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January 15, 2020

Leading the Next CBD Wave—Safety and Efficacy

Author Affiliations
  • 1Addiction Institute, Mount Sinai Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Psychiatry. 2020;77(4):341-342. doi:10.1001/jamapsychiatry.2019.4157

Cannabidiol (CBD), a phytocannabinoid with potential medicinal properties, has recently hit all levels of society with tidal wave force that very few saw coming. After being virtually unknown by most people not even a decade ago, CBD is now in the general lexicon with numerous companies riding the CBD wave: more than 1000 products are being sold through the internet, dispensaries, pharmacies, large national retail stores, boutique shops, and local bodegas. This, along with extensive media coverage, has made CBD a household name and spawned an international business with an estimated market value of more than $60 billion within the next few years.

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1 Comment for this article
Leading the Next CBD Wave-Safety and Efficacy…and likely long-term unknown neurobiological effects
Eric Murillo-Rodriguez, PhD. | Laboratory of Molecular and Integrative Neurosciences. School of Medicine Division of Health Sciences. Universidad Anáhuac Mayab. Mérida, Yucatán México
I read with interest the recently published article recently published in JAMA Psychiatry (January 15, 2020. doi:10.1001/jamapsychiatry.2019.4157) by Yasmin L. Hurd, in which the author remarks that cannabidiol (CBD), a molecule present in Cannabis sativa, displays promising potential medicinal properties 1. Indeed, extensive studies describing the pharmacological properties of CBD managing health disparities are available. 2 However, I think that the author of the article might have highlighted that the lack of a comprehensive the mechanism of action of this phytocannabinoid may lead to undescribed long-term health effects after chronic prescriptions.

After a thorough revision of the
article, I consider that that scarce evidence with respect to the safety of CBD in log-term uses in young subjects might represent more medical concerns than it apparently solves. This concern is based in the following aspects: (i) The on-line availability and access to CBD. A diversity of uncontrolled and available CBD-containing products (e.g. oils, foods, drinks, gums, etc.) in internet, which some of them not meeting rigorous FDA standards would increase the influx of juvenile subjects with acute illnesses searching purported medicinal products that could cause additional concerns more than resolution of these conditions 3; (ii) The brain networks controlling neurobiological functions are still actively developing during the early years suggesting that the development of neurons in early ages, may be under the unknown long-term effects of CBD. 4

The absence of evidence does not mean the evidence of absence meaning that the limited current knowledge of the likely long-term disturbances in adulthood as consequence of uses of CBD during childhood is extremely scant and restricts to draw conclusions. These limitations are partially because of the experimental designs used in the available reports (e.g., dosage (low or high dose), frequency of usage (chronic or acute), route of administration (central of peripheral), animal model/clinical condition (epilepsy, anxiety, depression, etc.)), among other variables.

The neurobiological outcomes from exposure to CBD may be a single event across childhood but may also be an uncovered disturbance that might appear after prolonged time. A key consideration is that without achieving longitudinal pharmacoepidemiological studies that discard time‐varying exposure related neurobiological problems in chronically CBD-treated subjects we will be limited to reject the putative medical threats of prolonged uses of CBD during childhood.

Given the medical regulations in several countries allowing the medicinal prescriptions of Cannabis sativa or compounds derived of cannabinoids, including CBD, it legitimates our concerns whether chronic CBD medication in childhood may promote neurobiological alterations in adulthood, or even aging.

1. Hurd YL. Leading the Next CBD Wave-Safety and Efficacy. JAMA Psychiatry. 2020; 10.1001/jamapsychiatry.2019.4157.
2. Russo EB. Cannabis Therapeutics and the Future of Neurology. Front. Integr. Neurosci. 2018; 12: 51.
3. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017; 318 (17): 1708-1709.
4. Vijayakumar N, Op de Macks Z, Shirtcliff EA, Pfeifer JH. Puberty and the human brain: Insights into adolescent development. Neurosci Biobehav Rev. 2018; 92: 417-436.