Grotenhermen Franjo, Russo Ethan, Zuardi Antonio Waldo
nova-Institut GmbH, Chemiepark Knapsack, Hürth, Germany.
PHYTECS, Los Angeles, California.
Cannabis Cannabinoid Res. 2017 Jan 1;2(1):1-4. doi: 10.1089/can.2016.0036. eCollection 2017.
This short communication examines the question whether the experimental data presented in a study by Merrick et al. are of clinical relevance. These authors found that cannabidiol (CBD), a major cannabinoid of the cannabis plant devoid of psychotropic effects and of great interest for therapeutic use in several medical conditions, may be converted in gastric fluid into the psychoactive cannabinoids delta-8-THC and delta-9-THC to a relevant degree. They concluded that "the acidic environment during normal gastrointestinal transit can expose orally CBD-treated patients to levels of THC and other psychoactive cannabinoids that may exceed the threshold for a positive physiological response." They issued a warning concerning oral use of CBD and recommend the development of other delivery methods. However, the available clinical data do not support this conclusion and recommendation, since even high doses of oral CBD do not cause psychological, psychomotor, cognitive, or physical effects that are characteristic for THC or cannabis rich in THC. On the contrary, in the past decades and by several groups, high doses of oral CBD were consistently shown to cause opposite effects to those of THC in clinical studies. In addition, administration of CBD did not result in detectable THC blood concentrations. Thus, there is no reason to avoid oral use of CBD, which has been demonstrated to be a safe means of administration of CBD, even at very high doses.
这篇简短的通讯探讨了Merrick等人的一项研究中所呈现的实验数据是否具有临床相关性这一问题。这些作者发现，大麻二酚（CBD），一种大麻植物中的主要大麻素，没有精神活性作用，并且在多种医疗状况下具有很大的治疗应用价值，它在胃液中可能会在相当程度上转化为具有精神活性的大麻素δ-8-四氢大麻酚（delta-8-THC）和δ-9-四氢大麻酚（delta-9-THC）。他们得出结论：“正常胃肠道转运过程中的酸性环境可能会使口服CBD治疗的患者接触到的THC和其他具有精神活性的大麻素水平超过产生阳性生理反应的阈值。”他们就口服CBD发出了警告，并建议开发其他给药方式。然而，现有的临床数据并不支持这一结论和建议，因为即使是高剂量的口服CBD也不会引起THC或富含THC的大麻所特有的心理、精神运动、认知或身体影响。相反，在过去几十年里，多个研究团队在临床研究中一致表明，高剂量的口服CBD会产生与THC相反的效果。此外，给予CBD并未导致可检测到的THC血药浓度。因此，没有理由避免口服CBD，即使在非常高的剂量下，口服CBD也已被证明是一种安全的给药方式。
