Charlotte’s Story 11 Things You Didn’t Know About CBD Gummies Everyone is talking about CBD gummies. Now that hemp-derived CBD products are federally legalized (as long as they have 0.30% or less THC). There are
AMA Journal of Ethics ®
After attempting to treat their daughter Charlotte’s daily seizures for three painful years to no avail, the Figi family was nearly out of options and hope. Five-year-old Charlotte suffers from Dravet Syndrome, a rare and severe form of epilepsy that cannot be controlled by medication . The Figis had tried nearly every treatment short of brain surgery or a medically induced coma to alleviate Charlotte’s seizures, including a variety of medications that did little to reduce the seizures, left Charlotte “doped out,” and had the potential to become addictive. By the age of five, Charlotte was experiencing nearly 300 seizures a week and had lost the ability to talk, walk, and eat. The Figis, who had been against marijuana use, discovered an online video of a California boy who had a severe form of epilepsy like Charlotte’s. The video showed the boy receiving a marijuana concentrate (oil) which seemed to alleviate his seizures . The oil was high in cannabidiol (CBD), the therapeutic agent in marijuana, rather than delta-9-tetrahydrocannabinol (THC), the psychoactive agent that produces the “high,” so the oil could be used therapeutically while intoxicating the user no more than the medications Charlotte had already tried [1, 2].
The Figis contacted hundreds of doctors who refused to recommend marijuana for Charlotte, either because of her age, their opinions of the plant’s efficacy, or fears of violating federal law . Finally the Figis found two doctors, Margaret Geddy and Alan Shackelford, who were willing to recommend marijuana for Charlotte. Though both had reservations about administering such a powerful and federally illegal substance to such a young child, the alternatives seemed far worse. Dr. Geddy explained that it was a rather easy decision to give marijuana to a developing child when she had suffered so much brain damage and multiple brushes with death from constant seizures. The Figis received the recommendation and obtained the oil. The first time Charlotte received the oil, she went from having 300 seizures a week to having just one . Unfortunately, high-CBD plants were in short supply—CBD has been bred out of marijuana plants over the past several decades, as growers sought to increase THC levels to produce a more powerful high [1-3].
That’s when the Figis met with the Stanley family, owners of one of the largest marijuana dispensaries in Colorado. The Stanleys had a strain that was high in CBD and low in THC and thus unpopular with regular patients because it lacked psychoactive effects. After hearing Charlotte’s story, the Stanleys modified their existing strain to create one extremely high in CBD, naming it Charlotte’s Web. Charlotte still receives the oil twice a day. She has only a few seizures a month and is now able to walk and talk again . Since Dr. Sanjay Gupta gave national attention to Charlotte’s story in his CNN program explaining why he changed his opinion on medicinal marijuana, more than 100 families from 43 states have relocated to Colorado to treat their children with Charlotte’s Web .
It’s plausible that if Drs. Geddy and Shackelford had not been willing to recommend marijuana to Charlotte, her life would have been markedly worse, if not prematurely ended, and the miracle strain known as Charlotte’s Web would not exist. Furthermore, if it weren’t for Dr. Gupta’s reporting of the story, many families would not have had the courage or even the idea to travel to another state to treat their children’s seizures .
Possibly the greatest effect of Charlotte’s story was the changing of social opinion on medicinal marijuana. Since Charlotte’s tale was told back in August 2013, eleven states have passed legislation legalizing high-CBD oils, which will give the 9,000 patients on the waiting list a better chance of obtaining it . When such debilitating conditions afflict children, families—and legislators—appear more open to the idea of trying radical, less invasive treatment options [1, 6].
Concerns about Medicinal Marijuana’s Status
There are several barriers to physicians’ prescribing marijuana for medical use. Although it remains illegal under federal law and is classified as a schedule 1 drug under the Controlled Substances Act (CSA) , 23 states and the District of Columbia have decriminalized its use for medicinal purposes . Discrepancies between federal and state medicinal marijuana laws have placed doctors—and patients—in a difficult situation: to provide their patients with medicinal marijuana, doctors must risk violating federal law and, potentially, the revocation of their Drug Enforcement Agency (DEA) licenses . For example, physicians in Massachusetts have been extremely slow in writing recommendations for patients . This delay is partly fueled by visits from DEA agents to physicians who were involved with dispensaries. Several such physicians reported that the DEA issued an ultimatum to them: sever ties with the medical marijuana industry or risk losing your DEA license for prescribing controlled substances .
Currently, it is illegal for physicians (even in states where medicinal marijuana is legal) to prescribe the drug because it is schedule 1, and prescribing it would constitute aiding and abetting the acquisition of marijuana, which could result in revocation of DEA licensure and even prison time . However, in states where medicinal marijuana is legal, doctors can write a recommendation for the plant, after determining and certifying that the patient suffers from one of the conditions that the state’s law deems to warrant medicinal marijuana —generally debilitating conditions such as cancer, glaucoma, multiple sclerosis, and HIV/AIDS . This recommendation “loophole” was upheld by the US Court of Appeals for the Ninth Circuit in Conant v. Walters, which decided that a physician’s discussing the potential benefits of medicinal marijuana and making such recommendations constitute protected speech under the First Amendment . The court reasoned that doctors should not be held liable for conduct that patients might engage in after leaving the office and that open and unrestricted communication is vital in preserving the patient-doctor relationship and ensuring proper treatment [11, 13].
Once the physician writes the patient a recommendation for medicinal marijuana, the patient must register with his or her state’s database to obtain a marijuana patient ID card, after which he or she can pick up medicinal marijuana from a dispensary . In most states, possession of the identification card allows a patient to obtain, possess, or grow medicinal marijuana without violating state law but provides no shield against violations of federal law, which trumps state law based upon the supremacy clause . Federal legislation that would protect patients in states where medicinal marijuana is legal is pending .
Concerns about Evidence
Though many patients seek access to medicinal marijuana, some doctors are reluctant to recommend it due to a dearth of hard clinical data regarding its efficacy in treating certain conditions . Marijuana’s schedule 1 status makes it difficult to conduct research because any cultivation, clinical testing, or research on it must attain the extremely rare approval of the federal government , and only one organization, the National Center for Natural Products Research at the University of Mississippi, is authorized by the federal government to manufacture marijuana . This creates a vicious circle: marijuana is schedule 1 and has no currently accepted medical use in treatment because there is no data on its safety and efficacy; there is no data because marijuana is schedule 1 and clinical testing is restricted .
Aside from the lack of data on efficacy, some doctors are reluctant to recommend a drug whose form, contents, dosage, and type cannot be specified, as they would be in a typical drug prescription . The amount of marijuana the patient can obtain is limited by state law . The type of marijuana and mode of delivery is determined by the recommendations of dispensary employees . Furthermore, because of its dual legal status, the product and its growing and cultivation are largely unregulated and unstandardized. This can lead to safety concerns; there have been incidents of pesticides, molds, and other contaminants, the consumption of which could lead to serious health problems, being found on plants .
Intraprofessional Consequences of Legal Inconsistencies
In states where medicinal marijuana is legal, but a majority of physicians are reluctant to write recommendations, an influx of “pot docs” is often seen, reflecting a commercialization of medical marijuana recommendations . These are physicians who primarily treat a variety of ailments for which marijuana is recommended, and they often advertise their businesses as being centered on medicinal marijuana . This is a concern to some in the states whose medicalization movements were predicated on the belief that medicinal marijuana would only be available to a limited number of people with debilitating conditions and would not facilitate recreational use of the drug [8, 12]. Proponents of medicalization argue that doctors often prescribe drugs for off-label purposes, thus strict limits on ailments warranting recommendations would unduly restrict patients’ access to the medicine .
But many states expand their covered ailments beyond such extreme conditions . Because, for example, California’s law about the conditions for which marijuana use is allowed includes a catchall “or any other illness for which marijuana provides relief” provision , pot docs are able to write prescriptions for problems such as anxiety, insomnia, and chronic pain [3, 8]. Some physicians feel that these pot docs cheapen the profession by acting as quasimedical drug dealers who make money by providing their patient with an easy, accessible high, rather than treating a serious ailment .
Some states are trying to avoid this by requiring that recommending physicians have an existing bona fide clinical relationship with the patient who is seeking the recommendation [9, 14]. Of course, this requirement, while protecting the legitimacy of the recommendation, may create tension within the patient-doctor relationship when patient desires medicinal marijuana but the physician will not recommend it, either for reasons having to do with its therapeutic potential, lack of control over the dosage patients receive, or overall objections to its use .
One last objection that physicians in some states have with medicinal marijuana is the lack of regulation regarding clinical training on the medical and legal aspects of the new laws . Massachusetts was the first state to require that physicians take a two-hour course before they could recommend medicinal marijuana to their patients . Doctors generally prescribe only drugs that have been rigorously tested, their clinical results reported in published articles, and information about indications for their use, the mechanisms by which they achieve results, and their expected side effects available in package inserts or the Physicians’ Desk Reference. None of these resources for information about the efficacy, dosing, or regulations that come from FDA-approved drugs are available for medical marijuana .
A Turning Tide
Stories like Charlotte’s successful treatment and Dr. Gupta’s change of heart have helped shift opinions—especially those of physicians—regarding medicinal marijuana. A study reported in April 2014 by WebMD surveyed 1,544 doctors in 12 specialties and 48 states  and found that 56 percent of those surveyed believed that medicinal marijuana should be legalized nationally and 69 percent believe it can deliver real benefits for certain treatments and conditions. The majority of positive responses came from oncologists and hematologists, probably because of marijuana’s use in treating cancer-related pain, counteracting nausea, and stimulating appetites reduced by chemotherapy . Furthermore, a study published in the Journal of Adolescent Health in 2014 reviewed data measuring drug use and the perceptions of adolescents and found that legalizing medicinal marijuana at the state level causes no measured increase in youth marijuana use, thus addressing a key concern of those who oppose medicinal marijuana . As more states legalize marijuana and others continue to expand and refine their regulations, physicians will likely play an important role as trusted sources for evidence on clinical efficacy and side effects and have a responsibility to be informed on the topic .
In late May of 2014, the Republican-controlled House of Representatives voted to block the federal government and its agencies from interfering with physicians, patients, and dispensaries acting in compliance with state medicinal marijuana laws . Approval from the Senate would help settle conflicts between state and federal law .
Furthermore, the FDA announced in June 2014 that it will begin the process of reevaluating marijuana’s schedule 1 status . This is good news for physicians concerned about the lack of data on marijuana; if its classification were lowered to schedule 2, more studies on its efficacy could be conducted and doctors would have a larger pool of data regarding its potential uses and side effects from which to draw judgments about its use . As more states expand their laws, more patients consume the drug, and more data becomes available, physicians will become more confident about using medical marijuana.
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The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.
Joseph Gregorio is a second-year law student at DePaul University College of Law in Chicago and was the 2014 DePaul American Medical Association summer scholar. He is an active contributor to the DePaul Health Law Institute’s E-Pulse Health Law blog. Joseph received his BS in psychology at Western Illinois University. His research interests are public health law, bioethics, and psychology.
11 Things You Didn’t Know About CBD Gummies
Everyone is talking about CBD gummies. Now that hemp-derived CBD products are federally legalized (as long as they have 0.30% or less THC). There are many people who live in states without a medical cannabis program. And CBD supplements can unlock some of the medicinal benefits of cannabinoids for symptom management.
If you have been thinking about buying CBD gummies, the first thing you should know is that not all CBD supplements are created equal. There is a difference between clinical grade CBD and other products that may be available on the market. Read the label carefully to educate yourself on the difference. The Food and Drug Administration (FDA) does not currently have standards for CBD products, which means a high number of ‘fake CBD’ supplements available online.
Here are eleven important things you should know about CBD gummy supplements:
1. They Taste Good
In the early days of innovating edibles, gummies had a medicinal taste. That’s not the case anymore. While a CBD supplement in the form of a gummy shape with fruit flavoring will never taste as good as candy, it doesn’t smell like cannabis. And it doesn’t taste like cannabis either.
The CBD is derived from hemp, which is not as pungent or strong smelling. So, if you open a package of gummies in the car, your vehicle is not going to smell like weed, which is a good thing. Part of the appeal is that CBD gummies can provide most of the health benefits of cannabis, discreetly and conveniently.
Many people try CBD oil. It is convenient and affordable to use by sublingual uptake. That is administering drops under the tongue for rapid absorption. The problem? The oil typically tastes bad. There is a reason why some people add their CBD oil to coffee or tea or orange juice. And it leaves an aftertaste. Most CBD gummies taste great and have no aftertaste.
Get your free bottle with this special offer. Pay only shipping.
2. CBD Gummies May Help With Inflammation
Did you know that most chronic diseases are caused by inflammation? We tend to think of inflammation as swelling after an injury. But at the cellular level, your body is constantly fighting inflammation because it can do a lot of damage to your health.
Our modern diets aren’t the best. Even when you try to eat a healthy and balanced diet, you are eating preservatives unless you are shopping exclusively at a health food store. Chemicals that are not natural and not found in organic food sources. They are meant to extend shelf life. Make the food we eat to look better and taste better. But these artificial additives wreak havoc on our bodies.
One of the scary things about inflammation is that you may not recognize the signs. Often, people suffer from high inflammation where the symptoms are virtually invisible for years. Your physician may not even realize it as a health problem for you until you develop an associated chronic disease.
The health risks associated with chronic or long-term inflammation include:
- Memory impairment
- Cholesterol imbalance
- Elevated CRP levels
- Aches and pains
- Skin problems
- Digestive issues
Chronic Inflammatory Diseases (CIDs) can trigger your body to overreact in defense responses. For example, inflammation is one of the causes of the most severe cases of Covid-19. For Covid-19 patients, a cytokine storm happens, which attacks the body’s immune defenses. Chronic inflammation is one of the common features for patients most at risk for life-threatening response to the coronavirus.
3. You Can Get Low-Carb or Keto CBD Gummies
Some people with health conditions like diabetes have to be very careful about the number of carbohydrates they consume daily. There are carbohydrates in healthy foods too, which are not as bad for you. For example, the fruit has naturally occurring sugars but also fiber. That helps offset the impact on blood glucose levels.
But other foods, which are simple carbohydrates, are high on the glycemic index. That means it is just a small amount of simple carbohydrates, and your blood sugar will rise quickly. The immediate effect for people with diabetes are symptoms like dry mouth, headaches, hyperactivity, or mood variances like irritability.
Over the long-term, a diet that is high in carbohydrates can create health problems. For people with diabetes, vision damage and nerve damage resulting in numbness or neuropathic pain. High blood sugar also weakens the immune system, leaving some people with chronic diseases prone to serious infections. And sometimes, those infections can be life-threatening. So, choosing low-carbohydrate foods and supplements is a good idea.
Many manufacturers of CBD gummy supplements are now using Monk Fruit to sweeten their products. That is a sweetener that is healthier than other alternatives, and it is low on the glycemic index. You may have to search around for a CBD gummy made with Stevia or Monk Fruit, but they are out there for people on carbohydrate restricted diets.
4. CBD Gummies Are Easier on Your Throat and Lungs
When you take a CBD edible, it is non-psychoactive. That means you will not experience the same intoxicating effects of smoking medical cannabis. That makes CBD ideal for daytime use when you have symptoms of pain, inflammation, or anxiety.
Some people have respiratory conditions like asthma or emphysema. That makes smokable CBD varieties (vape oil), or smokable hemp flower is not a good alternative. The inhalation of smoke can irritate or aggravate symptoms.
Eating a CBD gummy is safer than smokable varieties, but CBD absorption through the digestive tract is slower. That means that the benefits of the cannabinoids last longer and are released over time, which is also economical and convenient for people who want to use CBD to naturally manage pain and inflammation symptoms.
5. Very Minimal Side Effects with CBD Gummies
Some people with health conditions are concerned about the interaction between prescription medications and medical marijuana. There are very few medications that can be contraindicated with medical marijuana. Talk to your doctor for advice if you have a medical card and prescription medication review.
It is virtually impossible to ingest too much cannabidiol with CBD gummies. Taking CBD gummies may produce only two side effects:
- Dry mouth
- Decreased ability to absorb prescription medications or other supplements
One of the safety considerations about CBD gummies that you should discuss with your doctor pertains to liver functioning. Supplement CBD gummies can impact the way your liver absorbs prescription drugs. That is why it is very important to discuss your use of CBD gummy supplements with your primary care physician (PCP).
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6. Supplementing CBD Can Boost Your Antioxidant Levels
Every day we are ingesting things called free radicals into our body. Think of free radicals like these microscopic invaders that enter the body, and attach to healthy cells. And when they do, they create damage to the cell. Damage that spreads and can result in serious health risks over time through cellular oxidation.
Free radical damage is also linked to premature aging and impaired organ functioning. Clinical studies have also connected free radical damage to chronic diseases like diabetes, Alzheimer’s, and other neurodegenerative disorders.
The human body has a natural defense against free radicals. Glutathione and other antioxidants are produced in the liver. The antioxidants are like a security team that is dispatched to “seek and destroy” free radicals. And remove them from the body.
Clinical grade CBD gummies also provide an antioxidant boost for your body. And can help reduce free radicals and cellular damage linked to chronic and neurodegenerative diseases.
7. CBD Supplements May Help Reduce Cancer Activity
There are many clinical studies that have reported CBD may help reduce certain types of cancer. In animal testing on mice and rats who were dosed with CBD, there were antitumoral results. In plain language, the CBD appeared to reduce the growth rate of test subjects’ tumors.
Some of the studies suggested that:
- Cannabidiol may inhibit functions in the body (including inflammation) that can increase cancer risk.
- CBD may prevent tumor cells from spreading.
- Cancer cell growth may be inhibited with the long-term use of cannabidiol.
- CBD may help kill tumors or help achieve cancer remission for certain types of cancer.
There is no hard evidence that cannabidiol will cure cancer. However, an exciting new study was published that is providing new hope for patients living with cancer. Read: “Cannabinoids in Cancer Treatment: Therapeutic Potential and Legislation.”
8. Cannabidiol (CBD) May Help Reduce the Severity of Seizures
How effective are cannabinoids at reducing some of the symptoms of epilepsy? This is one area of cannabinoid research that has been conclusive. Patients with epilepsy who receive cannabinoid treatments can experience fewer seizures. It can also help reduce the severity of seizures for children and adults with moderate to severe epilepsy.
Cannabinoids work to reduce seizures that the U.S. Food and Drug Administration fast-tracked prescription medications that are cannabis derived. Specifically for Dravet Syndrome or Severe Myoclonic Epilepsy, which is diagnosed in children.
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9. CBD Gummies Daily May Help With Anxiety and Depression
Did you know that anxiety disorders are the most common mental health condition in the United States? It is estimated that there are about 40 million American adults who have one or more types of anxiety disorders. Or approximately 18.1% of the population, according to The Anxiety & Depression Association of America.
Many people living with anxiety do not seek formal treatment. Even though there are a variety of treatment options available, including prescription medications and talk-therapy. According to the ADAA, this is concerning because as many as 36.9% of Americans never seek treatment or help for their anxiety disorder. And anxiety predisposes patients to other health risks, including compromise of the immune system and psychiatric disorders.
Supplementing CBD Can Help Balance Receptors Responsible for Mood and Healthy Sleep
Cannabidiol (CBD) can reduce anxiety and depression by acting on two different regions and functions of the brain. The adenosine and serotonin receptors are responsible for controlling heightened emotions when someone experiences anxiety. And serotonin is responsible for overall mood, including happiness and sadness and symptoms of depression.
When adenosine receptors are working well, your body effectively manages stress. But if the receptors are impaired and not working, anxiety levels can peak. People who struggle with depression or low mood have in common the impaired functioning of serotonin receptors. And if serotonin receptors are also not working correctly, it can cause insomnia.
Researchers do not fully understand how it works. But what they do know through clinical studies is that cannabidiol can positively affect both the serotonin and the adenosine receptors. That can provide relief for people who struggle with anxiety or depression.
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10. People With Insomnia May Improve Sleep Quality
You may not have depression or anxiety, but you could have chronic insomnia. This condition impacts approximately 30% to 48% of older adults in the United States. The Sleep Foundation reports that 23.8% of teenagers may have chronic anxiety.
Cannabidiol may help people with chronic insomnia improve their sleep quality. In one study, while comparing to a placebo, patients dosed with CBD slept longer, with fewer interruptions. With doses of 25 – 175 mg, after a three-month study and follow -up 51.6% of the participants had reported improved sleep. But 26.8% of people had reported sleep quality declined.
That suggests that CBD may work for many people who struggle with insomnia. And because CBD gummies are easy to take (and tasty) before bed, it makes the supplement an excellent alternative to consider compared to prescription sleep medications.
Some people with insomnia experience higher levels of the stress hormone cortisol at night. It is normal for higher levels of cortisol to happen in the morning to provide additional ‘wake up energy.’ Cannabidiol may help regulate or lower cortisol levels gently to improve sleep.
11. Can Help Reduce Bacterial Infections
People who have autoimmune diseases like cancer, lupus, diabetes, multiple sclerosis, and celiac disease are prone to infections. That means bacterial and viral infections can become serious. Or even life-threatening for people with chronic diseases. And there are some bacterial infections like MRSA and sepsis that have been shown to resist treatment with antibiotics.
Prior to the Covid-19 health crisis and pandemic, clinical researchers evaluated CBD as a potential treatment for superbugs. Those are types of bacteria that are resistant to antibiotics. It is important to research because the World Health Organization has acknowledged that antibiotic-resistant bacteria are approaching dangerous levels of threat worldwide.
Researchers that tested CBD against bacteria strains (staph) and streptococcus (strep) found some interesting results. The clinical tests showed that:
- CBD is less likely to increase the resistance of bacteria.
- CBD can kill certain types of bacteria within three (3) hours. That is compared to an average of 6-8 hours for standard prescription antibiotics.
- CBD works best for gram-positive bacteria. That includes bacterial infections that cause skin infections and pneumonia. It was less effective for gram-negative bacteria like E.coli and salmonella or gastrointestinal infections.
With more clinical testing and medical data, we may see a future where physicians routinely prescribe clinical-grade cannabidiol (CBD) to patients with infections. Or for post-operative care to help reduce skin or surface infections after discharge from the hospital. This could include CBD gummies and topical ointments applied for daily wound care.
Patients with chronic and autoimmune diseases may also use CBD to reduce the risk of contracting a bacterial infection. Since the side-effects are nominal for most patients, taking a daily CBD supplement may prove beneficial.
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