Abstract
This short communication examines the question whether the experimental data presented in a study by Merrick et al. are of clinical relevance. These authors found that cannabidiol (CBD), a major cannabinoid of the cannabis plant devoid of psychotropic effects and of great interest for therapeutic use in several medical conditions, may be converted in gastric fluid into the psychoactive cannabinoids delta-8-THC and delta-9-THC to a relevant degree. They concluded that “the acidic environment during normal gastrointestinal transit can expose orally CBD-treated patients to levels of THC and other psychoactive cannabinoids that may exceed the threshold for a positive physiological response.” They issued a warning concerning oral use of CBD and recommend the development of other delivery methods. However, the available clinical data do not support this conclusion and recommendation, since even high doses of oral CBD do not cause psychological, psychomotor, cognitive, or physical effects that are characteristic for THC or cannabis rich in THC. On the contrary, in the past decades and by several groups, high doses of oral CBD were consistently shown to cause opposite effects to those of THC in clinical studies. In addition, administration of CBD did not result in detectable THC blood concentrations. Thus, there is no reason to avoid oral use of CBD, which has been demonstrated to be a safe means of administration of CBD, even at very high doses.
Highlights
Cannabidiol (CBD) is a cannabinoid of the cannabis plant devoid of intoxicating effects
Recently Merrick et al.[2] conducted an experimental in vitro study, which demonstrated that CBD rapidly cyclizes to THC in an acidic environment such as in the stomach. They concluded that patients treated with oral CBD may be exposed to significant levels of THC, which may cause unwanted psychological effects, and suggest that other delivery methods such as transdermal-based applications, which decrease the potential for formation of psychoactive cannabinoids, should be explored
A double-blind study with 42 patients diagnosed with schizophrenia or schizophreniform disorder conducted at the University of Cologne showed that oral CBD (800 mg daily) significantly reduced psychotic symptoms after 2–4 weeks of treatment and induced fewer side effects, such as extrapyramidal symptoms, increased prolactin levels, and weight gain, compared with amisulpride.[15]
Summary
Cannabidiol (CBD) is a cannabinoid of the cannabis plant devoid of intoxicating effects. The efficacy and safety of CBD on Parkinson’s disease patients with psychotic symptoms were studied in a 4-week open trial.[14] A flexible oral dose of CBD, ranging from 150 to 400 mg/day in the last week, plus patients’ usual treatments showed that psychotic symptoms were significantly reduced, cognitive and motor symptoms were not affected by the cannabinoid, and no serious side effects were reported. A double-blind study with 42 patients diagnosed with schizophrenia or schizophreniform disorder conducted at the University of Cologne showed that oral CBD (800 mg daily) significantly reduced psychotic symptoms after 2–4 weeks of treatment and induced fewer side effects, such as extrapyramidal symptoms, increased prolactin levels, and weight gain, compared with amisulpride.[15] No relevant cardiovascular or THC characteristic psychological effects were noted. Patients responded well to reduction of clobazam dosage with no change in CBD.[18]
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