The only form of CBD that is FDA-approved is Epidiolex, a purified formulation of CBD used for rare forms of epilepsy. All the other CBD sources being enthusiastically marketed today are unregulated. They often contain amounts of CBD that are substantially different (too much or too little) than the labels indicate, and frequently contain higher levels of THC (the intoxicating chemical found in marijuana) than is permitted in a legitimate CBD product. Anyone choosing to use CBD should be cautious about the product they select and ideally consult with their healthcare provider before using it.
With a lack of research on CBD oil for lupus, we have to go on what we know about CBD in general and can understand from research into conditions with similar symptoms or pathology. This potential treatment is likely to get attention from lupus researchers eventually, though, for several reasons.
A lot of pro-marijuana websites have long claimed that it's legal in all 50 states as long as it doesn't have more than 0.3% THC. They based that argument on the provisions of a specific farm bill. But in 2018, the 9th Circuit Court of Appeals ruled that the old bill didn't apply to hemp or products derived from it.
We probably don't yet know all of the possible side effects of CBD. Some side effects that have been reported are:
Is CBD Legal?
It's too early in the research process for us to be able to say "yes" about many of the claims. However, we're learning enough to be able to say "it's possible," or even, "we think so."
Technically, federal law overrules state law. However, that doesn’t mean those states will stop arresting and trying people for CBD use, especially if they want to challenge the new federal law. If you’re in one of those states, talk to an expert about any possible trouble you could get into for using CBD products. The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
Lupus can include pain from neuropathy (nerve damage), and multiple studies suggest that CBD can alleviate that type of pain from diabetes, HIV, and other sources.
CBD Oil for Lupus
You'd think the question of whether CBD is legal would get a straightforward, yes or no answer, but the legality issue can be confusing.
Marijuana growers focus on strains and techniques that increase THC levels. Cannabis that's grown for hemp tends to have a lot more CBD than THC.
Dr. Koumpouras’ excitement over the new drug comes at a time when products containing CBD have flooded supermarkets, labeled with claims that they treat everything from back pain to insomnia. Although CBD is not yet approved by the FDA, the hype around it stems from the popularity of the marijuana plant it is derived from.
But these questions are why Dr. Koumpouras is focusing on a compound that, until recently, few have studied.
This is why he’s exploring a candidate for a new lupus treatment option: a molecule with a cannabinoid template structure that binds to cannabinoid receptors, the same receptors involved in the chemicals found in the marijuana plant.
In 2018, Dr. Koumpouras joined a multi-site randomized clinical trial that aims to recruit 100 participants to examine whether a drug using a synthetically created cannabinoid molecule that binds preferentially to CB2 receptors (called Lenabasum) can help ease pain and inflammation in patients with lupus. Participants will receive Lenabasum or a placebo for almost three months and will continue to be monitored for pain and inflammation levels, as well as lupus disease activity. The study is ongoing, but Dr. Koumpouras anticipates that it will wrap up by early next year.
What is CBD?
Lupus affects approximately 240,000 people in the United States, and yet at present doctors neither know the exact cause nor have a cure. Instead, current treatments focus on improving quality of life by controlling symptoms and minimizing flare-ups to reduce risk of organ damage.
His research is one of many new studies at Yale and elsewhere looking at the endocannabinoid system and molecules related to CBD action for use in treating everything from Crohn’s disease to psoriatic arthritis, and he hopes that this new data will be used to help paint a more complete picture about the chemical for future treatment options.
CBD is a form of cannabinoid called “cannabidiol.” Cannabinoids are a type of chemical that binds to CB1 and CB2 receptors found throughout the body. CB1 receptors are mostly located in the nervous system, connective tissues, gonads, glands, and organs; CB2 receptors are primarily found in the immune system, along with the spleen, liver, heart, kidneys, bones, blood vessels, lymph cells, endocrine glands, and reproductive organs. (Collectively this is called the endocannabinoid system.)
From “miracle drug” to medicine?
What these cannabinoids do when they bind to the receptors depends on which receptor is activated, and thus can produce effects ranging from the firing of neurotransmitters (the chemical messengers sent from the brain to the rest of the body) that alter mood, to reducing inflammation and promoting digestion.
“The landscape for treatment of lupus is a bit bleak,” says Fotios Koumpouras, MD, a rheumatologist and director of the Lupus Program at Yale Medicine. “A multitude of drugs have failed in the last 10 to 15 years. Most of the drugs we use are being repurposed from other conditions and are not unique to lupus. Many of them can’t be used during pregnancy, which is a problem because lupus mostly affects young women. All of these issues create the impetus to find new and more effective therapies.”