What is CBD – The story behind cannabidiol, the cannabis product that gets you well, not high.

You’ve heard of CBD, the cannabis product whose popularity has reached almost craze-like proportions. CBD has come from obscurity to ubiquitousness in just the last few years. It is perhaps best known for its ability to reduce anxiety and promote happiness, but CBD’s applications are seemingly endless; it has been successfully used to fight pain, insomnia, depression, schizophrenia, eating disorders, Parkinson’s disease, and even cancer. Indicative of its wide range of uses, CBD-infused products are the fastest-growing segment of the beauty industry and likewise an emerging part of the pet care industry (CBD chewable, for example, are used to calm dogs). CVS, Rite-Aid, and Walgreens drug stores now carry CBD products. Carl’s Jr., the fast-food chain, has created a burger served with a CBD infused sauce. In New York City, CBD-infused coffee is all the rage. Medical celebrities Dr. Oz and Dr. Sanjay Gupta advocate CBD use, as well as non-medical celebrities such as Whoopi Goldberg, Morgan Freeman, and Gwyneth Paltrow. Studies show that in states where CBD has been legal, opioid use and opioid-related deaths have declined. Several former professional athletes are arguing on behalf of CBD use in sports medicine, where its anti-inflammatory power would allow players to recover more quickly and not risk opioid addiction. The FDA even joined the bandwagon last year, approving a CBD treatment for childhood epilepsy, Epidiolex, despite the fact that cannabis remains illegal in the eyes of the federal government.

CBD use, in other words, is growing by leaps and bounds, with a projected $22 billion market by 2022. But what exactly is CBD?

CBD is Cannabidiol, which is derived from the flower of cannabis, the only plant genus that contains a unique class of molecular compounds called phytocannabinoids. More than 80 phytocannabinoids have been identified, but the two most prevalent are tetrahydrocannabinol, or THC, and cannabidiol, or CBD. THC is the psychoactive ingredient of cannabis; CBD is an anti-psychoactive ingredient.

Cannabis has two subspecies—marijuana, which is rich in THC and has thus been cultivated for the “high” associated with its recreational use—and hemp, which is low in THC historically was cultivated for the industrial uses of its tough fibers. Last December, in part, because of a growing body of scientific evidence showing CBD’s therapeutic attributes, the federal government legalized hemp. Although 33 states have legalized medical marijuana (including ten states with legal recreational use), at the federal level marijuana remains prohibited.

Both hemp and marijuana contain CBD. The full legalization of the hemp is part of the reason some observers believe the CBD market will have a societal impact as momentous as the tech revolution two decades ago. But to really understand what CBD is and why it has only so recently burst into such almost revolutionary prominence, it helps to know a little bit of both the history of cannabis and the biology of its use.

Cannabis is believed to have been used medicinally, recreationally, and for spiritual rites throughout much of humankind’s history. It has been used, in some form, by societies throughout the world. The oldest known written record regarding its use comes from 4,750 years ago in China. Ancient Greeks used it to dress wounds on horses and to apply to human nosebleeds. It was medicinally popular among Vikings and medieval Germans for relieving pain during childbirth and for toothaches, while Queen Elizabeth used cannabis to relieve her menstrual cramps.

But only in recent decades have we come to understand how and why cannabis affects humans. The plant was largely excluded from the scientific study due to its widespread illegality until the 1960s when an Israeli chemist named Raphael Mechoulam was able to obtain confiscated hashish from the police and study it. He elucidated the structure of THC and CBD, and then in 1992 made an even more fundamental discovery —  the existence of the Endocannabinoid System (ECS) in the human body. The ECS is the body’s largest system of receptors and is found throughout the brain, nervous system, and organs. It has been described as “the molecular bridge between body and mind.” Scientists have come to believe the ECS is among the most important physiological systems involved in human health because it both regulates mood and maintains homeostasis, keeping internal systems balanced in the face of external stress and inflammation.

 “By using a plant that has been around for thousands of years, we discovered a new physiological system of immense importance,” Mechoulam later said. “We wouldn’t have been able to get there if we had not looked at the plant.”

The implications of this discovery, including the burgeoning applications of CBD, are only beginning to take shape. In discovering the ESC, Mechoulam uncovered naturally occurring neurotransmitters, called endocannabinoids, that are structurally nearly identical to the phytocannabinoids found in cannabis. THC mimics these endocannabinoids and binds to the two main kinds of receptors in the body, CB1, and CB2. CBD doesn’t directly bind to CB1 or CB2 receptors but instead serves as a “reuptake and breakdown inhibitor,” preventing the breakdown of naturally occurring endocannabinoids in the body.

CBD’s health impacts thus span the Endocannabinoid System. In particular, researchers have found CBD increases the levels of anandamide, the endocannabinoid known as the “bliss molecule,” derived from the Sanskrit word “ananda,” which means extreme happiness, or “one of the highest states of being.” CBD has been shown to generally serve as a boon for brain health, serving as both a neuroprotectant and enhancing neuroplasticity. It has been shown to be effective, applied topically, in reducing inflammation and overall bodily pain. Some early studies regarding CBD’s use in treating cancer, particularly in fighting tumor growth, are promising if not yet definitive, but it has already earned a place in overall cancer treatment for its ability to reduce nausea and helpfulness in managing pain.

Significantly, CBD’s benefits appear to come with no costs, in terms of deleterious side effects or danger of addiction. “In humans, CBD exhibits no effects indicative of any abuse or dependence potential,” reports the World Health Organization. “…To date, there is no evidence of public health-related problems associated with the use of pure CBD.”

Because this is all relatively new science, and its societal and legal acceptance is likewise so recent, studies of CBD’s efficacy in a number of treatments are still preliminary and its actual marketing is often suspect. Many products are being released without the benefit of much regulatory oversight, and the CBD levels and overall quality of many such products are not as advertised. But none of this negates the reality that an ancient remedy has been refined and has quickly become one of the great balms of our times.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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