Authored by Kylie Huber
Art by Flavia Scott
Since the 2018 Agriculture Improvement Act – in which the FDA removed hemp and hemp’s derivative cannabidiol from the Controlled Substances Act – there has been little regulatory oversight by the FDA on cannabidiol (CBD), resulting in mounting pressure from the public and Congress on the FDA to provide a streamlined set of regulations. [1] The lack of clear directives has resulted in a boom of recreational marijuana startups that flout false medical claims: marketing statements in the past have claimed CBD itself can treat Alzheimer’s disease, autism, and cancer.
Additionally, many suppliers sell mislabeled products. In a publication by the Journal of the American Medical Association, only 30.95% of CBD products claiming to have solely CBD in them were labeled correctly. [2] Furthermore, a 2015 Johns Hopkins study revealed that CBD products, on average, had a 36-1 TCH-CBD ratio, despite the fact that the products themselves were advertised as solely pain-relieving CBD products. [3] There was only one product out of the 44 found to have a 1-1 THC to CBD ratio – a ratio that has been connected to fewer negative side effects.
Thus, the agency’s recent call to Congress in January 2023 to create a coordinated effort toward more comprehensive enforcement activity demonstrates a shift in its priorities. I will be framing this new announcement by the FDA around CBD’s role in treating substance-use disorder. The FDA’s greater involvement in cannabis regulation, particularly in the instantiation of a lower THC-CBD ratio in marijuana products, would ultimately be a significant and steady start to proper knowledge and usage about the benefits of cannabidiol.
While the aforementioned advertising claims that CBD products can cure entire neurodegenerative diseases are false and far-fetched, new scientific research has revealed CBD’s benefits as an intervention for addiction and addictive behaviors. In a study done by the Department of Psychiatry at the Université de Montréal [4], CBD was shown to be a fatty acid amine hydrolase inhibitor, meaning it has the potential to serve as a therapeutic agent, and has been connected to certain neural circuits that form addictive behaviors.
After conducting a literature search, the Montreal researchers found a study that showed significant effects of cannabidiol on opioid addiction and its subsequent addictive behaviors, particularly during the relapse phase of opioid addiction [5]. More specifically, in a rat study, CBD curbed conditioned heroin-seeking behavior for at most two weeks following the last administration, with no impacts to motor function. Studies like these are ultimately important to understanding the possibilities and limitations of cannabidiol in opioid-addiction recovery during phases of relapse.
In human studies, the outcomes are even clearer. Crippa et al conducted a study in which a female with cannabis dependence – initially using cannabis 7 days a week – was given CBD for eleven days at gradually increasing increments. Her daily assessments revealed a rapid decrease in withdrawal symptoms. She had a score of zero by day 6 on tests including Marijuana Withdrawal Symptom Checklist and the Beck Anxiety Inventory [6]. When she did eventually relapse, cannabis usage was far less frequent at a rate of once or twice a week. In a similar study, Morgan et al gave samples with either high or low CBD to THC ratios to patients with a history of marijuana-related addictive behaviors. Patients reported that samples with a high CBD to THC ratio gave lower ratings of their experienced enjoyment for the stimuli induced by cannabis after receiving treatment from cannabidiol.
With cannabis addiction itself, cannabidiol had benefits within patients’ withdrawal and relapse phases. These have been rudimentary reports, with interest in the area increasingly growing. Nevertheless, they are still compelling given that there are not many available medications for addictive behaviors with cannabis.
The movement by the FDA to create a more informed and standardized set of policies regarding CBD products – ones that are different from the existing ones imposed on caffeine or sugar – would help not only the advancement of proper scientific research but also people in their daily lives. A more robust approach to CBD product advertising would reduce unfair loss of employment via drug tests. For example, in October 2012, a truck driver tested positive for THC on a drug test, despite being told by a CBD product manufacturer that the product he purchased and consumed had no THC [7].
The FDA’s 2023 announcement has the potential for positive movement forward in productive use of cannabidiol. More specifically, its enhanced communication with Congress paves the way for greater federal support for CBD research to see the extent of its medical benefits. This has already been shown with Congress’s first discrete passage of cannabis related changes in its Medical Marijuana and Cannabidiol Research Expansion Act in December 2022 [8]. This act would alleviate federal restrictions on medical cannabis research.
While January’s Congressional announcement at first glance seems to target a small, specific industry, its impacts on American public health are vast. The impacts of pandemic isolation on mental health and substance abuse have been staggering. After 2020, 25.4% of illegal drug users had a drug disorder [9], and in the same year, 32.1% of adults in the United States experienced a mental health condition and substance abuse concurrently [10]. Thus, greater attention by Congress and the FDA serves as a path forward toward a solution for a nationwide addiction and mental health crisis.
Works Cited
Kaplan, S. (2019, May 31). Cannabis Companies Push F.D.A. to Ease Rules on CBD Products. The New York Times. https://www.nytimes.com/2019/05/31/health/cannabis-fda-regulate.html
Evans, D. G. (2020, October). Medical Fraud, Mislabeling, Contamination: All Common in CBD Products. Missouri Medicine 117(5), 395. https://www.dalgarnoinstitute.org.au/images/resources/pdf/cannabis-conundrum/CannabisNationalReview-Missouri_Medicine_2020_w_Cover.pdf
Evans, D. G. (2020, October). Medical Fraud, Mislabeling, Contamination: All Common in CBD Products. Missouri Medicine 117(5), 395-396. https://www.dalgarnoinstitute.org.au/images/resources/pdf/cannabis-conundrum/CannabisNationalReview-Missouri_Medicine_2020_w_Cover.pdf
Prud’homme, M. et al. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Sage Journals 9, 34. https://journals.sagepub.com/doi/10.4137/SART.S25081
Prud’homme, M. et al. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Sage Journals 9, 35. https://journals.sagepub.com/doi/10.4137/SART.S25081
Prud’homme, M. et al. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Sage Journals 9, 36. https://journals.sagepub.com/doi/10.4137/SART.S25081
Evans, D. G. (2020, October). Medical Fraud, Mislabeling, Contamination: All Common in CBD Products. Missouri Medicine 117(5), 398. https://www.dalgarnoinstitute.org.au/images/resources/pdf/cannabis-conundrum/CannabisNationalReview-Missouri_Medicine_2020_w_Cover.pdf
Malyshev, A., & Ganley, S. (2023, January 19). Cannabis Industry looks ahead to 2023 after facing Challenges in 2022. Reuters. https://www.reuters.com/legal/litigation/cannabis-industry-looks-ahead-2023-after-facing-challenges-2022-2023-01-19/
(2023, January 1). Substance abuse and addiction statistics [2023]. National Center for Drug Abuse Statistics. Retrieved April 23, 2023, from https://drugabusestatistics.org/
Duszynsky-Goodman, L. (2023, March 9). Mental Health Statistics. Forbes. https://www.forbes.com/health/mind/mental-health-statistics/
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