Hemp Oil Benefits and Challenges
Cannabinoid rich hemp oil has emerged as a promising botanical therapeutic with both clinical experience and published studies to support its use. The Stanley brothers are largely credited for first awakening the public to its benefits. The six Colorado siblings developed a hemp extract low in ∆9-Tetrahydrocannabinol (THC), the psychoactive component in marijuana, and high in cannabidiol (CBD), a phytocannabinoid that is not associated with the intoxicating effects of the plant. That hemp extract came to be known as Charlotte’s Web after the parents of a little girl named Charlotte Figi convinced the brothers to provide their daughter with CBD-rich hemp oil.1 Charlotte suffered from a severe type of medication-resistant epilepsy known as Dravet syndrome. She was having 300 seizures per week and her heart frequently stopped. After consuming three to four milligrams of the hemp oil per pound of body weight, Charlotte’s seizures disappeared. The case received a lot of publicity in major media outlets such as CNN.1
Since then the demand for hemp as a medicinal has skyrocketed and so too has the number of companies producing it and doctors prescribing it. Its benefits have been demonstrated both clinically and in the scientific literature. Based on that scientific research and clinical observations, I employ hemp oil in clinical practice to support the health of patients with epilepsy, anxiety, depression, post-traumatic stress disorder, schizophrenia, inflammation, and pain among other applications. In this article, I will discuss a new cannabinoid certification program for both manufacturers and healthcare practitioners.
Challenges of Hemp for Practitioners
When new segments of most fields of commercial enterprise enter the marketplace, there are the initial well-intentioned pioneers. This is also true in the hemp oil marketplace. However, like the dietary supplement industry in its early years, the hemp oil marketplace is a Wild Wild West. Up until now, no entity was ensuring the consumer that optimal quantities of the beneficial cannabinoids found in hemp oil were actually contained in the purchased product. As a manufacturer, in order to maintain a respectable reputation and avoid legal complications, it’s important to ensure that the hemp oil you’re producing lives up to its label specifications. A 2017 article in JAMA tested 84 CBD/hemp oil extracts purchased online and found that although CBD oil labeling had the highest degree of accuracy compared to other products tested, 55% of the CBD oil products tested were either underlabeled (more CBD was detected in the product than claimed on the label) or overlabeled (CBD content that was negligible or less than 1% of the amount on the label).2 In this study, the overlabeled CBD products contained insufficient levels similar to concentrations that resulted in Food and Drug Administration (FDA) warning letters sent to 14 businesses in 2015-2016. Some of the products also contained more THC than noted on the label. In the United States, only cannabinoid-rich hemp oil brands that contain less than 0.3% of the psychoactive cannabinoid THC are legal. Therefore, certainty surrounding the THC content of a particular brand is essential.
The International Center for Cannabis Therapy (ICCT) found similar inaccuracies when its scientists tested hemp oil products sold mainly in online shops in Europe. Not one of the products tested was legally compliant as European legislation requires zero THC in hemp oil. Furthermore, the vast majority of products contained very little CBD and/or high concentrations of heavy metals and pesticides.
Another challenge that has arisen with the availability of hemp oil is that up until now, healthcare practitioners could not tap into a centralized knowledge base where they could have their cannabis questions answered. Because of hemp oil’s relative newness in the dietary supplement arena, there are many healthcare practitioners who are unclear of the proper dosage. Some of them have employed hemp products in their practice with little success not realizing that the product may have contained insufficient CBD. I have also encountered uncertainty among practitioners about the best way to incorporate hemp oil into already-prescribed supplement regimens, whether there are any contraindications to its use, and how its effects differ from marijuana. In interacting with attendees of lectures I have conducted on the endocannabinoid system, it became clear to me that a number of healthcare practitioners have many questions and concerns about the prescribing of hemp oil as well as the endocannabinoid system on which it acts.
The Entourage Effect of Hemp Oil
The entourage effect is a concept originally proposed by Doctors Mechoulam and Ben-Shabat two decades ago. It originally referred to the ability of certain endocannabinoid system components to enhance the beneficial effects of the two most important actors in this system: anandamide and 2-arachidonylglycerol.3,4 Since then the definition of the entourage effect evolved. It now can refer to the fact that components of cannabis or hemp oil other than THC and CBD—such as phytocannabinoids and terpenes—can actually act synergistically to THC, CBD, or each other.
CBD Receptors and Pain Perception
Hemp oil may be the answer to today’s opioid and pain crisis. Opioid overdose is associated with more than 115 deaths per day in the United States.5 Finding an alternative to their use is therefore critical.
The endocannabinoid system is closely associated with pain management. The receptors in this system including CB1 and CB2 are activated by endogenous endocannabinoids. However, CBD as a phytocannabinoid and other phytocannabinoids in hemp oil also affect receptors in this system as does THC, the psychoactive component of cannabis.6,7
The certification course will include an in-depth discussion of endocannabinoid receptors and their role in pain management.
Hemp Oil and Neurodegenerative Conditions and Mood Disorders
An abundance of evidence indicates hemp oil impacts the pathophysiology, progression, cause, and ecology of neurodegenerative conditions, mood disorders, and epilepsy. The certification program will help the busy healthcare provider digest this research and discover how it can be applied in clinical practice.
The Gut-Brain Axis and Cannabinoids
An increasing amount of evidence points to an interplay between intestinal and neurological systems and that this connection is modulated by the gut microbiota, the population of microorganisms found in the intestinal tract. This link between neurological and intestinal systems has become known as the gut-brain axis. Intriguing evidence has emerged that the endocannabinoid system is involved in this interaction.8,9 The certification program will delve deeply into the role of the endocannabinoid system in the gut-brain axis and how this knowledge can be used to reduce inflammation and support the health of patients with anxiety and depression.
Legal Considerations of Prescribing Hemp Oil
Based on the expertise of a leading attorney in this field of practice, practitioners who receive their cannabinoid certification will move forward with confidence and reassurance on the clinical application of hemp thanks to information presented in a comfortable and simple manner. A number of questions about the legality of hemp oil often arise. These include: 1) What is the difference between federal and state law and the issues of intrastate commerce? 2) Is it true that hemp oil is legal in all 50 states? 3) Is it likely for a person who tests positive to THC, that it could be from hemp oil use alone? 4) Do I need to have special charting or record keeping if I sell hemp oil to patients? 5) If a product that I sell as hemp contains THC beyond the “Legal Limit” to be considered hemp, what is my risk? Hoban Law Group, the leading cannabis business law firm which has presented on behalf of the industry in front of the 9th circuit court, will answer these questions and discuss legal considerations of implementation of hemp oil therapy in practice.
“If you are carrying a hemp product or selling a product with more than 0.3 percent THC then you are dispensing marijuana,” said Jason Searns counsel to Hoban Law Group. “It is legally essential to know without question what you are dispensing. With the legal system and U.S. government delineating the role of hemp oil, it is important for clinicians to adhere to a high standard of education as offered by organizations such as the international research and educational organization ICCT.”
The Endocannabinoid System and Immunity, Cancer, Senescence, and Healthy Aging
The endocannabinoid system has been found to play an important role in diverse aspects of health. Hemp oil, through its modulation of this system, is a likely option for many health challenges faced by our patients. For example, endocannabinoids are synthesized by most immune cells and upregulate or downregulate a number of immune functions.10 The CB2 receptor is also involved in reducing oxidative stress associated with cellular senescence, indicating the endocannabinoid system is involved in healthy aging.11 The certification program will help practitioners understand the myriad ways in which the endocannabinoid system is involved in health and how modulating that system through hemp oil can achieve beneficial results.
Essential Facts Practitioners Must Know About Employing Hemp Oil in Clinical Practice
The different delivery mechanisms of cannabis can influence how it affects the body. The certification program will allow healthcare providers to become proficient in understanding these delivery systems. For example, there is a next generation of CBD products moving into the American market. These products have efficient, transdermal properties so they bring the active substances deep into the tissue. It is also important when using hemp oil not to unduly disturb the endocannabinoid system and overwhelm natural production of the endocannabinoids or alter receptor activity. The certification program will help practitioners understand how to achieve the benefits of hemp oil without causing this undesirable effect. Processing and extraction processes commonly used and pharmacokinetics, pharmacodynamics will also be discussed.
CBD and other phytocannabinoids and constituents of hemp oil modulate inflammatory pathways. CBD reduces the inflammatory mediators interleukin-6 (IL-6) and TNF-α in rodent models.12-14 The certification program will discuss in detail hemp oil’s role in influencing inflammatory pathways in various disease states.
Adopted from Chris Meletis’ Townsend’s Letter article.
- Young S. Marijuana Stops Child’s Severe Seizures. CNN. August 7, 2013. https://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/index.html Accessed February 3, 2018.
- Bonn-Miller MO, Loflin MJE, Thomas BF, et al. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017 Nov 7;318(17):1708-9.
- Piomelli D, Russo EB. The Cannabis sativa Versus Cannabis indica Debate: An Interview with Ethan Russo, MD. Cannabis Cannabinoid Res. 2016;1(1):44-6.
- Ben-Shabat S, et al. An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol. 1998 Jul 17;353(1):23-31.
- National Institute on Drug Abuse. Opioid Overdose Crisis. February 2018. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis Accessed February 3, 2018.
- Miller RJ, Miller RE. Is cannabis an effective treatment for joint pain? Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):59-67.
- Morales P, Hurst DP, Reggio PH. Molecular Targets of the Phytocannabinoids: A Complex Picture. Prog Chem Org Nat Prod. 2017;103:103-31.
- DiPatrizio N. Endocannabinoids in the Gut. Cannabis Cannabinoid Res. 2016 Feb;1(1):67-77.
- Storr MA, Sharkey KA. The endocannabinoid system and gut-brain signalling. Curr Opin Pharmacol. 2007 Dec;7(6):575-82.
- Chiurchiù V. Endocannabinoids and Immunity. Cannabis Cannabinoid Res. 2016 Feb 1;1(1):59-66.
- Hu Y, Zhou KY, Wang ZJ, et al. N-stearoyl-l-Tyrosine inhibits the cell senescence and apoptosis induced by H2O2 in HEK293/Tau cells via the CB2 receptor. Chem Biol Interact. 2017 Jun 25;272:135-44.
- Durst R, Danenberg H, Gallily R, et al. Cannabidiol, a nonpsychoactive Cannabis constituent, protects against myocardial ischemic reperfusion injury. Am J Physiol Heart Circ Physiol. 2007 Dec;293(6):H3602-7.
- Barichello T, Ceretta RA, Generoso JS, et al. Cannabidiol reduces host immune response and prevents cognitive impairments in Wistar rats submitted to pneumococcal meningitis. Eur J Pharmacol. 2012 Dec 15;697(1-3):158-64.
- Li K, Feng JY, Li YY, et al. Anti-inflammatory role of cannabidiol and O-1602 in cerulein-induced acute pancreatitis in mice. Pancreas. 2013 Jan;42(1):123-9.