Cannabis sativa (C. sativa) is an herbaceous plant that has been cultivated for medicinal and recreational purposes for hundreds of years.1 Marijuana refers to the dried leaves, flowers, stems, and seeds from the C. sativa plant, while cannabis refers to a variety of products derived from the C. sativa plant.2,3 C. sativa contains many secondary metabolites termed phytocannabinoids, of which the main ones are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).1 Cannabidiol can be plant-derived or synthetically produced—both of which have similar pharmacokinetic and biological effects.4
Cannabidiol does not have the psychoactive/intoxicating effects of THC and is thought to have fewer side effects than THC. Both cannabidiol and THC have anti-inflammatory and antioxidant properties; however, cannabidiol, unlike THC, also has anticonvulsant, anxiolytic, and antipsychotic properties, which means cannabidiol, but not THC, has therapeutic potential for neurologic conditions such as epilepsy, anxiety, and psychotic disorders.3
As many as 1 in 3 adults in the United States report using cannabidiol (commonly referred to as CBD) as an OTC health supplement.
In 2020 as many as 1 in 3 adults in the United States reported using CBD as an over-the-counter (OTC) health supplement sold in stores and online for mood, sleep, gastrointestinal (GI) relief, pain support, and other purposes .5,6 The content of cannabis in OTC products varies greatly based on growing conditions, contamination, and formulation; however, there are currently no federal standards for the content, purity, or potency of OTC cannabidiol products, and the US Food and Drug Administration (FDA) has not approved any OTC cannabidiol to date.6,7 The composition of OTC cannabidiol products has been shown to significantly differ from the cannabidiol products used in clinical studies, and there are limited efficacy and safety data to support the use of OTC cannabidiols.6 Cannabidiol products sold OTC cannot claim to prevent, diagnosis, treat, or cure any diseases because they have not been FDA-approved.
In recent years there has been growing interest in cannabidiol for neurologic disorders and a growing interest among patients for healthcare providers (HCPs) to prescribe cannabis-based therapies.7,8 For example, a survey of >400 US neurologists, nurses, and pharmacists demonstrated a generally favorable attitude toward medical cannabidiol and cannabis, especially the FDA-approved cannabidiol.7 That being said, mixed levels of knowledge about cannabidiol and cannabis exist among these clinicians, with most of them unable to counsel their patients on these products. It is important for neurologists and other clinicians to be educated on cannabidiol and the differences between cannabidiol and other cannabis products so that they can explain them to patients and their caregivers during treatment decision discussions.
