Ahead of cannabidiol (CBD) Awareness Day (8th August 2022), Dr Simon Erridge Head of Research & Access at Sapphire Medical Clinics gives the lowdown on the key differences between CBD oils and cannabis based medical products (CBMPs):
“It’s a complex area of health and so naturally there is confusion amongst consumers about the differences between high street CBD products and prescription-grade medical cannabis. CBD Awareness Week is a fantastic way to clarify any misunderstanding and help to guide people in the right direction of the most suitable therapy for them.”
- CBD or cannabidiol is a compound derived from the cannabis plant and is available in both “high street” CBD products, as well as part of medicinal cannabis treatments – which need to be started by a specialist consultant. The main compounds utilised in both CBMPs and CBD products are the cannabinoids CBD and tetrahydrocannabinol (THC) which have been investigated for their useful therapeutic properties.
- Oil-based CBD products are available without prescription as wellness products. Most commonly this is as CBD oils administered under the tongue or as gummies. However, topical preparations are also available, including CBD-enriched ointments, oils, moisturisers, and serums that are absorbed through the skin. Wellness CBD products must contain less than the regulated quantities of THC.
- Medical cannabis is a broad term used to refer to any medical products derived from, or related to, cannabis. In legal terminology and the medical field, they are often referred to as cannabis-based medicinal products (CBMPs). CBMPs were rescheduled, permitting their use on prescription in November 2018. CBMPs must comply to good manufacturing practice standards to ensure that the concentrations of CBD and THC are consistent, as well as being safe to use.
- A study performed by the Centre of Medicinal Cannabis of 29 widely available CBD products found that only 11 had CBD content within 10% of that advertised on the bottle. In addition, 16 products had measurable levels of controlled substances such as THC. However, since the initial publication of this study novel foods regulations have come into place to improve the standards to which these products are held. Whilst this is an important step to ensure the safety of consumption, it is not equivalent to the regulations which medical products must meet.
- CBMPs come in a number of formulations including whole cannabis flower – which is prescribed to be vaporised, as well as oils, capsules, and sprays containing cannabinoids.
- Cannabinoids are compounds that interact with the body’s endocannabinoid System (ECS). The ECS is made up of numerous transmitters, receptors, and enzymes. The most well studied receptors are cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). CB1 is predominantly found in the brain and is acted upon by the body’s own cannabinoids (endocannabinoids) to regulate emotions, motor coordination, and cognition. CB2 is found in immune cells and activation by endocannabinoids affects the immune system. In addition to their effects on the endocannabinoid system they have indirect and direct effects on receptors that are involved in pain pathways, mood and anxiety levels, inflammation, and movement.
- There are over 120 cannabinoids found in the cannabis plant, the most prevalent being THC and CBD. THC is similar to endocannabinoids, and has stimulating effects at the CB1 and CB2 receptors. This is the mechanism by which THC has been proposed as a novel therapeutic for anxiety and pain which has not responded to first line treatments.
- Medical cannabis can currently be considered for several indications and can be prescribed by a specialist clinician, supported by a multi-disciplinary team, for diagnosed conditions where first line therapies have failed. GPs and other healthcare professionals can only prescribe medical cannabis under a shared care agreement with a specialist doctor.
- Currently, Sativex, Nabilone, and Epidyolex are currently the only licensed medical cannabis products in the UK. However, other unlicensed products may also be prescribed in patients where first-line therapies have been unsuccessful. Research from the UK Medical Cannabis Registry has shown that patients have experienced associated improvements in anxiety, sleep and pain outcomes after starting care at Sapphire Medical Clinics.
- The number of conditions where medical cannabis may be prescribed if first-line treatments have not been sufficient to relieve symptoms is broad and includes chronic pain, mental health conditions, insomnia, and neurological conditions to name a few. Patients are able to find out if they may be eligible for medical cannabis by using Sapphire Medical Clinics’ free eligibility assessment: https://www.sapphireclinics.com/eligibility-assessment/