CBD and Cannabis Research

Some research focuses specifically on CBD (cannabidiol), which is the nonpsychoactive element of cannabis, and other research focuses on medical cannabis, with various ratios of CBD and THC (tetrahydrocannabinol). CBD is a nonpsychoactive cannabinoid, and THC is the psychoactive cannabinoid.

CBD products are extracted from hemp or marijuana, which are essentially the same cannabis plant but are cultivated differently, hemp plants being grown to contain less than 0.3% THC.

Concussion patients are using CBD oil from hemp, which has virtually no THC, or marijuana products (vape, tincture, etc.) with various ratios of CBD and THC.

We use the term medical cannabis (or medical marijuana) because that is what is being used in research studies. The critical point is that where marijuana is legal, either as medical marijuana or recreational marijuana, the products are regulated and you can purchase marijuana with specific ratios of CBD to THC.

Study indicates medical cannabis improves concussion symptoms

A December 2018 study in the journal Neurology indicates that medical cannabis (marijuana) helps concussion patients with concussion symptoms, especially pain, mood, sleep, and quality of life. The study also specifies the optimal forms of medical cannabis for the patients in the study, in terms of rations of CBD to THC, and methods of intake, such as a tincture (oral) or a vapor pen (inhaling). Read more in our blog post Study finds medical marijuana improves concussion symptoms.

Clinical trials

In the United States, the first big study on cannabinoid treatment for concussion is being done by the University of Miami which received a $16 million grant for the research. The study is a five-year, three-stage study that will "assess the effectiveness of a new cannabinoid-based pill to treat concussion injuries. This partnership aims to propel this research and potential treatment forward by using two classes of drugs in a combination that scientists believe will reduce brain inflammation and the immune response." See also the Miami Herald article.

As reported in UHealth in July 2018, the "findings of a pre-clinical pilot study were recently released, and they show that the combination therapy improved the cognitive functions of animals, compared with those treated with a single vehicle. In addition, there were no adverse effects from either the combination therapy or the individual components."

The cannabinoid combination therapy is made up of CBD (Cannabidiol, an element of cannabis) and Dexanabinol (HU-211) which is synthetic cannabinoid which is an "anticonvulsant and neuroprotective, and is widely used in scientific research as well as currently being studied for applications such as treating head injury, stroke, or cancer."

The next phase of the University of Miami study will be a small pilot study with people; the cannabinoid-based pill will be "to a control group and two groups of TBI patients, acute and chronic."

For additional information, see our blog post: Clinical Trial for a CBD pill for concussions.

In Canada, a new study led by NEEKA Health Canada will "test if CBD-based therapies can reduce the severity of post-concussion brain disorders in former NHL players." The National Hockey League Alumni Association and Canopy Growth Corp. (a cannabis and hemp company) are partnering with NEEKA for the clinical research; approximately 100 former players will be enrolled in the randomized, double-blind study.

Research

CBD and/or THC as a protectant for the brain

In a 2017 study, "a team at the Hebrew University of Jerusalem has found that rats and mice subjected to traumatic brain injury (TBI) showed significantly better recovery when treated with cannabinoid compounds, possibly opening the way for clinical trials in the near future."

A November 2017 report by the World Health Organization (WHO), in its "Overview of diseases for which CBD may have therapeutic benefits" discusses the neuroprotectant effects of CBD. It does not specifically list concussions or traumatic brain injury, but the neuroprotectant effects of CBD are listed for Alzheimer's and Inflammatory Diseases. "Alzheimer's disease: Antiinflammatory, antioxidant, antiapoptotic in in vitro and in vivo models of AB-evoked neuroinflammatory and neurodegenerative responses." "Inflammatory Diseases: Antinflammatory properties in several in vitro and in vivo models; inhibition of inflammatory cytokines and pathways."

A February 2017 study, "Endocannabinoids: A Promising Impact for Traumatic Brain Injury", by authors Lesley D. Schurman et al., was published in Frontiers in Pharmacology.

A 2014 study, Effect of Marijuana Use on Outcomes in Traumatic Brain Injury, reviewed the records of all trauma patients admitted to the surgical intensive care unit at Harbor-UCLA Medical center over a period of 2 years. All patients sustaining a traumatic brain injury and who had been given a urine test for drugs were selected for the study. After accounting for variables, "A positive THC screen is associated with decreased mortality in adult patients sustaining TBI." "The THC(+) group had a significantly lower mortality rate than the THC(-) group." The THC positive group had a 2.4% mortality rate compared to the THC negative group which had an 11.5% mortality rate.

In a 2012 study, researchers took newborn rats and restricted blood flow/oxygen levels to their brains, created a hypoxia-ischemia (HI) brain injury. They found that "CBD administration after (injury)..led to long-lasting neuroprotection." They found that dosing with CBD after the brain injury reduced the volume and extent of brain damage, reduced inflammation in the brain, and prevented the impairment of neurological behavior. The researchers observed that overall, rats given the HI brain injury had long-lasting functional impairments, but the rats that were given CBD after the injury had functional results similar to the group of control rats who were not given brain injuries.

CBD for treatment of pain, including headaches and migraines

In a 2019 study published in Neurology, researchers found that 88.3% of patients with chronic migraines who were given medical cannabis reported a reduction in headache frequency, along with improvements in sleep, anxiety, and mood. Headaches are the most common symptom after a concussion, with the most common type of headache resembling a migraine, according to the American Migraine Foundation. Researchers Laszlo Mechtler et al. found that significantly more patients taking the 20:1 (THC to CBD) ratio reported headache reduction than those taking the 1:1 (THC to CBD) ratio.

A 2018 comprehensive literature review found that "there is accumulating evidence for various therapeutic benefits of cannabis/cannabinoids, especially in the treatment of migraine and headache."

A 2018 survey of oncology doctors regarding medical marijuana found that "sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies". "In the new study, cancer doctors said their conversations about marijuana were almost always started by patients and their families, not by the doctors themselves. Overall, nearly eight in 10 cancer doctors reported having discussed marijuana with patients or their families, with 46 percent recommending it for pain and other cancer-related problems to at least one patient in the past year."

In April, 2018 a new was introduced to the Veteran's Affairs Committee that would "encourage the U.S. Department of Veterans Affairs (VA) to 'conduct and support research relating to the efficacy and safety of medical cannabis on the health outcomes of covered veterans diagnosed with chronic pain, post-traumatic stress disorder, and other conditions.'"

A November 2017 report by the World Health Organization (WHO), in its "Overview of diseases for which CBD may have therapeutic benefits" lists "Pain: Analgesic effect in patients with neuropathic pain resistant to other treatments."

In 2016 researchers in the Johns Hopkins University School of Medicine (Baltimore, Maryland) began recruiting football players on the active roster in the NFL for a study of cannabis versus opioid consumption and "Evaluate how general health (e.g. mood, sleep, stress) relates to cannabinoid and opioid use." Players supporting the study are Derrick Morgan, Jake Plummer, and Eugene Monroe, who donated $80,000 toward the research. From the Player Research Invitation: "With emerging evidence about both the harms associated with opioid use and potential benefits of cannabinoids for pain and inflammation, some players have called for the NFL to re-evaluate its policy regarding cannabinoid use and the current practices surrounding opioid use. "

A 2014 study reviewed research since a 2004 "landmark" investigation that concluded that "cannabinoids can block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, irritable bowel syndrome and muscle spasm." The 2014 study is a review of ten years of subsequent research, confirming that "underlying endocannabinoid deficiencies indeed play a role in migraine, fibromyalgia, irritable bowel syndrome and a growing list of other medical conditions...Further research and especially, clinical trials will further demonstrate the usefulness of medical cannabis. As legal barriers fall and scientific bias fades this will become more apparent."

CBD treatment to reduce insomnia and anxiety

A November 2017 report by the World Health Organization (WHO), in its "Overview of diseases for which CBD may have therapeutic benefits" lists "Anxiety: Reduction of muscular tension, restlessness, fatigue, problems in concentration, improvement of social interactions in rodent models of anxiety and stress, reduced social anxiety in patients."

A 2017 study states that "Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia."

Another 2017 study found that "Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia...CBD may hold promise for REM sleep behavior disorder."

A 2016 Colorado-based study found that CBD oil "can be an effective compound to reduce anxiety and insomnia secondary to PTSD." The case-study patient was given 12 mg to 25 mg once daily, which "appears to provide relief of key symptoms with minimal side effects." "Her scores on the sleep scale and the anxiety scale consistently and steadily decreased during a period of 5 months...she was ultimately able to sleep through the night most nights in her own room, was less anxious at school and home, and displayed appropriate behaviors."

A 2013 study investigating CBD effects on sleep in rats, found that "CBD appears to increase total sleep time."

A 2007 study treated people with Sativex, a pharmacological medicine (a combination of CBD and THC,15 mg of each) which has regulatory approval from 30 countries outside the United States, as of 2018. The researchers found "marked improvement in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis" with no need for dosage increases over time. The researchers note that lack of good sleep quality is a "key source of disability in chronic pain syndromes."