Elsevier

Pharmacological Research

Volume 121, July 2017, Pages 213-218
Pharmacological Research

Review
Cannabidiol in medical marijuana: Research vistas and potential opportunities

https://doi.org/10.1016/j.phrs.2017.05.005Get rights and content

Abstract

The high and increasing prevalence of medical marijuana consumption in the general population invites the need for quality evidence regarding its safety and efficacy. Herein, we synthesize extant literature pertaining to the phytocannabinoid cannabidiol (CBD) and its brain effects. The principle phytocannabinoid Δ9-tetrahydrocannabinol (Δ9-THC) and CBD are the major pharmacologically active cannabinoids. The effect of CBD on brain systems as well as on phenomenological measures (e.g. cognitive function) are distinct and in many cases opposite to that of Δ9-THC. Cannabidiol is without euphoriant properties, and exerts antipsychotic, anxiolytic, anti-seizure, as well as anti-inflammatory properties. It is essential to parcellate phytocannabinoids into their constituent moieties as the most abundant cannabinoid have differential effects on physiologic systems in psychopathology measures. Disparate findings and reports related to effects of cannabis consumption reflect differential relative concentration of Δ9-THC and CBD. Existing literature, notwithstanding its deficiencies, provides empirical support for the hypothesis that CBD may exert beneficial effects on brain effector systems/substrates subserving domain-based phenomenology. Interventional studies with purified CBD are warranted with a call to target-engagement proof-of-principle studies using the research domain criteria (RDoC) framework.

Introduction

It is estimated that approximately 180 million people between the ages of 18–65 have self-administered marijuana at least once in their lifetime globally [1]. According to the Global Burden of Disease Study, it was estimated that approximately 13 million people worldwide are dependent on cannabis [2]. It has also been reported that the rates of cannabis consumption in the general population is increasing, particularly amongst younger populations (i.e. high school students) [3]. The anticipated legalization of marijuana in various countries and jurisdictions (e.g. USA, Canada) in 2017, with the accompanied commercial interest in the sale of cannabinoid-containing products (i.e. medical marijuana), is predicted to further increase cannabis utilization, inviting the need for rigorous safety and efficacy data.

The overarching aim of this article is to provide healthcare providers and other stakeholders with pragmatic data-driven decision support regarding the pharmacology and putative clinical applications of CBD. We have specifically chosen three of the most common mental health complaints wherein patients seek out advice related to the use of medical marijuana as a treatment (i.e., anxiety, depression, and sleep) [4]. We delimit our focus to CBD, an active moiety in medical marijuana; recent systematic reviews and meta-analyses provide replicable and convergent evidence of the hazardous effects of Δ9-THC [5], [6].

Section snippets

Methods

This is a narrative, non-systematic review of pre-clinical and clinical studies. An electronic literature search was conducted using the following databases: PubMed, PsychInfo, and Scopus from inception to November 2016. The search term cannabidiol was cross-referenced with the terms anxiety, depression, sleep, cannabis, and medical marijuana. We delimited our search to articles written in English that were published within the past ten years. Pharmacological, molecular, and physiologic studies

Conclusion

Despite rapid changes in the social, political, cultural and legal landscape, as well as the significant increase in cannabis utilization, there is insufficient decision support provided by available evidence regarding CBD. Taken together, Δ9-THC elicits adverse psychological and physiological effects amongst users, while CBD has unique pharmacologic, physiologic, and behavioural effects with suggestions of salutary effects on brain substrates subserving anxiety, mood and sleep complaints.

At

Key points

  • 1)

    High cannabis consumption in the Canadian general population and increasing.

  • 2)

    Federal decriminalization expected to further increase consumption.

  • 3)

    Preponderance of data indicates that Δ9-THC is deleterious to brain function and behaviour.

  • 4)

    Extant data regarding cannabidiol (CBD) indicates that CBD may exert salutary effects on brain mechanisms implicated as abnormal in some psychopathological states.

Potential neurotherapeutic effects of cannabidiol:

  • antipsychotic

  • antidepressive

  • antianxiety/anxiolytic

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