CANNABIS... HYPE OR HOPE?

Can products containing CBD help us?

The CBD market in the UK is already worth £300m

As the amount of CBD oils and Cbd-infused foods, drinks and cosmetics continues to multiply, you might be tempted to see if one could be helpful for problems such as insomnia and anxiety. Or hearing about relatives or friends who have used CBD to reduce or come off painkillers, for example, might inspire you to do the same.

But the boom in this market leaves a number of unanswered questions. Not least, how did cannabis make the leap from illegal dope smoking to CBD oils (and more) now being on sale in health stores, pharmacies and even pop-up shops? You may also be confused about whether CBD oil is the same as medical cannabis or cannabis-based medical products (CBMP). And, even more importantly, wondering what’s legal, what’s safe and whether it works or not?

Cannabis contains cannabinoids. With more than 100 discovered, leading to cannabis being described as a potential treasure chest of new medicines, the two most investigated are tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC gives the ‘high’ and products containing it, including oils, foods or cosmetics, are illegal in the UK. CBD, however, isn’t illegal, and won’t make you feel intoxicated.

IS CBD OIL A MEDICINE?

Definitely not. The CBD oil you can buy over the counter is classed as a novel food supplement, so no health claims can be made and CBD food-related products need to be approved by the European Commission. None have been so far, says the Food Standard Agency (FSA), as the process takes two years. In the meantime, the FSA is considering the best way to ensure products ‘move towards complying with safety regulations’.

This means CBD products sold over the counter are unregulated, and may contain little or even no CBD. One product costing £90 in a high-street pharmacy didn’t contain any CBD at all, according to the Centre For Medicinal Cannabis, an industry body that tested 30 products. A few items also contained tiny traces of THC, making them technically illegal.

On the question of whether it works, so far doctors say the jury is still out. But, together with all sectors of the CBD industry, they want to see proper regulation so that consumers can be confident in what they’re buying. Shomi Malik, development director of the Centre For Medicinal Cannabis, and a second trade body, the Association for the Cannabinoid Industry (ACI), says the industry hopes to establish a kitemark for retail CBD products later this year.

HOW DOES CBD WORK?

The number of cannabis entrepreneurs is increasing rapidly, and the UK CBD

market, already worth an estimated £300m, is predicted to grow to almost £1bn by 2025. So, how can CBD affect so many different aspects of our health?

The answer is the body’s endocannabinoid system (ECS), says Professor Mike Barnes, consultant neurologist, rehabilitation physician and chair of the Medical Cannabis Clinicians Society. Discovered in the 1960s by scientists researching cannabis, it is a collection of cell receptors and corresponding molecules. ‘Think of cell receptors like locks on the surface of cells, which can be unlocked by corresponding chemical molecules,’ he says. Science never been your thing? You just need to know that the keys are chemical messengers called endocannabinoids, and we produce these naturally to tell the body to start and stop various processes, such as digesting food, fighting infection, dealing with pain or even sleeping.

‘Receptors are found throughout the body, but especially in the brain, central nervous system, immune system, gut and peripheral nervous system,’ explains Professor Barnes. ‘Which is why, if the endocannabinoid system is not working well, it can contribute to a wide variety of conditions, including fibromyalgia and irritable bowel syndrome.’

Like other experts, Professor Barnes wants to see the market regulated, but says over-the-counter CBD products can help with pain relief, sleep problems and anxiety. ‘You need 60-100mg a day to treat pain, although about 10% of the population respond to quite low doses because they metabolise it slowly,’ he says. ‘My wife Catherine used CBD to come off opioids that she’d taken for fibromyalgia and arthritic pain, although she now supplements that with a private prescription for medical cannabis.’

AN ALTERNATIVE TO OPIOIDS?

The lack of medical evidence surrounding CBD makes other clinicians cautious. Dr Michael Platt is a consultant pain specialist at Imperial College NHS Trust and is also medical director of Sapphire Medical Clinic, a private London clinic prescribing medical cannabis.

‘Cannabis oil from health food shops is very safe and may help calm anxiety and ease pain,’ he says. ‘The problem is that the products are not produced under good manufacturing practice conditions, so there is no quality control. Furthermore, therapeutic doses used in medicine are often far greater than those supplied in wellness products. For medical conditions, it is much better for people to consult a qualified medical practitioner to fully evaluate their condition alongside any other health issues and medications.’

In terms of prescription medical cannabis, several types of pain seem to be affected successfully, says Dr Platt, including chronic muscle spasm and inflammatory conditions, as well as in other systems, including the digestive system, particularly inflammatory bowel disease. He adds, ‘Cannabis medications are much safer than opioids as the body does not become physically dependent on cannabis.’

CAN IT CALM ANXIETY?

While we all feel anxious at certain times, such as ahead of a job interview, public speaking or due to those curve balls life throws at us, for some people, anxiety is constant and affects daily life. Generalised anxiety disorder is a long-term condition, while anxiety is also a main symptom of conditions such as post-traumatic stress disorder and various phobias.

In the case of using CBD oil for anxiety, clinical advisers at charity Anxiety UK (anxietyuk.org.uk) say there is not enough evidence. There is also concern that turning to CBD may deter people from getting treatments that are proven to work, such as cognitive behavioural therapy.

David Baldwin, professor of psychiatry and head of the Mental Health Group at the University of Southampton, is also an adviser to Anxiety UK and says, ‘It’s important that people interested in cannabidiol-based products make sure the preparation does not contain THC, as this could make them feel worse.’

Both the potency and frequency of smoking street cannabis containing high THC is likely to increase the likelihood of mental health problems, as shown by research in 2019, led by Dr Marta Di Forti of King’s College London.

ALL IN THE MIND?

‘Cannabis is potentially a medical treasure chest,’ says Professor Val Curran, director of University College London’s Clinical Pharmacology Unit, who has given different forms of cannabis to hundreds of people in her research over the last 20 years. ‘However, the vast majority of products available over the counter contain so little CBD that effectiveness is really limited to a placebo effect.’

This is not without value, as a placebo (when you feel better because you were expecting to) can reduce symptoms through psychological rather than physiological means. Oxford GP Simon Curtis, who trains doctors and is medical director of NB Medical Education, agrees, adding, ‘One of the notable findings is that the placebo effect is often quite big. If people have a strong belief in a product, it’s much more likely to be effective and help them.’

He is increasingly asked about medical cannabis, mostly by patients with disabling long-term conditions for which there are no easy answers.

WHAT CAN BE PRESCRIBED ON THE NHS?

Medical cannabis can only be obtained on prescription and, until 2018, was not allowed in the UK until a hard-fought battle led by parents of children with rare forms of epilepsy resulted in a change in the law. The cannabisderived medicines now available on the NHS have varying quantities and ratios of THC to CBD. In 2019, two medicines were approved by the National Institute for Health and Care Excellence (NICE) to be prescribed on the NHS by specialist doctors. Epidyolex, made from cannabis oil, can reduce seizures in children with two rare forms of epilepsy. Sativex, a spray containing CBD and THC, can treat muscle spasticity in multiple sclerosis. In the UK and overseas, research trials are under way into the wider use of cannabis-based medicines, including for use to treat certain forms of cancer.

CHECK THE LABELS

Until regulation is sorted out, choose CBD products from a company that displays certification of product analysis by an accredited laboratory on its website, advises Shomi Malik. Longer term, it would be better for an independent body, rather than a trade body, to regulate CBD products, says Harry Sumnall, professor of substance use at Liverpool John Moores University. He says, ‘When you get an industry body that captures the regulatory role, a cynic might argue they are more orientated towards industry interests.’ Meanwhile, as painstaking medical research seeks to discover if cannabis will provide breakthrough treatments for hard-to-treat conditions, one thing is certain: the excitement around CBD isn’t going away any time soon.

ONE PRODUCT COSTING £90 IN A HIGH STREET PHARMACY DIDN’T CONTAIN ANY CBD AT ALL.