At Eats of Eden health food store in Limerick, staff were keeping a close eye on the global cannabis trend. They could see that cannabidiol was making huge waves in the US and Canada. It was seen as a legal alternative to marijuana and there were claims it was beneficial for a plethora of health problems — from epilepsy to pain, anxiety to sleep difficulties.
“We knew it would ripple over to Ireland, that it would take off here,” says Eats of Eden proprietor Cillín Cleere, a nutritional therapist with a degree in biochemistry and one of the first to stock it in Ireland.
Cannabidiol (CBD) is one of the major cannabinoids in the cannabis plant — out of a total of more than 110 in the plant. It’s also found in hemp. CBD is not psychoactive in the same way THC is, so it won’t make you high. Its pharmacology is different to THC, the principal euphoria-inducing psychoactive agent in cannabis.
Charlotte’s Web is one of the most high-profile CBD oils. A high-CBD, low-THC cannabis extract, it has been on the market the longest.
Cleere isn’t sure if his was the first health food store in Ireland to stock CBD oil but he says Eats of Eden “definitely got behind it in a big way”. For nearly two years now, it’s been selling Swiss, Northern Irish, and Irish-made CBD oil products, with prices ranging from €18 to €73, depending on strength/volume of the individual product.
Feedback has been “incredible”, he says, adding that in the store, CBD oil “probably would be the top seller at the moment”.
Those who buy it span a broad demographic – “including parents who give it to their kids, busy professionals on the go, weekend warriors and athletes, and a good few pet owners. People generally come in looking for advice on immune and joint support or help with a hectic, busy lifestyle which can leave their nerves a bit frazzled.” Cleere says repeat business is pretty good.
In Ireland, CBD is not illegal under the Misuse of Drugs Act. But neither is it a recognised, legal medicine approved by the Health Products Regulatory Authority.
“In Ireland, we can buy CBD so long as it contains less than 0.2% THC. People can buy it online, in health food stores, and in some pharmacies. They can use it legally,” explains David Finn, professor of pharmacology and therapeutics at NUI Galway.
So why would you buy it? Finn points to a top three of disorders where the greatest weight of evidence for CBD benefit currently exists. “Inflammatory pain is one of the key disorders that CBD has been proposed for — such as low back pain and arthritic pain. Another key disorder where there is some published evidence for efficacy is childhood epilepsy. And there’s some limited evidence that CBD could be useful for psychiatric disorders including anxiety disorders.”
Last year, the New England Journal of Medicine carried news of a trial of CBD for drug-resistant seizures in Dravet syndrome — complex childhood epilepsy. It found CBD resulted in a greater reduction in convulsive-seizure frequency than placebo. And a review published in the journal Neurotherapeutics in 2015 found evidence from human studies “strongly supports the potential for CBD as a treatment for anxiety disorders”. This review emphasised the “potential value and need for further study” of CBD in treatment of anxiety.
Limerick-based GP Raymond O’Connor, a senior research fellow in the department of general practice Graduate Entry Medical School at UL, says there’s anecdotal evidence that CBD helps with spasticity in MS, nausea caused by chemotherapy, and in severe epilepsy.
“It has also been used in certain forms of arthritis, Parkinson’s disease, and migraine. But I’d like to see patients taking it under the care of a consultant with a special interest.”
Cleere says the huge scientific interest in cannabis was sparked by the discovery of the endocannabinoid system (ECS), a complex, fat-based network of chemical messengers and receptors that help fine-tune our biochemistry, keeping us healthy and strong.
“All animals have an ECS — ours helps regulate appetite, pain and stress levels. It balances mood and memory [and keeps] our immune system in tip-top shape. We now know a diet lacking in vitamins, minerals, and omegas, along with eating processed foods, prolonged stress and exposure to harmful chemicals all contribute towards weakened ECS. When [this happens], illness occurs, a phenomenon referred to as endocannabinoid deficiency syndrome,” explains Cleere.
He says many plants make molecules identical to our own ECS messengers that can directly nourish a weakened ECS system. “The cannabis family has the highest concentration of these nourishing molecules known as cannabinoids, which include THC and CBD. Other food sources include Echinacea, black pepper, and dark chocolate. Small amounts of cannabinoid-rich foods and oils contribute towards healthy ECS.”
Finn sounds a warning note. He points out that the cannabis plant is complex. Alongside its 110-plus cannabinoids, it also has 700 other molecules. “Oils prepared from the plant will usually contain other molecules and components [besides cannabidiol] and it’s currently uncertain to what extent these other molecules contribute to the pharmacological effect of the oil.”
He says some CBD oils will contain significant amounts of cannabidiol, but adds there’s huge variability among the different oils and some of the preparations may have too much or too little cannabidiol. “The oils can vary from batch to batch, from seller to seller. What you buy in a pharmacy in Cork could be very different to what you might buy in a health food store in Galway.”
Finn recommends consumers try to understand the contents, purity, and quality of what they’re taking. “Very few of the oils that you can buy on the market have been tested rigorously in clinical trials.”
Dr Henry Fisher, scientific lead at Cannabis Europa, an organisation dedicated to building Europe’s medical cannabis industry, warns against sourcing CBD oil online or from an unknown source. “The source might claim it has less than 0.2% THC, but it could contain more and have an unwanted psychoactive effect.”
Charlotte Caldwell (@keepbillyalive), George Freeman MP (@GeorgeFreemanMP), and Dr. Henry Fisher (@_Hydrofluoric) discussing on medical cannabis on Victoria Derbyshire @VictoriaLIVE this morning. We look forward to continuing the conversation at #CannabisEuropa pic.twitter.com/P4P9IjhWAp— Cannabis Europa (@cannabiseuropa) May 21, 2018
At least, he says, if you buy it from reputable health food stores, it should have undergone the necessary quality assurance tests to ensure it complies with required minimal THC levels.
Fisher says CBD “definitely” has health benefits but it’s not a panacea. “It won’t help with everything. A lot of misleading claims have been made about it.”
He sees a good benefit in its anti-inflammatory effect and in the fact there are no reports of it harming health. In this way, it’s perhaps superior to ibuprofen, which can cause digestive problems. “If it presents an alternative to non-steroidal anti-inflammatory drugs, it’s worth investigating.”
However, he cautions that the amounts of cannabidiol people buy in CBD oils tend to be low. “How much is a pharmacological effect and how much placebo is up for debate,” he says.
Finn says while CBD appears to be generally well-tolerated, some people have reported side-effects that include gastrointestinal symptoms like diarrhoea, vomiting, and nausea. Other side-effects can include dizziness, fatigue, and sedation. Finn also warns that CBD can affect how other drugs are metabolised in the body, so it’s important to liaise with your doctor if taking prescribed medicine.
William McLoughlin, a barrister and a member of Chronic Pain Ireland — he was national secretary up until its recent AGM — has heard varied feedback from people affected by chronic pain who have taken CBD oil.
Some say it helped their symptoms, though not miraculously. Some felt some small benefit, while for others it didn’t work at all. People will hail it as a magic cure. Unfortunately, it’s not — it’s an aid but nothing else
says McLoughlin, who has not taken CBD oil himself though he has chronic pain as a result of a bad tackle on the rugby pitch.
Most of the people he knows, who have gone on CBD oil, are still taking it a month later. “They say it reduced their pain level and increased their mobility after being on it a few weeks. It also had a knock-on effect on their mental health, family relationships, and friendships. They were engaging more positively with the world.”
However, McLoughlin doesn’t believe CBD is an antidepressant. “I believe, because their pain’s reduced and they’re more mobile, they’re able to get out more and be more social. The knock-on effect is increased wellbeing.”
Anecdotally, he says people haven’t reported side-effects — yet. “Even after three days of codeine, which you can buy over the counter, there’s a strong danger of addiction.”
McLoughlin believes there’s a place for CBD in pain management. “As part of an arsenal of pain-management tools, it’s definitely one that should be considered — but in accordance with medical advice.”
There’s also some limited evidence for CBD effectiveness in pets — mostly cats and dogs — for inflammatory pain, says Finn. “That’s probably where most evidence [in animals] is at present,” he says.
As you prep your pet for fireworks or travel for the upcoming 4th of July consider calming products for your pet that contain CBD.— Pet Stuff USA (@PetStuffUSA) June 27, 2018
Cannabidiol (CBD) from the hemp plant is safe for use in pets as it is non-psychoactive and pets cannot overdose. pic.twitter.com/AjNixffL45
Cleere says he has “a good handful of customers”, who give their pets CBD oil to help with discomfort due to illness. “If you consider most of our pets are fed a diet exclusively of processed food (nuts and canned meat) and are subjected to a plethora of chemicals from habitual worm and tick doses, it’s no wonder their ECS weakens and they become ill, says Cleere, who urges people to “feed your pets some real food and give them some hemp”.
While there’s variability in the degree and nature of health benefits reported after taking CBD oil, there seems to be no debate about the taste — most people agree it’s vile. ‘Tastes foul but does what it says on the box!’ says one online reviewer. ‘It does taste horrible, but washing it down with a strong-tasting drink worked,’ says another.
Should CBD have a place on the shelves of our pharmacies and health food stores? “Yes, absolutely,” says Fisher.
“It’s certainly not harmful. It’s not psychoactive. It has some modest health benefit. It perfectly deserves its place alongside vitamins and various other alternatives.”