In the modern world, our first approach to treating an illness is to find the most suitable pharmaceutical drug, which we typically get either over-the-counter or on prescription. However, while these medicines are normally effective, they can unlock a whole new box of issues, including dependency and side effects.
Becoming reliant on medication can be mentally unsettling, and nasty side effects like nausea and dizziness typically require further treatment, leaving patients on a cocktail of pharmaceutical-grade drugs before they know it.
In the case of opioid painkillers, dependency may even be life-threatening, with the risk of overdose frighteningly high. In 2016, abuse of prescription opioid painkillers and recreational opiates accounted for more than 40,000 US lives, according to the Centers for Disease Control and Prevention (CDC).
This cycle of illness, drugs, side effects and more drugs is wearing thin with many, and combined with the new wave of medical cannabis science, a clear divide has formed between those who favor prescription drugs, and those who’d rather take natural, plant-based medicines.
From a historical perspective, medicinal cannabis use makes perfect sense, with the herb being used for millennia across the world, but particularly in Africa and Asia.
Technological advancements have greatly developed our knowledge of cannabis, and scientists now know which compounds are responsible for various effects. For example, the psychoactive “high” mostly comes from a therapeutic cannabinoid called tetrahydrocannabinol (THC). However, numerous other cannabinoids have medicinal properties, sans the hallucinogenic effects.
Cannabidiol (CBD) is the most studied and seemingly most useful non-intoxicating cannabinoid, and the market for CBD products has exploded in the 2010s, thanks in part to the relaxation of laws surrounding non-psychoactive hemp.
CBD over opioids
Opioid-based painkillers like Tramadol are now regularly prescribed for chronic pain, with stronger synthetic drugs such as fentanyl available on prescription for the most extreme discomfort. These drugs are designed to interact with opioid receptors in the opioid system. The pain relief from these drugs is substantial, however sustained use leads to increased tolerance, stronger doses and addiction.
However, CBD may be helpful for chronic patients, and also those who have ended up dependent on opioids, as the cannabinoid seems to exhibit anti-addiction properties by interfering with pleasure-reward mechanisms.
By elevating concentrations of anandamide in the body, CBD is promoting a neurotransmitter that works to ease both physical and mental pain. How CBD tackles addiction is less clear, but some evidence indicates that CBD is active in the opioid system.
Not all pain is the same – for example, some chronic pain is persistent and always at a similar intensity, whereas the worst effects of inflammatory and neuropathic pain tend to come from flare-ups.
For internal neuropathic pain, CBD vape oil and e-liquid treatment is ideal, because the relief comes very quickly. Meanwhile, lingering pain is economically and perhaps more efficiently managed by orally-consumed CBD products (e.g. capsules, edibles, coffee).
Experimenting with gels, creams and balms infused with cannabis or CBD is a novel method of coping with localized pain. These ensure that the cannabinoid receptors in the affected area are directly activated.
CBD: the new anti-inflammatory drug?
Immune system response is still not well that understood, and this has made it difficult to control. Researchers have struggled to find ways of influencing inflammation, but studies into the endocannabinoid system have found that immune system response is accessible via cannabinoid receptor 2 (CB2). Endocannabinoids look to signal a stoppage in inflammation, after a wound has fully healed or an infection is neutralized.
This discovery may be crucial, as the current leading class of anti-inflammatories (non-steroidal anti-inflammatory drugs, or NSAIDs) are known to cause concerning side effects, including stomach ulcers.
The best CBD product for inflammation depends, unsurprisingly on the type of inflammation. Internal conditions like irritable bowel syndrome (IBS), which could be exacerbated by endocannabinoid deficiency, respond well to both CBD vape juice and CBD edibles, or even tincture oils.
For osteoarthritis, a form of inflammation which affects the joints, CBD creams and other topicals are likely to produce better results.
CBD’s promise as an antidepressant
Cannabinoid research is providing genuine hope for antidepressant researchers, after decades of stagnation in medication development. The current situation with depression medicine is far from ideal, with selective serotonin reuptake inhibitors (SSRIs) slow to show benefits – for up to 40 percent of patients, these drugs may not even work at all. And then there are the side effects to contend with, which range from drowsiness to impotence. Depersonalization and derealization have also been anecdotally reported with SSRIs.
However, a glut of promising studies on CBD and the brain have found that the ECS could be important in correcting off-balance brain chemistry. The CB1 receptor modulates many variables, mood being one, and the bond between anandamide and this receptor is important for good mental wellbeing. Factors outside of the ECS also affect mood, but the potency of anandamide as an antidepressant makes the link with the CB1 receptor an essential one.
Some of the most exciting research on cannabinoids has been on their neuroprotective and neurogenesis properties. Studies on the hippocampus and the prefrontal cortex and cannabinoid treatments, which are associated with depression, have demonstrated that CBD is able to repair these regions of the brain, by restoring neuronal circuitry and helping to form new brain cells.
A 2018 study on rats carried out in Brazil showed that CBD was effective from the first treatment and for up to seven days after the last dose at blocking synaptic proteins which damage neuronal circuitry in the prefrontal cortex. Meanwhile, CBD-initiated neurogenesis in the hippocampus helps to regrow the brains of adult rats with depression. These results have not yet been replicated in humans, but rats are used for such studies because their brains are similar to humans. General memories and our autobiographical memory are stored in the hippocampus.
The only CBD products that aren’t suitable for managing depression are topicals, as the cannabinoids remain in the skin, and do not reach the brain.