Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Abstract

Recent approval of Epidiolex Ò (pharmaceutical cannabidiol/CBD) for the treatment of Lennox Gastaut syndrome (LGS) and Dravet syndrome highlights a therapeutic efficacy of CBD in the treatment of epilepsy. However, a large number of patients with epilepsy elect to use alternative artisanal CBD products due to cost or access constraints. Despite widespread availability and variety of these artisanal CBD products, studies evaluating their safety or efficacy are rare, making conclusions about clinical utility uncertain. The purpose of the present study was to evaluate cross-sectional and longitudinal associations of artisanal CBD product use with quality of life, mental health, healthcare utilization, and epilepsyspecific outcomes within a large, observational cohort of people with epilepsy. Participants who reported using artisanal CBD products at baseline (Artisanal CBD Users; n = 280) and participants who used no cannabis-based products (Controls; n = 138) completed web-based assessments evaluating psychiatric symptoms, healthcare utilization, and epilepsy-specific factors. Follow-up surveys were collected in a subset of participants (n = 190) following baseline assessment for longitudinal comparison. Crosssectionally, higher quality of life, lower psychiatric symptom severity, and improved sleep were observed among Artisanal CBD Users at baseline compared with Controls. Initiation of artisanal CBD product use was also related to improved health outcomes longitudinally. No group differences were observed for seizure control, but both groups included a high number of individuals with no past month seizures. Artisanal CBD Users reported significantly better epilepsy medication tolerability, use of fewer prescription medications overall, and reduced healthcare utilization compared with Controls. These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life as well as for seizure control.

Determination of contaminants in artisanal cannabis products used for childhood epilepsy in the Australian community: A sub-analysis of the ‘PELICAN’ study

“…With many individuals continuing to self-medicate with artisanal cannabis preparations in Australia [4,5,7] and the US [8], contaminants may be unknowingly ingested by many vulnerable individuals suffering chronic illness, including children and adolescents with epilepsy. In a previous study, we collected individual samples of cannabis extracts from families in Australia who were using them to treat their child's epilepsy, and conducted an analysis of cannabinoid and terpenoid content [4].…”

Online survey of medicinal cannabis users: Qualitative analysis of patient-level data

“…In light of this, the current manuscript presents a qualitative thematic content analysis of open-ended survey responses detailing the experiences of 808 medicinal cannabis users. Earlier quantitative analyses of data from the present study sample reported significant health benefits associated with medicinal cannabis use ( Schlienz et al, 2020 ; Martin et al, 2021 ; Strickland et al, 2021 ). Schlienz et al (2020) initially found significantly better self-reported quality of life, health satisfaction, and sleep, and significantly lower pain severity, anxiety, and depression among a sample of 808 medicinal cannabis users compared to a control group of 468 patients with similar health issues and demographics who were not medicinal cannabis users.…”

“…Finally, Strickland and others (2021) compared a subsample of patients with epilepsy who used cannabidiol (CBD) products ( n = 280) with a control group of individuals with epilepsy who did not use CBD or medicinal cannabis ( n = 138), finding better quality of life and sleep, and lower severity of psychiatric symptoms among the CBD users at baseline. No difference was found in self-reported seizures, though this may indicate a floor effect due to the high proportion ( >40%) of respondents who reported no past-month seizures ( Strickland et al, 2021 ).…”

“…Participants provided demographic and health-related information on their medical conditions, treatments, and medicinal cannabis use. Quantitative data regarding participant health outcomes were previously reported ( Schlienz et al, 2020 ; Martin et al, 2021 ; Strickland et al, 2021 ). The current study presents novel data from free-text participant responses.…”

“…These data indicate that patients with a wide array of health conditions report notable physical and mental health benefits associated with medicinal cannabis use that are not evident in patients who do not use medicinal cannabis, and that upon initiation of medicinal cannabis use significant improvements are reported across diverse areas such as sleep, mood, and healthcare utilization (Schlienz et al, 2020;Martin et al, 2021;Strickland et al, 2021). To supplement these findings, the current study provides a qualitative account of participants' lived experience as medicinal cannabis users based on open-ended response data.…”