cbd oil dosage for lupusDecember 15, 2021
Marijuana growers focus on strains and techniques that increase THC levels. Cannabis that's grown for hemp tends to have a lot more CBD than THC.
With a lack of research on CBD oil for lupus, we have to go on what we know about CBD in general and can understand from research into conditions with similar symptoms or pathology. This potential treatment is likely to get attention from lupus researchers eventually, though, for several reasons.
A lot of pro-marijuana websites have long claimed that it's legal in all 50 states as long as it doesn't have more than 0.3% THC. They based that argument on the provisions of a specific farm bill. But in 2018, the 9th Circuit Court of Appeals ruled that the old bill didn't apply to hemp or products derived from it.
What Is CBD Oil?
CBD oil is used to treat a host of different conditions, although it's not approved for any of these conditions, as of mid-2018:
We probably don't yet know all of the possible side effects of CBD. Some side effects that have been reported are:
Technically, federal law overrules state law. However, that doesn’t mean those states will stop arresting and trying people for CBD use, especially if they want to challenge the new federal law. If you’re in one of those states, talk to an expert about any possible trouble you could get into for using CBD products. The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
In states where marijuana and/or CBD is legal, there's no longer a clash between state and federal law, so the products are legally safe to use. Still, some states have specific laws on the books banning hemp products. So what does the Farm Bill mean for those states?
Lupus can include pain from neuropathy (nerve damage), and multiple studies suggest that CBD can alleviate that type of pain from diabetes, HIV, and other sources.
Treatment decisions should never be taken lightly, and that applies to "natural" treatments like CBD as well—especially when you take the law into account. Consider the pros and con carefully, and be sure to discuss this option with your healthcare provider. As with any treatment, it's important to watch for side effects.
CBD Side Effects.
So far, we don't have conclusive evidence that CBD oil can safely treat lupus, but research is currently being conducted to help make this possible.
It's too early in the research process for us to be able to say "yes" about many of the claims. However, we're learning enough to be able to say "it's possible," or even, "we think so."
When it comes to taking CBD oil, you have a lot of options: smoking, taking capsules, drops or sprays under the tongue, and as a topical ointment. Research in the United States is in the early stages, though, since for decades, legal restrictions made it extremely difficult to study the medical benefits of marijuana.
CBD doesn't appear to lead to addiction or abuse. It's also believed to have a low toxicity level, which means it takes a lot to cause an overdose.
Is CBD Legal?
You'd think the question of whether CBD is legal would get a straightforward, yes or no answer, but the legality issue can be confusing.
CBD is short for cannabidiol. While it comes from cannabis, it doesn't get you high because it doesn't have psychoactive properties. The high comes from a different chemical in the plant called THC (tetrahydrocannabinol).
If you look online, you can find a lot of claims about using CBD oil for medicinal purposes. Claims are so glowing, in fact, that you might start to wonder if they can possibly be true. Certainly, when they come from websites that promote marijuana legalization and use, you may be wise to question the veracity.
The World Health Organization says CBD oil may also:
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist.
This is why he’s exploring a candidate for a new lupus treatment option: a molecule with a cannabinoid template structure that binds to cannabinoid receptors, the same receptors involved in the chemicals found in the marijuana plant.
So, our bodies have their own endocannabinoid system, but cannabinoids can also be found in nature, most abundantly in the marijuana plant. The two most well-known types of cannabinoids in the marijuana plant are THC (tetrahydrocannabinol) and CBD (cannabidiol). THC binds to both the CB1 and CB2 receptors, but the CB1 receptor seems to be responsible for many of the well-known psychoactive effects of marijuana, such as euphoria, increased heart rate, slower reaction times, and red eyes. CB2 receptor binding results in the production of a series of proteins that reduce inflammation. (These proteins are called “resolvins” because they appear to resolve inflammation.) The pharmacology of CBD at cannabinoid receptors is complex and highly variable, but CBD has been shown to activate the endocannabinoid system.
Dr. Koumpouras’ excitement over the new drug comes at a time when products containing CBD have flooded supermarkets, labeled with claims that they treat everything from back pain to insomnia. Although CBD is not yet approved by the FDA, the hype around it stems from the popularity of the marijuana plant it is derived from.
What is CBD?
What these cannabinoids do when they bind to the receptors depends on which receptor is activated, and thus can produce effects ranging from the firing of neurotransmitters (the chemical messengers sent from the brain to the rest of the body) that alter mood, to reducing inflammation and promoting digestion.
Dr. Koumpouras learned from a colleague of ajulemic acid, a side-chain analog of Δ8-THC-11-oic acid, which was designed as a potent therapeutic agent free of the psychotropic adverse effects typical of most cannabinoids. This molecule may help relieve pain and reduce inflammation in systemic lupus erythematosus (SLE), the most common type of lupus. “Reducing inflammation is crucial for patients with lupus because it is what causes the buildup of scar tissue in vital organs that can eventually lead to their deterioration and malfunction,” he says. This cannabinoid molecule was already in study for other diseases, including systemic sclerosis and dermatomyositis.
But these questions are why Dr. Koumpouras is focusing on a compound that, until recently, few have studied.
But whether CBD actually provides those benefits in a significant way remains to be seen. Only a few studies—small ones—have definitively proven the effectiveness of medicines that involve the endocannabinoid system. To date, the only FDA-approved medication containing CBD is Epidiolex, a medication used to treat two rare forms of severe epilepsy—Lennox-Gastaut syndrome and Dravet syndrome, both which begin mostly in infancy and early childhood. In a group of three clinical trials, Epidiolex seemed to reduce the number of seizures significantly. And yet, Vinita Knight, MD, a Yale Medicine pediatric neurologist, says her patients who take Epidiolex have had mixed results. Some have had reductions in seizures and others haven’t shown much improvement. “We’re not seeing as much success as what’s been reported on Facebook and Twitter,” she says, but adds that so far it has only been prescribed for children with the most debilitating and difficult-to-treat seizures. In addition, some researchers believe that CBD works most effectively in combination with other cannabinoids and compounds found in the marijuana plant, in what is known as the “entourage effect.” Thus, it would be less effective as an isolated chemical in pill form, but that, too, remains unproven.
CBD is a form of cannabinoid called “cannabidiol.” Cannabinoids are a type of chemical that binds to CB1 and CB2 receptors found throughout the body. CB1 receptors are mostly located in the nervous system, connective tissues, gonads, glands, and organs; CB2 receptors are primarily found in the immune system, along with the spleen, liver, heart, kidneys, bones, blood vessels, lymph cells, endocrine glands, and reproductive organs. (Collectively this is called the endocannabinoid system.)
His research is one of many new studies at Yale and elsewhere looking at the endocannabinoid system and molecules related to CBD action for use in treating everything from Crohn’s disease to psoriatic arthritis, and he hopes that this new data will be used to help paint a more complete picture about the chemical for future treatment options.
From “miracle drug” to medicine?
A lupus diagnosis can be devastating. The disease causes the body’s immune system to attack its own tissues and can affect internal organs—including the brain, heart, and lungs—which can start to deteriorate. Lupus flare-ups can leave patients so fatigued and in pain that they’re unable to do the simplest of things, such as walk, cook, or read. Many can’t go outdoors without layers of sunscreen, because the disease can make them extremely susceptible to sunburn.
“The landscape for treatment of lupus is a bit bleak,” says Fotios Koumpouras, MD, a rheumatologist and director of the Lupus Program at Yale Medicine. “A multitude of drugs have failed in the last 10 to 15 years. Most of the drugs we use are being repurposed from other conditions and are not unique to lupus. Many of them can’t be used during pregnancy, which is a problem because lupus mostly affects young women. All of these issues create the impetus to find new and more effective therapies.”
Fotios Koumpouras, MD, is researching a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) to see if it can help ease pain and inflammation in patients with lupus.
In 2018, Dr. Koumpouras joined a multi-site randomized clinical trial that aims to recruit 100 participants to examine whether a drug using a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) can help ease pain and inflammation in patients with lupus. Participants will receive Lenabasum or a placebo for almost three months and will continue to be monitored for pain and inflammation levels, as well as lupus disease activity. The study is ongoing, but Dr. Koumpouras anticipates that it will wrap up by early next year.
Lupus affects approximately 240,000 people in the United States, and yet at present doctors neither know the exact cause nor have a cure. Instead, current treatments focus on improving quality of life by controlling symptoms and minimizing flare-ups to reduce risk of organ damage.
“The more data the better,” he says. “The more we’re able to make informed decisions.”