Charlotte's Web (cannabis)
Charlotte's Web is a strain of medical marijuana processed into a marijuana extract that is high in cannabidiol (CBD) content, called Realm Oil and Alepsia. It does not induce the psychoactive "high" typically associated with recreational marijuana use.
Charlotte's Web is named after Charlotte Figi, whose parents say she experienced a reduction of her epileptic seizures after her first dose of medical marijuana at five years of age, and whose usage of the strain was featured in the 2013 CNN documentary "Weed". Media coverage increased demand for Realm Oil and similar products high in CBD, which has been used to treat cancer and epilepsy in toddlers and children. While high profile and anecdotal reports have sparked interest in treatment with cannabinoids, there is insufficient medical evidence to draw conclusions about their safety or efficacy.
Families who say they have run out of pharmaceutical options have moved to Colorado to access the strain. The demand has spurred calls for more research to determine whether these products actually do what is claimed. While the use of medical marijuana products is allowed in many U.S. states, the nationwide legal status of Realm Oil is less clear.
Development and growth of the strain
The strain was developed by the Stanley brothers (Joel, Jesse, Jon, Jordan, Jared and Josh) through a process of breeding which created a variety with less tetrahydrocannabinol (THC) and more cannabidiol (CBD) than typical varieties of marijuana. The strain shows potential for medical usage, especially for those who do not wish to experience the typical high of recreational marijuana use. Because it is so low in THC, the strain was originally called "Hippie's Disappointment" and it "has close to no value to traditional marijuana consumers."
The Stanley brothers grow the plants at their farm and greenhouses. A CBD rich oil, which they call "Realm Oil" and "Alepsia", is extracted from the harvested plants and concentrated through rotary evaporation. To make it easier to perform clinical trials, they are planning to move the Charlotte's Web part of their operation to Uruguay. By doing so, they will also be able to import it to any U.S. state as hemp.
Named after Charlotte Figi
Charlotte (born October 18, 2006), the daughter of Matt and Paige Figi, was diagnosed with Dravet syndrome (also known as severe myoclonic epilepsy of infancy or SMEI), a condition where 80% of individuals have a mutation of the SCN1A gene. When Charlotte was five years old, her story was featured in the August 11, 2013 CNN documentary "Weed", hosted by Sanjay Gupta. On Nov. 25, 2013, Paige Figi was a guest on The Doctors TV show, where Charlotte's story was told.
According to her parents, Charlotte was having 300 grand mal seizures a week, which were reduced to two to three per month. At one point her seizures were so violent that her parents put a do not resuscitate order in her medical records: they had already tried "every other option before resorting to this type of prescription ...". They first tried a type called R4, which was low in THC and high in CBD. Then they sought the help of the Stanley brothers, "one of the state's largest marijuana growers and dispensary owners". They also got the cooperation of two physicians licensed in Colorado to prescribe medical marijuana, Margaret Gedde and Alan Shackelford.
The Figis examined the options available and tried the variety which later would carry the name of their daughter. Her parents and physicians said she improved after being put on a regular regimen, and the Stanley brothers changed the name of the strain from Hippie's Disappointment to Charlotte's Web. Rather than smoking the product, Charlotte uses an olive oil solution containing the high CBD marijuana extract that she receives under her tongue or in her food. Her parents said in 2013 that she had about four seizures per month, and is able to engage in normal childhood activities.
Publicity and demand
The documentary received widespread publicity, and it popularized Charlotte's Web and Realm Oil as a possible treatment for epilepsy and other conditions. Colorado has legalized both the medicinal and recreational use of marijuana, and many parents have flocked there with their suffering children in search of Charlotte's Web and other forms of medical marijuana. In November 2013, CBS Denver reported that "[t]here is now a growing community of 93 families with epileptic children using marijuana daily. Hundreds are on a waiting list and thousands are calling." They have been termed "marijuana refugees", "part of a migration of families uprooting their lives and moving to Colorado, where the medicinal use of marijuana is permitted ... forced to flee states where cannabis is off limits."
The mother of a child with a highly curable and common form of childhood cancer, acute lymphocytic leukemia (ALL), who moved to Colorado to seek treatment with the marijuana extract, was investigated when she refused chemotherapy for her three-year-old child.
The Realm of Caring Foundation was set up by the Stanley brothers to help individuals receive treatment.
Need for research and caution
Colorado law permits the use of medical cannabis for eight conditions: cancer, glaucoma, HIV/AIDS, muscle spasms, seizures, severe pain, severe nausea and cachexia or dramatic weight loss and muscle atrophy. The publicity surrounding anecdotal reports of successful treatment of intractable epilepsy with cannabinoids is likely to lead to a surge in interest. There is little supportive clinical evidence about the safety or efficacy of cannabinoids in the treatment of epilepsy; a 2012 Cochrane review said there is not enough evidence to draw conclusions about their use. There have been few studies of the anticonvulsive properties of CBD and epileptic disorders. The major reasons for the lack of clinical research have been the introduction of new synthetic and more stable pharmaceutical anticonvulsants, the recognition of important adverse effects and the legal restriction to the use of cannabis-derived medicines.
The interest created by the documentary highlighted a need for increased scientific research, as well as caution against "bad medicine" and raising false hopes: Ed Maa, a Colorado neurologist, specialist in epilepsy, and board member of the Colorado Epilepsy Foundation, stated: "This is not going away. ... I think it needs to be studied vigorously and very quickly." He hopes to "launch a clinical trial to study the pot and its potential". Physicians have called for more research to better understand the potential benefits of controlled use of medical marijuana; Sharon Levy, MD, MPH, and director of the Adolescent Substance Abuse Program at Children's Hospital Boston and an assistant professor of pediatrics at Harvard Medical School in Massachusetts said:
- "The AAP strongly supports more cannabinoid research to better understand both how these substances can be used therapeutically as well as their potential side effects—which we may well be underestimating ... [But] the AAP does not support 'medical marijuana' laws as they circumvent regulations put in place to protect patients, and children are a particularly vulnerable population."
Physicians have expressed both positive interest and worry about the sudden explosion of interest in the legalization of medical marijuana and its research, admitting legalization is both "a scientist's dream or a doctor's nightmare". They fear that some parents are too open to trying anything before proper research has been conducted, and that they may be disappointed. They are "alarmed by parallels to past miracle-cure manias later proved false ..." and "... wary of the heightened placebo effect in treatments involving children, when reports of progress depend on the view of parents". There is also danger that "the [legalization] movement also opens the way for bad medicine ... through treatments at best giving hope to the hysterical and at worst delivering damaging side effects". According to Alan Shackelford, Charlotte Figi's physician: "We really don't know how it works... The cannabidiol seems to act as a neuro-stabilizer, but how? The research is minuscule on this."
- "While there are some anecdotal reports of marijuana use in treating epilepsy, scientific evidence for the routine use of marijuana for this indication is lacking. The lack of information does not mean that marijuana is ineffective for epilepsy. It merely means that we do not know if marijuana is a safe and efficacious treatment for epilepsy....
- "In addition, little is known about the long term effects of using marijuana in infants and children, and chronic exposure during adolescence has been shown to have lasting negative effects on cognition and mood. Such safety concerns coupled with a lack of evidence of efficacy in controlled studies result in a risk/benefit ratio that does not support use of marijuana for treatment of seizures at this time."
Orrin Devinsky, a neurologist at New York University's Comprehensive Epilepsy Center, where he will conduct clinical trials on Epidiolex, a high-CBD drug from GW Pharmaceuticals, expressed his sympathy for those who "can't wait for results from research":
- "If I had a child who had failed 15 medications and drug treatments and there was nothing else to do, and they were having many seizures a day that were terribly disabling, I think it would be a very reasonable thing to do to try a high-CBD cannabis product."
He also expressed concern that the number of parents using the Charlotte's Web extract will make it harder to find children for the clinical trials, and that:
- "There are many more unknowns than knowns ... the focus of the community—lay and scientific and governmental—should be on getting good information. That should be the real focus of what we need right now."
The Epilepsy Foundation and Devinsky issued a joint statement calling for increased research and immediate access to medical marijuana, specifically naming Charlotte Figi's case. Devinsky said:
- "We need to make a balanced decision about compassionate use. If I were Charlotte Figi's parents and lived in Colorado I would have done exactly what they did. And as a doctor, I would gladly prescribe marijuana products for many of my patients who failed existing therapies if it were legal in my state.... Until we have the scientific data, we should make medical marijuana available to physicians who care for people with treatment-resistant epilepsy and their patients."
The American Cancer Society says:
- "While it shows promise for controlling cancer pain among some patients, there is still concern that marijuana may cause toxic side effects in some people and that the benefits of THC must be carefully weighed against its potential risks. There is no available scientific evidence from controlled studies in humans that cannabinoids can cure or treat cancer."
While the use of medical marijuana products is allowed in many U.S. states, the nationwide legal status of Realm Oil is less clear.
Josh Stanley has said that Charlotte's web is 0.5% THC and 17% CBD, and he claims that "Alepsia.... is as legal as other hemp products already sold in stores across Utah, including other oils, clothing and hand creams, but is illegal, federally, to take across state lines."
In Utah, Rep. Gage Froerer, R-Huntsville, said in October 2013: "Nothing in federal or state law prohibits the sale or use of hemp products." He pledged to consult with the Utah Substance Abuse Authority, saying: "We need to take a strong look at this and make sure that we as a legislature and we as citizens understand really what this is and what it's not." In November 2013, he said he would address "three components in sponsoring legislation: access, quality control and research. He said the Utah Department of Health would probably be involved in quality-control efforts ..." Annette Maughan, President of the Epilepsy Association of Utah, said: "The current Utah law doesn't exclude its use but also doesn't allow for its use. We are in limbo until Utah lawmakers decide what to call it."
In 2013, the parents of a two-year-old with Dravet's syndrome confronted New Jersey governor Chris Christie, who signed a bill allowing access for sick children to medical marijuana in a controversy dubbed "pot for tots". In 2014, legislative proposals in New York, Washington state, Minnesota, and Florida are being considered, where "even some staunch opponents of medical marijuana now are willing to make an exception" to allow the marijuana extract for medical treatment.
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