Wilson M. Compton, MD, MPE1; Emily B. Einstein, PhD1

JAMA Netw Open. 2020;3(10):e2021067. doi:10.1001/jamanetworkopen.2020.21067

Consumer products containing cannabidiol (CBD) have markedly increased in popularity.¹ Although many of these products are marketed in ways that may suggest potential effects on a variety of bodily functions, the precise health conditions that consumers believe they are treating with CBD products is uncertain. Is a consumer seeking a general wellness benefit, or are they attempting to treat a specific health condition? That is, is the consumer using CBD as a medication? If so, the US Food and Drug Administration (FDA) may have an important role to play in combatting unsupported claims of medical benefit. The article by Leas et al² addresses this issue, and their analysis of user testimonials on the largest social media forum devoted to discussing CBD provides support for the idea that consumers are using products containing CBD to treat conditions that have FDA-approved, effective therapeutics. Although this finding is not unexpected given the substantial increase in sales and marketing of CBD-containing products,¹ these data highlight a potential patient population that may be substituting CBD for evidence-based care.

Media portrayals of CBD as a health aid and a proliferation of products from cosmetics to candy that tout CBD as an ingredient contribute to the perception that CBD is a benign natural product.³ In addition, CBD is often cited as the component of cannabis that is nonpsychoactive likely because it does not contribute to the typical cannabis intoxication. Unlike Δ9-tetrahydrocannabinol (THC), CBD is a cannabinoid that does not make people high, and so this drug is not popular for recreational use. However, FDA approval of a CBD formulation to treat severe seizure disorders shows the capacity of CBD to alter brain activity. In addition, preclinical work shows that CBD has psychoactive properties based on its association with lessening the symptoms of such conditions as anxiety and addiction.^4,5 Furthermore, CBD may also interact with medications or diminish their efficacy owing to its effects on components of drug metabolism.⁶ For these reasons, it is important that consumers understand that CBD should be regarded as a psychoactive chemical with multiple biological effects and is not just an uncomplicated dietary supplement.

A challenge to using evidence in the CBD debate, as Leas and colleagues² suggest, is that the evidence base is still developing at a pace that is outstripped by the uptake of CBD. For instance, the study suggests that some persons with an addictive disorder are using CBD to treat their own condition. Such use of an unproven treatment could mean that effective treatments are not properly used; in some cases, this could result in serious harm.

For complete article

Also see Self-reported Cannabidiol (CBD) Use for Conditions With Proven Therapies

 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771735

Marijuana & Pregnancy (American College of Obstetricians & Gynaecologists)

“Medical marijuana is not safer than recreational marijuana.”

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Nature Medicine volume 26, pages1536–1540 (2020)

Abstract: Cannabis use in pregnancy has increased^1,2, and many women continue to use it throughout pregnancy³. With the legalization of recreational cannabis in many jurisdictions, there is concern about potentially adverse childhood outcomes related to prenatal exposure⁴. Using the provincial birth registry containing information on cannabis use during pregnancy, we perform a retrospective analysis of all live births in Ontario, Canada, between 1 April 2007 and 31 March 2012. We link pregnancy and birth data to provincial health administrative databases to ascertain child neurodevelopmental outcomes. We use matching techniques to control for confounding and Cox proportional hazards regression models to examine associations between prenatal cannabis use and child neurodevelopment. We find an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in the offspring. The incidence of autism spectrum disorder diagnosis was 4.00 per 1,000 person-years among children with exposure compared to 2.42 among unexposed children, and the fully adjusted hazard ratio was 1.51 (95% confidence interval: 1.17–1.96) in the matched cohort. The incidence of intellectual disability and learning disorders was higher among offspring of mothers who use cannabis in pregnancy, although less statistically robust. We emphasize a cautious interpretation of these findings given the likelihood of residual confounding.                                                          

 For complete research

Further…

Associations Between Prenatal Cannabis Exposure and Childhood Outcomes

Findings: This cross-sectional analysis of 11 489 children (655 exposed to cannabis prenatally) found that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology during middle childhood, even after accounting for potentially confounding variables.

Meaning: Prenatal cannabis exposure may increase risk for psychopathology; consistent with recent recommendations by the Surgeon General of the United States, these data suggest that cannabis use during pregnancy should be discouraged by clinicians and dispensaries.

Conclusions and Relevance: This study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2770964

Abstract

Liver safety concerns were raised in randomized controlled trials of cannabidiol (CBD) in patients with Lennox‐Gastaut and Dravet syndromes but the relevance of these concerns to healthy adults consuming CBD is unclear. The objective of this manuscript is to report on liver safety findings from healthy adults who received therapeutic daily doses of CBD for ~3.5 weeks and to investigate any correlation between transaminase elevations and baseline characteristics, pharmacogenetic, and pharmacokinetic data. Sixteen healthy adults were enrolled in a phase 1, open‐label, fixed single‐sequence drug‐drug interaction trial to investigate the effect of repeated dose administration of CBD (1500 mg/day) on cytochrome P450 (CYP) 1A2 activity. Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For 5 (31%) participants, the value exceeded 5× ULN, therefore meeting the international consensus criteria for drug‐induced liver injury. There was no correlation between transaminase elevations and baseline characteristics, CYP2C19 genotype, or CBD plasma concentrations. All ALT elevations above the ULN began within 2–4 weeks of initial exposure to CBD. Among the 6 participants with ALT elevations who were discontinued from the protocol, some had symptoms consistent with hepatitis or hypersensitivity.

We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug‐induced liver injury. Given the demonstrated inter‐individual variation in susceptibility, clinicians should be alert to this potential effect from CBD, which is increasingly available in various non‐prescription forms and doses to consumers.

For complete research

Missouri Medicine: Medical Fraud, Mislabelling, Contamination: All Common in CBD Products – Glaucoma Made Worse by Marijuana –  Other Critical Reviews of Unscientific Cannabis Claims

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