In a new book, Professor Kylie O’Brien PhD, discusses the evidence behind medical cannabis and a range of mental health conditions, to help clinicians prescribe safely.
Professor Kylie O’ Brien had carved an impressive academic and medical career, in her home country Australia, before moving into medical cannabis. She joined Releaf Group in 2020 where she now works as chief scientific officer and this year launched the International College of Cannabinoid Medicine (ICCM Ltd), an international online education platform providing educational resources on medicinal cannabis for healthcare practitioners.
As an internationally recognised expert in Chinese medicine, integrative medicine and medical cannabis, she is now due to release her second book, ‘O’Brien & Blair, Medicinal Cannabis and CBD in Mental Healthcare: Springer, 2021.’
The motivation behind it, she says, was to combine colleague Dr Philip Blair’s “clinical experience” with scientific evidence which would provide a “level of rationale” for healthcare practitioners to consider medicinal cannabis, so they don’t dismiss it.
Some of the different conditions discussed in the detailed clinician’s guide include autism spectrum disorder, insomnia, anxiety, depression, PTSD and Alzheimer’s disease. It examines how CBD, or THC, could be used to benefit different mental health conditions.
Mental health conditions increase
It couldn’t be released at a better time. Post-lockdown mental health statistics are rising as the world struggles to cope with Covid. According to the Office for National Statistics, by the middle of 2020, one in five people in Britain had depression. This was double the 2019 figure. Diagnosis of conditions such as Autism is also on the rise. The British Medical Association estimates that 700,000 people in the UK have a diagnosis of autism.
O’Brien said that there is a need for more education in medicinal cannabis that has strong evidence to back it up.
“There is a need for more education and to actually put evidence behind it,” she said. “The reason we wrote this book on medicinal cannabis and CBD in mental health care is that a lot of doctors don’t know there is robust evidence.
“The book looks at six different conditions including anxiety, depression, PTSD, insomnia, Alzheimer’s disease and autism spectrum disorder. A lot of doctors want to know how safe cannabis is. The top reason for using medical cannabis is usually chronic pain and the second is typically anxiety. We need to educate healthcare practitioners about the level of evidence that exists as well as where there are gaps.”
There are limited studies when it comes to CBD, or even THC, and mental health. Some studies suggest that CBD may affect serotonin levels or that it may have an effect on the receptors located in the brain. A recent study into Alzheimer’s Disease showed CBD treatment increased levels of IL-33 and TREM2, sevenfold and tenfold, respectively. Proteins TREM2 and IL-33 are important to the ability of the brain to consume dead cells and other debris like the beta-amyloid plaque that piles up in patients’ brains, both of which are reduced in Alzheimer’s patients.
Mental Health evidence
While more evidence is needed, what’s out there so far is promising.
“In terms of two main mental health conditions of anxiety and depression, there is stronger evidence for the efficacy of medicinal cannabis for anxiety disorders but less for depression, ” O’Brien explained.
“There is a range of evidence that CBD and in some cases THC may also be helpful in various mental health conditions. There are cross-sectional studies on people with PTSD, particularly war veterans who use cannabis and self-medicate many of their symptoms with it,” she said.
She added: “There is a growing amount of clinical trials now to test this out in a real sense. The evidence is mixed but there is certainly enough to show there is promise.”
It’s also important to consider the real-world evidence. O’Brien and Blair have included case studies throughout the book, derived from Dr Blair MD’s clinical practice, which can be extremely powerful tools in demonstrating to doctors the benefits of this treatment. While clinical trials studies can often have narrow inclusion criteria or not allow for co-morbidities, the personal touch of adding patient stories can teach doctors a lot about how a condition reacts to individual dosage amounts or ratios.
She explained: “You can often get narrow inclusion criteria for clinical studies and strict exclusion criteria so that you can only really generalise results to people who have similar characteristics. That’s the limitation of randomised control trials. Doctors often learn from case studies. I think that is a valid form of evidence that often gets relegated further down the pyramid of evidence in medicine when it really shouldn’t.”
But O’Brien stressed also that prescribers are right to be cautious, with some studies showing higher levels of THC may have mental health concerns, though this is often dose-related.
“You can look into the research and find that high levels of THC can be associated with anxiety and other mental health issues. The cultivated varieties of cannabis bred for the recreational market have been bred to have very high amounts of THC. The negative side effects of THC are typically dose-related,” she continued.
“A lot of the literature around safety and negative effects of cannabis is associated with recreational use. You have to bring it into context. That is not to say that cannabis medicines won’t have side effects in some people at certain doses. It’s another reason why these should be prescribed by a healthcare practitioner who is trained in cannabinoid medicine,” she said.
Mental healthcare professionals
If healthcare professionals are not willing to prescribe, patients may choose to access the medicine illicitly, which could put them at greater risk of harm on the black market.
“An advantage of people going to a healthcare practitioner trained in medicinal cannabis is that they can get valuable advice on dosing,” said O’Brien.
“If you are looking into oils, the ones on the legal market that are prescribed by doctors have good quality control. When you buy products on the grey or black market then you don’t know what you are getting.
“It is always a concern that you could have some contamination in cannabis medicines available on the grey or black market. I always advise people to get it prescribed because of that quality control.”
In Australia, O’Brien feels that doctors are becoming more comfortable prescribing for mental health conditions. However, this is not always the case in other countries where there may be more stigma or less education around the benefits of cannabis.
“Our doctors trained in medicinal cannabis are comfortable prescribing for mental health conditions and there is more demand for it,” she said.
“A lot of doctors become more comfortable with it as their knowledge base and clinical experience grows, it gives them confidence.”
But the stigma hasn’t gone away entirely.
O’Brien said: “Many people don’t understand how it is used in medicine or its value or therapeutic actions. “It brings it back to why education is so important.”
It was this that inspired her to set up the ICCM, to bring together clinical experts in medicinal cannabis from across the world to improve knowledge and ultimately patient access.
“You need to hold your beliefs for a moment and look at some of the evidence to get a different appreciation of it. I think there is still a stigma attached to it and I think, like a lot of things that have been demonised over a long time period, it is going to take time to shift that.”
Men’s mental health: “It’s something you have to deal with every day”
Ian McLauren and Sam Williamson, co-founders of CBDiablo speak about mental health support and what needs to change for men.
In the final part of our Men’s Mental Health series, Ian McLauren and Sam Williamson, co-founders of CBDiablo speak about how their own experiences and why they choose to give back to a mental health charity.
Ian McLauren and Sam Williamson, co-founded CBDiablo together in 2019, an online, Edinburgh-based CBD store that has a particular focus on mental health.
Both men have experienced mental health difficulties in their lives, which made them feel passionate about offering help to others. So much so that they donate a portion of their profits to mental health charities.
Ian explained how his experience of bullying while at school, started his struggle with mental health.
“My mental health journey started when I was a teenager. I struggled a lot with bullying and I experienced anxiety. When I got a little bit older, this led to suicidal thoughts and I needed to go to counselling,” he said.
A report from 2018, revealed that bullying can have a massive effect on pupils’ mental health. In a survey of 2,000 students, one fifth said they had experienced bullying while three quarters felt this directly impacted their mental health. A further 33 per cent reported having suicidal thoughts as a result.
“When I got to university, I got sick with a reoccurring chest infection which led to [me experiencing] depression and struggling to function,” Ian continued.
“My life is quite heavily impacted with my mental health and even today it’s a struggle. It’s something you have to deal with every day but I’ve gotten to a place where I’m on top of it.”
It can be difficult to open up about mental health, especially for men. They are less likely to access psychological therapies than women, according to The Mental Health Foundation. Only 36 per cent of referrals to the NHS talking therapies are men. As a result, men may resort to other more dangerous ways of coping with mental health strain, such as drinking, drugs or violence.
Mental health and staying CALM
The charity, Campaign Against Living Miserably (CALM) estimates that 125 people die by suicide every week in the UK, with 75 per cent of those deaths being men.
Ian said: “I spoke to my mum and she pushed me in the direction of help. I was very nervous and unsure what to do. When I was at university, it got to a point where I didn’t want to lay around in bed anymore, so I knew I needed to go and get a job and complete my studies. I went to the doctors and got help that way. I don’t remember it being difficult, but it wasn’t my choice either, I was either forced by situation, or by a parent.”
Ian and Sam met in their first year of university. After they completed their studies, they moved into marketing and SEO, but it wasn’t until they worked with a CBD company that they came across its benefits for mental health. They decided to go into business together but were determined to have a charitable focus.
Sam said: “We tried CBD when we started working with the client and we felt a benefit from it fairly early on, especially for things like sleep. Sleep is obviously a big part of your mental health.”
A lack of sleep creates a vicious circle when it comes to health. Poor sleep can impact mental health leaving a person feeling sluggish, stressed or increasingly anxious. Increased stress or anxiety can then affect the quality of sleep contributing to poor mental health.
Ian added: “We really enjoyed CBD, so we thought we would do something by ourselves. But [we wanted to] do something that means something. The obvious choice was mental health because of my own experiences. We made a beeline for CALM as well because it represents who we are.
“I’ve got two brothers and Sam has three brothers. We both have dads or uncles and it’s not always easy to open up, especially for men. That’s why we chose a mental health charity and one with a predominately male focus.”
Mental Health charities
CALM is a charity that takes a stand against suicide in the UK, by raising awareness of the stereotypes, offering help and running life-saving services.
It offers a free and confidential web chat for anyone in need of help and also hosts support services for anyone who has lost someone due to suicide. While the charity is not solely focused on men, it has launched campaigns such as #BestManProject which aims to challenge male stereotypes, encourage positive behavioural changes and address help-seeking behaviour using art, music or sport.
Both Ian and Sam decided to donate 20 per cent of their profits to CALM. They are incredibly transparent about the donation process often posting their donations to the charity on Instagram. In September, they posted that they donated £665. CALM highlighted that just £8 can answer one life-saving call and that they managed to answer over 83 of these over the month of August.
The brand also highlights mental health and wellness across their social media, choosing to focus on Movember for men’s health. Movember is the mental health campaign that sees men grow their facial hair to raise awareness.
The response has been positive. Sam explained it is one of the reasons that people stay with the brand, while they often email to say it has been the start of their own mental health journey.
“It’s a bit part of the reason why people continue to buy from us,” Sam said.
Ian added: “We get a lot of people emailing to say it’s changed their life, which is great, or that it has been a building block towards feeling better. It might have been part of their journey towards therapy or improving their lifestyle. CBD does seem to be quite a fundamental part of it for some people.”
When it comes to changing the way men speak about their mental health, Ian highlighted that it can be a generational thing.
“I think a lot of the time, older generations of men don’t want to seem weak or vulnerable and that’s transcended down to younger generations,” he said.
“Even though things are a little better, there is partly a pride or bravado. If you are struggling with mental health or feeling bad then you’re not really meant to bring it up, so it’s awkward to talk to somebody.”
He continued: “A lot of guys don’t feel equipped to deal with that conversation either. If a friend comes to you who is struggling, then I don’t think a lot of men know how to deal with that. Girls seem to deal with it really well, it seems to be discourse between friends but for men, not so much.”
In speaking with other charities that deal with male mental health or creating communities where men can go to feel less isolated, they have also learned that sometimes it can be down to body language.
Ian added: “Apparently men like to sit next to each other, side by side, but women prefer to be face to face, which is how they like to open up. There are those key differences but it’s not clear if it’s biology that causes that. These are differences that might stop health services from being equipped to deal with different people because there are slight differences in the way people open up.”
CBDiablo donates 20% of profits to suicide prevention
CBDiablo is hell-bent on making a difference in the industry
Industry-leading CBD company, CBDiablo is hell-bent on making a difference by offering 20 per cent of its profits to suicide prevention
There are about a million CBD brands in the UK to choose from – each claiming they offer something different from the next.
Founders of CBDiablo, Ian McLaren & Sam Williamson, set out to leave their mark on the CBD industry by deciding to donate 20 per cent of CBDiablo’s profits to The Campaign Against Living Miserably (CALM), a leading campaigner against suicide.
It is a shocking fact that every week 125 people in the UK take their own lives, with males making up 75 per cent of that number, and Ian knows he could have ended up as part of that percentage.
“It means a lot to me personally because I struggled with my mental health as a teenager which grew into suicidal thoughts and anxiety,” Ian said.
“I became quite unwell at university with recurrent chest infections and went into a spiral of depression and had a really tough time getting into my twenties. Myself and Sam have five brothers between us and we have all suffered to some degree with our mental health, and it hasn’t always been easy to discuss our struggles openly.”
How CBDiablo got started.
The pair stumbled into the CBD industry by chance. They worked with several CBD businesses for a number of years before setting out on their own in 2019 (funding the operation with only £3,000 from personal savings).
As you may expect, the same responsibility and pride that the founders hold for their mission have been extended to the products they sell.
“We used the years of experience, knowledge and connections in the industry to find nothing short of the most effective range of CBD products we could – from ethical producers who shared our values,” said Sam.
“While there are some brands who like to market themselves as the best CBD in the UK, we like our products to speak for themselves. We have spent a lot of time researching and sourcing the most effective products we can. We take our commitment to providing the most effective CBD products we can find, as seriously as we take our social cause.”
Sam added: “I think our reviews on Trustpilot, glowing reviews from cannabis influencers and blogs, and loyal customer base speaks volumes about the range of products we have put together. It’s something we’re super proud of.”
So far, CBDiablo has donated over £11,000 to CALM which has answered 1400 potentially life-saving calls.
CBDiablo offers a range of CBD oils & Capsules, CBD gummies and hemp extracts which all enjoy glowing recognition.
When it comes to what people think, the most popular CBD oil the company sell is their 1000mg CBD oil (10 per cent) which contains a full spectrum of naturally occurring hemp bioactives (phytocannabinoids, terpenes, flavonoids and Omega 3 & 6 Fatty acids) using European hemp and co2 extraction methods.
The oil is produced in an ISO9001 & BRCGS approved facility in Edinburgh, and lab-tested by a 3rd party for safety and quality.
For those with a sweet tooth, the company sell CBD gummies, which are mouth-watering. They come with 4 assorted flavours and delivery a clean dose of hemp-derived CBD (10mgs per gummy). They have a more-ish soft, yet firm, texture and a lovely natural flavour; they do not have the lingering bitterness that some gummies have.
The gummies also have been highly reviewed by many, including The CBD Monkey.
So, what is next for CBDiablo?
The brand is still small, but it is clear that they are carving a significant path in the industry and are close on the heels of even the most well funded CBD brands in the UK.
“We have continued to surpass expectations and growing exponentially – we have a few exciting projects in the pipeline,” Ian said.
“The next step for us is creating a CBD sports brand with BSCG certified CBD oils and CBD thermal Balms, alongside a range of Liposomal supplements.
“It’s called ‘Daemon Power and will be launching at the end of the year… our aim is to focus on supplying powerful supplements to those in extreme, impact and power sports. Particularly rugby players.”
With such a successful two years, the sky seems to be the limit for CBDiablo.
CBD Guides: Can CBD help with generalised anxiety disorder?
We examine the science behind taking CBD for anxiety to see if it could help with the symptoms
Anxiety is one of the most common mental health conditions in the UK and it can have a debilitating effect on a person’s daily life. Could CBD help to ease the symptoms?
Anxiety is a natural reaction to stress creating fear or apprehensive feeling about what will happen. While anxiety can happen to everyone from time to time, there are some people who struggle with strong feelings of anxiety every day. These feelings of anxiety can be a symptom of post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD) or social anxiety disorder.
GAD is a life-long condition that can leave people feeling anxious most days or struggling to relax. The NHS estimates that it can affect up to 5 per cent of the population. It is also thought to affect more women than men.
What are the symptoms of generalised anxiety disorder?
The psychological symptoms of generalised anxiety disorder can be restlessness, a feeling of dread, feeling on edge, difficulty concentrating and irritability. Patients with GAD may remove themselves from situations where they feel these emotions most such as social situations or work.
It can also cause physical feelings such as dizziness, fast or irregular heartbeat, dry mouth, shortness of breath, stomach aches or excessive sweating. All of which can be exhausting.
What is CBD?
CBD is a cannabinoid found in the cannabis plant. It is non-toxic unlike the cannabinoid tetrahydrocannabinol (THC).
We have different receptors throughout our bodies. It is thought that CBD interacts with these receptors by giving them signals. In particular, it may interact with the receptors, CB1 and CB2 which are found in the immune and nervous systems.
How does CBD work for anxiety?
CBD is thought to interact with the receptors in the brain potentially sending signals to the neurotransmitter, serotonin. There is still a lot of research needed in this area to understand how the two interact.
Serotonin is the neurotransmitter responsible for your mental health and lower levels are sometimes associated with depression or anxiety. This is why the prescription treatment for anxiety is usually selective serotonin reuptake inhibitors (SSRI).
Reducing anxiety in SAD
A study examining the effect of CBD on people with Social Anxiety Disorder (SAD) found that it may help to reduce anxiety.
SAD is a social disorder where people can feel panic at the thought of social settings or speaking to groups of people. Participants in this study were given 400 mg of CBD or a placebo. The researchers reported that those in the group given the CBD recorded lower levels of anxiety.
Improving sleep quality
Another study examined if CBD could help to improve sleep quality while reducing anxiety. The study involved 72 participants with 47 experiencing anxiety of which a further 25 had poor quality sleep. Each participant was given a daily dose of 25mg of CBD then asked to self-report how they felt afterwards. The researchers recorded that 79.2 per cent recorded reduced anxiety while 66.7 per cent said their sleep had improved after the first month.
How do I take CBD for anxiety?
There is no right or wrong way to take CBD for anxiety. It comes down to lifestyle, personal preference and availability.
Here are three of the most popular ways to take CBD
Edibles are great if you aren’t a fan of the hemp taste that some oils may have. They are available in many different versions from brownies to gummy bears. It’s also a discreet way to have a dose of CBD without anyone knowing.
However, there are some downsides to edibles
They can often be found in sugary sweets which can be difficult if someone is following a particular diet or reducing their sugar intake. Edibles can take longer to work so if you need a quick dose of CBD then this isn’t the method for you.
A large percentage of CBD can be lost in the digestion process meaning that you may absorb less than the amount you had intended.
Patches are a good choice if you often forget to take oils or capsules on a regular basis.
They can be applied to the skin easily and left for a day or two depending on the brand. They are designed to be discreet and forgotten about. The CBD in the patch is absorbed through the skin and into the system.
Oil or tincture
Oils and tinctures are the popular way of taking CBD.
There isn’t much difference between the two as they are both ingested through the mouth. To take, pop a small drop of oil or tinctures under the tongue allowing it to absorb for a few minutes before swallowing.
The main difference between tinctures and oils is the carrier. Tinctures use alcohol whereas oil is, well, oil. Oils normally use a carrier such as hemp, rapeseed or flaxseed. Tinctures will usually have a sweetener or flavouring added to mask the bitterness of the alcohol.
What is the best CBD for anxiety?
There isn’t one particular method or type of CBD that works for anxiety. It comes down to personal preference and lifestyle. If the above methods don’t appeal then there are loads of other ways to take it including bath bombs, skincare, massage oil or even capsules.
There is bound to be a method for everyone.
How quickly does CBD work for anxiety?
While it does depend on different factors, some are faster than others.
If you vape or use oil then it will be faster acting than edibles. It is also worth noting that weight may also play a part in how quickly a dose affects you. It’s best to start with a low dose letting it build up over time. A lot of people when new to CBD expect it to work instantly as if it was the same as paracetamol. CBD takes time to build up in the system.
Keeping a record of the different effects you feel can help you to determine future doses, what brands work for you and what methods you prefer.
Would CBD help with depression and anxiety?
CBD is also thought to help with depression as well as anxiety. The two conditions are usually closely linked.
A study from 2011 examined the effect of CBD on people with SAD. The participants were given either 400 mg of oral CBD or a placebo. Those who were in the CBD group reported feeling less anxiety.
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