The only approved drug with CBD treats epilepsy. Here's what you need to know about it and over-the-counter CBD products for seizures.
Approved and unapproved CBD
While there are hundreds, if not thousands, of cannabidiol (CBD) products on the open market, only one drug containing CBD has actually been approved by the Food and Drug Administration (FDA). That’s Epidiolex, indicated for two forms of rare childhood epilepsy.
The approval, of course, came only after rigorous research had found the drug to be safe and effective.
The CBD products you can find easily on the internet and elsewhere have not been rigorously tested, yet many people say they also find relief for seizure disorders from CBD oils, CBD tinctures, and other CBD products, when carefully chosen.
This is what you need to know about approved and unapproved CBD products for treating seizures.
What is CBD?
CBD is one of two main ingredients in the cannabis plant. The other is delta-9-tetrahydrocannabinoid (THC). THC produces the “high” that comes from using marijuana, while CBD does not.
CBD can also come from the hemp plant, a cousin of the cannabis plant with lower levels of THC. The 2018 Farm Bill allowed farmers to cultivate hemp legally as long as it contains no more than 0.3 percent THC.
Epilepsy and seizures
The term epilepsy refers to a group of disorders with many different causes. The common thread is that they all involve neurons that misfire, causing seizures.
Seizures can cause a disruption in a person’s thinking and movement, and symptoms can include confusion, staring into space for a few moments, a loss of muscle control, jerking movements of the arms and legs, or a loss of consciousness.
People can have seizures without actually being diagnosed with epilepsy (say, after a head injury or a high fever). In order to be diagnosed with epilepsy, you have to have at least two seizures, according to the National Institute of Neurological Disorders and Stroke.
In research, epileptic and other seizures tend to be lumped together. “We tend to think of it as a common pathway,” says Kevin Chapman, MD, a member of the board of directors of the American Epilepsy Society.
CBD and seizures
Two main studies cleared the way for the approval of Epidiolex. One, published in The New England Journal of Medicine, found that 43 percent of participants who took cannabidiol saw their seizures cut in half, while 5 percent became seizure free.
The second study, appearing in the same journal, found similarly significant declines in seizures. In general, “pediatric patients responded better than adults,” says Bonni Goldstein, MD, medical director and owner of Cannacenters, a medical practice in Los Angeles, and author of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain.
Outside of those studies, what we know comes largely from animal studies and some retrospective studies. But this type of research leaves many important questions unanswered, Dr. Goldstein says.
Although Epidiolex was approved for only two specific conditions, doctors sometimes prescribe the drug off-label for other types of epilepsy, says Dr. Chapman, who is also with pediatric neurology at the Barrow Neurological Institute at Phoenix Children’s Hospital.
Is CBD safe?
“Most people tolerate the medicine fairly well,” says Dr. Chapman. But some people do have liver problems or other side effects, most commonly sleepiness and some gastrointestinal problems. The side effects typically improve when the medication is discontinued.
There can also be interactions with some medications, including antianxiety and high blood pressure medications. Visit the National Library of Medicine for a list of drugs with potential interactions.
It’s a smart idea to discuss CBD with your doctor before you try it.
Is it legal to buy CBD?
Epidiolex is certainly legal, even if doctors prescribes it off label. Classifying other CBD products is much harder, though it helps to know the source of your CBD: cannabis (marijuana) or hemp.
At this point, 36 states, plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands, have legalized medical marijuana, which contains CBD. The National Conference of State Legislatures keeps a running tally of where medical marijuana is legal. The Drug Enforcement Administration (DEA), on the other hand, still lists marijuana and all its components, including CBD, as Schedule I controlled substances. That means CBD from marijuana is not legal on the federal level.
CBD from hemp is regulated differently. According to the 2018 Farm Bill, hemp products that contain no more than 0.3 percent THC are not considered controlled substances under federal law. Some states restrict buying hemp-based CBD products, however.
Types of CBD
You can buy CBD in four basic forms: topical, such as in creams you put on your skin; those you can inhale (vape); capsules and edibles you ingest; and products you absorb under your tongue (sublingual), explains Martin A. Lee, co-founder and director of Project CBD, a California nonprofit that promotes CBD research, and author of Smoke Signals: A Social History of Marijuana–Medical, Recreational, and Scientific.
They differ in how long they take to kick in and how long they act, among other things. Each of these products then comes in three varieties:
Full-spectrum CBD, which contains all of the components of the hemp plant (Cannabis sativa), including CBD and small traces of THC and plant compounds known as terpenes
Broad-spectrum CBD, which contains all components of the hemp plant except THC
CBD isolates, which contain only CBD
You’re likely to get a better effect with a broader-spectrum of components, says Lee. However, if you are worried about failing a drug test for marijuana, which actually tests for THC, CBD isolates are your best option.
Finding a good product
It’s important to know that just because a CBD product is legal doesn’t mean it’s high quality.
“As a provider, the thing I’m most concerned of is the lack of regulation on these products,” says Dr. Chapman. “They aren’t required to meet certain criteria. They may print something on the label, but they’re not required to stick to those.”
You can minimize this danger by only buying from companies that have independent third-party labs verify the ingredients on the label. Ask for a certificate of analysis (COA) to confirm this. Buy from a licensed dispensary, if you can.
Experts typically recommend that you look for products that were also:
- Extracted using supercritical carbon dioxide, a high-tech method that doesn’t leave toxic solvents behind, or with food-grade ethanol
- Free from pesticides, heavy metals, mold, and other contaminants
- Made from U.S.-grown hemp
- Certified organic
- Produced in compliance with FDA Good Manufacturing Practices
When it comes to seizure disorders specifically, the vast majority of patients require higher doses, says Dr. Goldstein. Because of this, it’s best to get something that’s concentrated, meaning there are more milligrams of CBD per milliliter.
“If you need 300 milligrams a day and you buy a bottle with 1,000 milligrams, you just bought three doses,” she says. “Don’t buy a 50-milligram bottle.”
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