CBD use in medicine

The controversy regarding the benefits of medical cannabis and especially the use of the plant extracts in children is ongoing. In most countries worldwide cannabis, whether medicinal or not, is currently illegal. Still, the use of medical cannabis is growing, especially in countries such as Belgium, Canada, Australia, Netherlands and some US states (Behere et al., 2017). 

Today, many commercial companies offer products consisting of medical cannabis extracts. These products differ in their administration mode (e.g. edible products, smokeable products, inhaled products, oil products for oral intake etc.) as well as in their cannabinoid extract content, as the content ratios of THC and CBD vary. 

Several trials showed beneficial effects of medical cannabis use in different illnesses. For example, The National Academy of Sciences, Engineering and Medicine claims that there is substantial evidence for the effectiveness of cannabis in the treatment of chronic pain in adults, as well as moderate evidence for improvement of short-term sleep disturbances in patients with chronic pain (Romero-Sandoval et al., 2018). Also, cannabinoids are currently used to reduce weight loss, emesis and pain that often accompany cancer. In addition, several cannabinoids have been shown to exert anti-proliferative and pro-apoptotic effects in various cancer types, both in vitro and in vivo (Massi et al., 2013). 

In epilepsy, there is an increase in the demand to treat children and adults who suffer from treatment resistant seizures with medical cannabis. Surveys conducted among parents of children suffering from epilepsy suggest improvement following treatment with CBD-enriched cannabis extracts. These results however, do not necessarily apply when it comes to treating adults with epilepsy (Alexander et al., 2009). Still, in a retrospective study that examined the effect of CBD enriched medical cannabis oil on children with intractable epilepsy, the treatment caused a reduction in seizure frequency in 89% of patients (Tzadok et al., 2016). 

Epilepsy is common (20-30%) in ASD and is more prevalent in individuals with autism-like behavior resulting from particular genetic predispositions (e.g. Angelman syndrome, Rett syndrome, Dup15q syndrome, etc.)(Gu, 2017). In a pre-clinical study that tested the efficacy of CBD in a mouse model for Dravet Syndrome, a severe childhood epilepsy disorder, CBD effectively reduced both seizures and autism-like behaviors (J. S. Kaplan et al., 2017). In a clinical trial among patients who suffer from Dravet syndrome, cannabidiol treatment resulted in a greater reduction in convulsive- seizure frequency than placebo, but was associated with higher rates of adverse events (Nabbout et al., 2017). In a clinical study on Sturge-Weber Syndrome patients, chronic treatment of CBD decreased seizures significantly and improved quality of life (E. H. Kaplan et al., 2017). In an online survey, parents of children with infantile spasms (IS) and Lennox-Gastaut syndrome (LGS) reported a reduction in seizures frequency in 85% of the cases, while 14% reported complete seizure cessation after administration of CBD-enriched cannabis preparations (Hussain et al., 2015). The U.S. Food and Drug Administration (FDA) recently approved Epidiolex, a CBD based oral solution, for the treatment of seizures associated with the two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older (“FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy,” 2018) 

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