tag:theconversation.com,2011:/us/topics/cbd-oil-56941/articlesCBD oil – The Conversation2023-02-09T13:35:20Ztag:theconversation.com,2011:article/1869012023-02-09T13:35:20Z2023-02-09T13:35:20ZCBD is not a cure-all – here’s what science says about its real health benefits<figure><img src="https://images.theconversation.com/files/488378/original/file-20221005-18-19r1y.jpg?ixlib=rb-1.1.0&rect=440%2C26%2C5514%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since 2018, it has been legal in the U.S. to use a drug made from purified cannabis-derived cannabidiol – CBD – to treat certain childhood seizure disorders.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/scientist-checking-cannabis-plants-in-marijuana-royalty-free-image/1298557693?adppopup=true">Visoot Uthairam/Moment via Getty Images</a></span></figcaption></figure><p>Over the last five years, an often forgotten piece of U.S. federal legislation – the Agriculture Improvement Act of 2018, also known as the <a href="https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019">2018 Farm Bill</a> – has ushered in an <a href="https://peoria.medicine.uic.edu/cbd-blog/">explosion of interest</a> in the medical potential of cannabis-derived cannabidiol, or CBD. </p>
<p>After decades of debate, the bill made it legal for farmers to grow industrial hemp, <a href="https://www.nifa.usda.gov/industrial-hemp">a plant rich in CBD</a>. Hemp itself has tremendous value as a cash crop; it’s used to produce biofuel, textiles and animal feed. But the CBD extracted from the hemp plant also has numerous medicinal properties, with <a href="https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476#">the potential to benefit millions</a> through the treatment of seizure disorders, pain or anxiety. </p>
<p>Prior to the bill’s passage, the resistance to legalizing hemp was due to its association with marijuana, its biological cousin. Though hemp and marijuana belong to the same species of plant, <em>Cannabis sativa</em>, they each have a unique chemistry, <a href="https://doi.org/10.1177%2F2045125312457586">with very different characteristics and effects</a>. Marijuana possesses tetrahydrocannabinol, or THC, <a href="https://nida.nih.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects">the chemical that produces the characteristic high</a> that is associated with cannabis. Hemp, on the other hand, is a strain of the cannabis plant that contains virtually no THC, and <a href="https://www.cdc.gov/marijuana/featured-topics/CBD.html#">neither it nor the CBD derived from it</a> can produce a high sensation. </p>
<p><a href="https://pennstate.pure.elsevier.com/en/persons/kent-vrana">As a professor and chair</a> of the <a href="https://scholar.google.com/citations?user=B7QZGgoAAAAJ&hl=en">department of pharmacology</a> at Penn State, I have been following research developments with CBD closely and have seen some promising evidence for its role in treating a broad range of medical conditions.</p>
<p>While there is growing evidence that CBD can help with certain conditions, caution is needed. Rigorous scientific studies are limited, so it is important that the marketing of CBD products does not get out ahead of the research and of robust evidence.</p>
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<figcaption><span class="caption">Before purchasing any CBD products, first discuss it with your doctor and pharmacist.</span></figcaption>
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<h2>Unpacking the hype behind CBD</h2>
<p>The primary concern about CBD marketing is that the scientific community is not sure of the best form of CBD to use. CBD can be produced as either a pure compound or a complex mixture of molecules from hemp that constitute <a href="https://www.healthline.com/nutrition/cbd-oil-benefits">CBD oil</a>. CBD can also be formulated as a <a href="https://www.healthline.com/health/best-cbd-cream-for-pain#A-quick-look-at-the-best-CBD-creams-for-pain">topical cream or lotion</a>, or as a <a href="https://www.drugs.com/lifestyle/cbd-gummies-health-benefits-3515165/">gummy</a>, <a href="https://www.medicalnewstoday.com/articles/best-cbd-capsules#how-to-shop">capsule</a> or <a href="https://www.medicalnewstoday.com/articles/cbd-oil-vs-tincture#risks">tincture</a>. </p>
<p>Guidance, backed by clinical research, is needed on the best dose and delivery form of CBD for each medical condition. That research is still in progress.</p>
<p>But in the meantime, the siren’s call of the marketplace has sounded and created an environment in which CBD is often <a href="https://www.nbcnews.com/health/health-news/even-without-proof-cbd-finding-niche-cure-all-n945516">hyped as a cure-all</a> – an elixir <a href="https://www.forbes.com/health/body/cbd-for-sleep/#">for insomnia</a>, <a href="https://www.healthline.com/health/cbd-for-anxiety">anxiety</a>, <a href="https://www.health.harvard.edu/blog/cbd-for-chronic-pain-the-science-doesnt-match-the-marketing-2020092321003">neuropathic pain</a>, <a href="https://www.mdanderson.org/cancerwise/cbd-oil-and-cancer--9-things-to-know.h00-159306201.html">cancer</a> and <a href="https://www.acc.org/About-ACC/Press-Releases/2022/09/06/14/48/As-CBD-Use-Rises-Clinical-Trials-Needed-to-Determine-Safety-Efficacy-in-Heart-Disease-Patients">heart disease</a>. </p>
<p>Sadly, there is precious little rigorous scientific evidence to support many of these claims, and much of the existing research has been performed in animal models. </p>
<p>CBD is simply <a href="https://doi.org/10.1038/d41586-019-02524-5">not a panacea for all that ails you</a>.</p>
<h2>Childhood seizure disorders</h2>
<p>Here’s one thing that is known: Based on rigorous trials with hundreds of patients, CBD has been shown to be a <a href="https://www.neurocenternj.com/blog/cbd-for-seizures-use-effectiveness-side-effects-and-more/#">proven safe and effective drug for seizure disorders, particularly in children</a>. </p>
<p>In 2018, the U.S. Food and Drug Administration granted regulatory approval for the use of a purified <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">CBD product sold under the brand name Epidiolex</a> for the treatment of <a href="https://medlineplus.gov/genetics/condition/lennox-gastaut-syndrome/">Lennox-Gastaut</a> and <a href="https://dravetfoundation.org/what-is-dravet-syndrome/">Dravet syndromes</a> in children. </p>
<p>These two rare syndromes, appearing early in life, produce large numbers of frequent seizures that are <a href="https://www.neurologylive.com/view/childhood-epilepsies-dravet-and-lennox-gastaut-syndromes">resistant to traditional epilepsy treatments</a>. CBD delivered as an oral solution as Epidiolex, however, <a href="https://doi.org/10.3389/fphar.2020.00063">can produce a significant reduction</a> – greater than 25% – in the frequency of seizures in these children, with 5% of the patients becoming seizure-free. </p>
<h2>More than 200 scientific trials</h2>
<p>CBD is what pharmacologists call a promiscuous drug. That means it could be effective for treating a number of medical conditions. In broad strokes, CBD affects more than one process in the body – a <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">term called polypharmacology</a> – and so could benefit more than one medical condition.</p>
<p>As of early 2023, there are <a href="https://clinicaltrials.gov/ct2/results?cond=&term=cannabidiol&cntry=US&state=&city=&dist=">202 ongoing or completed scientific trials</a> examining the effectiveness of CBD in humans on such diverse disorders as chronic pain, substance use disorders, anxiety and arthritis. </p>
<p>In particular, CBD appears to be <a href="https://www.ncbi.nlm.nih.gov/books/NBK547742/">an anti-inflammatory agent and analgesic</a>, similar to the functions of aspirin. This means it might be helpful for treating people suffering with inflammatory pain, like arthritis, or headaches and body aches. </p>
<p>CBD also holds potential for use in <a href="https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy.html">cancer therapy</a>, although it has not been approved by the FDA for this purpose. </p>
<p>The potential for CBD in the context of cancer is twofold: </p>
<p>First, there is evidence that it <a href="https://doi.org/10.3390/biom11040582">can directly kill cancer cells</a>, enhancing the ability of traditional therapies to treat the disease. This is not to say that CBD will replace those traditional therapies; the data is not that compelling. </p>
<p>Second, because of its ability to reduce pain and perhaps anxiety, the addition of CBD to a treatment plan may <a href="https://doi.org/10.3390/biom11040582">reduce side effects</a> and increase the quality of life for people with cancer.</p>
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<figcaption><span class="caption">Things to consider before purchasing a CBD product.</span></figcaption>
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<h2>The risks of unregulated CBD</h2>
<p>While prescription CBD is safe when used as directed, other forms of the molecule come with risks. This is especially true for CBD oils. The over-the-counter CBD oil industry <a href="https://www.forbes.com/health/body/cbd-legalization-by-state/">is unregulated and not necessarily safe</a>, in that there are no regulatory requirements for monitoring what is in a product. </p>
<p>What’s more, rigorous science does not support the unsubstantiated marketing claims made by many CBD products. </p>
<p>In a <a href="https://doi.org/10.1159/000489287">2018 commentary</a>, the author describes the results of his own study, which was published in Dutch (in 2017). His team obtained samples of CBD products from patients <a href="https://www.researchgate.net/publication/321679450_Grote_variatie_in_samenstelling_cannabisolie_noopt_tot_regels">and analyzed their content</a>. Virtually none of the 21 samples contained the advertised quantity of CBD; indeed, 13 had little to no CBD at all and many contained significant levels of THC, the compound in marijuana that leads to a high – and that was not supposed to have been present. </p>
<p>In fact, studies have shown that there is <a href="https://theconversation.com/the-dietary-supplement-youre-taking-could-be-tainted-with-prescription-medications-and-dangerous-hidden-ingredients-according-to-a-new-study-181418">little control of the contaminants that may be present</a> in over-the-counter products. The FDA has <a href="https://www.fda.gov/news-events/public-health-focus/warning-letters-and-test-results-cannabidiol-related-products">issued scores of warning letters</a> to companies that market unapproved drugs containing CBD. In spite of the marketing of CBD oils as all-natural, plant-derived products, consumers should be aware of the risks of unknown compounds in their products or unintended interactions with their prescription drugs. </p>
<p>Regulatory guidelines for CBD <a href="https://www.statnews.com/2023/02/03/fda-right-agency-regulate-cbd-products-but-it-needs-help/">are sorely lacking</a>. Most recently, in January 2023, the FDA concluded that the existing framework is “not appropriate for CBD” and said it would work with Congress to chart a way forward. In a statement, the agency said that “<a href="https://www.fda.gov/news-events/press-announcements/fda-concludes-existing-regulatory-frameworks-foods-and-supplements-are-not-appropriate-cannabidiol">a new regulatory pathway for CBD is needed</a> that balances individuals’ desire for access to CBD products with the regulatory oversight needed to manage risks.” </p>
<p>As a natural product, CBD is still acting as a drug – much like aspirin, acetaminophen or even a cancer chemotherapy. Health care providers simply need to better understand the risks or benefits.</p>
<p>CBD may <a href="https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743#">interact with the body in ways that are unintended</a>. CBD is eliminated from the body by the same liver enzymes that remove a variety of drugs such as blood thinners, antidepressants and organ transplant drugs. Adding CBD oil to your medication list without consulting a physician could be risky and could interfere with prescription medications. </p>
<p>In an effort to help prevent these unwanted interactions, my colleague Dr. Paul Kocis, a clinical pharmacist, and I have created a free online application called the <a href="https://cann-dir.psu.edu/">CANNabinoid Drug Interaction Resource</a>. It identifies how CBD could potentially interact with other prescription medications. And we urge all people to disclose both over-the-counter CBD or recreational or medical marijuana use to their health care providers to prevent undesirable drug interactions.</p>
<p>In the end, I believe that CBD will prove to have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">place in people’s medicine cabinets</a> – but not until the medical community has established the right form to take and the right dosage for a given medical condition.</p><img src="https://counter.theconversation.com/content/186901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent E Vrana receives unrestricted research grant funding from PA Options for Wellness (a Pennsylvania-approved clinical registrant medical marijuana company).
Vrana is the director of the Pennsylvania-designated Medical Marijuana Academic Clinical Research Center at Penn State. </span></em></p>CBD isn’t a miracle cure for everything that ails a person – but science shows that it has the potential to help treat a number of health conditions.Kent E Vrana, Professor and Chair of Pharmacology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1924772022-11-09T17:34:58Z2022-11-09T17:34:58ZCarbon-busting hemp could help transform Scottish agriculture to zero emissions<p><a href="https://www.britannica.com/plant/hemp">Hemp</a> is one of the oldest traded plants in the world, and cultivation in Scotland started as far back as the <a href="https://www.tandfonline.com/doi/pdf/10.1080/00369229018736795?needAccess=true">11th century</a>. Historically, cannabis – the name of the plant from which hemp is derived – was used to produce rope, cloth, lighting oil and medicine from around <a href="https://books.google.co.uk/books?hl=en&lr=&id=UEaTaDYGl2UC&oi=fnd&pg=PA1&dq=Clarke,+1999+hemp&ots=Szpn51uY5F&sig=WHOQWGwuqPBVgVYBdttQezUfZEs#v=onepage&q=Clarke%2C%201999%20hemp&f=false">the year 1000 until the late 1800s</a>.</p>
<p>These days hemp is big business in places like North America and France, but the UK has been much slower to embrace this market, with little production going on or infrastructure to support it. However, our new <a href="https://sefari.scot/document/potential-market-opportunities-for-hempseed-and-fibre-in-scotland">study</a> makes clear the myriad benefits and opportunities this plant provides – including, crucially, the reduction of carbon emissions and its usefulness in helping to mitigate the effects of climate change.</p>
<p>Hemp was widely used in the UK until the 20th century when cheap and abundant jute and cotton made it uncompetitive. The decline in its industrial use was gradually replaced by its misuse as a psychoactive drug. This resulted in European and North American countries banning its cultivation. By 1928, cultivation was banned in the UK too. Currently, hemp production is <a href="https://www.gov.uk/government/publications/industrial-hemp-licensing-guidance/industrial-hemp-licensing-factsheet">restricted</a> except under Home Office licence. </p>
<p>According to the United States Department of Agriculture (USDA), the total value of hemp production in the US was about <a href="https://www.nass.usda.gov/Newsroom/2022/02-17-2022.php">$824m</a> (£723m) in 2021. In Europe, <a href="https://agriculture.ec.europa.eu/farming/crop-productions-and-plant-based-products/hemp_en#:%7E:text=Hemp%20production%20in%20the%20EU,-Hemp%20is%20a&text=In%20the%20same%20period%2C%20the,%25">France is the largest producer</a> of hemp, followed by the Netherlands and Austria. The UK does not have any current data on production, but there are pockets of hemp farming dotted around the country.</p>
<p>In Scotland the crop is grown at small scale in Aberdeenshire and in the Borders, with enormous potential to make the country’s agricultural sector carbon neutral.</p>
<p>In 2018, Scottish agricultural emissions were <a href="https://www.gov.scot/publications/resas-climate-change-evidence-arable-farmer-led-group/pages/3/">7.5 million tonnes of CO₂e</a> (carbon dioxide equivalent). According to researchers, hemp is <a href="https://www.dezeen.com/2021/06/30/carbon-sequestering-hemp-darshil-shah-interview/">twice as effective as trees</a> when it comes to sinking carbon. Working on the basis that one hectare of farmed hemp <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1089680/Phase_1_report_-_University_of_York_-_HEMP-30_catalysing_a_step_change_in_the_production.pdf">absorbs 22 tonnes of CO2</a>, just 170,455 hectares of hemp could absorb all the emissions produced by Scotland’s agricultural sector if the crop is grown twice a year.</p>
<p>Aside from the <a href="https://www.goodhemp.com/hemp-hub/environmental-benefits-of-hemp-how-good-is-it/#:%7E:text=Hemp%20is%20basically%20nature's%20purifier,of%20carbon%20dioxide%20than%20trees.">environmental benefits</a> as “nature’s purifier” in removing carbon dioxide from the air, the crop is an excellent source of plant protein for humans and animals. It also has huge potential for other uses such as organic insecticides/herbicides, an environmentally friendly concrete substitute known as “<a href="https://www.building.co.uk/focus/hempcrete-a-natural-solution-in-the-quest-for-better-materials/5115430.article">hempcrete</a>”, building insulation, biofuel and <a href="https://www.epa.gov/sites/default/files/2015-04/documents/a_citizens_guide_to_phytoremediation.pdf">phytoremediation</a> – a process which cleans contaminated soils and water.</p>
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<img alt="A large modern design house made of wood and hempcrete with trees in the background." src="https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493296/original/file-20221103-15-9mey6z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A Highland house made of hempcrete.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/e/e9/Highland_Hemp_House_finished_hempcrete.jpg">Tommy Gibbons / Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Our study – a collaboration between the University of Aberdeen’s <a href="https://www.abdn.ac.uk/rowett/">Rowett Institute</a>, <a href="https://www.sruc.ac.uk/">Scotland’s Rural College</a> (SRUC), the <a href="https://saos.coop/">Scottish Agricultural Organisation Society</a> (SAOS) and the <a href="https://scottishhempassociation.com/">Scottish Hemp Association</a> (SHA) – is a detailed analysis of the opportunities for Scotland’s hemp production. </p>
<p>It also provides specific recommendations about how the whole supply chain can be revamped and boosted. As agricultural and food economists, we wanted to explain the current trends in new hemp product developments worldwide, and outline the strengths, weaknesses, opportunities and risks that the industry faces in the UK.</p>
<h2>Huge agricultural potential</h2>
<p>Despite these opportunities, cultivation in Scotland is plagued with significant barriers. These include a lack of well-established markets for farmers, strict regulations and the cost of obtaining a licence, low profitability and a lack of processing facilities.</p>
<p>The industry in France is an encouraging example, where hemp fibre contributed around €40m, and <a href="https://www.healthline.com/nutrition/cbd-oil-benefits">cannabidiol oil</a> (an active ingredient found in industrial hemp) <a href="https://apps.fas.usda.gov/newgainapi/api/Report/DownloadReportByFileName?fileName=Industrial%20Hemp%20in%20France_Paris_France_07-31-2021.pdf">€131m</a> to the economy in 2020.</p>
<p>Our report provides expert recommendations on the necessary steps to advance the Scottish hemp sector, based on trade research, HMRC trade data, interviews with farmers and Mintel’s <a href="https://www.mintel.com/global-new-products-database">Global New Products Database</a>. </p>
<p>We found that although the UK is among the top five countries to launch new hemp-based products – health supplements, nutritional drinks, snacks and breakfast cereals, for example – there is no economic assessment of hemp’s contribution to the economy. </p>
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<p>Five benefits associated with hemp products include low or reduced allergens, it’s suitable for vegans, vegetarians, it’s gluten-free and can be grown organically. So it has the potential to be a cost-effective product bringing both health and environmental benefits.</p>
<p>Our report contains short- to long-term advice for farmers and companies involved in the hemp chain. In the short term, we recommend support for hemp as a carbon credit crop – this works like <a href="https://carboncredits.com/the-ultimate-guide-to-understanding-carbon-credits/?sl=cc-google-ads&gclid=CjwKCAjwzY2bBhB6EiwAPpUpZpCrOKx_qjce4ff1LePlXf9gLudzwPyH0MkiJ8MyLydS5AT18kQiDBoCaYoQAvD_BwE">“permission slips for emmissions”</a> – as well as the provision of educational and technical support to hemp growers.</p>
<p>Recommended medium-term strategies involve relaxing the regulation of hemp and establishing a strong hemp processing sector. Long-term strategies need to focus on building a strong collaboration between farmers, processors and retailers, while also establishing a seed production centre and a well-co-ordinated UK hemp association.</p>
<p>Hemp is rich in potential and benefits for Scotland and beyond. If we want to make serious inroads on reducing emissions, this could be an important step in the right direction.</p><img src="https://counter.theconversation.com/content/192477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wisdom Dogbe receives funding from Scottish Environment, Food and Agriculture Research Institutes (SEFARI). </span></em></p><p class="fine-print"><em><span>Cesar Revoredo-Giha receives funding from the Scottish Government - Rural and Environment Science and Analytical Services Division (RESAS) as part of their Strategic Research Programme 2022-27.</span></em></p>A new study emphasises the huge potential and environmental benefits of hemp production and provides a road map to develop the nascent industry across the UK.Wisdom Dogbe, Research Fellow and Applied Agricultural Economist, University of AberdeenCesar Revoredo-Giha, Senior Economist, Team Leader of Food Marketing Research, Reader in Food Chain Economics, Scotland's Rural CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1776752022-05-03T17:17:34Z2022-05-03T17:17:34ZCanada needs better CBD policies to protect consumers from unlicensed products<figure><img src="https://images.theconversation.com/files/460848/original/file-20220502-11-zes056.jpg?ixlib=rb-1.1.0&rect=17%2C35%2C5973%2C3934&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While licensed retailers are subject to inspections and constrained to selling products sourced through licensed channels, the unlicensed market seems to operate outside these requirements, with little pressure from law enforcement.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Cannabis has become <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2020002/article/00002-eng.htm">increasingly common</a> since a Canadian Senate committee <a href="https://sencanada.ca/content/sen/committee/371/ille/rep/summary-e.pdf">first recommended legalizing the substance</a> in 2002. They argued that prohibiting it didn’t reduce the use of cannabis products and that legalization was a better move.</p>
<p>The <a href="https://www.doi.org/10.25318/82-003-x202000200002-eng">goals of legalization</a> were “to keep profits out of the pockets of criminals” and “to protect public health and safety by allowing adults access to legal cannabis.” In October 2018, the first sales of legal, adult-use cannabis — including CBD, or cannabidiol, products — occurred.</p>
<p><a href="https://doi.org/10.1108/TCJ-10-2020-0147">Our research</a> investigates how businesses strategize in the emerging cannabis industry that is still in its early stages of formation. </p>
<p>As this industry takes shape, it is worth evaluating whether legalization has accomplished its intended goals, particularly as it pertains to complex products such as CBD.</p>
<h2>CBD Problems in Canada</h2>
<p>While Canadian consumers turn to <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html">CBD products to treat various health concerns</a>, government policy <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-3.html#h-77140">prohibits both product packaging and retailers</a> from making specific health claims. </p>
<p>Despite this, a 2021 Canadian study of over 2,000 CBD products sold through 70 websites (both licensed and unlicensed) <a href="https://doi.org/10.1186/s12889-021-11282-x">found that unlicensed sellers often tout CBD</a> as a natural wellness solution to many health problems. The study also found that 53 per cent of products made health claims for 171 medical conditions and ailments on their packaging.</p>
<p>As the industry attempts to attract new users, consumers are seeking information on product use. Sometimes, as outlined in this CBC <em>Marketplace</em> episode, consumers unknowingly turn to unlicensed sellers of CBD products:</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Ckjo6Levoqs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CBC News investigation on CBD products that are still illegal in Canada.</span></figcaption>
</figure>
<p>While licensed retailers are <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/compliance-enforcement-report-cannabis-inspection-data-summary/2019-2020.html">subject to inspections and constrained to selling products sourced through licensed channels</a>, the unlicensed market seems to operate outside these requirements, with little pressure from law enforcement.</p>
<p>As seen in the CBC <em>Marketplace</em> episode, inadequate enforcement, combined with a lack of consumer knowledge on which products are safe and legal, leaves a gap for potentially ineffective or contaminated products to slip through.</p>
<p>Further, testing to confirm the safety and contents of cannabis products in Canada is not easily accessible. Such testing could enable consumers to examine licensed, unlicensed and homegrown products to ensure products are free from contaminants, like pesticides and mould.</p>
<figure class="align-center ">
<img alt="Someone holding a bowl of cannabis buds" src="https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460850/original/file-20220502-12-r3b88x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inadequate enforcement, combined with a lack of consumer knowledge on which CBD products are safe and legal, leaves a gap for potentially ineffective or contaminated products to slip through.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>This creates a confusing system for consumers to navigate and has unintentionally hampered policymakers’ efforts to reduce illegal sales and promote safe use. To help understand the health benefits and risks, potential consumers of licensed CBD products are <a href="https://www.canada.ca/en/services/health/campaigns/cannabis/health-effects.html">encouraged to speak with their doctor, rather than a retailer</a>.</p>
<p>However, real and perceived stigma persists even within the <a href="https://doi.org/10.1186/s42238-020-00056-8">health-care</a> <a href="https://doi.org/10.1111/ijn.12836">community</a>. To combat this stigma, members of the cannabis industry use rhetorical tactics, such as addressing <a href="https://doi.org/10.1177/10564926211019481">historical misconceptions stemming from cognitive biases</a>, to argue that the industry should not be stigmatized. For example, just because some cannot separate the historical origin of cannabis from its potential harms, it does not mean its proven potential benefits should be disregarded.</p>
<h2>Competing narratives</h2>
<p>Despite legalization, the cannabis industry remains heavily stigmatized. Competing viewpoints exist and while <a href="https://doi.org/10.1016/j.tifs.2019.12.025">many people support legalization and safe use</a>, others still <a href="https://doi.org/10.1503/jpn.190136">strongly oppose it</a>. </p>
<p>Without acknowledging the complex history of legalization, <a href="https://www.canada.ca/en/health-canada/news/2018/10/canada-legalizes-and-strictly-regulates-cannabis.html">public health</a> and <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2020002/article/00002-eng.htm">statistics reporting</a> will continue to undermine productive conversations about health and safety that are needed to address cannabis stigma.</p>
<figure class="align-center ">
<img alt="A row of cannabis products on a shelf" src="https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460841/original/file-20220502-16-bvakm5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Despite legalization, the cannabis industry still remains heavily stigmatized.</span>
<span class="attribution"><span class="source">(Shutterstock).</span></span>
</figcaption>
</figure>
<p>Before legalization, <a href="https://www.thegrowthop.com/cannabis-culture/living-legacy-is-it-time-to-get-with-it-and-get-rid-of-the-term-black-market">many cannabis market participants were change agents</a>: they enabled and advocated for access to safe and effective products, pioneering the medical market by refining strains known to help specific conditions. </p>
<p>After legalization, many existing participants faced significant intersecting <a href="https://harrisonjordanlaw.com/apply-ontario-dispensary-license/">financial</a> and <a href="https://doi.org/10.3138/jcs-2020-0042">social</a> barriers to <a href="https://investingnews.com/daily/cannabis-investing/saskatchewan-scraps-lottery-system-cannabis-retail-licenses/">acquiring licenses</a> needed for legal market entry.</p>
<p>The work many market participants did to help legalize and legitimize the industry was undermined by the government’s use of terms like “criminals” and “<a href="https://thegrowthop.com/cannabis-culture/living-legacy-is-it-time-to-get-with-it-and-get-rid-of-the-term-black-market">black market</a>” in <a href="https://www.publicsafety.gc.ca/cnt/trnsprnc/brfng-mtrls/prlmntry-bndrs/20200930/026/index-en.aspx">public safety</a> messaging. This is why some participants prefer the term “legacy market” instead.</p>
<h2>What can be done?</h2>
<p>We propose the following practical recommendations that can be implemented in the short term to protect consumer health and safety:</p>
<p><strong>Problem 1:</strong> Consumers are unaware of the difference between licensed and unlicensed sellers.</p>
<p><strong>Solution:</strong> Run <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources/lower-risk-cannabis-use-guidelines.html">public education programs</a> and social marketing campaigns, such as California’s “<a href="https://bcc.ca.gov/consumers/weedwise.html">Get #Weedwise</a>” campaign, aimed at changing consumers’ behaviour. </p>
<p><strong>Problem 2:</strong> There is real and perceived stigma towards cannabis and people who use it within the health-care community.</p>
<p><strong>Solution:</strong> Education for health-care providers, grounded in research and science, articulating the benefits and risks of medical and adult-use cannabis is needed.</p>
<p><strong>Problem 3:</strong> Labels and words that connote negativity (e.g., black market, criminals, weed, marijuana, pot, drugs) inhibit licensed businesses’ ability to manage stigma.</p>
<p><strong>Solution:</strong> Labels should try to use positive and inclusive language (e.g., legacy market, unlicensed producers and sellers, cannabis) that encourages productive conversations among policymakers, health-care practitioners, the media and the general public.</p>
<p><strong>Problem 4:</strong> It is difficult to access testing for products originating from unlicensed, recreational or homegrown sources.</p>
<p><strong>Solution:</strong> Publicly accessible and affordable <a href="https://www.politico.eu/article/future-german-coalition-agrees-to-legalize-cannabis">product testing</a> is needed, regardless of licensing status. In addition, accurate and detailed <a href="https://doi.org/10.1159/000489287">labelling</a> is necessary for both licensed and unlicensed products.</p>
<p>It is clear that the legalization of cannabis in Canada is still a work in progress. The above steps would improve consumer safety and promote licensed supply channels, and implementing these recommendations in the short-term would be a significant step toward achieving the stated goals of cannabis legalization. In the long-term, policymakers should engage stakeholders in re-examining CBD policies and ensure they are protecting, rather than confusing, consumers.</p><img src="https://counter.theconversation.com/content/177675/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Policy-makers and stakeholders in Canada should re-examine CBD policies and ensure they are protecting, rather than confusing, consumers.Majid Eghbali Zarch, Assistant Professor, Faculty of Business Administration, Memorial University of NewfoundlandJennifer Marlowe, Research Assistant, Faculty of Business Administration, Memorial University of NewfoundlandSandy Brennan, Project Coordinator, Marketing and Communications, Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1723992021-12-13T19:06:52Z2021-12-13T19:06:52ZIt’s legal to buy over-the-counter cannabis in Australia – but it’s still a long way from your local chemist<figure><img src="https://images.theconversation.com/files/436029/original/file-20211207-19-1schdva.jpg?ixlib=rb-1.1.0&rect=17%2C17%2C5734%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/cbd-hemp-oil-hand-holding-260nw-1507445519.jpg">Shutterstock</a></span></figcaption></figure><p>Since <a href="https://www.news.com.au/lifestyle/health/cbd-oil-cannabidiol-now-available-over-the-counter-in-australian-pharmacies/news-story/c5e516bdc8bd6639163d5e39453a7927">early 2021</a>, the Therapeutic Goods Administration (TGA) has allowed the sale of low-dose cannabidiol (CBD) preparations over the counter at Australian pharmacies. But you won’t find any at your local chemist.</p>
<p>The situation is <a href="https://www.sciencedirect.com/science/article/pii/S0955395920302747">different overseas</a>. In the United States, although <a href="https://www.raps.org/news-and-articles/news-articles/2021/8/fda-reaffirms-that-cbd-products-cant-be-marketed-a">not approved</a> at a federal level, it is possible to buy over-the-counter products such as sweets <a href="https://www.healthline.com/health-news/cvs-to-sell-cannabidiol-products-over-the-counter">containing CBD</a> in several states. In the United Kingdom, low-dose CBD oil can be sold as a dietary supplement, but not a medicine. </p>
<p>CBD is a chemical found in the cannabis plant. Like tetrahydrocannabinol (THC), also found in cannabis, it does have psychoactive effects. It can make people sleepy and affect the brain’s electrical signals. Unlike THC, it won’t get you “high” or induce other psychotic effects.</p>
<p>Getting a medicine to market in Australia, even a non-prescription one, requires extensive research and investment. It might be too much for small cannabis producers to take on, and a turn-off for big pharmaceutical companies if that investment is at the expense of upcoming blockbuster drugs. And the process might not be worth it if research shows the benefit of cannabinoids is small compared with other therapies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-smoking-marijuana-affect-academic-performance-two-researchers-explain-how-it-can-alter-more-than-just-moods-168158">How does smoking marijuana affect academic performance? Two researchers explain how it can alter more than just moods</a>
</strong>
</em>
</p>
<hr>
<h2>Setting high standards</h2>
<p>In Australia, it became legal to purchase products containing low-dose (less than 150 milligrams a day) CBD over the counter after the TGA <a href="https://www.tga.gov.au/media-release/over-counter-access-low-dose-cannabidiol">down-scheduled the substance</a> from a Schedule 4 (prescription medicine) to a Schedule 3 (pharmacist-only medicine). </p>
<p>But so far, no product containing CBD has been approved by the Australian Register of Therapeutic Goods (ARTG), which is a requirement of pharmacist sale. ARTG approval means regulatory quality data on its safety, contaminants, microbial content, shelf-life and efficacy meet the TGA standards and is known and tested in regulatory grade laboratories. </p>
<p>The time and financial costs for drug development to meet the ARTG standards can be significant. Aspiring cannabis companies may not anticipate the difference between selling a product like cannabidiol compared to other products such as toys or clothing. </p>
<p>Expert clinical groups including physicians, psychiatrists, the <a href="https://ama.com.au/sites/default/files/documents/AMA_submission_to_the_TGA_proposed_amendments_to_the_Poisons_Standard_interim_decision_on_CBD.pdf">Australian Medical Association</a> and Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists opposed the down-scheduling, citing the lack safety data, lack of efficacy data, issues with product labelling and the potential for interactions with prescription medicines. </p>
<p>In fact there is only one regulatory-grade CBD product approved for use in Australia, <a href="https://www.tga.gov.au/sites/default/files/auspar-cannabidiol-210115.pdf">Epidyolex</a>, which is approved for treating forms of severe childhood epilepsy, and only available on prescription. (A drug called Sativex is also approved that contains both CBD and THC.)</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctor with oil dropper in hand" src="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Low-dose cannabinoids provide less than 150 mg per day to the user.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/cbd-hemp-oil-doctor-holding-260nw-1433210075.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>From a patient-safety perspective, regulating formulation and ensuring safety and quality data has met the TGA bar is imperative. Proving effectiveness is reasonable too. By down-scheduling and yet insisting on ARTG approval, the use of illicit CBD products may decrease – a win for population health if it transpires.</p>
<p>For industry, the TGA’s decision to down-schedule but require ARTG approval could be seen helpful to ensure quality and restrict supply. It has been estimated there is a <a href="https://www.grandviewresearch.com/industry-analysis/australia-legal-cannabis-market">potential</a> for hundreds of millions of dollars of market in Australia and crop development is <a href="https://www.abc.net.au/news/rural/2021-02-17/medical-cannabis-crop-facility-approval-in-gascoyne-wa/13160764">already underway</a>. So, major investment into drug development by a CBD company could be financially rewarding, as long as the standards are met.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-its-time-to-treat-medicinal-cannabis-as-an-alternative-therapy-not-a-pharmaceutical-169458">Why it's time to treat medicinal cannabis as an alternative therapy, not a pharmaceutical</a>
</strong>
</em>
</p>
<hr>
<h2>What could low dose CBD be good for?</h2>
<p>There are currently no recommended medical uses for low-dose CBD. <a href="https://pubmed.ncbi.nlm.nih.gov/31290177/">Clinical trial data</a> suggests a benefit of higher dose CBD for some children with a severe form of epilepsy who haven’t responded to other drugs. But it’s not clear whether the benefits could also have been explained by the fact patients <a href="https://pubmed.ncbi.nlm.nih.gov/31290177/">also took Valium</a>. And there were significant side effects reported that were higher in the CBD group.</p>
<p>With some high-profile proponents including <a href="https://www.abc.net.au/news/2021-12-06/basketball-legend-lauren-jackson-medicinal-cannabis-chronic-pain/100672048">basketballer Lauren Jackson</a>, there are increasing calls in many countries for patients, particularly those with chronic pain, to legally use cannabinoids. There are also <a href="https://www.news.com.au/lifestyle/health/cbd-oil-cannabidiol-now-available-over-the-counter-in-australian-pharmacies/news-story/c5e516bdc8bd6639163d5e39453a7927">claims</a> low-dose CBD could help people with anxiety, insomnia, arthritis or inflammatory issues, but this has yet to be backed by research into effectiveness or safety. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="oil capsules and dropperf" src="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Over-the-counter CBD products must be approved for registration to be sold in Australian. So far, none have passed those tests.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/joliet-illinois-usa-december-9-260nw-1253672308.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>We don’t know whether any cannabis business has applied to the TGA to have its product registered and been rejected due to failures on the safety, efficacy and quality side. </p>
<p>However, due to cannabis’ complicated extraction, synthesis, combinations, drug interactions and side-effects profile, it seems unlikely many non-medical companies would have the facilities, systems and people available in Australia to be able to achieve the required standards. </p>
<p>So far, big pharmaceutical companies have not shown significant interest in low-dose CBD. They may not be sure low-dose drugs will be recommended by doctors, or be waiting for more research. They may not judge CBD to be a potential blockbuster compared with other therapies in their pipelines. </p>
<p>There are some <a href="https://www.afr.com/companies/healthcare-and-fitness/local-medical-cannabis-company-scores-92m-deal-20210120-p56vhv">local producers exporting cannabis</a> and embarking on clinical trials. Federal health minister Greg Hunt has <a href="https://www.afr.com/companies/healthcare-and-fitness/local-medical-cannabis-company-scores-92m-deal-20210120-p56vhv">said</a> Australia is “poised to become a recognised leader in the global supply of the highest-quality medicinal cannabis products”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-products-are-being-sold-as-sleep-remedies-heres-the-evidence-about-their-effectiveness-168166">Cannabis products are being sold as sleep remedies – here's the evidence about their effectiveness</a>
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</p>
<hr>
<h2>Coming to a chemist soon?</h2>
<p>If we are using cannabis as a medicine, we should <a href="https://www.tga.gov.au/scheduling-decision-final/notice-final-decision-amend-or-not-amend-current-poisons-standard-cannabidiol">make the same demands</a> we do of other medicines to protect patient safety. This requires good manufacturing practice, good laboratory standards of measurement, appropriate labelling, and sufficient clinical information for informed patient consent.</p>
<p>Medical professionals should know what they are prescribing or recommending and be able to refer to dose-response data for each compound. They need to know the pharmacology and the drug interactions, the evidence for their use in specific conditions and any negative effects.</p>
<p>They also need to understand the legal, professional and regulatory obligations placed on prescribers and dispensers. If products are being bought at the chemist, they may interfere with other drugs or foods. Companies who want to sell such products in Australia will need to focus on bringing their drug development into line with regulatory standards. Time will tell how many can do that.</p><img src="https://counter.theconversation.com/content/172399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J Martin is the Chief Investigator for the NHMRC funded Centre for Research Excellence, Australian Centre for Cannabinoids Research Excellence.J. Martin has a family member who is a shareholder in a cannabis start‐up company in Australia. This has been fully declared to the funding agency and is subject to a governance order from the University of Newcastle regarding management of this potential conflict.</span></em></p><p class="fine-print"><em><span>Catherine Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The TGA gave low-dose cannabis sales without prescription the green light in February. But no product has jumped through all the regulatory hoops to market yet.Jennifer Martin, Professor of Medicine and Chair of Clinical Pharmacology, University of NewcastleCatherine Lucas, Clinical pharmacologist, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1694582021-10-13T02:17:52Z2021-10-13T02:17:52ZWhy it’s time to treat medicinal cannabis as an alternative therapy, not a pharmaceutical<figure><img src="https://images.theconversation.com/files/426059/original/file-20211012-25-1hxl4tj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The recent approval of two <a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/medicinal-cannabis-agency/medicinal-cannabis-agency-information-health-professionals/medicinal-cannabis-products-meet-minimum-quality-standard">domestically produced</a> cannabidiol (CBD) oil products – non-intoxicating cannabis compounds – may have provided new optimism to patients on cannabis prescriptions. Slow progress with product approvals had meant some <a href="https://www.1news.co.nz/2021/09/26/limited-medicinal-cannabis-options-could-push-kiwis-to-black-market-says-patient/">patients had feared</a> they would need to turn to the black market.</p>
<p>Yet these new approvals are hardly consolation for the majority of people who <a href="https://assets-global.website-files.com/5e332a62c703f653182faf47/5ec5b275d19bd02d748c0f15_Rychert%20FINAL.pdf">continue to self-medicate</a> with illegally sourced cannabis, including via “<a href="https://thespinoff.co.nz/society/06-08-2020/the-green-fairies-at-the-forefront-of-new-zealands-fight-to-legalise-cannabis/">green fairies</a>”, personal networks, drug dealers or by growing their own. </p>
<p>Many of those are the very communities that advocated for the legalisation of medicinal cannabis in the first place, but which currently remain outside the tenuous legal system.</p>
<p>After years of anticipation and 18 months since the establishment of the Medicinal Cannabis Scheme (<a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/medicinal-cannabis-agency/about-medicinal-cannabis-scheme">MCS</a>), many who use cannabis medically are still missing out. </p>
<p>Affordability and continued problems with accessing prescriptions are part of the problem. So too is the <a href="https://jamanetwork.com/journals/jama/fullarticle/2338251">lack of clinical trials</a> to prove efficacy of cannabis in the treatment of many conditions.</p>
<p>But with the equity and fairness of the whole system in question, perhaps another approach is needed. Specifically, should we start thinking about medicinal cannabis in terms of an alternative therapy rather than as a pharmaceutical medicine?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1424055027937673218"}"></div></p>
<h2>Slow progress and blame</h2>
<p>It has been four years since the government <a href="https://www.beehive.govt.nz/release/medicinal-cannabis-ease-suffering">announced</a> its “commitment to make medicinal cannabis more available”, and nearly three years since <a href="https://www.legislation.govt.nz/act/public/2018/0054/latest/DLM7518707.html">an amendment</a> to the Misuse of Drugs Act enabled the Ministry of Health to develop regulations for the MCS.</p>
<p>The regime was opened for product applications in April 2020, with local industry working on certification and product development. Extensions to the “transitional period” were passed to continue sale of products imported from overseas. But this ended abruptly on October 1, leaving just four Canadian products approved under the MCS available from New Zealand pharmacies. </p>
<p>Domestic producers <a href="https://www.nzherald.co.nz/nz/politics/thousands-will-suffer-major-medicinal-cannabis-fix-wont-help-patients-losing-products-next-month/LBUKHNIEVLN3DRW2UH4MRBC42A/">blamed</a> the slow progress on regulatory thresholds nearly as tough as for pharmaceutical products. In response, the health minister <a href="https://www.nzherald.co.nz/nz/politics/andrew-little-unleashes-on-medicinal-cannabis-industry-patient-suffering-from-end-of-grace-period-is-on-them/FRJYNWTOFRCLWFDGIX4V52OHIQ/">blamed the industry</a> for not working hard enough to meet those standards. </p>
<p>In the meantime, patients and prescribing doctors are left with few legal products to choose from.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1443772065820069893"}"></div></p>
<h2>Lack of clinical proof</h2>
<p><a href="https://assets-global.website-files.com/5e332a62c703f653182faf47/5e332a62c703f6cc482fd4f8_Pledger-2069-NZMJ-1433.pdf">Five percent</a> of New Zealanders use cannabis for broadly defined medicinal uses, with pain, sleep and anxiety the leading conditions. But scientific and clinical trial evidence for the effectiveness of cannabis for these conditions remains limited. </p>
<p>For decades, prohibition under international drug treaties has stalled research into the potential medical properties of cannabis. But while more clinical trials are needed, the safety profile of medicinal cannabis – particularly the non-intoxicating CBD products – is <a href="https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf">good and well tolerated</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/cbd-marijuana-and-hemp-what-is-the-difference-among-these-cannabis-products-and-which-are-legal-154256">CBD, marijuana and hemp: What is the difference among these cannabis products, and which are legal?</a>
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<p>Nevertheless, many doctors remain <a href="https://journal.nzma.org.nz/journal-articles/medical-cannabis-knowledge-and-expectations-in-a-cohort-of-north-island-new-zealand-general-practitioners">understandably reluctant</a> to recommend and prescribe cannabis-based products.</p>
<p><a href="https://msresearch.nz/wp-content/uploads/2020/07/Exploring-medicinal-use-of-cannabis_NZMJ.pdf">Our survey</a> of over 3,600 medicinal cannabis users found only one in three patient requests for medicinal cannabis prescriptions were successful. Other researchers have found <a href="https://openaccess.wgtn.ac.nz/articles/thesis/Framing_the_use_of_cannabis_as_a_medicine_in_New_Zealand_Regulatory_Clinician_and_Patient_contexts/14633439">only a 20%</a> success rate. </p>
<p>This is unlikely to change until gold-standard, double-blind, placebo-controlled trials demonstrate the efficacy of cannabis-based products for specific health conditions.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1442228716336148484"}"></div></p>
<h2>A restrictive regime</h2>
<p>The stigma and reputational risk of discussing cannabis use with medical professionals also deter patients from requesting a prescription. Studies of medicinal cannabis users found patients <a href="https://pubmed.ncbi.nlm.nih.gov/28471927/">conceal their cannabis use</a> to avoid moral judgments in the provider–patient relationship.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-products-are-being-sold-as-sleep-remedies-heres-the-evidence-about-their-effectiveness-168166">Cannabis products are being sold as sleep remedies – here's the evidence about their effectiveness</a>
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<p>Furthermore, not everyone benefits equally from the new medicinal cannabis prescription products. <a href="https://journal.nzma.org.nz/journal-articles/predictors-of-medicinal-cannabis-users-willingness-to-utilise-a-new-prescription-medicinal-cannabis-scheme-in-new-zealand">Our research</a> suggests the current system favours Pākehā and those on higher incomes.</p>
<p>In contrast, those on lower incomes, Māori and those who grew their own cannabis to use therapeutically were least likely to engage with the MCS. </p>
<p>This tends to reinforce perceptions that the new prescription regime is too restrictive, bureaucratic and expensive. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medicinal-cannabis-to-manage-chronic-pain-we-dont-have-evidence-it-works-157324">Medicinal cannabis to manage chronic pain? We don't have evidence it works</a>
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<h2>The way forward</h2>
<p>This is where reframing of the policy debate as one about alternative therapies could benefit both patients and the medical profession.</p>
<p>Much as we already do for a range of dietary supplements, the non-intoxicating cannadiol products could be easily <a href="https://assets-global.website-files.com/5e332a62c703f653182faf47/5e332a62c703f6d4f52fd606_Rychert-18821421.pdf">made available</a> without the need for prescriptions and pharmacies. This is <a href="https://www.sciencedirect.com/science/article/pii/S0955395920302747">already happening</a> in jurisdictions in the US and EU. </p>
<p>By classifying medicinal cannabis as an alternative therapy there is potential for patients to be more forthcoming about their use with their GPs. Allowing patients to grow their own could also introduce more equity to the system. </p>
<p>Above all, this would recognise patients’ right to therapeutic self-determination and increased access, while freeing doctors from having to prescribe “medicines” that in many cases lack clinical trial evidence.</p><img src="https://counter.theconversation.com/content/169458/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marta Rychert receives funding from the New Zealand Marsden Fund and NZ Health Research Council.</span></em></p><p class="fine-print"><em><span>Chris Wilkins receives funding from the New Zealand Royal Society Marsden Fund and Health Research Council of New Zealand.</span></em></p><p class="fine-print"><em><span>Vinuli Withanarachchie works on a project funded by the NZ Health Research Council</span></em></p>Non-intoxicating cannabis products are safe and well tolerated by those who use them, so why not lower the clinical threshold for their manufacture and sale?Marta Rychert, Senior Researcher in Drug Policy, Massey UniversityChris Wilkins, Associate Professor of illegal drug research, Massey UniversityVinuli Withanarachchie, Research Officer, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1101462019-01-30T11:53:06Z2019-01-30T11:53:06ZCBD: Rising star or popular fad?<figure><img src="https://images.theconversation.com/files/256182/original/file-20190129-108370-104hyle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">CBD, made from hemp, is being hyped as treatment for pain, nausea and a variety of maladies. But studies so far do not show benefit in humans.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cannabis-cbd-oil-hemp-products-725285644?src=BI2TvBgjgI8jLdBgumusnQ-1-8">ElRoi/Shutterstock.com</a></span></figcaption></figure><p>Cannabidiol, or CBD, has become a household name. On many <a href="https://twitter.com/RoxayneVz/status/1088492675844710400">social media sites,</a> people suggest “but have you tried CBD oil?” on posts pertaining to any health-related issue. </p>
<p>CBD, a minor constituent of marijuana, is widely touted as <a href="https://www.mindbodygreen.com/articles/what-are-the-effects-of-cbd">nature’s miracle by CBD enthusiasts</a>. It does not get people high, unlike marijuana’s main constituent, delta-9-tetrahydrocannabinol (THC). However, given the recent surge in its popularity, you’d think the molecule is magic. </p>
<p>We are behavioral pharmacology scientists, and we study how drugs act on the body. Specifically, we have an interest in developing <a href="https://addictionresearch.health.ufl.edu/faculty/jenny-l-wilkerson-ph-d/">new drugs for the treatment of pain</a> that possess lessened drug abuse potential, and <a href="https://addictionresearch.health.ufl.edu/faculty/lance-mcmahon/">therapeutic interventions for drug abuse</a>. Although there is scientific interest in the use of CBD for both pain and drug addiction, as well as many other medical indications, there is a lot that we still do not know about CBD.</p>
<h2>CBD and THC: How do they work?</h2>
<p>Drugs affect the body by binding and acting at various protein molecules, usually on the surface of the cells in the body, called receptors. These receptors then send signals that can impact bodily functions.</p>
<p>Marijuana has an effect on the body because many animals have receptors termed “cannabinoid receptors.” There are two known cannabinoid receptors that are responsible for the effects of marijuana. Only one of them, the cannabinoid type 1 receptor (CB1R), is responsible for the high from marijuana. These cannabinoid receptors are predominately found on nerve cells located throughout the body, including the brain. </p>
<p>CBD doesn’t get people high because CBD does not <a href="http://molpharm.aspetjournals.org/content/34/5/605.long">bind or act on CB1R</a>. CBD also does not bind or act on the other cannabinoid receptor, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22442754">the cannabinoid type 2 receptor (CB2R), predominately found on immune cells</a>. In contrast, THC binds and activates both of these receptors.</p>
<p>Studies indicate that CBD does, however, act on several other types of receptors. These include the serotonin 5-HT1A receptor, which can help regulate <a href="https://www.sciencedirect.com/science/article/pii/S1087079201901741">sleep</a>, <a href="https://link.springer.com/article/10.1007/s00213-010-2097-z">mood</a>, <a href="https://www.pnas.org/content/95/18/10734.short">anxiety</a> and <a href="https://link.springer.com/article/10.1385/MN:30:2:117">pain</a>. CBD may also indirectly alter the body’s own cannabinoid receptor activity. </p>
<p>However, scientists do not yet understand the exact manner in which CBD acts on the body. Likewise, many health-related anecdotal claims pertaining to CBD are not founded on solid scientific evidence, and may be due to well-documented <a href="https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect">placebo effects</a>.</p>
<p>There is strong evidence, however, that CBD has enduring health benefits in the treatment of intractable epilepsy. </p>
<h2>Charlotte’s Web</h2>
<p>It has been nearly six years since <a href="https://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/index.html">the story of the Charlotte’s Web strain of marijuana</a> broke into national and international media. This strain of marijuana was named after Charlotte Figi, who struggled with intractable pediatric epilepsy until she was given oil extracted from the strain, which contains a higher CBD-to-THC content. </p>
<p>Charlotte’s father saw an online video of a child from California with seizures who was being treated successfully with marijuana. As it turns out, the active compound that was helping Charlotte was not THC but CBD. </p>
<p>Based upon clinical evidence, GW Pharmaceuticals developed and licensed its own CBD extract, a drug now called Epidiolex. <a href="https://www.sciencedirect.com/science/article/pii/S0140673618301363?via%3Dihub">Clinical trials</a> with Epidiolex for the indications of Dravet syndrome and Lennox Gastaut syndrome, two forms of pediatric epilepsy, were resoundingly positive. </p>
<p>In June 2018, the Food and Drug Administration approved Epidiolex for treatment of these two forms of epilepsy in children that have not responded to other treatments. </p>
<p>Meanwhile, as the clinical trials for Epidiolex were underway, <a href="https://academic.oup.com/brain/article/139/8/2164/1753701">a landmark study from Indiana University</a> demonstrated a possible mechanism for CBD’s astounding effects on Dravet and Lennox Gastaut syndromes. These two syndromes are associated with genetic mutations in two genes that are important in the regulation of sodium ions.</p>
<h2>A specific understanding</h2>
<p>Nerve cells regulate the way they send signals by how ions, or molecules with either an overall positive or negative electric charge, flow in and out of their cells. The most common ions that regulate nerve cell signaling are sodium, potassium, calcium and chloride. These ions move in and out of the cell via pores known as ion channels.</p>
<p>In many forms of epilepsy, however, the movement of ions is not properly controlled. This leads to aberrant firing of the brain’s nerve cells and seizure activity. </p>
<p>In both forms of the epilepsy for which CBD is effective, there are alterations in the channels that control the flow of sodium in and out of nerve cells, or what is called a “sodium channelopathy.”</p>
<p>The study from Indiana University found that CBD can directly inhibit the aberrant flow of sodium ions in nerve cells that have sodium channelopathies. Importantly, CBD does not seem to impact the flow of sodium in healthy nerve cells.</p>
<p>Although CBD has marked effects on these sodium channelopathies, this does not mean that CBD will produce meaningful benefits to other forms of epilepsy. </p>
<p>Other forms of epilepsy are linked to regulation problems related to the flow of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733250/">potassium ions</a> in cells. This type of pediatric epilepsy is resistant to all known therapeutics, including CBD. </p>
<h2>A potential pain therapeutic?</h2>
<p>There are also claims that CBD can be used to address pain. And indeed, mounting evidence in pre-clinical laboratory studies show that CBD may be of use for the treatment and prevention of neuropathic pain, or an amplified response that may be due to nerve cell damage. In a mouse model of this type of pain, CBD injections <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bph.12439">prevented</a> and <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bph.13887">reversed the development of one hallmark sign of neuropathic pain</a>, called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281368/">mechanical allodynia</a>. This is the sensation of pain due to a non-noxious stimulus, such as the feeling of clothing on an area of skin that has a sunburn. A new study from McGill University in Montreal, Canada, shows that <a href="https://journals.lww.com/pain/fulltext/2019/01000/Cannabidiol_modulates_serotonergic_transmission.16.aspx">oral administration of CBD</a> produces these same effects in rats with a similar type of pain. </p>
<p>In both of these studies, the scientists discovered that these effects are likely due to actions at serotonin receptors. A study from scientists at the University of Kentucky suggested that CBD applied to the skin, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/">transdermal CBD, may reduce inflammation in a rat model of arthritis</a>.</p>
<p>However, additional studies from the laboratory at Temple University show that <a href="https://journals.lww.com/behaviouralpharm/Abstract/2015/04000/Distinct_interactions_of_cannabidiol_and_morphine.7.aspx">CBD does not work for all types of pain when tested in animals</a>.</p>
<p>An important caveat to these findings is that not all compounds that produce effects in rodent pain studies will work in humans. Further, most of these studies examined the effects of injected CBD. So far, there is little evidence showing therapeutic effects of either edible or transmucosal, the administration of a drug across a mucous membrane, CBD for pain. There is only limited evidence for the use of transdermal CBD. Thus, until more scientific studies are conducted, the hype that CBD can successfully treat various forms of pain in humans is premature.</p>
<h2>CBD: Beyond the laboratory</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/255469/original/file-20190124-196228-1n2v4jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A sign outside a market in Atlanta on Jan. 18, 2019 advertising the availability of CBD.</span>
<span class="attribution"><span class="source">Lynne Anderson/</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>Still curious about all the hype? Before running to the local supermarket health food isle to purchase CBD to conduct your own at-home trial, there are a few more points to consider. </p>
<p>Most CBD products sold in grocery stores are touted as “hemp-derived.” That is, they come from a cannabis plant that has a purportedly extremely low amount of THC. Typically, hemp-derived products are made from the stalks and roots of the plant. This is in contrast to marijuana, which can contain varying amounts of THC and comes from the flowers of the cannabis plant. Recently, hemp-derived products were removed from the Controlled Substances Act. </p>
<p>However, it remains unclear if hemp-derived CBD works in the same exact manner as marijuana-derived CBD. Further, the FDA does not approve of CBD products as dietary supplements, or the marketing of any health-related claims. Also, the agency prohibits the addition of either THC or CBD to food products sold in <a href="https://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm">interstate commerce for human or animal consumption</a>. </p>
<p>As long as there are no associated medical claims, the FDA allows the use of hemp oil and seeds in cosmetics. However, the usefulness of hemp products in cosmetics also remains to be determined. </p>
<p>Further, as many of the items on the supermarket shelf are not approved by the FDA, there is limited oversight into their production, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818782/">the amount of CBD, if any, that these products contain are often mislabeled or misleading</a>.
Thus, it is too soon to say if CBD is truly a rising star, or merely a fad that will burn out and fall to Earth.</p>
<p><em>Editor’s note: This article has been updated to correct the name of the company, GW Pharmaceuticals, that developed Epidiolex.</em></p><img src="https://counter.theconversation.com/content/110146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Wilkerson has received funding from the NIH. </span></em></p><p class="fine-print"><em><span>Lance McMahon receives funding from the NIH. </span></em></p>Cannabidiol, or CBD, is being touted in popular culture as a miracle cure-all. From creams to gummies and more, CBD has exploded onto the health scene. But what does the science actually say?Jenny Wilkerson, Assistant Professor of Pharmacodynamics, University of FloridaLance McMahon, Professor and Chair of Pharmacodynamics, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1099912019-01-24T22:18:39Z2019-01-24T22:18:39ZWhere’s the weed? Clues to Canada’s cannabis shortages<figure><img src="https://images.theconversation.com/files/255245/original/file-20190123-135145-kprlmp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A depiction of a cannabis bud drops from the ceiling at Leafly's countdown party in Toronto as midnight passes and marks the first day of the legalization of cannabis across Canada. </span> <span class="attribution"><span class="source">(Chris Young/The Canadian Press)</span></span></figcaption></figure><p>Where’s the weed!? </p>
<p>That’s been a common Canadian <a href="https://www.cbc.ca/news/business/canada-cannabis-shortage-years-1.4988195">refrain lately</a>. Shortages <a href="https://www.ctvnews.ca/canada/cannabis-retailers-still-short-of-supply-on-second-day-of-legal-pot-1.4139990">appeared almost immediately</a> after recreational cannabis sales began last October.</p>
<p>Provincial distributors subsequently blamed producers and federal regulators. Lacking stock, Québec <a href="https://www.sqdc.ca/en-CA/about-the-sqdc/shopping-at-the-sqdc/regular-opening-hours">closed stores three days a week</a>. <a href="https://edmontonjournal.com/cannabis/cannabis-business/aglc-hits-pause-on-retail-cannabis-licences-as-nation-sees-pot-shortage">Alberta froze retailer licensing</a> and <a href="https://ottawacitizen.com/opinion/columnists/armstrong-ontarios-following-a-pot-luck-path-to-inefficient-cannabis-selling">Ontario limited store licences to 25</a>.</p>
<p><a href="https://ottawacitizen.com/news/local-news/medical-patients-should-come-first-if-there-is-a-marijuana-shortage-says-patient-advocate">Medical cannabis shortfall concerns</a> appeared even earlier. Some users worried producers were prioritizing more lucrative recreational products or overseas markets.</p>
<p>In response, federal regulators pointed to increasing <a href="https://www.cbc.ca/news/business/medical-pot-shortages-1.4887318">industry inventories</a> and <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/industry-licensees-applicants/licensed-cultivators-processors-sellers.html">producer licences</a>. Producers blamed <a href="https://www.bbc.com/news/world-us-canada-46200873">new-industry growing pains</a> and regulatory red tape. Meanwhile, some <a href="https://calgaryherald.com/cannabis/cannabis-business/cannabis-experts-from-legal-u-s-states-surprised-dismayed-by-alberta-store-freeze">analysts criticized</a> provincial licensing limits as over-reactions.</p>
<p>How can Canada seemingly have large cannabis supplies and yet widespread shortages? <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data/supply-demand.html">Recently released</a> Health Canada <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data.html">cannabis inventory and sales data</a> provide some clues.</p>
<h2>Growing supplies</h2>
<p>Cannabis producers greatly expanded their stockpiles prior to legalization last year. Between January and September, month-end inventories of “dry” cannabis (flowers and leaves) more than doubled from 40 to 102 tonnes. </p>
<p>Similarly, cannabis-infused oil supplies more than tripled, from 14 to 48 kilolitres. Inventory growth slowed in October as recreational sales began.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254766/original/file-20190121-100270-jk4g01.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Producers’ month-end inventories of oil and dry cannabis. Prepared by author from Health Canada data.</span>
<span class="attribution"><span class="source">Michael Armstrong</span></span>
</figcaption>
</figure>
<p>So as officials have noted, there was lots of cannabis overall. That doesn’t mean there weren’t shortages.</p>
<h2>Medical decline and rebound</h2>
<p>Consider medical cannabis. Between April 2017 and September 2018, oil sales per registered client increased 18 per cent. Meanwhile, dry sales plunged 53 per cent, from 11.0 grams per client to just 5.1. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=330&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=330&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=330&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=415&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=415&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254769/original/file-20190121-100264-5j481x.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=415&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical quantities sold relative to total registered clients. October and November 2018 use September’s client count. Prepared by author from Health Canada data.</span>
<span class="attribution"><span class="source">Michael Armstrong</span></span>
</figcaption>
</figure>
<p>Dry sales’ steep decline might reflect a gradual medical shift to oils. But shortages also might have contributed.</p>
<p>The post-legalization sales increases support that theory. November’s oil sales were 18 per cent above September’s. But dry sales soared 103 per cent. Medical clients seemingly refilled their dry supplies after legalization made prescription transfers easier.</p>
<p>Differences between oil and dry cannabis also appear in the recreational cannabis data.</p>
<h2>Oil flows, dry cannabis struggles</h2>
<p>For cannabis oil, recreational sales hit 1.9 kilolitres in November, legalization’s first full month. But comparison to October’s stronger numbers suggests retailers lost sales of roughly 1.8 kilolitres due to shortages. That implies potential recreational demand was around 3.8 kilolitres monthly. Meanwhile, medical sales hit 5.9 kilolitres.</p>
<p>Distributor inventories ended November in good shape. They more than doubled to 7.6 kilolitres. That’s enough to satisfy more than two months of recreational demand. </p>
<p>Similarly, producers ended with 26.3 kilolitres of finished (ready-to-ship) oil. That’s nearly three months of combined recreational and medical demand. Plus, their production and outbound shipping rates both exceeded total end-user demand. That suggests shortages would ease over time.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254651/original/file-20190120-100279-1lnc6wv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rectangles show month-end inventories of unfinished (dashed lines) and finished (solid lines) products. Arrows show the month’s flows of products from producers toward consumers. Green indicates dry cannabis, orange indicates oils. Numbers indicate tonnes of dry cannabis and kilolitres of oil. Estimated by author from Health Canada data.</span>
<span class="attribution"><span class="source">Michael Armstrong</span></span>
</figcaption>
</figure>
<p>By comparison, dry cannabis struggled in November. Sales were 5.1 tonnes, but lost sales were perhaps about 8.3 tonnes. That put monthly recreational demand around 13.4 tonnes. Medical sales hit 3.7 tonnes.</p>
<p>Distributors’ inventory climbed significantly to 10.5 tonnes. But that’s insufficient for even one month’s demand.</p>
<p>Producer’s finished goods inventory of 15.1 tonnes likewise represented less than a month of combined recreational-medical needs. Production and shipments also trailed demand. That implies shortages would continue worsening.</p>
<h2>Explanations?</h2>
<p>Several explanations are possible for dry cannabis shortfalls existing despite large total inventories.</p>
<p>One is that 86 per cent of producers’ dry inventory was unfinished and not yet available for sale. Much of that was recent crops being <a href="https://lift.co/magazine/tag/seed-to-sale">dried and cured</a>. But the large contrast with finished goods suggests possible processing and packaging bottlenecks too.</p>
<p>Another reason is these data add-up inventories across all producers. By contrast, each recreational customer is served by just one provincial distributor.</p>
<p>Suppose one source has a surplus while another has a shortage. Their total inventory could look healthy. But half their users would see empty shelves.</p>
<p>As well, supply and demand are much harder to balance for individual products than for overall product categories. That’s a common retail problem.</p>
<p>For example, imagine visiting a clothing store. Request “a shirt”, and sales staff could show you hundreds. But specify “a long-sleeved, medium-tall, all-cotton, emerald-green shirt” and they might have none to offer, despite huge inventory overall.</p>
<p>Cannabis buyers and sellers likely experienced such mismatches. Medical clients treating conditions <a href="https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm">like epilepsy</a> would be especially at risk. They’d want specific product formulations, not random substitutes.</p>
<p>One factor that doesn’t look important is cannabis exports. In 2018, those averaged only 2.5 per cent of monthly production. That’s probably too small to significantly affect domestic availability.</p>
<p>Another non-issue was cannabis growing itself. Producers’ unfinished dry stockpiles remained almost unchanged during November. That suggests crop harvesting rates kept up with processing.</p>
<h2>Bigger market, bigger challenges</h2>
<p>The industry faces larger challenges longer term. Estimates of Canada’s total demand <a href="https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Final%20Final%20Commentary_523.pdf">vary widely</a>. But <a href="https://ottawacitizen.com/news/local-news/demand-for-pot-will-be-much-higher-than-anyone-anticipated-after-legalization-says-report-commissioned-for-health-canada">Health Canada’s latest assessment</a>, for dry cannabis and oil equivalents combined works out to about 77 tonnes monthly.</p>
<p>So the legal cannabis industry must not only provide better availability of the specific products users want. To eventually serve every recreational and medical user, it also needs to massively grow its capacity. And it must do that <a href="https://theconversation.com/legal-cannabis-vs-black-market-can-it-compete-104915">while competing with black markets</a> despite federal restrictions on <a href="https://theconversation.com/wheres-the-weed-branding-is-essential-for-cannabis-companies-87400">branding and promotion</a>.</p><img src="https://counter.theconversation.com/content/109991/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael J. Armstrong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Government data suggest medical cannabis availability improved after legalization in Canada. But producers have struggled to meet demand for recreational cannabis other than oils.Michael J. Armstrong, Associate professor of operations research, Goodman School of Business, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1003562018-07-24T10:33:44Z2018-07-24T10:33:44ZMedical cannabis users could still be criminalised in UK despite government accepting its benefits<figure><img src="https://images.theconversation.com/files/229009/original/file-20180724-194134-3ibiux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Cannabis is high on the agenda at the moment. Not only have California and Canada passed <a href="https://www.theguardian.com/world/2018/jun/20/canada-legalises-cannabis-senate-vote">new laws</a> to legalise marijuana, but in the UK, two recent high profile medical cases have forced the issue of medical cannabis right up to government level.</p>
<p>The outcry over <a href="https://www.theguardian.com/society/2018/jul/05/billy-caldwell-heads-home-amid-doubts-over-cannabis-oil-access-northern-irleand-medication-epilepsy">Billy Caldwell</a> and <a href="https://www.bbc.co.uk/news/uk-england-coventry-warwickshire-44788448">Alfie Dingley</a> – two epileptic boys who rely on cannabis oil to control their seizures – has led the UK government to accept that cannabis extracts <a href="https://www.gov.uk/government/news/medicinal-cannabis-review-part-2-commissioned">may have medical benefits</a>. </p>
<p>The Advisory Council on the Misuse of Drugs – the official body that advises the government – has since <a href="https://www.gov.uk/government/publications/advice-on-scheduling-of-cannabis-based-medicinal-products">recommended that</a> some forms of cannabis should be allowed for medical uses. This means that doctors might be able to prescribe them to patients. But the devil, as always, is in the detail, and in practice, people who use cannabis therapeutically will still be treated as criminals.</p>
<p>This is for two reasons. One is that the the council has only recommended “rescheduling” some forms of cannabis. The other is that the types of raw, organic cannabis that many people already use to treat their own conditions will probably still be completely banned.</p>
<h2>Drug control explained</h2>
<p>In the UK, <a href="https://www.gov.uk/government/publications/controlled-drugs-list--2">the Misuse of Drugs Regulations</a> include five schedules that categorise all the substances that are controlled by the Misuse of Drugs Act. These schedules determine the level of restriction applied to these substances</p>
<p>Schedule one has the highest level of control. Drugs in this group – which currently includes cannabis – are not considered to have any medical benefit. And they cannot be possessed without a specific licence from the Home Office. Schedule two substances can be possessed with a prescription. The Advisory Council on the Misuse of Drugs <a href="https://www.gov.uk/government/publications/advice-on-scheduling-of-cannabis-based-medicinal-products">has recommended</a> that only substances which fit a definition of “cannabis-derived medicinal products” be moved out of schedule one, and into schedule two.</p>
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Read more:
<a href="https://theconversation.com/cbd-oil-what-you-need-to-know-99430">CBD Oil: what you need to know</a>
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</em>
</p>
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<p>It is possible that standardised whole-plant cannabis products – including those already sold in <a href="https://bedrocan.com/about-us/gmp-certification/">the Netherlands</a> and in <a href="https://www.tilray.ca/en/blog/post/tilray-becomes-north-americas-first-gmp-certified-medical-cannabis-producer/">Canada</a> – might meet the definition. But this definition is to be written by the Department of Health and Social Care and the Medicines and Healthcare products Regulatory Agency (MHRA). At the moment, the MHRA has approved only one cannabis formulation, sold as <a href="http://www.mhra.gov.uk/spc-pil/?prodName=SATIVEX%20OROMUCOSAL%20SPRAY&subsName=CANNABIDIOL&pageID=SecondLevel">Sativex</a>. This has been through the full medicines approval process to be prescribed for the treatment of <a href="https://www.mssociety.org.uk/about-ms/what-is-ms">Multiple Sclerosis</a> related muscle spasms. No other whole-plant cannabis products are approved as medicines in the UK. </p>
<h2>The problems</h2>
<p>The MHRA <a href="https://www.gov.uk/government/news/mhra-statement-on-products-containing-cannabidiol-cbd">has already refused</a> to grant approval for standardised cannabis extracts, <a href="https://theconversation.com/cbd-oil-what-you-need-to-know-99430">such as cannabidiol</a> – sold as CBD oil – to be considered as a medicine. If this approach to defining medicines were to remain, no cannabis products would be moved to schedule two.</p>
<p>The Advisory Council’s reason for not moving other types of cannabis out of schedule one is that it “should not be given the status of medication”. But neither the Misuse of Drugs Act nor the schedules of the Misuse of Drugs Regulations determine what a medication actually is – this is done <a href="http://www.rudifortson4law.co.uk/blog">via UK and EU medicines legislation</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229010/original/file-20180724-194140-1p2yf7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lots of people use cannabis to help them deal with chronic pain.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>There is also the issue of whether schedule two is appropriate for any form of cannabis. Other substances in this schedule include morphine, diamorphine (heroin) and methadone. These can all kill by overdose. This is why they are subject to the tight storage, recording and reporting restrictions imposed by schedule two. </p>
<p>Cannabis is <a href="https://www.independent.co.uk/news/health/how-much-marijuana-take-to-kill-you-fatal-weed-a8043856.html">not lethal</a> in overdose, and is also less harmful than other substances placed in schedule two. Some <a href="https://www.gov.uk/government/publications/controlled-drugs-list--2/list-of-most-commonly-encountered-drugs-currently-controlled-under-the-misuse-of-drugs-legislation">schedule three and four drugs</a> – such as some benzodiazepines – and even some substances that are legally sold, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311234/">such as alcohol</a>, can kill by overdose. </p>
<h2>Criminalising patients</h2>
<p>If cannabis-based medicines are moved into schedule two, the costs and bureaucracy involved will likely deter many doctors from prescribing. But an even larger problem is that most people who use organic cannabis for conditions including chronic pain, arthritis, the side effects of chemotherapy and even the self-medication of brain and other tumours, will continue to be criminalised. The clinical evidence for some of these uses is stronger than for others. But <a href="https://www.eveningexpress.co.uk/fp/news/local/i-was-trying-to-save-my-own-lifecancer-sufferer-speaks-out-after-case1/">some people report</a> much greater benefits compared with pharmaceutical medicines, with less harmful side effects. </p>
<p>The decision to self medicate with cannabis is taken by adults who have the right to make informed choices about their own lives. And as the Home Office knows, criminalising possession <a href="https://www.gov.uk/government/publications/drugs-international-comparators">is not backed up</a> by evidence that it reduces the harms or use of cannabis.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229012/original/file-20180724-194137-2glop2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A recent report claimed legalisation in the UK would reduce organised crime, improve the quality and safety of cannabis and turn over £6.8 billion annually.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Current UK law, and recent recommendations err on the side of caution, so people who use cannabis for medical benefit in the UK, will continue to be criminalised. This is despite the fact that the medical benefits of cannabis have now been accepted. </p>
<p>Of course, enabling people to benefit from substances with medical properties, while also minimising the harms done by both drug use and drug laws, is a complex balance to achieve. And it is clear that this is going to be a balance that will require careful consideration of both the criminal law and medicines regulations.</p><img src="https://counter.theconversation.com/content/100356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Stevens is a member of the Advisory Council of the Misuse of Drugs, but does not speak on its behalf. He is a member of the Green Party. He is also living with a brain tumour.</span></em></p>Medical cannabis in the UK? Don’t hold your breath.Alex Stevens, Professor in Criminal Justice and Faculty Director of Public Engagement, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/994302018-07-19T11:47:29Z2018-07-19T11:47:29ZCBD Oil: what you need to know<figure><img src="https://images.theconversation.com/files/228049/original/file-20180717-44070-cww8o1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>There’s plenty of anecdotal evidence that Cannabidiol (CBD) oil – a concentrated oily extract made from cannabis – can help treat a variety of ailments. It’s said to help with everything from <a href="https://theconversation.com/cannabis-oil-for-epilepsy-what-you-need-to-know-98499">epileptic seizures</a> to <a href="https://www.menshealth.com/health/a19607404/marijuana-drug-addiction-cbd-opioid-cocaine-use/">opioid addiction</a>, <a href="https://www.projectcbd.org/ptsd-post-traumatic-stress-syndrome">PTSD</a> to <a href="https://www.express.co.uk/life-style/health/986813/arthritis-pain-inflammation-treatment-joints-osteoarthritis">arthritis</a>.</p>
<p>But despite CBD oil’s high profile status, there’s still a lot of confusion about what it actually is, and what it’s made from. Certain types of CBD oil are already legally available in the UK – such as those made from hemp – whereas other types are very much illegal in the UK – though are available to buy in other countries </p>
<p>CBD oil extracted from hemp is often marketed as a food supplement to promote well-being – similar to other herbals like Echinacea – and boost the immune system. Although Hemp CBD oil is legal, it is not a medicine and should not be confused with the recent confiscation of 12-year-old <a href="https://theconversation.com/cannabis-oil-for-epilepsy-what-you-need-to-know-98499">Billy Caldwell’s CBD oil</a> at Heathrow airport. </p>
<p>Billy had flown with his mother to Canada to buy the CBD oil – which helps to keep his daily epileptic seizures at bay. But his oil was confiscated because it was made from cannabis flowers and leaves, and so was classed as illegal in the UK, pushing childhood epilepsy and CBD oil into the <a href="https://www.independent.co.uk/news/health/billy-caldwell-medical-cannabis-epilepsy-marijuana-nhs-customs-confiscate-a8393401.html">spotlight</a>. </p>
<h2>Cannabis law explained</h2>
<p>So far, so confusing, but part of the problem is that terms like cannabis and hemp are often used interchangeably – which masks the nuances and complexities of the cannabis plant. </p>
<p><em>Cannabis sativa</em> L, the scientific name of the cannabis plant, is cultivated to produce two distinctive products – industrial hemp, and cannabis. The main difference between hemp and cannabis is based on two criteria. First, the levels of cannabinoids – a family of chemical compounds, the cannabis plant naturally produces – and second, the end use. </p>
<p>According to current UK drug laws, cannabis is classified as an illegal drug because of the psychoactive properties of THC, the component in it that creates the “high”. And under UK law, cannabis is deemed to have a high potential for abuse – with no accepted medical <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/119126/cannabis-class-misuse-drugs-act.pdf">properties</a>. </p>
<h2>Hemp vs cannabis</h2>
<p>But this is where it gets even more confusing because cannabis can be bred to create different strains. Cannabis consumed for recreational purposes is selectively bred to optimise high THC content strains – to maximise the “high” feeling. But cannabis also contains CBD, which is a non-psychoactive component.</p>
<p>Hemp, on the other hand, is harnessed as seed, oil and fibre to produce a wide range of products. It is cultivated to produce a low concentration of the psychoactive cannabinoid THC – as well as higher levels of the non-psychoactive cannabinoid CBD. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228047/original/file-20180717-44100-pixv8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Industrial hemp plant products: tea, oil, rope, protein powder and hemp fabric.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Cannabis is classified as hemp if it has a maximum level of 0.2% THC. Billy’s CBD oil, confiscated at Heathrow, was made from cannabis with a higher level than 0.2% of THC – so it was classed as cannabis, which is why it was confiscated. </p>
<h2>Medical marijuana</h2>
<p>A recent survey conducted by <a href="https://news.sky.com/story/most-britons-want-medicinal-cannabis-legalised-sky-data-poll-11410060">Sky News</a> found that 82% of their poll subjects agreed that medical cannabis should be legalised. Professor Dame Sally Davies, the chief medical officer for England, who was appointed to investigate the current scientific and medical evidence, about the therapeutic properties of cannabis-based products, also believes this. She recently <a href="https://www.independent.co.uk/news/health/medical-cannabis-legalise-uk-prescribe-epilepsy-dame-sally-davies-doctors-a8429231.html">said that</a> “doctors should be able to prescribe” cannabis. </p>
<p>Davies has recommended the removal of cannabis from schedule one <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/722010/CMO_Report_Cannabis_Products_Web_Accessible.pdf">classification</a> – which covers a group of drugs considered to have no medical purpose, that cannot be legally possessed or prescribed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228394/original/file-20180719-142408-1fas03c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The future of pharmacies?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>In Billy Caldwell’s case, the home secretary, Sajid Javid, made the decision to grant Billy access to imported CBD oil. This fresh approach to reconsider the classification of cannabis has been <a href="https://www.theguardian.com/society/2018/jun/16/billy-caldwells-mother-hopeful-of-cannabis-medicine-licence">seminal</a>, and mirrors wider sentiment in other countries. In the US, for example, medical cannabis programmes have been <a href="https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881">initiated in 30 states</a>. Hence, medical tourism to Canada – where cannabis is legal for medicinal purposes – and the US to gain access to CBD oil. </p>
<p>In the UK, however, Sajid Javid will not reclassify cannabis until the <a href="https://www.gov.uk/government/organisations/advisory-council-on-the-misuse-of-drugs">Advisory Council on the Misuse of Drugs</a> provides recommendations about the public health implications – which will include the abuse potential of cannabis-based CBD. Though it seems very likely that the home secretary will continue to move towards a patient focused resolution. </p>
<p>For patients like Billy then, what this means is that cannabis-based CBD oil could soon be prescribed in the UK under controlled conditions, by registered practitioners, and for medical benefit.</p><img src="https://counter.theconversation.com/content/99430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yewande Okuleye's PhD was funded by the Arts and Humanities Research Council and GW Pharmaceuticals 2014-2017. Yewande Okuleye is part of the Operation Black Vote Parliamentary Shadow Programme.
</span></em></p>Cannabis, medical marijuana and CBD oil explained.Yewande Okuleye, Assistant researcher, University of LeicesterLicensed as Creative Commons – attribution, no derivatives.