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Epilepsy Patients Who Use ‘Artisanal CBD’ Have Higher Quality Of Life, Study Finds

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Epilepsy patients who used nonprescription CBD products reported a higher quality of life and better sleep than patients who did not take the cannabinoid, according to the results of a newly published study in the peer-reviewed journal Epilepsy & Behavior.

Patients who used CBD products also better tolerated epilepsy medications, used fewer prescription medications overall and experienced reduced psychiatric symptoms such as anxiety, the study found.

No significant differences in seizure control were observed between patients who used CBD and those who did not, but the study’s authors noted that “both groups included a high number of individuals with no past month seizures.”

“These findings further emphasize the need for controlled research to determine optimal CBD product types, doses, and concomitant use of other medications that maximize possible clinical benefit while minimizing potential risks,” the report says.

Healthcare utilization by Artisanal CBD product use. Plotted are the percentage of participants reporting use of prescription medications, over-the-counter medications, or the specified event in the past month or those using an artisanal CBD product (black bars) or not using an artisanal CBD product (white bars) in the baseline assessment. Artisanal refers to non-pharmaceutical (i.e., non-Epidiolex!) use. * p < .05; ** p < .01.

J.C. Strickland, H. Jackson, N.J. Schlienz et al., Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy, Epilepsy & Behavior.

The study, “Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy,” was published Tuesday. It focuses specifically on what authors call “artisanal CBD”—alternatives to the prescription drug Epidiolex, which the U.S. Food and Drug Administration approved in 2018 to treat certain rare types of epilepsy.

“Pharmaceutical CBD is currently a restricted prescription medication, and insurance coverage is often limited to only those patients with the specific approved indications,” the report says. “As a result, a large number of patients with epilepsy elect to use alternative CBD products sold widely as dietary supplements by commercial vendors.”

The research was funded by Realm of Caring, a nonprofit foundation devoted to cannabinoid therapies that is sponsored by companies that make CBD products. The group conducted the study in collaboration with researchers at the Johns Hopkins University School of Medicine.

“Despite the widespread availability and variety of these alternative cannabinoid products—here referred to as artisanal CBD in contrast to pharmaceutical CBD—controlled studies evaluating their safety or efficacy are rare,” the authors write, “making conclusions about the clinical utility of these products uncertain.”

To arrive at their conclusions, researchers analyzed the results of surveys returned by 280 epilepsy patients who said they used so-called artisanal CBD products and 138 patients who used no cannabis products. The participants were selected using Realm of Caring patient registries and social media posts, and follow-up surveys were collected from a subset of 190 participants.

Most patients (74 percent) were white, and roughly half (55 percent) were female. The average age was 21 years old, and most (90 percent) reported no history of non-medical or recreational cannabis use. A majority (93 percent) reported epilepsy as their primary condition, while the other 7 percent developed epilepsy related to cancer, autoimmune or neuropsychiatric conditions, sleep disorders or other conditions.

Although those who took CBD products reported fewer seizures than those who did not, the difference was not statistically significant and may be due to random chance.

Other measures of well being, however, were higher in patients who took CBD. Participants filled out standardized questionnaires on quality of life, pain, anxiety and depression and sleep.

While some indicators, such as pain, did not meaningfully differ between the groups, artisanal CBD users reported greater health satisfaction. Sleep was significantly better among CBD users, and patients who used CBD were also less likely to meet the clinical threshold for anxiety.

Epilepsy medication adverse effects. Plotted are group mean scores on the Liverpool Adverse Events Profile on total scores (top panel) and individual items (bottom panel). Controls (white bars) and participants using an artisanal CBD product (black bars) are plotted. Error bars are standard error of the mean. A clinical cutoff of greater than 45 is also presented in the top panel in the dotted line). Artisanal refers to non-pharmaceutical (i.e., non-Epidiolex!) use. Individual items available in the Supplemental Materials.

J.C. Strickland, H. Jackson, N.J. Schlienz et al., Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy, Epilepsy & Behavior.

Those who used CBD also had lower odds of having gone to the emergency room or calling in sick to work or school during the past month.

“Generally, higher quality of life, lower psychiatric symptom scores and improved sleep were observed among people using an artisanal CBD product based on both cross-sectional and longitudinal comparisons,” the study says. “Artisanal CBD Users reported significantly better epilepsy medication tolerability, a lower odds of prescription medication use and traditional anticonvulsant use, and reduced healthcare utilization compared with Controls.”

“These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life and as well as for seizure reduction,” the researchers noted.

Other patients—about 1 in 5 of the survey participants—reported adverse effects from CBD. These included drowsiness (11 percent), apparent worsening of epilepsy symptoms (4 percent), high or prohibitive cost of CBD products (4 percent), worries over legality (3 percent) and either concerns about or experienced interactions with other drugs.

CBD dosing didn’t seem to significantly impact the outcomes, although higher doses of CBD were associated with higher quality of life scores and lower odds of a past-month outpatient visit. In general, participants reported using a median dose of 1.4 milligrams of CBD per kilogram of body weight, which authors note “is well below the dose commonly associated with pharmaceutical products (e.g., 10 mg/kg/day is the current recommended maintenance dose for pharmaceutical CBD).”

Authors acknowledge there are a number of limitations to the study, for instance the fact that it’s drawn from self-reported data. “These limitations mean that we are not able to directly verify epilepsy characteristics and did not have control over factors like CBD dose or frequency of administration,” they wrote. Moreover, participants were drawn from Realm of Caring’s patient registry, “which may not generalize to the broader population of patients with epilepsy. Of note, the nature of the sample means that there is a possible referral bias and related increases in expectation for clinical benefit.”

Some of the authors also have links to the commercial cannabis industry, according to a study disclaimer. Of the study’s eight named co-authors, one, Ryan Vandrey, has received compensation as a consultant or advisory board member from Canopy Growth, MyMD Pharmaceuticals, WebMD and Syqe Medical. Another, Marcel O. Bonn-Miller, is an employee of Canopy Growth and a past director at AusCann Group Holdings.

Overall, the study says, the findings “highlight real-world evidence for the possible utility of artisanal CBD products in a diverse and heterogenous population of patients with epilepsy. Although the lack of a placebo control group precludes determination of efficacy, the consistent observation of clinically meaningful differences between groups at baseline and with Controls who initiated artisanal CBD product use over time suggests that use of these products can improve health and quality of life for patients with epilepsy.”

Congress To Vote On Marijuana, Psychedelics And CBD Amendments This Week Following Committee Action

Photo by Kimzy Nanney

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.

Ben Adlin is a Seattle-based writer and editor. He has covered cannabis as a journalist since 2011, most recently as a senior news editor for Leafly.

Science & Health

Don’t Feed Marijuana Buds To Donkeys, New Study Warns

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Feeding donkeys fresh marijuana buds is inadvisable, according to a new study that looked at novel cases of cannabis toxicosis in two equine.

The study, published in the Journal of Veterinary Diagnostic Investigation, investigated what happened after a jack and jenny (the terms for male and female donkeys, respectively) were fed a few grams of cannabis that was being legally grown for human consumption.

The donkeys’ symptoms sound a lot like what happens when a person takes an edible that’s too strong. They presented as lethargic and their hearts were beating faster than normal, for example. But while it took longer to come down from the high for the donkeys compared to humans, with symptoms lasting 44 hours in the younger jenny before she was taken to the hospital, the study says both “recovered uneventfully within 24 hours of peak effects.”

“Marijuana toxicosis is typically seen by companion animal veterinarians. However, with increased marijuana availability, there is a greater potential for toxicosis in other species,” the study authors wrote. To the scientists’ knowledge, this is the first study documenting cases of cannabis consumption in donkeys.

A positive outcome from the donkey highs was that scientists had a chance to experiment with testing procedures to confirm that the symptoms were due to exposure to cannabinoids. They used a “screening assay in collaboration with a veterinary diagnostic laboratory,” which the study authors said “may be useful when an equine practitioner suspects marijuana toxicosis in a patient.”

While they were able to determine those cannabinoid concentrations in the donkeys’ plasma, the researchers noted that more data is needed to figure out what dose of cannabis causes toxicosis in the species.

In terms of treating donkeys who ate too much marijuana, the study says practitioners could potentially use gastric lavage, administer activated charcoal or use laxatives.

“These adjunctive therapies are targeted at decreasing gastric absorption and facilitating excretion to limit the adverse clinical effects of cannabis,” they wrote. “There is no scientific evidence to support the benefit of these therapies for marijuana toxicosis in equine patients. However, activated charcoal and gastric lavage are effective means of supportive treatment for marijuana toxicosis in canine patients.”

The study doesn’t directly comment on the ethics of feeding cannabis to donkeys, but as a general rule, people are discouraged from intentionally intoxicating animals and should take precautions to avoid accidental ingestion.

Another study released last year found that, apparently, some canines are even getting intoxicated off marijuana by eating the feces of people who’ve consumed cannabis.

Separately, there is interest within the scientific community about the effects of non-intoxicating CBD in animals like dogs and horses.

Dogs with epilepsy experience considerably fewer seizures when treated with CBD oil, a study published in the journal Pet Behaviour Science in 2019 found.

The prior year, a separate study determined that CBD can alleviate the symptoms of osteoarthritis in dogs.

The Food and Drug Administration (FDA), for its part, has repeatedly warned pet owners about using CBD to treat firework-related anxiety in pets around the July 4 holiday.

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Banking Activity Increases In States That Legalize Marijuana, Study Finds

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While marijuana businesses often struggle to find banks that are willing to take them on as clients due to risks caused by the ongoing federal prohibition of cannabis, a new study found that banking activity actually increases in states that legalize marijuana.

The research doesn’t make a direct connection between state-level marijuana reform and the increased activity, but it does strongly imply that there’s a relationship—even if the factors behind the trend aren’t exactly clear.

Researchers set out to investigate banking trends in states that have legalized cannabis, looking at bank regulatory filings with the Federal Deposit Insurance Corporation (FDIC) from 2011 to 2016. They found evidence that “banking activity (deposits and subsequent loans) increase considerably in legalizing states relative to non-legalizing states.”

That’s in spite of the fact that banks and credit unions run the risk of being penalized by federal regulators for working with businesses that deal with a federally controlled substance.

“While uncertainty can result in overly cautious behavior and hinder economic activity, we do not find evidence of this with cannabis laws and the banking industry,” the authors wrote in the new paper—titled, “THC and the FDIC: Implications of Cannabis Legalization for the Banking System.”

The study analyzed data from “150,566 bank-quarter observations from 6,932 unique banks located in 46 different states.” It found that deposits increased by an average range of 3.14-4.33 percent—and bank lending increased by 6.54-8.62 percent—post-legalization.

“Our results indicate that deposits and loans increased for banks after recreational cannabis legalization.”

Of course, it makes sense that legal states would see increased financial activity in the banking sector after opening a new market, even if only some banks choose to take the risk of working directly with cannabis businesses. The emerging marijuana industry also supports an array of ancillary firms and traditional companies that provide services to dispensaries and grow operations.

As of June 30, there were 706 financial institutions that had filed requisite reports saying they were actively serving cannabis clients. Thats up from 689 in the previous quarter but still down from a peak of 747 in late 2019.

But the question remains: why are some banks deciding to take on marijuana clients while others remain wary of federal repercussions?

The study authors—from the University of Arizona, Drexel University, San Diego State University and Scripps College—put forward two possibilities about why “the risk from regulatory uncertainty did not decrease banks’ willingness to accept deposits or make loans.”

The increase “may suggest that banks were either unconcerned about the potential risk associated with accepting cannabis related deposits or optimistic about the chances that regulations will adapt to the needs of legalizing states,” the paper reasons.

Confidence about working with a federally illegal industry may well have been bolstered in 2014 when the Financial Crimes Enforcement Network (FinCEN) under the Obama administration issued guidance to financial institutions on reporting requirements for cannabis-related businesses.

The second option, optimism about federal reform, also seems possible. It was around the time that the bipartisan Secure and Fair Enforcement (SAFE) Banking Act was first introduced that there was a notable spike in financial institutions reporting that they have marijuana business clients.

In the years since, that legislation has been approved in some form five times in the U.S. House of Representatives, but it’s continued to stall in the Senate. In general, banks reporting marijuana accounts has remained relatively stable since 2019.

“Although many have speculated about the increased legal risks to banks, there is a lack of evidence for instances where banks are criminally prosecuted or lose their federally insured status,” the study states. “If these negative repercussions rarely happen, it makes sense that banks would not respond to the legislative uncertainty.”

“As more state regulators issue statements in support of banks and credit unions serving the cannabis industry, the financial institutions can become more optimistic about the chances that regulations will adapt in their favor with time,” the authors wrote.

Despite optimism for future reform that certain lawmakers have expressed, it doesn’t necessarily take the sting out of the latest failed attempt to secure protections for banks that choose to work with state-legal cannabis businesses as part of a large-scale defense bill.

A pro-reform Republican senator recently slammed Democrats for failing to advance marijuana banking reform despite having a congressional majority and control of the presidency.

For what it’s worth, the secretary of the U.S. Treasury Department recently said that freeing up banks to work with state-legal marijuana businesses would “of course” make the Internal Revenue Service’s (IRS) job of collecting taxes easier.

With respect to the SAFE Banking Act, a bipartisan coalition of two dozen governors recently implored congressional leaders to finally enact marijuana banking reform through the large-scale defense legislation.

A group of small marijuana business owners also recently made the case that the incremental banking policy change could actually help support social equity efforts.

Rodney Hood, a board member of the National Credit Union Administration, wrote in a recent Marijuana Moment op-ed that legalization is an inevitability—and it makes the most sense for government agencies to get ahead of the policy change to resolve banking complications now.

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Young People Who Use Marijuana Have Better Orgasms and Sexual Function, Study Says

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Young people who smoke marijuana and drink alcohol have better orgasms and overall sexual function than their peers who abstain or use less, a study in Spain recently concluded.

Because the existing scientific literature on the impact of drinking and drug use on sexual functioning is contradictory—finding both benefits and harms—a team of researchers from the University of Almeria designed the new observational study to analyze their affect with three commonly used surveys to detect potential risky drinking and cannabis use, as well as changes to one’s sexual functioning.

“Sexual function in young people who use cannabis and alcohol more frequently was shown to be better than in those who do not use either.”

From January to June 2020, researchers assessed 185 females and 89 males between the ages of 18 and 30 who were either regular cannabis or alcohol users or non-users, excluding those who used other substances like opiates or MDMA, as well as screening out those with pre-existing conditions like depression and diabetes, which could have a negative impact on their sexual performance.

“Sexual function is improved in young people who are high-risk cannabis consumers with a moderate risk of alcohol use, resulting in increased desire, arousal, and orgasm,” the study, published at the end of last month in the Journal Healthcare, found. “This improvement is usually associated with a reduction in anxiety and shame, which facilitates sexual relationships.”

The cannabis users scored higher than non-users on both the overall sexual functioning scale and the subscales of arousal and orgasm. And those who used cannabis the most were found to report higher sexual functioning and arousal scores than the moderate users. No differences were found on the desire and orgasm subscales between moderate and heavy users and no differences were detected amongst men and women respondents to the survey.

“Our findings indicate that young people who use cannabis frequently, regardless of gender, have better overall sexual function.”

When it comes to alcohol use, no significant differences in either overall sexual function or in any of the subscales measured, were found between drinking and non-drinking participants. However, there were statistically significant differences based on levels of alcohol consumption, potentially suggesting some dose dependent outcomes.

Those who reported heavy drinking scored higher on the total sexual function questionnaire and the arousal subscale than those who did not drink at all, the study found. And the high consumption participants had significantly higher total questionnaire and orgasm subscale scores than the moderate consumption participants. But those participants who reported an existing alcohol dependence had significantly lower scores than their peers whose drinking was evaluated to be merely at a higher risk for dependency.

These marijuana results are consistent with previous studies that found cannabis use enhances sex and masturbation, increases sexual desire and leads to better orgasms, as well as those that have found cannabis consumers have more sex than cannabis abstainers, and a higher score on sexual health inventories and serum testosterone levels.

“The findings of this study revealed a higher score in sexual function, as well as arousal and orgasm, in subjects at risk of having cannabis-related problems and risk of addiction associated with alcohol consumption.”

Older studies that previously found some evidence of erectile dysfunction among heavier alcohol consumers may have been influenced by the older ages of the respondents, according to the research team behind the new paper, which focused on individuals in their late teens and 20s, “where erectile dysfunction is less common.”

Questions remain about the different types of sexual relationships (long-term vs sporadic vs unstable) that frequent consumers engage in or if there is any correlation between use and relationship type.

The research team also cautioned that this study did not capture any potential medium range and longer-term consequences of heavier drinking and cannabis use, including any potential proclivity to engage in less safe sex practices due to inebriation.

Since the increased desire, arousal, and orgasms in young people who are high-risk cannabis consumers with a moderate risk of alcohol use, is usually associated with a reduction in anxiety and shame, which facilitates sexual relationships, the study called for future sex education practices to focus on strategies that reduce shame and anxiety, to prevent young people from developing potential drug and alcohol dependency issues later on in their lives.

Photo courtesy of Martin Alonso.

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