I believe that marijuana should be legalized, regulated, and taxed, just like alcohol and tobacco. If marijuana is going to be approved for use as medicine rather than for recreational use, however, the standards of evidence it must meet should be no different than any other drug, and for the vast majority of indications for which it’s touted medical cannabis doesn’t even come close to meeting that standard.David H. Gorski, MD, PhD, FACS, surgical oncologist at the Barbara Ann Karmanos Cancer Institute
There is zero credible and convincing evidence to suggest that CBD is effective for serious conditions, like treating cancer. There is also none that shows routine use while well can prevent disease. There are in fact studies that suggest frequent use of cannabis can lead to an increased risk of cancer, testicular in this instance.
Is it possible that the illegal marijuana trade has happened upon a short cut to legitimacy and legalization by pursuing the medical legalization of CBD and by association, the legalization of cannabis?
What’s all the fuss about?
Cannabidiol (CBD) oil is everywhere and seemingly in everything these days. It’s the new panacea for a sick society and will, if their hype is believed, cure a massive range of illnesses and conditions. It’s even recommended as a daily supplement to help smooth out our stress filled lives.
I’m not sure I agree with the supplement label, but I can vouch for the stress removal aspect. Who knew ‘comfortably numb’ would be the the 21st centuries answer to stress.
CBD is one of the many chemical compounds called cannabinoids that is isolated from cannabis (marijuana). Marijuana contains over 400 chemicals of which, at least 120 are cannabinoids, chemicals that stimulate cannabinoid receptors in the human body. We are actually the proud owners of cannabinoid receptors and our bodies produce their own cannabinoids.
The most well-studied cannabinoids that are isolated from cannabis are delta-9-tetrahydrocannabinol (THC) and CBD. Unlike THC, CBD is not psychoactive (a drug affecting the mind) and there are hundreds if not thousands of producers and products now on the market, sold everywhere from country markets to pet stores to pharmacies. Like most panaceas, the hype outpaces the evidence and the snake oil salesmen and quacks are out in full force.
What are the facts
Lets start with a few simple facts and work our way up from there. These facts are important and key to understanding how the marketing of CBD is manipulated, even to the point where marketing claims are at odds with each other.
Most Hemp/Cannabis oils contain little to almost no THC, Remember that is the ingredient that is psychoactive and messes with your head. This fact is proudly advertised by the manufacturers. The THC levels are mostly below the limit of detection for common assays and manufacturers brag that it’s impossible to fail a drug test if you’re consuming hemp seed oil because “THC levels in our products are barely measurable.”
So no argument there, unless of course the manufacturers would like to retract their statements. Why does this matter you ask? It does matter, because it’s the THC that shows some clinical potential to address tumors, more on this later.
As long as we are in agreement, that the ingredient looked to and referenced for all the research claims made by sites like Medical Jane, references an ingredient that is mostly not present in their product.
Quality Control ? Who needs it.
It has suited the CBD camp to pursue their legalization under the guise of a natural product, rather than that of a drug. The drug industry is heavily regulated and with good reason. One of the benefits of this regulation is strict quality control, something sadly lacking in the natural healthcare sector.
Whilst Canadians enjoy rigorous quality checks on the CBD oils they purchase, Americans are not protected in the same way and legalization and marketing controls vary from state to state, but are mostly non-existent. Depending on where you live, CBD oil might only be available on the black or “grey” market which means there’s little consumers can rely on with respect to product quality and consistency.
No one is checking and consumers are happily sipping away, placing their trust in the manufacturers.
Without being assured that you’re purchasing a high quality product, it’s impossible for consumers to base expectations on published evidence. If you can’t trust what’s on the label of your CBD oil, then any published evidence of benefit, even if it’s of the highest quality, becomes largely irrelevant.
Studies in countries like the Netherlands have shown wide variations between label claims and actual ingredients, and the stated CBD:THC ratio is often, if not invariably, incorrect.
The Drug Debate
Medical (prescription) products based on cannabis or that contain cannabinoids are available in many countries. Epidolex is an FDA-approved CBD extract that is approved for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome.
Marinol, a synthetic THC, is approved for nausea and vomiting associated with chemotherapy, and for the treatment of AIDS-related anorexia. Clearly, the development of these medications points to medically validated benefits of cannabinoids. Yes, these exist, no one is denying that.
The coexistence of CBD in both supplement form and prescription form raises the question of whether or not CBD oil should be treated as a drug or as a supplement. Often these products co-exist in both retail and regulated markets, re-branded and sold by their manufacturers into the different channels.
This classification system is important and can be simply explained as follows. Drugs are generally considered unsafe and unproven until evidence (clinical trials) show otherwise. Supplements and “natural products” are seen as having long histories of use and are considered safe until evidence emerges to show otherwise.
The marketing strategy of CBD manufacturers, having managed to latch onto existing medical claims and utilize these to essentially have an illegal substance re-branded as natural, is nothing short of genius. Few actually appreciate this blatant sleight of hand, pulled off in full view of the public and with the apparent consent of regulatory authorities.
The acceptance of medical marijuana in the public space appears to be far more driven by politics than it is by science, as was pointed out in a recent New York Times article about the impending legalization of medical cannabis in New York State:
New York moved last week to join 22 states in legalizing medical marijuana for patients with a diverse array of debilitating ailments, encompassing epilepsy and cancer, Crohn’s disease and Parkinson’s. Yet there is no rigorous scientific evidence that marijuana effectively treats the symptoms of many of the illnesses for which states have authorized its use.
Instead, experts say, lawmakers and the authors of public referendums have acted largely on the basis of animal studies and heart-wrenching anecdotes. The results have sometimes confounded doctors and researchers.
A lot of people stand to make a lot of money. A lot of people are also poised to pay with their lives for it.
CBD oil does have pharmacological and drug-like effects, there can be little doubt of this. The stronger the emerging claims become, the louder the calls for re-classification will become. Lets examine the validity of a few of these claims made by the CBD industry.
The Cancer Cure
The internet abounds with emotional and painful stories of people that have been cured of their cancer, all thanks to their use of CBD oils. The words ‘miracle’ and ‘life-saving’ permeate these stories. What does real science have to say about the efficacy of CBD on tumors? Note, we aren’t referring to anecdotal evidence and hearsay, but rather hard clinical data.
You cannot have this discussion without first acknowledging the glaring quality control issues surrounding CBD, the consistency and potency of THC, and the volumes present in these oils. Its important to point out here that I am not suggesting there are no potential benefits from THC in the fight against cancer, there may well be and these need to be investigated further.
Associating any of the medical claims attached to THC with CBD is where the danger lies. It is intentionally misleading marketing, designed to offer false hope to desperate individuals and it is unquestionably, morally and ethically reprehensible.
Herbs, when they work, are adulterated drugs. The active ingredient is usually a minor constituent, embedded in thousands of other constituents that make up herbs. It’s almost impossible to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition.
Producing a potent and consistent pharmaceutical compound is an expensive and complicated process, one of the reasons chemists seek to create synthetic variants that can be consistently reproduced. For any clinical trials to produce reliable results, the treatment needs to be consistent, obviously. For the results of these trials to be emulated in the public space, the same rule applies. Consistent quality.
Current manufacturing processes for CBD make this impossible with potency varying from crop to crop and by season. Without regulation, manufacturers take further advantage by ‘watering down’ the final product even further. No one checks.
Manipulating the Data
Medical Jane is at the forefront of promoting the medical benefits of cannabis online through the publication of medical research. In every single instance Medical Jane invokes medical research, the research or trials are not based on Hemp Oil and can thus be argues to bear no relevance whatsoever to CBD.
Each of the studies examines either purified cannabinoids or, in the case of this study, a chemically modified cannabinoid. This study cited in Molecular Cancer, for instance, looks Δ9-tetrahydrocannabinol, the most abundant and potent cannabinoid in marijuana, and JWH-133, a non-psychotropic CB2 receptor-selective agonist.
Both inhibit the growth of HER2(+) breast cancer cells in cell culture and in mice, but the concentrations needed are pretty high, with an IC50 (concentration that is 50% of maximum inhibition) in the range of 5 to 10 μM, concentrations achievable with injection of purified compound but certainly not by smoking pot.
You are also highly unlikely to achieve these levels by drinking hemp oil, As we’ve already established, and manufacturers have confirmed, there is little to sometimes no THC in CBD oils. How then can claims relating to this ingredient be offered as proof of the efficacy of CBD?
Invitro tests (performed outside of a living organism) and mice are also a long step away from proven human efficacy. Oral bioavailability of THC from such oils is notoriously low, between 4–20%, making it unlikely that concentrations well above the 10 μM necessary to inhibit or kill more than 50% of the cancer cells are achievable with oral dosing. Drinking litres of CBD is clearly not going to offer a workaround either..
None of the various studies cited, such as this one, which shows inhibition of the epidermal growth factor pathway by purified cannabidiol (CBD), a non-psychotropic cannabinoid or this one, the aforementioned study that examines purified Δ9-THC and JWH-133 against HER2(+) breast cancer, support the use of medical marijuana, either smoked as the plant or ingested as an oil, to treat breast cancer.
A recent review concludes that “current preclinical data does not yet provide robust evidence that systemically administered Δ9-THC will be useful for the curative treatment of cancer,” although CBD might have a role based on preclinical data.
Again, in the words of Dr Gorski;
Neither cannabinoid, however, is likely to be curative for advanced cancer. It’s possible that specific cannabinoids might have a role to play in the multimodality treatment of cancer, but, given what we know about them from preclinical studies, it’s highly unlikely that cannabinoids, medical marijuana, or hemp oil can cure stage IV cancer of any kind.
First, do no harm
This medical ethic, drilled into the head of every first year medical student, doesn’t apply to the cannabis industry. They’ve not sworn an oath designed to place your interests and your health before all else. They are purely driven by profits and will exploit whatever means necessary to maximize said profits, even at the expense of your life.
As more people join the pseudoscience cult of marijuana, ascribing their miraculous recoveries to cannabis, little attention is given to their existing conventional medications and treatments. Treatments that often bring these patients to the point where they are able to garner what little benefit the Cannabis oils and products may offer. Ascribing their recovery solely to Cannabis, is both misleading and dangerous.
Whilst we rejoice in the apparent cures of these individuals, we need to look beyond the hype. We need to study, in a controlled environment, the effects of Cannabinoids when used in conjunction with conventional medicines.
We already know enough to be able to say without doubt, that on their own, Cannabinoids cannot cure cancer. To assert these false claims and then use them to exploit a very vulnerable segment of the population purely for profit is grossly unethical and borders on criminal.
Whilst may form an important part of the multimodality treatment of cancers, it’s far to early to call the race. It is not whether these compounds exhibit any effects that is in question here, Science openly acknowledges that something is at play, it simply hasn’t had the time yet to work out what that is and until it does, the quacks and pseudo-scientists need to be reeled in.
They do a discredit to any potential benefits the plant may show, they impede the scientific processes required to ascertain these benefits and to they negate the efforts of legal, properly qualified medically trained doctors currently experimenting with cannabis in the fields of pain and nausea management in chemo patients and other fields of medicine.
Conning people out of cash is one thing, conning them out of their health and life and is an entirely different issue. As long as we continue to confuse correlation with causation, we will require legislation to protect these vulnerable individuals and it’s time the state wakes up to these dangers. It has an obligation to public safety. First do no harm.
On Drug Interactions
You wont be surprised at this point to learn that cannabis interacts and interferes with the pharmacological action of other drugs. If it walks like a duck and quacks like a duck…Which drugs are these and if it is a medically proven fact, why are warnings not adhered to CBD oils? Another questionable benefit cannabis enjoys, operating under the CAM banner of a ‘natural product’.
A total of 376 drugs are known to interact with cannabis. 354 are considered moderate, but 24 of these are listed as major or serious enough to warrant warning. These drugs are listed below and linked for additional information on each. Always inform your doctor or health care provider of any medications you are using, including natural and homeopathic products.
- levomethadyl acetate
- morphine liposomal
- sodium oxybate
In case you’re left with the feeling that I would like to see cannabis revert to its original criminalized status, nothing could be further from the truth. I have in the past, and still occasionally, engaged in the consumption of a stress busting joint or brownie. It is a mostly harmless pursuit and possibly far less toxic than cigarette smoke and alcohol.
Prosecuting and incarcerating cannabis users is insanity, a waste of policing resources and hugely damaging to the lives of those affected. I am firmly in the camp of legalization, treating cannabis as we do alcohol and tobacco. Neither of the two aforementioned, however, make spurious claims as to their medicinal and curative properties and herein lies the problem.
Lets take a step back and a time out, rather than allowing the cannabis industry to dictate it’s preferred area of unsanctioned medical testing, namely on you, it’s customers. The fact that it currently manipulates existing science and relies on half truths and the misinterpretation of data to sell itself, should be proof enough of the industries bonafide’s.
Its called baffling with bullshit, and when I last checked, misrepresenting your product to the public was a criminal offense. Especially when it involved the customers health and, potentially, their life. Add to that the manipulation of vulnerable individuals to provide you with testimony to corroborate your story, and you should be looking at life.