To her credit, Nora Volkow, head of NIDA, published an op-ed in support of CBD research. It’s just that it doesn’t erase responsibility for standing in the way of medical progress this entire time. While it’s a remarkably reasonable document for having been written by the head of NIDA, it’s still insidious in a few places.
The fact that chemicals in marijuana can speak the body’s chemical language (and cause both beneficial and harmful effects) is not surprising and does not make marijuana special. Many plants, including the opium poppy, tobacco, and coca are similar in that regard. Extracting and amplifying the medicinal benefits of such plants and minimizing their potential harms can lead the way to effective medications, but are also a major scientific challenge.
In marijuana’s case, future medicinal uses will most likely lie in drugs based on cannabinoid chemicals or extracts with defined concentrations that can be reliably produced. There are very few precedents for a whole plant being approved as a drug (only two “botanical drugs” are currently approved in the U.S.). This is because creating a standardized plant medicine poses major difficulties — especially in a case like marijuana where there are countless, widely varying strains and large numbers of chemical components about which little is yet known. Marijuana has over 500 chemicals in total, including the 100 or so cannabinoids, so we will still be learning about this plant for years to come. However, we are quickly learning a lot about THC and CBD, and because of its unique properties, CBD, especially, may be poised to make great inroads into our pharmacopoeia.
Other plants that “speak the body’s chemical language” include lemons, black pepper, cinnammon, hops, lemongrass, oregano, nutmeg, and tea. Things that are fed to children in large amounts. She’s relying on the fact that the public has no deep understanding of biochemistry to put everything in context.
It’s an unstated assumption that precise dosing is necessary for something to be medically useful. Coffee, tea, alcohol, and cocaine are all used in indeterminate quantities. “Strong” and “weak” is precise enough for people to titrate their doses. Do we have specific reasons for believing that people might consume “too much CBD” in a way that’s dangerous? A gram of high-CBD CO2 extract might contain 600 mg of CBD, and last someone a month. Research studies with CBD administer that amount in a single dose, and it’s well-tolerated. People will smoke until it’s not hurting anymore, then stop.
There are very few precedents for a whole plant being approved as a drug, but that’s not a justification one way or another. She’s not presenting any evidence that restocking with different strains of high-CBD cannabis every month is a dangerous practice. People do that all the time, and many of them probably enjoy the variety. It sounds scarier to say “500 chemicals.” While it’s true that there’s a lot we don’t know about all of those chemicals, it’s also true that people have been eating and smoking them in large amounts for thousands of years. They all lived. We don’t have to know how something works to know that it works (including standard psychiatric medications). In fact, the disadvantage of standardized extracts is that same thing: we don’t know everything about how cannabis works. CBD, myrcene, and pinene counter-act some of the disadvantages of THC. Smoking a mixture of those chemicals is better than THC by itself. The idea that we want the most selective drugs possible is scientifically outdated. Instead, we have the “entourage effect.”
This review will explore another echelon of phytotherapeutic agents, the cannabis terpenoids: limonene, myrcene, α-pinene, linalool, β-caryophyllene, caryophyllene oxide, nerolidol and phytol. Terpenoids share a precursor with phytocannabinoids, and are all flavour and fragrance components common to human diets that have been designated Generally Recognized as Safe by the US Food and Drug Administration and other regulatory agencies. Terpenoids are quite potent, and affect animal and even human behaviour when inhaled from ambient air at serum levels in the single digits ng·mL(-1) . They display unique therapeutic effects that may contribute meaningfully to the entourage effects of cannabis-based medicinal extracts. Particular focus will be placed on phytocannabinoid-terpenoid interactions that could produce synergy with respect to treatment of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus). Scientific evidence is presented for non-cannabinoid plant components as putative antidotes to intoxicating effects of THC that could increase its therapeutic index.
Marijuana has so much good stuff in it that the safest bet is to just smoke all of it. You wouldn’t want to miss out on any of the benefits.
The thought that someone, somewhere is smoking unstandardized plants to improve their lives, without asking for permission, keeps people like Nora Volkow up at night. Dealing with anxiety by controlling people on a large scale is probably less healthy than just getting high.