Not a Freudian Slip: CBD and Mental Health - Therapeutic Magic or Myth? Part 1

Contributor: Connie Mester, MPH
To learn more about Connie, click here.

 

After several weeks of feeling overwhelmed and stressed about an upcoming move and job change, I could feel those life changes taking a toll on my mood and sleep.  What’s worse, the stress was triggering my skin issues to intensify, making me even more uncomfortable.  I was ready to try (almost) anything for relief.  A friend gave me a few CBD gummies and recommended that I eat one just before bed.  Over the next several nights I slept like a baby, I seemed to be able to work through challenges without overreacting, and my inflamed skin began to improve.  Armed with my anecdotal evidence, I wanted to uncover the facts about how these gummies could help alleviate the symptoms I was feeling as I moved through some tough life transitions.

Is it possible for a single plant-derived compound to have such broad clinical impact and alleviate symptoms of so many conditions?  Could a daily dose of CBD oil (cannabidiol) improve a person’s depression, anxiety, and stress symptoms and help reverse the negative trend of increasing mental illness? This article series will touch on the history and legal journey of cannabis, highlight market growth, explore the evidence surrounding the potential health impacts, and propose a way to adequately harness its therapeutic value to support mental health improvement.

For starters, understanding the term cannabis and the difference between hemp, marijuana, THC, and CBD is necessary.  Cannabis is a plant that has different varieties and produces over 400 different chemicals.1  Hemp and marijuana are cannabis plant varieties which have different chemical compounds with similar structures that produce varying levels of cannabidiol (CBD) and tetrahydrocannabinol (THC) chemicals.  These chemicals affect receptors throughout the body in different ways. Hemp and marijuana plants are farmed and cultivated in different ways and harvested for different purposes. However, they look quite similar, making it hard to distinguish between the two.2

Hemp is the non-intoxicating cannabis variety that contains 0.3% or less THC and is harvested for industrial (rope, clothing, paper, housing material), food (cooking oil, hemp flour, etc.), and medicinal products.  The cannabis variety, marijuana, contains more THC which binds to different receptors in the body producing the euphoric effects that make users feel high.  Due to the difference between their THC levels, hemp and marijuana have different legal regulations. Marijuana-derived CBD is federally illegal regardless of its percentage of THC.  However, CBD derived from hemp containing 0.3% THC or less is not regulated as a controlled substance.

Hype
Even with confusion around the plant varieties and their legal restrictions, the CBD market has grown rapidly over the last several years and is projected to rise even faster, with sales expected to exceed $20 billion in the U.S. by 2024, according to BDS Analytics.3  CBD is increasingly integrated into mainstream society and infused into a diverse array of beverages, foods and snacks, cosmetics, health products, and even pet products.  Retailers like grocery stores (Kroger), major pharmacy chains (CVS, Walgreens, and Rite Aide), gas station convenience stores, and nutrition stores are banking on its continued growth. Increasing public interest triggered the launch of National CBD Day (8/8) as an opportunity to raise awareness of CBD. However, many remain skeptical of its benefits and are unsure about how to obtain safe and legal products.

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History
Understanding why CBD shifted from medicinally appropriate to illegal may help remove the misguided stigma. Cannabis has been used for hundreds of years and has a long history of providing relief around the world.  However, in 1930 Harry Aslinger, in an effort to secure his position with the Federal Narcotics Bureau, leveraged his influential network of politicians and Washington leaders to begin his quest to criminalize cannabis use.  Motivated by racial hate and eagerness to enforce political power over non-whites, Aslinger fabricated a drug threat, using a calculated campaign to generate fear by labeling cannabis as a toxic substance that made people crazy and violent.4

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image005.jpgUnder Aslinger’s influence and ignoring physician endorsement, the medical use of cannabis was removed from the U.S. Pharmacopoeia and National Formulary in 1941 and classified by the Drug Enforcement Administration (DEA) in 1970 as a schedule 1 controlled substance (alongside heroin, LSD, and ecstasy). This new classification not only eliminated cannabis as a therapeutic option for physicians to prescribe, but also discontinued funding for medical research and regulatory provisions on product quality and standardization.5  Those actions resulted in little focus on scientific research to further validate the positive effects and pushing cannabis to the underground market. 

Health Impact
As I witnessed first-hand how my body and mind responded to the CBD supplement, I became more interested in learning how the natural healing properties of CBD can be beneficial to so many illnesses. I was surprised to uncover all of the scientific literature on the positive impacts of CBD, especially related to mental health conditions. Cannabis has been used to reduce anxiety for centuries, is linked to a reduction in depression, and many experience significant improvements in PTSD symptoms.6-11 The condition chart lists mental/cognitive conditions that have positive evidence of the impact CBD can have, albeit limited research has been conducted on this controversial topic. This chart is not comprehensive by any means, and there’s further research to suggest CBD has possible additional applications and benefits that remain undiscovered.12 

To date, funding for research has been limited because of the controversial drug classification. In September 2019, the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH), awarded $3 million in research funds to investigate cannabis and its role in pain management, as the urgent need for opioid alternatives that are less addictive, more effective, and safer is great.  With continued funding we can begin to properly educate clinicians and inform consumers on ways to adequately harness the therapeutic value of CBD to support physical and mental health improvement.   

Using scientific rigor to replace misguided stigma with validated evidence, true medical value and undiscovered uses can be identified and leveraged to strengthen safety and quality control, as adequate provisions and quality standards are absent in the unregulated CBD industry.  Further, with so many product variations and options, selecting the safest, most appropriate product can be challenging. Providing insight into what to look for when purchasing CBD products will aid in responsible use.  

In the next article in the series, we will dive deeper to look at the potential adverse effects and risks and discuss how to identify reputable sources when purchasing CBD products. 

 

Contact Connie at:
connie.mester@gmail.com

 

References

  1. Atakan Z. (2012). Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic Advances in Psychopharmacology, 2(6), 241–254.  doi:10.1177/2045125312457586  
  2. Economic Research Service (2000). Identification: Industrial Hemp or Marijuana? USDA Industrial Hemp in the United States. p2 https://www.ers.usda.gov/webdocs/publications/41740/15852_ages001eb_1_.pdf?v=0
  3. BDS Analytics. (2019). U.S. CBD Market Anticipated to Reach $20 Billion in Sales by 2024. Retrieved on July 20, 2019 from https://bdsanalytics.com/u-s-cbd-market-anticipated-to-reach-20-billion-in-sales-by-2024/
  4. Adams C. (2016). The man behind the marijuana ban for all the wrong reasons. CBS News. Retrieved on July 25, 2019 from https://www.cbsnews.com/news/harry-anslinger-the-man-behind-the-marijuana-ban/
  5. Earleywin M. (2002).  Understanding Marijuana: A New Look at the Scientific Evidence New York: Oxford University Press. P15.
  6. Any Mental Illness (AMI) Among Adults. (2017).  National Institute of Mental Health.  Retrieved on July 28, 2019 from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154785
  7. Blessing EM, Steenkamp MM, Manzanares J and Marmar CR. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. doi: 10.1007/s13311-015-0387-1  
  8. Papagianni EP and Stevenson CW. (2019). Cannabinoid Regulation of Fear and Anxiety: An Update. Current Psychiatry Reports, 21(6), 38. doi: 10.1007/s11920-019- 1026-z  
  9. Shannon S, Lewis N, Lee H and Hughes S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18–041. doi: 10.7812/TPP/18-041
  10. Bitencourt RM and Takahashi RN. (2018). Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Frontiers in Neuroscience, 12, 502. doi: 10.3389/fnins.2018.00502
  11.  Zuardi AW, Crippa JA, Hallak JE, Pinto JP, Chagas MH, Rodrigues GG, Dursun SM, and Tumas V (2009).  Cannabidiol for the treatment of psychosis in Parkinson’s disease.  J Psychopharmacol. 23(8):979-83.  doi: 10.1177/0269881108096519  
  12. Graves DE. (2018). Cannabis shenanigans: advocating for the restoration of an effective treatment of pain following spinal cord injury. Spinal Cord Series and Cases, 4, 67. doi:10.1038/s41394-018-0096-1