By Dr Andy Yates and Bill Griffin
With an annual UK market worth over £300 million, increasing year on year by an average of 16 per cent, cannabidiol (CBD) can hardly be described as a passing fad. Market research commissioned by the Centre for Medicinal Cannabis (CMC) found that the UK CBD market will be approaching £1 billion by 2025. This makes the current CBD market value greater than vitamin C and D combined and will supplant the entire supplement market in around half a decade.
Two surveys conducted in May and June 2019 by Dynata and YouGov indicate that between 8-11 per cent of UK adults respectively – approximately 4-6 million people – have tried CBD.
It’s clear that uncertainty in the emerging cannabis industry surrounding CBD products – due to recent EFSA Novel Foods classification updates and Misuse of Drugs Regulations written before CBD had taken off as a food supplement – has not dampened the UK CBD market.
Pure CBD is not illegal in the UK as it is not classed as a controlled substance, unlike THC. Unfortunately, the vagueness of the laws governing CBD have given rise to a profitable, competitive, but largely unregulated, sector offering a diverse range of retail products.
Any product containing CBD that is used for medicinal purposes in the UK is classed as a medicine so must have a product license, CBD products must, therefore, avoid making any medical claims or else face enforcement by the MHRA.
In the recent release of NICE’s guidelines in prescribing Cannabis-Based Medicinal Products (CBMPs) they recommend that CBD alone should be used only for treating chronic pain in the context of a clinical trial, and other products (specifically, nabilone, dronabinol, THC (delta-9- tetrahydrocannabinol), and a combination of CBD and THC) should not be used, because “the benefits they offer are very small relative to their costs”.
NICE said that in the case of treatment-resistant epilepsy there was not enough evidence to make a recommendation. It is due to publish technology appraisals on use of CBD for adjuvant treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome at the end of the year, so use of CBD for seizures associated with these syndromes was excluded from the guideline.
The legality around making medicinal claims contradicts what people actually use the product for. A sizeable proportion of regular CBD users are deriving – or claiming to experience – a medicinal or therapeutic benefit from the CBD they buy.
The UK’s strengths in pharmaceuticals mean it is likely to play an important role in the development of pharma-grade CBD. There has been a steep rise in the number of studies globally into CBD’s therapeutic potential with 1 in 10 of these studies underway in the UK.
According to WHO’s “Critical Review: Cannabidiol” there appear to be no reports of public health problems (e.g. driving under the influence of drugs cases, comorbidities) associated with the use of pure CBD.
The review indicates that CBD has been found to have relatively low toxicity, although it also indicates that not all potential effects have been explored. None of the toxic effects specifically identified in the review appeared particularly troublesome. Adverse events reported in clinical studies investigating the therapeutic possibilities of CBD included, but were not limited to, somnolence, decreased appetite, diarrhoea, and fatigue.
“While the number of studies is limited, the evidence from well-controlled human experimental research indicates that CBD is not associated with abuse potential.” In one study, 600 mg of CBD given orally did not produce effects different from placebo in healthy subjects on the Addiction Research Center Inventory (ARC).
A clear signal that under-regulation is a problem for consumers was the results of a series of blind tests on popular CBD oils on the UK market commissioned by CMC. The biggest issues related to the accuracy of labels; the presence of controlled substances and some contaminants; and in one example from a high street pharmacy, the complete absence of any cannabinoids.
Only 38% of the products tested were within 10% of the advertised CBD content and 38% of products had less than 50% of the advertised CBD content. Almost half of the selected products had measurable levels of THC or CBN thus making them technically illegal in the UK. One product even had 3.8% ethanol which is over the 3.4% threshold that would qualify it as an alcoholic beverage!
Due to the uncertainty of CBD products on the market, CMC would advise that pharmacies stock a product that comes from a reputable source and to do their diligence on the CBD products they stock. Specifically, the CMC advises them to contact the product seller for further details on their individual product analysis or preferably their independent batch test results.
This article was written jointly by Dr Andy Yates, pharmacy lead, Centre for Medicinal Cannabis, and Bill Griffin, media lead, Centre for Medicinal Cannabis.
This article also appears in the September issue of Pharmacy Business.