Cannabidiol: pharmacology and therapeutic targets

Abstract

Rationale

Cannabidiol (CBD) products lacking regulatory approval are being used to self-treat a myriad of conditions and for their unsubstantiated health benefits. The scientific evidence supporting these claims largely arises not from controlled clinical trials, but from the recognition that CBD has numerous biological targets. Yet, CBD is commonly consumed and often in over-the-counter products that are unapproved and of unknown composition. Epidiolex® is the only product that has undergone rigorous pharmacokinetic assessment and testing in clinical trials; it was approved as a non-scheduled drug by the U.S. Food and Drug Administration for the treatment of intractable childhood-onset seizures. However, studies investigating CBD for other medical conditions are limited in number and often lack the scientific rigor, controls, or sample sizes required to draw clinically meaningful conclusions. Although Epidiolex® is safe for human consumption, recent changes in regulation of commercially available CBD products have resulted in limited quality control and products marketed with unknown CBD bioavailability. Even scientifically rigorous studies have used different sources of CBD and different suspension vehicles for administration, making it difficult to compare results among studies and resolve mixed outcomes.

Objectives

This paper reviews the molecular targets, pharmacokinetics, and safety and abuse liability of CBD; additionally, the extant evidence on its potential therapeutic effects for neurological disorders, pain, inflammation, conditions related to immune function, psychiatric disorders, and substance use are described.

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Funding

This work was supported by National Institute on Drug Abuse grants R21 DA045101 and R01 DA045700 (Dr. Babalonis); R01 DA016718 and R01 DA040637 (Dr. Walsh); and T32 DA035200 (Dr. Britch). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Britch, S.C., Babalonis, S. & Walsh, S.L. Cannabidiol: pharmacology and therapeutic targets. Psychopharmacology 238, 9–28 (2021). https://doi.org/10.1007/s00213-020-05712-8

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Keywords

  • Cannabidiol
  • Cannabis
  • Human
  • Pharmacokinetics
  • Medical cannabis
  • Marijuana