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===Legal status===
===Legal status===
====U.S. Food and Drug Administration====
The FDA has approved the first drug that contains purified cannabidiol derived from cannabis/hemp. It is the first drug approved for the treatment of patients with Dravet syndrome. The FDA granted Priority Review<ref>https://www.fda.gov/ForPatients/Approvals/Fast/ucm405405.htm</ref> designation for this application. Fast-Track<ref>https://www.fda.gov/ForPatients/Approvals/Fast/ucm405399.htm</ref> designation was granted for Dravet syndrome. A designation of Orphan Drug<ref>https://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseasesConditions/HowtoapplyforOrphanProductDesignation/default.htm</ref> was granted for both the Dravet syndrome and Lennox-Gastaut syndrome indications. GW Research Ltd.<ref>https://www.gwpharm.com/epilepsy-patients-caregivers/clinicians-researchers/research</ref> was given the FDA approval of Epidiolex.

====Non-psychoactivity====
CBD does not appear to have any psychoactive ("high") effects such as those caused by ∆9-THC in marijuana, but may have anti-anxiety and anti-psychotic effects.<ref name=Iseger2015/> As the legal landscape and understanding about the differences in medical cannabinoids unfolds, it will be increasingly important to distinguish "medical marijuana" (with noted varying degrees of psychotropic effects and deficits in executive function) – from "medical CBD".<ref name=Iseger2015>{{cite journal | vauthors = Iseger TA, Bossong MG | title = A systematic review of the antipsychotic properties of cannabidiol in humans | journal = Schizophrenia Research | volume = 162 | issue = 1–3 | pages = 153–61 | date = March 2015 | pmid = 25667194 | doi = 10.1016/j.schres.2015.01.033 }}</ref><ref>{{cite journal | vauthors = Sachs J, McGlade E, Yurgelun-Todd D | title = Safety and Toxicology of Cannabinoids | journal = Neurotherapeutics | volume = 12 | issue = 4 | pages = 735–46 | date = October 2015 | pmid = 26269228 | pmc = 4604177 | doi = 10.1007/s13311-015-0380-8 }}</ref>
CBD does not appear to have any psychoactive ("high") effects such as those caused by ∆9-THC in marijuana, but may have anti-anxiety and anti-psychotic effects.<ref name=Iseger2015/> As the legal landscape and understanding about the differences in medical cannabinoids unfolds, it will be increasingly important to distinguish "medical marijuana" (with noted varying degrees of psychotropic effects and deficits in executive function) – from "medical CBD".<ref name=Iseger2015>{{cite journal | vauthors = Iseger TA, Bossong MG | title = A systematic review of the antipsychotic properties of cannabidiol in humans | journal = Schizophrenia Research | volume = 162 | issue = 1–3 | pages = 153–61 | date = March 2015 | pmid = 25667194 | doi = 10.1016/j.schres.2015.01.033 }}</ref><ref>{{cite journal | vauthors = Sachs J, McGlade E, Yurgelun-Todd D | title = Safety and Toxicology of Cannabinoids | journal = Neurotherapeutics | volume = 12 | issue = 4 | pages = 735–46 | date = October 2015 | pmid = 26269228 | pmc = 4604177 | doi = 10.1007/s13311-015-0380-8 }}</ref>


Revision as of 00:29, 26 June 2018

Not to be confused with cannabinol or cannabinodiol.

Cannabidiol
Clinical data
AHFS/Drugs.comInternational Drug Names
ATC code
  • None
Legal status
Legal status
Pharmacokinetic data
BioavailabilityOral: 13–19%[1]
Inhaled: 11–45% (mean 31%)[2]
Elimination half-life9 hours[1]
Identifiers
  • 2-[(1R,6R)-6-isopropenyl-3-methylcyclohex-2-en-1-yl]-5-pentylbenzene-1,3-diol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
ChEBI
CompTox Dashboard (EPA)
ECHA InfoCard100.215.986 Edit this at Wikidata
Chemical and physical data
FormulaC21H30O2
Molar mass314.464 g/mol g·mol−1
3D model (JSmol)
Melting point66 °C (151 °F)
  • Oc1c(c(O)cc(c1)CCCCC)[C@@H]2\C=C(/CC[C@H]2\C(=C)C)C
  • InChI=1S/C21H30O2/c1-5-6-7-8-16-12-19(22)21(20(23)13-16)18-11-15(4)9-10-17(18)14(2)3/h9,12-13,17-18,22-23H,2,5-8,10-11H2,1,3-4H3/t17-,18+/m0/s1 checkY
  • Key:ZTGXAWYVTLUPDT-ZWKOTPCHSA-N checkY
 ☒NcheckY (what is this?)  (verify)
Part of a series on
Cannabis
Cannabis
Chemistry
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Pharmacology
Consumption
Economics
Effects
Forms
Law
Variants
  • Genus
  • Species
Related

Cannabidiol (INNTooltip International Nonproprietary Name;[3] abbreviated as: CBD) is one of at least 113 cannabinoids identified in cannabis.[4][5] It is a major phytocannabinoid, accounting for up to 40% of the plant's extract.[6] CBD does not have intoxicating effects like those caused by tetrahydrocannabinol (THC) and may have a downregulating effect on disordered thinking and anxiety.[7][8]

Uses

Pain associated with multiple sclerosis

Nabiximols (USAN, trade name Sativex) is an aerosolized mist for oral administration containing a near 1:1 ratio of CBD and THC. The drug was approved by Canadian authorities in 2005 to alleviate pain associated with multiple sclerosis.[9]

Research

Addiction treatment

Systematic reviews of preliminary research showed cannabidiol had potential for improving tobacco and cannabis dependence, although as of 2016, they indicate limited high-quality evidence for anti-addictive effects in people.[10][11][12]

Epilepsy

A 2014 Cochrane review included four randomized controlled trials, but all were of poor quality, and no reliable conclusions could be made about the effect of cannabidiol on epilepsy from the review or from similar reports.[13][14][15] Cannabidiol is the active ingredient in Epidiolex, which was approved by the US Food and Drug Administration in June 2018 as a treatment for the rare forms of childhood epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.[16]

Anxiolytic

A 2016 review indicated that cannabidiol has potential as an anxiolytic for relief of anxiety-related disorders, such as PTSD, phobias, and fear.[8]

Adverse effects

Cannabidiol safety in humans has been studied in several small studies, suggesting that it is well-tolerated, but with tiredness, diarrhea and decreased appetite as common adverse effects.[17]

Interactions

There is preclinical evidence to suggest that cannabidiol may reduce THC clearance, modestly increasing THC's plasma concentrations resulting in a greater amount of THC available to receptors, increasing the effect of THC in a dose-dependent manner.[18][19] Despite this, the available evidence in humans suggests no significant effect of CBD on THC plasma levels.[20]

Pharmacology

Pharmacodynamics

Cannabidiol has very low affinity for the cannabinoid CB1 and CB2 receptors but acts as an indirect antagonist of these receptors.[21][22] It may potentiate THC's effects by increasing CB1 receptor density or through another CB1 receptor-related mechanism.[23] Cannabidiol may also extend the duration of the effects of THC via inhibition of the cytochrome P450, CYP3A and CYP2C enzymes.[24][unreliable source?]

Cannabidiol has been found to act as an antagonist of GPR55, a G protein-coupled receptor and putative cannabinoid receptor that is expressed in the caudate nucleus and putamen in the brain.[25] It has also been shown to act as a 5-HT1A receptor partial agonist,[26] and this action may be involved in the antidepressant,[27][28] anxiolytic,[28][29] and neuroprotective[30][31] effects of cannabidiol. It is an allosteric modulator of the μ- and δ-opioid receptors as well.[32] Cannabidiol's pharmacological effects have additionally been attributed to PPARγ agonism and intracellular calcium release.[6]

Research suggests that CBD may exert some of its pharmacological action through its inhibition of fatty acid amide hydrolase (FAAH), which may in turn increase the levels of endocannabinoids, such as anandamide, produced by the body.[6] It has also been speculated that some of the metabolites of CBD have pharmacological effects that contribute to the biological activity of CBD.[33]

Chemistry

Cannabidiol is insoluble in water but soluble in organic solvents such as pentane. At room temperature, it is a colorless crystalline solid.[34] In strongly basic media and the presence of air, it is oxidized to a quinone.[35] Under acidic conditions it cyclizes to THC.[36] The synthesis of cannabidiol has been accomplished by several research groups.[37][38][39]

Biosynthesis

Cannabis produces CBD-carboxylic acid through the same metabolic pathway as THC, until the next to last step, where CBDA synthase performs catalysis instead of THCA synthase.[40]

Cannabidiol and THC biosynthesis[41]

Isomerism

Cannabidiol numbering
Cannabidiol numbering
7 double bond isomers and their 30 stereoisomers
Formal numbering Terpenoid numbering Number of stereoisomers Natural occurrence Convention on Psychotropic Substances Schedule Structure
Short name Chiral centers Full name Short name Chiral centers
Δ5-cannabidiol 1 and 3 2-(6-isopropenyl-3-methyl-5-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ4-cannabidiol 1 and 3 4 No unscheduled
Δ4-cannabidiol 1, 3 and 6 2-(6-isopropenyl-3-methyl-4-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ5-cannabidiol 1, 3 and 4 8 No unscheduled
Δ3-cannabidiol 1 and 6 2-(6-isopropenyl-3-methyl-3-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ6-cannabidiol 3 and 4 4 ? unscheduled
Δ3,7-cannabidiol 1 and 6 2-(6-isopropenyl-3-methylenecyclohex-1-yl)-5-pentyl-1,3-benzenediol Δ1,7-cannabidiol 3 and 4 4 No unscheduled
Δ2-cannabidiol 1 and 6 2-(6-isopropenyl-3-methyl-2-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ1-cannabidiol 3 and 4 4 Yes unscheduled
Δ1-cannabidiol 3 and 6 2-(6-isopropenyl-3-methyl-1-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ2-cannabidiol 1 and 4 4 No unscheduled
Δ6-cannabidiol 3 2-(6-isopropenyl-3-methyl-6-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ3-cannabidiol 1 2 No unscheduled

Based on: Nagaraja, Kodihalli Nanjappa, Synthesis of delta-3-cannabidiol and the derived rigid analogs, Arizona University 1987.

See also: Tetrahydrocannabinol#Isomerism, Abnormal cannabidiol.

Society and culture

Food and beverage

KickBack Cold Brew CBD-infused cold brew and tea coffee at Jackson Market grocery store in Los Angeles, California.
CBD-infused cold brew coffee and tea at a grocery store in Los Angeles, California.

Similar to recreational marijuana, food and beverage items can be infused with CBD as an alternative means of ingesting the substance.[42] In the United States, a number of products are marketed as containing CBD, but in reality contain little or none.[43]

CBD-infused food is increasingly becoming commonplace in the United States, as natural grocers are now picking up food and beverage products with CBD in them.[44] However, some companies marketing CBD-infused food products with claims that are similar to the effects of prescription drugs have received warning letters from the Food and Drug Administration for making unsubstantiated claims.[45]

Natural sources

Selective breeding by growers in the USA dramatically lowered the CBD content of cannabis; their customers preferred varietals that were more mind-altering due to a higher THC and lower CBD content.[46] To meet the demands of medical cannabis patients, growers are currently developing more CBD-dominant strains.[47] The growth in popularity of CBD has resulted in further selective breeding by growers intended to increase the CBD levels and lower the THC levels. Today, most CBD products on the market are sourced from industrial hemp which is classified as cannabis containing no more than 0.3% THC by dry weight.[48]

U.S. Food and Drug Administration

The FDA has approved the first drug that contains purified cannabidiol derived from cannabis/hemp. It is the first drug approved for the treatment of patients with Dravet syndrome. The FDA granted Priority Review[49] designation for this application. Fast-Track[50] designation was granted for Dravet syndrome. A designation of Orphan Drug[51] was granted for both the Dravet syndrome and Lennox-Gastaut syndrome indications. GW Research Ltd.[52] was given the FDA approval of Epidiolex.

Non-psychoactivity

CBD does not appear to have any psychoactive ("high") effects such as those caused by ∆9-THC in marijuana, but may have anti-anxiety and anti-psychotic effects.[7] As the legal landscape and understanding about the differences in medical cannabinoids unfolds, it will be increasingly important to distinguish "medical marijuana" (with noted varying degrees of psychotropic effects and deficits in executive function) – from "medical CBD".[7][53]

Various breeds/strains of "medical marijuana" are found to have a significant variation in the ratios of CBD-to-THC and are known to contain other non-psychotropic cannabinoids.[54] However it is only the amount of ∆9-THC that chemically gives a legal determination as to whether the plant material(s) used for the purposes of extracting CBD are considered hemp, or considered marijuana.[citation needed]

Any psychoactive marijuana, regardless of its CBD content, is derived from the flower (or bud) of the genus Cannabis. Non-psychoactive hemp (also commonly-termed industrial hemp), regardless of its CBD content, is any part of the cannabis plant, whether growing or not, containing a ∆-9 tetrahydrocannabinol concentration of no more than three-tenths of one percent (0.3%) on a dry weight basis. Certain standards are required for legal growing, cultivating and producing the hemp plant. The Colorado Industrial Hemp Program registers growers of industrial hemp and samples crops to verify that the THC concentration does not exceed 0.3% on dry weight basis.[55]

United Nations

Cannabidiol is not scheduled by the Convention on Psychotropic Substances.

United States

In the United States, cannabidiol is a Schedule I drug under the Controlled Substances Act.[56] This means that production, distribution and possession of CBD is illegal under federal law. In 2016, the Drug Enforcement Administration added "marijuana extracts" to the list of Schedule I drugs, which it defined as "an extract containing one or more cannabinoids that has been derived from any plant of the genus Cannabis, other than the separated resin (whether crude or purified) obtained from the plant."[57] Previously, CBD had simply been considered "marijuana", which is also a Schedule I drug.[56][58] In June 2018, the FDA approved oral use of CBD as an anti-seizure drug in treating rare types of childhood epilepsy.[16]

A CNN program that featured Charlotte's Web cannabis in 2013 brought increased attention to the use of CBD in the treatment of seizure disorders.[59][60] Since then, 16 states have passed laws to allow for the use of CBD products (not exceeding a specified concentration of THC) for the treatment of certain medical conditions.[61] This is in addition to the 30 states that have passed comprehensive medical cannabis laws, which allow for the use of cannabis products with no restrictions on THC content.[61] Of these 30 states, eight have legalized the use and sale of cannabis products without requirement for a doctor's recommendation.[61]

Although most states restrict the use of CBD products to certain medical conditions, manufacturers of CBD claim their products are derived from industrial hemp, and therefore legal for anyone to use.[62] A number of these manufacturers ship CBD products to all 50 states, which the federal government has so far not intervened in.[63][64] CBD is also openly sold in head shops and health food stores in some states where such sales have not been explicitly legalized.[62][65]

Australia

Prescription medicine (Schedule 4) for therapeutic use containing 2 per cent (2.0%) or less of other cannabinoids commonly found in cannabis (such as ∆9-THC). A schedule 4 drug under the SUSMP is Prescription Only Medicine, or Prescription Animal Remedy – Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.[66]

New Zealand

Cannabidiol is currently a class B1 controlled drug in New Zealand under the Misuse of Drugs Act. It is also a prescription medicine under the Medicines Act. In 2017 the rules were changed so that anyone wanting to use it could go to the Health Ministry for approval. Prior to this, the only way to obtain a prescription was to seek the personal approval of the Minister of Health.

Associate Health Minister Peter Dunne said restrictions would be removed, which means a doctor will now be able to prescribe cannabidiol to patients.[67]

Canada

Cannabidiol is a Schedule II drug in Canada. As such, it is only available with a prescription.[68] It is available as a spray, called Sativex produced by GW Pharmaceuticals in the UK, for use in multiple sclerosis. The Canadian Government announced that October 17, 2018 is the date when marijuana can be consumed recreationally without criminal penalties,[69] indicating that various cannabidiol products will be freely available to adult consumers.

Europe

Cannabidiol is listed in the EU Cosmetics Ingredient Database (CosIng).[70] However, the listing of an ingredient, assigned with an INCI name, in CosIng does not mean it is to be used in cosmetic products nor approved for such use.[71]

Cannabidiol is listed in the EU Novel Food Catalogue.[72] This listing only applies to isolated or synthetic CBD, not to crude hemp extracts or tinctures naturally containing CBD.

The European Industrial Hemp Association has issued a position paper suggesting regulatory framework in EU.[73]

Several industrial hemp varieties can be legally cultivated in western Europe. A variety such as "Fedora 17" has a cannabinoid profile consistently around 1% cannabidiol (CBD) with THC less than 0.1%.[74]

Although the World Health Organization listed Cannabidiolum in a list of International Nonproprietary Names for Pharmaceutical Substances (INN) on 30 June 2016. French and Spanish versions wrongly mention agonist action of CBD on cannabinoid receptors while the English version says CBD is a cannabinoid receptor antagonist.[citation needed]

Sweden

CBD is not classified in Sweden.

Sativex (CBD and THC) is a prescription product available for relief of severe spasticity due to multiple sclerosis.[75][76]

United Kingdom

Cannabidiol, in an oral-mucosal spray formulation combined with delta-9-tetrahydrocannabinol, is a prescription product available for relief of severe spasticity due to multiple sclerosis (where other anti-spasmodics have not been effective).[77]

As of 31 December 2016, products containing cannabidiol that are marketed for medical purposes are classed as medicines by the UK regulatory body, the Medicines and Healthcare products Regulatory Agency (MHRA) and cannot be marketed without regulatory approval for the medical claims.[78]

Switzerland

While THC remains illegal, CBD is not subject to the Swiss Narcotic Acts because this substance does not produce a comparable psychoactive effect.[79] Cannabis products containing less than 1% THC can be sold and purchased legally.[80]

See also

References

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