects on pleasure, memory, thought, concentration, sensory and time perceptions, and coordinated movement.
CB2 receptors, concentrated in peripheral tissues and immune cells, may play an anti-inflammatory and immunosuppressive role. In addition to directing the release of various neurotransmitters, this receptor regulates the release of certain cytokines. Innervation of both these receptors results in both physiological tachycardia, hypertension, dry mouth and throat as well as psychological elation, euphoria, heightened perception, irritability, poor coordination and balance effects.
Additionally, endocannabinoids N-arachidonoylethanolamine anandamide and 2-arachidonoylglycerol, both arachidonic acid derivatives, bind with CB1 and CB2. While the function of these endogenous ligands is not fully understood, their action may be attributed as antiemetic, antianalgesic, and anti-inflammatory. Endocannabinoids can also play a role in excitation of the neuronal networks, thus having effect on the quality of a seizure.
Previous studies have documented deficiencies in endocannabinoids in temporal lobe epilepsy patients as well as a rise in anandamide concentrations post seizures in mice, suggesting an antiseizure activity profile. THC seems to possess antiseizure activity but may be a proconvulsant in certain species. CBD halts the degradation of the endocannabinoid anandamide, which may have a role in inhibiting seizures. Several other synthetic forms of cannabinoids have been available for use in some countries, including dronabinol, nabilone, and nabiximols Table 2.
These products are being used to treat nausea and vomiting associated with chemotherapy, anorexia and weight loss in patients with acquired immune deficiency syndrome AIDS , and relief of spasticity and neuropathic pain associated with multiple sclerosis MS. Historically, patients and recreational users have inhaled or vaporized marijuana, resulting in a quick onset and higher peak concentrations.
Interpatient variability may affect which blood concentrations will be effective, and tolerance is known to occur owing to downregulation of CB1 receptors.
The debate about the use of cannabinoid products in pediatric patients has persisted owing to the lack of well-developed and published randomized controlled trials. There has been a wide variety of mostly case series and international studies for adult indications, such as chronic pain, MS, headache, and various neuropsychiatric disorders, which are beyond the scope of this review but have been reviewed elsewhere.
This has resulted in retrospective and parentally reported data in epilepsy and behavioral conditions. Despite the overall lack of published data on CBD in pediatric patients, most of the literature is devoted to its use in epilepsy. Current large prospective trials are underway for different epilepsy indications, and recent animal studies researching use in perinatal brain injury and neuroblastoma may open new avenues to consider cannabinoids for pediatrics.
A Cochrane review 23 was conducted in to assess the safety and efficacy of cannabinoid use in patients with epilepsy. The authors included blinded and unblinded randomized controlled trials. Only 4 studies met their criteria, including 1 abstract and 1 letter to the editor Table 3. All 4 trials were of low quality with small sample sizes and variations in product, dose, frequency, and duration.
The only reasonable conclusion made was that the efficacy of CBD use could not be confirmed, but the rate of adverse reactions in each of the studies was low over a short period. Included Studies in Cochrane Review The American Academy of Neurology conducted a systematic review in which included 34 studies that used medical marijuana to treat MS, epilepsy, and movement disorders. Despite this, parents and patients are making the decision to use these products for 3 reasons according to Cilio et al: It is important to note that the following studies are based on parental perceptions and thus we cannot draw definitive conclusions.
She suffered from frequent status epilepticus. Charlotte failed multiple medications, and at 5 years of age, she had significant cognitive delay and required help with all of her activities of daily living. Stories like Charlotte's have prompted parents across the country in similar situations to move their families across the country to gain access to these products.
Investigators at Stanford University administered a survey to parents on Facebook to identify parentally reported effects of CBD on their child's seizures. Twelve of these 19 patients were also able to be weaned from another antiepileptic drug. In addition, parents reported overall better mood, increased alertness, and better sleep. Parents reported oral CBD dosages of 0. As with previous surveys, dosage and formulations were varied but based on parental report of formulation used.
Overall, most parents As mentioned above, these surveys should be evaluated carefully given the inability to verify dose, formulation, and response. The conclusion that can be made is that there is a rather strong positive parental perception regarding the efficacy of cannabinoids, specifically CBD. Most orphan drug designations for CBD are for pediatric seizure disorders Table 4.
Published findings from open-label use of CBD for treatment-resistant epilepsy under an expanded-access program at 11 epilepsy centers in the United States suggest that CBD might reduce seizure frequency and might have an adequate safety profile in children and young adults with this condition.
After announcing positive results from 2 pivotal randomized, double-blind, Phase 3 trials for the treatment of seizures related to LGS, and a third for seizures associated with Dravet syndrome in , GW Pharmaceuticals expects to submit a single New Drug Application for both indications to the FDA in the first half of for its proprietary pharmaceutical-grade CBD product Epidiolex.
Cannabinoids and CBD use in this patient population is a growing interest on social media sites. While the data for these indications are limited to case reports using dronabinol, some of the benefits of CBD on behavior and motor skills reported in the aforementioned retrospective studies in epilepsy may be transferable to this population as well.
A 6-year-old patient with early infant autism received enteral dronabinol drops titrated up to 3. He had improvements in hyperactivity, irritability, lethargy, stereotype, and speech. The dronabinol dose ranged from 2. Seven of the 10 patients had significant improvement in their self-injurious behavior that lasted through the follow-up at 6 months.
Two of the 10 patients experienced agitation and the drug was discontinued. Perinatal brain injury can be induced by neonatal asphyxia, stroke-induced focal ischemia, and neonatal hypoxia-ischemic encephalopathy, among other things. These conditions lead to long-lasting functional impairment due to neuroinflammation, apoptotic-necrotic cell death, and brain lesions.
The endocannabinoid system responds early to neuronal damage, working to prevent glutamate excitotoxicity and regulate the inflammatory response.
While there are no current human studies, results from mice and pig models demonstrate that CBD can reduce the density of necrotic neurons and modulate cytokine release. Most recently, researchers have reported on the use of CBD in both in vitro and in vivo animal studies of neuroblastoma NBL , a common childhood cancer.
Worldwide, marijuana is the most commonly abused illegal substance and adolescent daily use is on the rise. Unfortunately, the neurocognitive and behavioral effects of marijuana use in pediatric patients, including its effects on psychological dysfunction, amotivation syndrome, and carcinogenic risk, have been widely reported.
Evolving legislation and the increased use of cannabinoid products outside of investigational studies have also impacted our health care delivery and emergency resources. The state of Colorado has been on the forefront of the medicinal and recreational use of cannabis debate.
Wang et al 48 reported the occurrences of pediatric emergency department visits associated with marijuana exposure before and after changes in drug enforcement in A total of patients younger than 12 years were evaluated for unintentional ingestions from January 1, , to December 31, Patients ranged in age from 8 months to 12 years and presented with symptoms of lethargy, ataxia, and respiratory insufficiency. While the dosages were not reported, 7 patients ingested a marijuana edible.
Eight of the 14 patients were admitted to the hospital with 2 admissions to the pediatric intensive care unit. Prior to diagnosis, these 14 patients received routine testing such as urinalyses, complete blood counts, and complete metabolic panels. Some of these patients also received more invasive testing including computed tomography, activated charcoal, lumbar punctures, and intravenous antibiotics.
All of these contribute to higher hospital and emergency room costs, increased lengths of stay, and potential harm to the patients. In addition to increased emergency room visits, from to , the call volume at Poison Control Centers for pediatric marijuana exposures had increased by None of these products are required to have safety packaging to prevent accidental ingestion by children. In addition, no warning labels or verification of product ingredients is required, leaving the medical community caught between providing safe medical care and allowing patient autonomy.
As mentioned previously, the AAP has published recommendations to limit the access of marijuana to children. In , amidst medical marijuana legalization in several states, Seamon et al 21 identified that pharmacists needed to be attentive to the legislative changes going on at the state and federal levels.
Pharmacists are uniquely poised to understand the medicinal chemistry as well as the practical implications associated with decriminalization and legalization. Pharmacists can continue to educate both medical professionals and lay people about the differences among cannabinoids, and help to remove the stigma around appropriate and legal use of CBD products.
At the same time, medical professionals need to remember the documented deleterious effects of acute marijuana intoxication on neurocognitive development and psychiatric issues. Many health care facilities are working through processes that address patient use of these medications. Whatever the state and situation, pharmacists need to be aware of the external factors associated with allowing a patient to use CBD in an inpatient setting.
Pharmacists are also poised to participate in the design and evaluation of current and future research in this area. The importance of drug interactions between CBD and other antiepileptics remains uncertain both for the efficacy and safety of CBD products. The difference in concentrations, dosages, and formulations of various products sold at private dispensaries is not standardized or regulated. Differences in state legislation on allowable concentrations and amounts can be confusing for patients and their families, and pharmacists can help to provide that information.
Various organizations have been helpful in updating and summarizing this information. Cannabis and its ingredients have had a fascinating history over the past years, but lack of published data precludes fully recommending its use for medicinal purposes in pediatrics.
Further study is underway and will add to our knowledge of the efficacy and safety of CBD in pediatrics.
Cannabinoids in Pediatrics
Despite CBD and THC sharing a near exact molecular formula of Still, the use of many medical marijuana and even CBD products are still. Scientists studying the health benefits of CBD have found it is a promising natural The body of research on cannabidiol, CBD oil benefits, THC, and other .. find the right formula; 10–40 mg of CBD or CBD+THC together is usually enough. The future of medical cannabis. Cannabis oils can then either be used directly ( under the tongue) or THC mg/mL | CBD THC-rich oil. . That being said, when you're making the cooking oil at home, it's much harder to correctly calculate the dosage since controlling temperature and.