There has always been an interest in the use of cannabis to treat epilepsy, but it was not until recent that appropriately controlled studies have been completed. In this paper Gaston and Szaflarski address the updated research around cannabidiol (CBD), a non-pshychoactive component of cannabis to treat epilepsy. Data from both open-label expanded access programs (EAPs) and randomized placebo-controlled trials (RCTs) of highly purified oral preparation of CBD, which was recently approved by the FDA, is discussed. In EAPs significant improvement in seizure frequency was seen among the treatment-refractory epilepsy (difficult to treat seizures) population. In addition, RCTs have demonstrated significant seizure reduction in patients with different syndromes. The most common side effects with the administration of highly purified CBD is diarrhea and sedation, with sedation being more common with patients taking concomitant clobazam (drug associated with seizures). There was also an increase of enzymes associated with the liver and heart that were being secreted when administering CBD. When administering CBD, it is reported that there is a clear interaction with clobazam, by significantly increasing the levels of the active metabolite N-desmethyclobazam, and this is measured by the CBD’s inhibition of the liver enzyme CYP2C19 (the long term effect is still unknown). EAPs also demonstrate POSSIBLE interactions with other drugs that are administered to treat seizures. In some cases it was reported that drug adjustments (related to epilepsy) had to be made after the administration of CBD. Even though, the research being done looks to be promising, the future effects are still unknown. CBDs safety and efficacy to treat epilepsy must be further researched. Future controlled studies encompassing various ratios of CBD and THC need to be done to further demonstrate the potential benefits for epilepsy patients. As of now the data looks to be promising and as a society we are making progress. As we make progress it brings to attention many of the bioethical values we have discussed. In particular non-malefesance and beneficence are called into question for the patients. Scientists want to do no harm while conducting clinical trials for the overall benefit of others (beneficience), but with the unknown long term effects, should we delve further into studies to find out? CBD may have the potential to treat difficult cases of epilepsy, but is that enough reason to venture into the unknown?
I think autonomy and justice come in to play here as well. Should we allow patients the autonomy to make their own decisions about taking a currently-federally-illegal drug whose benefits and drawbacks are not well-studied? And similarly, is it just for the government to keep a potentially life-changing treatment out of the hands of patients because it might be mildly psychoactive in some forms?
ReplyDeleteI agree with Ariana on autonomy! I have a friend who has a difficult case of epilepsy. While his medication does help subside his seizures for a few months, they are not as effective as they need to be for him! His brother was also diagnosed with epilepsy and received the Vagus Nerve Stimulator implant, which was effective in stoping his seizures. However, when my friend got the implant, it didn't work. I think being able to have a cheaper option, despite the consequence of being mildly psychoactive, would be a great option. The risk of venturing into the unknown is definitely worth it for people, such as my friend. If more studies were to prove this treatment effective, I think my friend would be willing to make that difficult choice of using a currently illegal drug. I also think that as more positive studies are done in this area, that the government will not be able to restrict treatment to patients who have tried all the other alternatives.
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