Health & Science
A powerful new form of medical marijuana, without the high
Medical marijuana plant propagated at a growing operation in Washington, DC. (Linda Davidson/The Washington Post)
By David Kohn December 31, 2016
Jackson Leyden had always been a healthy kid; he practiced taekwondo, and he played lacrosse and baseball. But in 2011, a few months after his eighth birthday, he began having seizures several times a day. Many were brief, a half-minute of staring into space, but he also had severe episodes in which he would collapse, sometimes injuring himself. Over the next two years, he was hospitalized about 50 times, and he missed much of fourth and fifth grade.
His parents took him to more than 20 doctors around the country, and he tried more than a dozen medications. Nothing worked. Two years ago, the Leydens were at the end of their rope. They decided to see whether marijuana might help. (Medical use of the drug is legal in the District, where they live, and the Leydens found a doctor willing to work with them.) In 2014, Jackson got his first dose of cannabis.
“Within a few days, he was having hardly any seizures,” says his mother, Lisa. “I was shocked.” Over the next few months, he stopped taking other medications.
Not only did the medicine help, it did so without making him high. The strain of marijuana that Jackson takes is unusual: It contains high levels of cannabidiol, or CBD, one of the two main molecules in marijuana; the other is tetrahydrocannabinol, or THC. While THC is famously mind-altering, CBD is not.
[Medical marijuana for kids: Often, no clear path, legally and practically]
Over decades, researchers have found that THC may help treat pain, nausea, loss of appetite and other problems, while CBD was thought to be biologically inactive in humans. But in the past 10 years, scientists have concluded that CBD may be quite useful. Dozens of studies have found evidence that the compound can treat epilepsy as well as a range of other illnesses, including anxiety, schizophrenia, heart disease and cancer.
Now 13, Jackson — whose diagnosis is undetermined — continues to use marijuana every day. (Like many patients, he ingests it in droplet form, which allows for more precise dosing and avoids lung problems.) He still has seizures, but they are less severe and they occur once every week or two, down from around 200 a month before he started using cannabis. He is back in school full time and is well enough to go on hikes and bike rides with his family.
Thousands of people around the country are using high-CBD marijuana.
“This is a really powerful compound,” says Mikhail Kogan, the medical director of the George Washington University Center for Integrative Medicine. “I’ve seen it work for a lot of my patients.” He prescribes high-CBD strains of cannabis regularly for such illnesses as epilepsy, post-traumatic stress disorder, anxiety, autoimmune disorders, autism and insomnia.
‘A game-changer’
In the cannabis plant, CBD and THC generally have an inverse relationship: The more THC there is, the less CBD, and vice versa. In recent years, growers have bred some plants to contain high levels of CBD. Some say the two compounds work synergistically and that for many ailments, combining CBD and THC is best.
What makes CBD especially appealing is that it doesn’t get the user high. Most recreational marijuana users want this effect, of course, but many patients would rather avoid it. This has allowed CBD to sidestep many of the political, legal and medical concerns that have hindered the spread of medical marijuana.
“CBD has been a game-changer for medical marijuana,” says Martin Lee, the director of Project CBD, a Northern California nonprofit that promotes use of the compound. “Its safety and lack of psychoactivity undermines any argument that it should be illegal. It’s really shifted the national discussion on this issue.”
What we can learn about legal marijuana from Washington, Colorado and Oregon. (Daron Taylor, Danielle Kunitz/The Washington Post)
As more scientists recognize the compound’s potential, there has been an “explosion of research,” according to Pal Pacher, a pharmacologist and cardiologist at the National Institutes of Health in Bethesda. He has been studying the chemical for more than a decade; his work has shown that CBD may have benefits in both heart disease and diabetes.
One key area of CBD research is epilepsy. Several scientists are focusing on its potential to reduce seizures, especially among those for whom other treatments have failed. “We’ve found significant positive effects with CBD,” says New York University neurologist Orrin Devinsky, who studies the compound for severe childhood epilepsy.
In a study whose findings have not yet been published, he and a colleague, Daniel Friedman, found that patients receiving CBD in addition to their usual medicines had 39 percent fewer convulsive seizures than patients who remained on their normal drug regimen. Given that the study included only the most treatment-resistant patients, this is an “excellent response,” Devinsky says.
Much more research is needed, he says, to establish whether CBD works, and if so for what conditions, but he understands that severely ill patients, or their parents, may not want to wait for this data: “If other drugs don’t work, it’s certainly reasonable to try this.”
The compound has also shown promise in treating anxiety, depression and schizophrenia. Much of this work has been in rats and mice, but several studies have found benefits for humans. For instance, German researchers showed in 2012 that giving CBD to schizophrenic patients reduced psychotic symptoms such as hallucinations and disordered thinking.
CBD seems to have anti-cancer properties, too. At the California Pacific Medical Center Research Institute in San Francisco, researchers Sean McAllister and Pierre Desprez have found that CBD can block cancer cells from metastasizing.
It’s not clear how CBD works. This is partly because it stimulates multiple biochemical pathways, which may account for its wide range of effects. The compound is a powerful anti-inflammatory and antioxidant, and it increases levels of the neurotransmitter serotonin as well as another molecule, anandamide, which reduces pain and anxiety.
Francisco Guimaraes, a pharmacologist at the University of Sao Paolo in Brazil, has found that it increases growth of new neurons in the brain, especially in the hippocampus, a region that plays a key role in depression and anxiety.
“[CBD] is a Disneyland for a pharmacologist,” he says. “There are so many possible mechanisms, so many possible ways it can be useful.”
But studying CBD is not easy: Scientists complain that laws and regulations put excessive constraints on their work. Although it doesn’t make users high, CBD (both the molecule and CBD-rich cannabis) is classified by the federal government as a Schedule 1 drug, which means they have high potential for abuse and no accepted medical use.
The list includes marijuana (undifferentiated by strain) and heroin. (While the federal government oversees marijuana research, marijuana use is regulated, in part, by state laws.) As a result, scientists who study the compound must follow a host of restrictive rules. Last year, responding to a request from several governors to change marijuana’s designation, the Drug Enforcement Administration announced that all cannabis would remain a Schedule 1 drug.
Still on Schedule 1
“It’s ludicrous and arbitrary,” according to Devinsky, who says getting government approval for his epilepsy trial required dozens of hours of extra work. Like most scientists who study the compound, he uses almost pure CBD. Although not at all psychoactive, it must be kept in a heavy safe with an alarm system.
Even as the research proceeds, thousands of people are using CBD as medicine. A British pharmaceutical company, GW Pharma, has developed two CBD drugs: Sativex, which contains a 1-to-1 ratio of CBD and THC, and Epidiolex, which is pure CBD. The former is prescribed for the painful muscle spasms that occur in multiple sclerosis, while the latter is aimed at childhood seizures. Sativex is not available in the United States, but it is approved in 29 other countries, including Canada, England and Israel.
Epidiolex has not been cleared for sale anywhere in the world; GW Pharma says it expects to begin the approval process with the Food and Drug Administration next year.
And thousands of Americans are using strains of cannabis with a strong CBD content. Advocates and medical marijuana dispensaries agree that as awareness about CBD grows, so does demand.
Stephanie Kahn, who with her husband, Jeffrey, runs the Takoma Wellness Center, a medical marijuana dispensary in Northwest Washington, says that about half of her 1,200 patients use CBD-rich products. Her dispensary offers several strains of high-CBD cannabis as well as CBD oil, with different ratios of CBD and THC, each of which she recommends for particular conditions. “We get questions about it every day,” she says. “A lot of our patients get relief with this, and a lot of times this works better than pharmaceutical drugs.”
No insurance
The cost of treatment varies: Depending on the dispensary and the dosage, it can range from around $100 a month to more than $1,000. Despite the cost, which is not covered by insurance, CBD medicines are drawing great interest for children with severe, intractable epilepsy. California and Colorado, which were among the first states to legalize medical marijuana, have become hot spots for such patients. Before other states legalized medicinal CBD use, some families moved to these states so they could have access to the compound.
One of the most experienced practitioners in this field is Los Angeles physician Bonni Goldstein, who has used the compound to treat dozens of children with intractable epilepsy. She says about half of these patients have seen a significant drop in the number of seizures. “Used in the right way, with the right patient, CBD is extremely powerful,” she says.
Yet even those who believe in this power recognize that CBD medicine remains largely unexplored: Treatments are not systematized, many products are not standardized or tested, and patients (or their parents) are generally left to figure out dosing on their own. While some suppliers and dispensaries test the CBD and THC levels of their products, many do not. “We really need more research, and more evidence,” Kogan says. “This has to be done scientifically.”
For Lisa Leyden, Jackson’s mother, these issues don’t negate the compound’s enormous potential. “I realize this isn’t perfect,” she says. “We absolutely need to know more. But in the meantime, many people need help. They’re in bad shape, and this seems to work.”
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Christine E Prefontaine
1/4/2017 11:40 PM EST [Edited]
Mr Kohn: I'm curious why you don't mention CBD formulations derived from hemp, which are completely legal and contain only trace amounts of THC. Check the NIH website, you'll find several articles exploring uses. Most, however, with a very small sample size.
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jkw
1/4/2017 4:19 PM EST
at some point the premises under which the DEA characterizes marijuana as à Schedule I dangerous drug will become obviously so outrageosly arbitrary and capricious that eben the most hardened, obsessive prohibitionists among Congress, particularly those who understand why RFRA was enaacted by Congress in 1993, and who don'twant its use as a protector of religious beliefs and practiced. undermined by the inconsistency of permitting a Schedule I dangerous drug, Peyote, for religious use somehow ,mitigating its dangerousness as a premised reason fo being a Schedule I dangerous drug being to be challenged by a similar religious use of marijuana by Rastafrians. And by the same token that will expose to public and judicial scrutiny that the plants on the Schedule I list are all used by indigenous, and many minority, peoples as part of their culture and religion
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Mitchell Girt
1/4/2017 6:16 AM EST
Uneducated, let's call it that. Rarely would I share a story similar to this one but this caught my eye. Okay, I will take it a step further, ignorant, I was ignorant! Now its okay if I call myself that, but if you think you are going to get away with it you've got another thing coming. The plant is aesthetically beautiful, at the same time offensive to those sworn to “protect” us from it. It’s a plant for goodness sake, of course it’s beautiful!
This type of plant has been part of my life, on and off for 45 years and at no time did I ever believe that it was medicinally useful. Furthermore the Cheech and Chong mentality did nothing for it’s proliferation in the medical community. If this plant can bring calm and good health to those in need of the weed, it is time to get on board with medicinal part of this plant. So, if you like getting high this might not be good news you high-ons. At some point if this plant proves to be a medicinal wonder and the THC and CBD components become reclassified as a pharmaceutical drug, I can see the Cheech and Chongs out there having to resort back to getting their sack from the local Snoop Dogg type who in turn get’s his supply from some underhanded drug dealer in Columbia. Nothing beats the romantic notions of going back to the dark alley to score a quarter OZ.
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Mitchell Girt
1/4/2017 6:10 AM EST [Edited]
As Americans we exist with our heads in our butts most of the time, getting our news from a media machine insistent on gaining your attention with half truths and loads of advertising. The war on drugs, especially marijuana is a farce but for a century we were fed by the media that pot will certainly LEAD to heroin. When in reality we were constantly being LED by the media. I can honestly say that my driveway LEADS to Bangkok Thailand but I am fairly certain I will not be going to Bangkok Thailand, maybe Bangkok… heh heh!
So if pot is the new wonder drug we so desperately need, lets get moving on it and try to help people in need, real need. Many of you have a green card because you stubbed your toe or you have a pain in the neck. When in reality you were one of those kids in the car in the high school parking lot who didn’t think the rest of the school could smell that cheap Mexican smoke on you when you came in from “lunch”.
Imagine the irony; FDA approves marijuana as a pharmaceutical drug and your green card becomes null and void. I know a few people who suffer chronic stubbed toe syndrome who will realize they should have stockpiled a ton of the good stuff before they get their cards taken away because they fought so hard for pot to be a “medical” drug.
This is a weird world where air is free and water is cheap and you can literally go to jail for smoking a weed. Don’t tell anyone but I dried out a bunch of Dandelion flowers and smoked it, now I no longer need Viagra AND my hair is growing back… on my palms!
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psumom
1/4/2017 3:09 AM EST
My daughter has daily seizures- it's not epilepsy so remains undiagnosed. We tried the CBD oil a couple years ago; it seemed to help a little, but really didn't seem to do much. Maybe she needed a stronger dose? It's legal now , here in Oregon, but still crazy-expensive! If it did help her, it'd cost more than we could afford. Such a big business, like the big drug companies.
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snidely whiplash
1/4/2017 12:21 AM EST
I am hoping it (CBD) help w. my Essential Tremor. About 10% of people over 65 have ET. I am in my late 70's - and it's getting worse. Even in Ca. CBD is hard to find w.o. paying big $$,
CBD has been discussed as a possible benefit for those w. tremor - but no tests I know of have taken place,
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TwoShadesOfBlue
1/3/2017 11:10 AM EST [Edited]
Three years ago, my wife suffered traumatic brain injury from a sinus infection that went into the brain. After emergency life-saving surgery, she was left prone to major and frightening seizures. After eventually settling on an anti-seizure medication that worked reasonably well, we found the results significantly improved by adding a set number of drops of standardized CBD oil in a gelatin cap three times per day to her regimen.
One problem with anti-seizure medications is that at the levels required to have the desired effect, they can sometimes turn you into a zombie by substantially dialing down the electrical activity in the brain. They can also have other undesirable psychoactive effects. But CBD oil allowed her to keep her prescription med dosage down to a very modest and side-effect free level. We're sold on standardized CBD oil.
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Charlton Heston
1/3/2017 9:27 AM EST
SFB Reagan told us that marijuana is the most dangerous drug available. That guy just wasn't too bright, was he?
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Rock Cowles
1/2/2017 7:13 PM EST
Still spreading disinformation: (Like many patients, he ingests it in droplet form, which allows for more precise dosing and avoids lung problems.) Chronic cannabis users have less lung cancer than nonsmokers. Many use Cannabis to treat asthma. What lung problems?
This is not a new plant and Cannabis is one of the oldest forms of medicine. Advocates for Medical Cannabis aren't just looking to get high, but there is nothing wrong with responsible recreational cannabis use by adults either.
www.RepealCannabisProhibition.com
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Michael Keller
1/3/2017 11:32 AM EST
Well, some folks just aren't very good smokers. "Lung problems" can include simple irritation and coughing. I suspect that smoking pot wouldn't be good for asthma sufferers, either.
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Opinionated and right
1/2/2017 11:28 AM EST
CBD threatens the pharmaceutical industry, hence, the ban. Billions are spent by lobbyists to prevent any natural method of treatment that would bite into their profits. My neurologist prescribed a drug to prevent seizures. There were 19 possible counterindications, including death. CBD has none AND it works with no side effects. Not only are my seizures gone, my anxiety and depression are minimized. Pharmaceuticals are dangerous and had little to no effect on depression and anxiety. Big pharma is killing people and ruining quality of life by making CBD illegal. There is no justification for preventing its sale and research.
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BernieGoetz
1/2/2017 7:33 PM EST
Also try vitamin D3 (5000 IU daily) for depression only because its cheap and easy. If marijuana was decriminalized medical marijuana wouldn't even be an issue.
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BernieGoetz
1/2/2017 11:06 AM EST
Pot smoking and masturbation are destroying America.
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kchitti
1/2/2017 1:55 PM EST
sounds like you could sorely use a bit of both
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BernieGoetz
1/2/2017 7:25 PM EST
Either one will make you crazy. They are the main 2 reasons there is so much mental illness in america. Legal prescription drugs help greatly, but they do not get at the root cause of americas problems.
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Rock Cowles
1/2/2017 7:14 PM EST
You must be doing it wrong.
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LisaMaire
1/2/2017 10:01 AM EST
Oh heaven forbid you get the high.
This is probably about as useful as marinol was. this simply allows the drug companies to manufacture it to make large amounts of money
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bumanchew
1/3/2017 9:44 AM EST
Well, it may surprise you but not everyone wants to get high, and not everyone responds to marijuana in the same way. No matter the 'strain', no matter the time (i.e., mid-1960s, when available stuff was notoriously weak compared to today, or today's) all it did for me was put me to sleep. Not much 'fun' there, is there? Since this is given to very young children (seizure disorders) who can't really tell anyone what they are 'feeling', why should it matter if there is no 'high'? And since the active compound itself has no euphoria-producing qualities, why do you criticize its use? Some people just need to be angry...
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Michael Keller
1/3/2017 11:36 AM EST
Some folks may not function very well if they're high, which might make them unable to work. The idea of CBD is to allow patients to get medical help and be able to function in society. Also, note that the high-CBD pot is still pot, just a particular strain (or strains), so it's not like the pharma companies are cornering the market. And the point of the drops is to make dosage accurate. It is, after all, being treated as medicine. Be happy they're doing the research, instead of complaining.
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Paz LeBon
1/2/2017 8:17 AM EST
All very great, altho lets not pretend or hint that THC is any less wonderful and medicinal. I dont take thc to get 'high' I take it to get well. same as you take cbd to get well, not to get 'low' Wink
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taverngeek
1/1/2017 3:54 PM EST
MJ may the item that redefines state vs federal powers. Colorado's MJ laws are intended to create an intrastate market that is separate from interstate MJ smuggling. If Sessions goes after state MJ legalization then it will be the most important court decisions ever where conservatives may side with legalization as that would be a reduction in federal powers. Judge Thomas dissented in Raich v Gonzales in which personal medical MJ growing was upheld as illegal since the majority said it wasn't distinguishable from illegal interstate MJ smuggling.
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Jumper
1/1/2017 4:01 PM EST
Interstate transport for sale is going to be illegal for a while. In-state models will be similar to microbreweries with grassroot resistance to attempts at state-declared monopolies.
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Jumper
1/1/2017 3:42 PM EST
At least low-THC, high-CBD pot is more useful than the "mild jalapeno," which is just insulting.
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