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Δ9-THC Intoxication by Cannabidiol-Enriched Cannabis Extract in Two Children with Refractory Epilepsy: Full Remission after Switching to Purified Cannabidiol.

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https://doi.org/10.3389/fphar.2016.00359

 

Δ9-THC Intoxication by Cannabidiol-Enriched Cannabis Extract in Two Children with RefractoryEpilepsy: Full Remission after Switching to Purified Cannabidiol.

Abstract

Animal studies and preliminary clinical trials have shown that cannabidiol (CBD)-enriched extracts may have beneficial effects for childrenwith treatment-resistant epilepsy. However, these compounds are not yet registered as medicines by regulatory agencies. We describe the cases of two children with treatment-resistant epilepsy (Case A with left frontal dysplasia and Case B with Dravet Syndrome) with initial symptom improvement after the introduction of CBD extracts followed by seizure worsening after a short time. The children presented typical signs of intoxication by Δ9-THC (inappropriate laughter, ataxia, reduced attention, and eye redness) after using a CBD-enriched extract. The extract was replaced by the same dose of purified CBD with no Δ9-THC in both cases, which led to improvement in intoxication signs and seizure remission. These cases support pre-clinical and preliminary clinical evidence suggesting that CBD may be effective for some patients with epilepsy. Moreover, the cases highlight the need for randomized clinical trials using high-quality and reliable substances to ascertain the safety and efficacy of cannabinoids as medicines.

 

So, it appears in this study that the trace THC present in CBD-enriched extract was enough to offset the beneficial effects of CBD on treatment-resistant epilepsy in these two children. By swapping this enriched extract to a purified extract, the researchers were able to restore the potent effects of CBD on controlling these two children's condition. 

 

What's not clear, and this may be detailed in the paper itself that I have yet to read, is what is this "enriched extract" and what is the purified CBD. I ask this because, at least with the THC cannabinoids, it is known that the terpenes in flowers also have their own effects that change the way you experience the cannabinoids you consume. If the extract from either the "enriched extract" or the purified CBD was processed in such a way that it did not remove the terpenes then this could also be a confounding factor. Nonetheless, it's interesting that the THC present in the enriched extracts was both enough to get them high and enough to offset the relevant medicinal effects of CBD. 

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Very interesting study.

 

Full text says the CBD-enriched extract was 4% THC, 89% CBD for the first case and 3.1% THC, 91% CBD in the second case.

 

They were targeting 200-250mg of CBD per day for the kids. That's significantly higher than the average doses most people seem to self-administer for CBD oil. At those doses, 3-4% THC content seems like it would be significant based on the dosing discussed in the other thread.

 

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I have to think: How did they not expect that to happen? Did they estimate the THC content was lower than it really was? Or did they assume the CBD would counter the THC effects.

 

With pure CBD products available, I wonder why they choice THC/CBD blends in the first place.

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To be fair, I wouldn't assume they had enough info about the THC content in the first place. The THC content of products marketed as "CBD oil" has been downplayed by a lot of the marketers, as far as I can tell.

 

Then there's the problem that typical consumer CBD dosing is an order of magnitude lower than the therapeutic CBD doses used in clinical studies. Outside of actual epilepsy and chronic pain patients, I'm seeing a lot of anecdotal CBD reports from people using what must be less than 30mg per day. Not surprising, given that 300mg of CBD per day would cost someone about $10 per day. What I'm not clear on is whether CBD has appreciable effects in the 1-30mg range, or if it's just a great placebo due to the constant hype and marketing.

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So the 2018 Farm Bill that just made it through Congress and reclassifies hemp, sativa plant with less than 0.3% THC content, as an agricultural crop and removes CBD from the Controlled Substances schedule.

 

Hopefully, that means that we will start to see some non-homeopathically dosed CBD products on the market.

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At 101% purity, you're basically getting an extra 1% for free.

 

Their $27/gram bulk price translates to $8 per day for the common 300mg dose used in studies. That's $250 per month. Not out of the question for someone who truly benefits, of course, but I'm not sure that many casual CBD oil users are actually willing to pay $250/month for it. I suspect most casual users are taking around 1/10th of that.

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