Many drugs are developed not because there's a great medical need, but rather there's big money to be made from them. In many cases, holistic therapies and medicines already exist that can take the place of any number of synthetic pharmaceuticals. Cannabis is one such therapy and it's time to ask questions and look at a new way of thinking about this plant, Dr Margaret Gedde, MD, PhD, Gedde Whole Health, Colorado, US, and the Clinicians' Institute of Cannabis Medicine, said. A wealth of research shows cannabis does indeed have outstanding promise as a medicinal plant, largely due to its cannabidiol (CBD) content. Cannabinoids interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body. There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system and more. Both the therapeutic and psychoactive properties of cannabis occur when a cannabinoid activates a cannabinoid receptor. About two years ago, Dr Gedde received her first request from a parent who wanted to use the high-CBD, low-Δ9-tetrahydrocannabinol (THC) form of cannabis for her child's epileptic seizures.
"I went ahead with that and started to learn about what this could do. Now, two years later, the news that cannabis is a therapy for epilepsy has reached the world. We're very committed to gather ongoing information about what's happening with these children and to get this information out to other physicians in a way that they can use and understand. We want to generate high-quality, publishable data from practice and our experience. We want to help people understand the background and the scientific basis of what cannabis can do and really start to understand that it's a medicine and bring it into what we have as medicine," she says.
|THC and CBD molecules, showing their extremely close resemblance|
- the 'drug' or other substance has a high potential for abuse,
- As a constituent of cannabis, the substance would be captured by the entry for cannabis in Schedule 9 (Prohibited Substance).
- CBD may also be a constituent of hemp seed oil ... defined as oil obtained by cold expression from ripened fruits (seeds) of Cannabis sativa and exempted from scheduling provided the oil contains 50 mg/kg or less of THC and is labelled with the warning statement: "Not for internal use" or "Not to be taken".
- CBD is mentioned in Schedule 8 (Controlled Drug) entry for 'nabiximols'* (defined as containing a range of cannabinoids including both THC and CBD).
Across the US there's no doubt that CBD needs to be rescheduled, as current scheduling is blatantly wrong. In Australia, an interim decision (on matters referred to an expert advisory committee, November 2014) to reschedule CBD (Schedule 4 - Prescription Only Medicine and Schedule 8 - Controlled Drug) was recommended by the Therapeutic Goods Administration (TGA) to be implemented 1 June 2015.
How Does Cannabis Compare to Prescription Drugs?
A number of prescription drugs are well known to be dangerous. Pharmaceuticals in general are among the leading causes of death in the US and some drugs have killed tens of thousands of individuals. The painkiller Vioxx is one classic example that killed over 60,000 before being pulled off the market. In Australia the Royal Australian College of General Practitioners (RACGP) and the Pharmaceutical Society of Australia (PSA) had called upon Federal and State governments to implement a national Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, after a Victorian coroner warned legal drugs were killing more people than illicit drugs or alcohol.
According to Dr Gedde, cannabis is certainly far safer than most prescription drugs and there's enough information to compare it against the known toxicities of many drugs currently in use. This includes liver and kidney toxicity, gastrointestinal damage, nerve damage and, of course, death. Moreover, CBD and other cannabis products often work when other medications fail, so not only are they generally safer, cannabis preparations also tend to provide greater efficacy. As noted by Dr Gedde:
Cannabis for Seizure Control in Children
In Dr Gedde's experience, about 25% of children experience a rapid reduction in seizures when given cannabis oil, sometimes within days, or weeks. But results do vary, and not every child will respond well in the immediate term. She notes that some children are so sensitised to medications that they need to start at a very low dose, and give it plenty of time to work.
The main objection of paediatricians at the Children's Hospital in Denver to using CBD in children, even for conditions like uncontrolled seizures, is that there are no studies in children of potential harms of long-term use of CBD. There might be long term adverse effects of CBD and other cannabinoids that we will only come to discover later.
"This is a good point in my view, and a reason not to suggest use of CBD as a dietary supplement or as a general 'health tonic' for children", Dr Gedde says. "In my view, it is important to weigh the use of a therapy, including potential risks not known, against the risks of the uncontrolled illness itself and of other therapies in use. For many patients, even with incomplete information about CBD, weighing those risks including known toxic effects of their current therapies does point to at least a therapeutic trial with CBD being a good choice."
According to Dr Gedde the main side effect you need to watch out for is the psychotropic effects of THC. However, she also stresses that THC actually has many valuable medical benefits, so depending on your problem, you may want higher or lower levels of THC. For example, in patients who suffer with severe pain, where the perception of pain causes great distress, the psychotropic effects of THC allows the patient to shift their perception of the pain in their mind and body.
Cannabis use in Australia is illegal no matter where you reside. State governments have promised trials of medical cannabis before the current plethora of purported 'medical cannabis' trials. The NSW Legislative Council, General Purpose Standing Committee No. 4 on 'The use of cannabis for medical purposes' recommended in May 2013
But for parents of children with intractable epilepsy it could be a case of too little too late and what parent could be blamed for risking that? One such parent, David Stevens writes;
GROW IT, MAKE IT, ADMINISTER IT!
As reported in The US National Library of Medicine (type the words 'cannabis epilepsy' in the search field and it will return nearly 800 very current results), one scientific study from 2010, Cannabidiol Displays Antiepileptiform and Antiseizure Properties In Vitro and In Vivo, states;
"Plant-derived cannabinoids (phytocannabinoids) are compounds with emerging therapeutic potential. Early studies suggested that cannabidiol (CBD) has anti-convulsant properties in animal models and reduced seizure frequency in limited human trials. CBD (100 mg/kg) exerted clear anti-convulsant effects with significant decreases in incidence of severe seizures and mortality ... Finally, CBD acted with only low affinity at cannabinoid CB1 receptors and displayed no agonist activity. These findings suggest that CBD acts, potentially in a CB1 receptor-independent manner, to inhibit epileptiform activity in vitro and seizure severity in vivo. Thus, we demonstrate the potential of CBD as a novel anti-epileptic drug in the unmet clinical need associated with generalised seizures".
Another study from 2013, Cannabidivarin (CBDV) suppresses pentylenetetrazole (PTZ)-induced increases in epilepsy-related gene expression, states;
"To date, anti-convulsant effects of the plant cannabinoid, CBDV, have been reported in several animal models of seizure. To examine changes to epilepsy-related gene expression following chemical convulsant treatment and their subsequent control by phytocannabinoid administration, we behaviourally evaluated effects of CBDV. Consistent with previous findings, CBDV significantly decreased PTZ-induced seizure severity and increased latency to the first sign of seizure. These results provide the first molecular confirmation of behaviourally observed effects of the non-psychoactive, anti-convulsant, cannabinoid, CBDV, upon chemically-induced seizures and serve to underscore its suitability for clinical development".
My personal opinion as an outsider looking in (I don't have a child with intractable epilepsy, thankfully) is that I would move mountains to help my child and these parents should never be criminalised for helping their sick and suffering children, never - the law is wrong in Australia and needs changed, now, not later, as later will be too late for some; and who would want that on their conscience? Exactly how much unnecessary paediatric poly pharmacy is involved with this disease alone is anyone's guess, but read on to learn just some of the nasty side-effects these real drugs have ...
Common Seizure Medication Side Effects Seizure medications work on the central nervous system. Most cause some degree of drowsiness or dizziness, at least at the beginning of therapy. Also, most anti-seizure medications can induce suicidal thoughts or actions and/or bring on or worsen depression. Seizure medications have a variety of possible side effects. The following is a list of potential side effects of different classes of seizure medications.
Benzodiazepines (Valium, Ativan, Klonopin, Onfi): Dependence, Possible severe seizures on sudden withdrawal, Respiratory depression, Increased risk of glaucoma, Liver injury
Carbamazepine (Tegretol) and related drugs: Upset stomach, Serious (even fatal) skin reactions, Serious blood disorders, Reduced sodium levels (oxcarbazepine)
Ethosuximide (Zarontin) and derivatives: Serious blood disorders
Ezogabine/Retigabine (Potiga): Potentially irreversible eye damage, Potentially irreversible skin discolouration
Felbamate (Felbalol): Liver failure, Potentially fatal anaemia (aplastic anaemia)
Lacosamide (Vimpat): Skin rash, Changes in heartbeat with possible fainting, Drug dependence
Lamotrigine (Lamictal): Serious rash, Stomach problems, Difficulty sleeping
Levetiracetam (Keppra, Keppra XR): Flu-like symptoms, Changes in behaviour, Changes in blood count
Perampanel (Fycompa): Severe changes in mood and behavior, including hostility, aggression, suicidal thoughts, Weight gain, Drug dependence
Phenobarbital and derivatives:
Phenytoin (Dilantin): Body hair growth, Birth defects,
Pregabalin (Lyrica): Swelling of hands and feet, Trouble concentrating, Weight gain
Rufinamide (Banzel): EKG changes, Interference with oral contraceptives
Tiagabine (Gabitril): Tremour, Agitation, Seizures in non-epilepsy patients
Topiramate (Topamax): Increased risk for glaucoma, Trouble concentrating, Decreased sweating, Increase in body temperature
Valproic acid and derivatives (Depakene, Depakote): Stomach upset, Temporary loss or thinning of hair, Toxicity to liver, Weight gain, Birth defects
Vigabatrin (Sabril): Irreversible visual problems, including reductions in acuity and colour differentiation
Zonisamide (Zonegran): Kidney stones, Rise in body temperature, Metabolic acidosis
expanded from Cannabis for the Treatment of Epilepsy and More
with additional information from Granny Storm Crow's List 2015, Google Scholar
funded NPS MedicineWise