Cannabinoids In The Treatment Of Epilepsy

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Currently, patients with chronic arthritic and musculoskeletal pain are the most prevalent users of therapeutic cannabis products . CBDV, another cannabinoid present in the cannabis plant, has been the focus of many recent studies. Despite this change in the classification of hemp and hemp-derived CBD, the only CBD product that has been rigorously studied and approved to be used as a medical therapy for epilepsy is the drug Epidiolex.

I don’t exercise before bed, I try to eat healthy, I go to bed at same time each night, etc….Just tired of waking up every couple of hours with dreams that continue where they left off, when I fall back asleep. What dosage of CBD oil do you recommend for a good nights sleep? I have absolutely NO physical reason for not being able to sleep and my dr. says I do not have depression, probably anxiety !!! She recommend Restoril which is awful, causes constant ringing in my ears PLUS it does not work, well maybe 4 hours sleep and that is it.

The major limitation of inhaling is the variability in inter-patient efficiency that is caused by differences in inhalation techniques, respiratory tract irritation during inhalation, etc. In fact, improved methods with which to standardise dosage have been proposed for these very reasons. It really helped when you talked about CBD and how it could help you sleep better. Recently, one of my cousins mentioned she’s been dealing with more anxiety attacks.

In 2018, almost half of the people in the United States had tried marijuana, 16% had used it in the past year, and 11% had used it in the past month. In 2014, daily marijuana use amongst US college students had reached its highest level since records began in 1980, rising from 3.5% in 2007 to 5.9% in 2014 and had surpassed daily cigarette use. The United Nations’ World Drug Report stated that cannabis “was the world’s most widely produced, trafficked, and consumed drug in the world in 2010”, and estimated between 128 million and 238 million users globally in 2015. Cannabis has an ancient history of ritual use and has been used by religions around the world. Hemp seeds discovered by archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century BC, confirming previous historical reports by Herodotus.

We now took her from the facility and plan to move to an Adult Family home but I am concerned with her not having any meds for agitation or to help sleep she might not be successful in the home. Are there any meds you can recommend for someone other than antipsychotics for behavior management? Well, I can understand why you’d like for her to be less sedated, although “sedated bliss” does sound better than often hollering. One thing I wonder is whether it’s being mostly driven by pain. Oral morphine usually provides relief for about 4 hours (longer if the person’s kidneys are impaired or shutting down). At the end of life people often have pain around the clock, so it’s often appropriate to provide pain medication that is dosed to cover them most of the time.

According to one study, 62% of CBD users take it for a medical condition. What’s more, almost 36% of users report that CBD treats their medical condition “very well” by itself. The mission of the Epilepsy Foundation is to lead the fight to overcome the challenges of living with epilepsy and to accelerate therapies to stop seizures, find cures, and save lives. Marijuana or cannabis in general has a number of side effects depending on how it is used. For example, if smoked, the negative effect of smoking on a person’s lungs and heart also apply to marijuana.

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In a Brazilian study, 57 men received either oral CBD or a placebo 90 minutes before they underwent a simulated public speaking test. The researchers found that a 300-mg dose of CBD was the most effective at significantly reducing anxiety during the test . And according to preclinical evidence from rodent studies, CBD may have beneficial effects on pain and inflammation related to arthritis, but human studies are lacking . The body produces endocannabinoids, which are neurotransmitters that bind to cannabinoid receptors in your nervous system. Steffens, S., Veillard, N. R., Arnaud, C., Pelli, G., Burger, F., Staub, C., Karsak, M., Zimmer, A., Frossard, J. L., & Mach, F. Low dose oral cannabinoid therapy reduces progression of atherosclerosis in mice.

Drugs And Medications Center

It’s important to get treated early, after the first episode of psychosis. That will help keep the symptoms from affecting your relationships, work, or school. Myxedematous psychosis may happen when your thyroid gland doesn’t work well, known as hypothyroidism. Because of the way thyroid hormone affects your brain, you may have hallucinations, delusions, and changes to your sense of taste or smell if there’s not enough in your body. Your doctor can test your level of thyroid-stimulating hormone to confirm myxedema psychosis and rule out other conditions like schizophrenia. Antipsychotic drugs like olanzapine and risperidone can stop symptoms and may help prevent future episodes.

It is the most commonly used illegal drug in the world, though it is legal in some jurisdictions, with the highest use among adults (as of 2018) in Zambia, the United States, Canada, and Nigeria. CBD can cause some side effects, such as dry mouth, low blood pressure, light headedness, and drowsiness. Signs of liver injury have also been reported with high doses of the prescription form of CBD, called Epidiolex. CBD is also used for anxiety, pain, a muscle disorder called dystonia, Parkinson disease, Crohn disease, and many other conditions, but there is no good scientific evidence to support these uses. CBD may also interact with certain prescription medications, dietary supplements, and over-the-counter drugs.

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This helps avoid detection but reduces the CBD production of the plant. Lastly, the National Centers for Complementary and Integrative Health suggests modest benefits of cannabinoids for chronic pain and multiple sclerosis symptoms. Research suggests these drugs may improve the quality of life and taste of food in cancer patients.

In geriatrics we do sometimes use opiates such as morphine, if we suspect that pain is a significant contributor to agitation. It’s also essential to use laxatives when using opiates, because they are constipating and that’s distressing for the older person and can aggravate behavior. My husband aged 84 has moderately severe vascular dementia. I am his carer – age 77 – and responsible for dolling out medication.

As patient and consumer demand increases, so does the need for greater scientific understanding of cannabis and cannabinoids. Clinical trials to examine the medical validity and safety of these dispensary and retail products have not been conducted, thus they are not FDA approved. Some jurisdictions use free voluntary treatment programs and/or mandatory treatment programs for frequent known users. Simple possession can carry long prison terms in some countries, particularly in East Asia, where the sale of cannabis may lead to a sentence of life in prison or even execution. Political parties, non-profit organizations, and causes based on the legalization of medical cannabis and/or legalizing the plant entirely have emerged in such countries as China and Thailand. A 2012 review found that the THC content in marijuana had increased worldwide from 1970 to 2009.

My husband is in late stages and I need help with his medications desperately. It’s hard to know what causes his behaviors the meds or this horrible disease. I’m sorry to hear about the negative experiences you’ve had with medications and the health care system.

This led to the exploration of how cannabinoids, including both the plant molecules and synthetic versions developed in laboratories that mimic their effects, might be used for therapeutic purposes. Cognitive behavioral therapy can help you recognize when you have psychotic episodes. It also helps you figure out whether what you see and hear is real or imagined. This kind of therapy also stresses the importance of antipsychotic medications and sticking with your treatment. Postictal psychosis happens in some people with epilepsy who’ve had a number of seizures in a row. It’s more likely when you’ve had a seizure disorder for a long time or you’ve had mental illness in the past.

Cbd For Obesity

Additionally, there is a currently ongoing study to evaluate the effectiveness of THC-free CBD oil in improving agitation among patients with Alzheimer’s disease. The study also suggests that CBD may reduce the accumulation of beta-amyloid plaque, which is a hallmark of Alzheimer’s disease. Beta-amyloid typically appears in the brain years before the onset of the disease, so CBD use could potentially delay the onset of Alzheimer’s. CBD may have neuroprotective properties that can reduce damage to the brain. According to one review from 2018, CBD might protect the brain by directly affecting the endocannabinoid system and influencing cannabinoids within the body.

Hemp has lower concentrations of THC and higher concentrations of CBD, which gives lesser psychoactive effects. There is concern that cannabis may contribute to cardiovascular disease, but as of 2018, evidence of this relationship was unclear. Research in these events is complicated because cannabis is often used in conjunction with tobacco, and drugs such as alcohol and cocaine that are known to have cardiovascular risk factors. Smoking cannabis has also been shown to increase the risk of myocardial infarction by 4.8 times for the 60 minutes after consumption. Reviews in 2019 found that research was insufficient to determine the safety and efficacy of using cannabis to treat schizophrenia, psychosis, or other mental disorders.

Furthermore, research into cannabinoid delivery systems is growing and a plethora of patents have shown interest in the companies working in this field, especially when it comes to local/transdermal administration. Combining formulations may provide an opportunity to produce rapid systemic effects and long-term outcomes (e.g., analgesia). This could what is cbd oil good for be achieved with intranasal cannabinoid sprays used as a low-dose adjuvant to patches in order to aid rapid absorption for systemic effects. Interesting and promising transdermal administration results can also be found in the use of terpenes as CBD and THC penetration enhancers, and thus improve the effectiveness of the therapeutic components.

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In New Zealand, Sativex is “approved for use as an add-on treatment for symptom improvement in people with moderate to severe spasticity due to multiple sclerosis who have not responded adequately to other anti-spasticity medication.” Concerning the treatment of inflammatory bowel diseases with cannabinoids, preclinical evidence has indicated that CBD protects against intestinal inflammation (reviewed in ). However, GW Pharmaceuticals, who completed a phase IIa pilot study in 2014 did not list CBD for the treatment of ulcerative colitis on its development pipeline .

But scientific research and real-world experience show that smoking hemp is actually beneficial! It appears that the benefits of hemp’s anti-inflammatory cannabinoids are far stronger than smoke’s harms. The term medical marijuana refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom. In November 2015, Uttarakhand became the first state of India to legalize the cultivation of hemp for industrial purposes.

Of note, CBD was combined with traditional treatments such as medications and dietary changes. Another study found that CBD is likely effective at treating acne due to its anti-inflammatory properties that decrease oil production. Reducing inflammation of sebocytes that produce oil in the skin may directly target the acne source. In 2019, over 49,000 people died from opioid-involved overdoses. The growing number of opioid-related deaths has led physicians to be more hesitant to prescribe opioids to treat pain. This leaves many people who suffer from chronic pain searching for natural, non-addictive ways to manage pain.

The report mentioned earlier by the British Pharmacological Society also highlights the ability of CBD to possibly treat substance abuse disorders. An estimated 7% of the population suffers from neuropathic pain caused by nerve damage. According to another study published in The Journal of Experimental Medicine, CBD significantly reduced inflammation in rodents. Of note, rodents did not develop tolerance to CBD with continued use.

It was used by Muslims in various Sufi orders as early as the Mamluk period, for example by the Qalandars. Smoking pipes uncovered in Ethiopia and carbon-dated to around c. Legalization has increased the rates at which children are exposed to cannabis, particularly from edibles.

Some hemp flower strains are more uplifting and energizing, while others are more calming. People may choose to use different strains during the day than at night to achieve desired effects. The path that led to CBD’s legality, in fact, was forged by parents who noticed just how much the cannabinoid helped their epileptic children.

Atherosclerosis is a disease in which the artery walls thicken and which eventually over the years can lead to the obstruction of proper blood flow. This does not necessarily mean marijuana prevents DM, but it potentially could and a finding like this definitely should encourage more research into this topic. The irony here is that alcohol is legal and marijuana is still illegal in large parts of the world. Marijuana, in general, has anti-inflammatory properties, And these properties even extend to your guts. One of the key processes which lead to the loss of brain cells in Alzheimer’s disease is Aβ aggregation.

He has been taking 5 mg of Aricept twice a day and 5 mg of memantine twice a day. When aggression comes on fairly quickly (e.g. over hours to days), we normally what are the side effects of cbd oil? search for anything that might trigger pain, discomfort, or delirium. Unfortunately, all I can do is offer a little information and encouragement.

3 Pulmonary Administration

The 2018 Farm Bill does not change existing laws surrounding state medical cannabis programs. People who had increases in their liver enzymes to a level three times or more than normal were also on valproic Was ist CBD-Öl? acid , a commonly used anti-seizure medication. It is thought that a part or byproduct of VPA may interact with CBD when it is broken down. This may put some people at increased risk for liver issues.

Used For Pain, Cancer, And Autoimmune Diseases

Alternatively, the loose regulation of supplements may allow for excessive CBD levels in products or harmful contaminants such as pesticides, heavy metals, and solvents [16+, 17]. Because preliminary research suggests that CBD improves rather than causes nausea and diarrhea, these effects most likely result from the irritating effects of other ingredients (e.g., carrier oils) on the bowels . About one in ten people who use CBD oil will experience dry mouth. So, make sure to speak with your doctor before starting on a CBD oil regimen. A high-potency phytocannabinoid wellness product for high intensity athletes.

Most consumers agree that organic hemp flowers taste better than strains grown with synthetics. Growing hemp in rich, living soil allows it to develop a more complex terpene profile. There are no residual chemicals from synthetic fertilizers and pesticides to create a harsh afterburn.

In order to complete this overview of topical CBD, we should note that CBD exerts interesting sebostatic and anti-inflammatory effects on human sebocytes , . Indeed, CBD has been shown to inhibit the proliferation of hyperproliferative keratinocytes , and to possess remarkable antibacterial activity . The authors also demonstrated the potent local activity of CBD as an anti-acne agent. Furthermore, its high lipophilicity means that CBD is expected to preferentially enter the skin via the transfollicular route and to accumulate in the sebaceous gland. Permeation profiles of a range of formulations have also been reported .

Hemp, like any other type of cannabis, is an herbal plant that grows annually. It’s also what’s called a photoperiod plant, which means its growing and ripening cycles track with the sun. And while many of the compounds in hemp flower are produced in truly trace amounts, every little bit counts. Cannabinoids, terpenes, and flavonoids seem to work better together. Smoking CBD flower, in fact, is one of the fastest and most powerful ways to get your CBD.

Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Chiu P, Olsen DM, Borys HK, Karler R, Turkanis SA. The influence of cannabidiol and delta 9-tetrahydrocannabinol on cobalt epilepsy in rats. Cannabidiol displays antiepileptiform and antiseizure properties in vitro and in vivo. Leite JR, Carlini EA, Lander N, Mechoulam R. Anticonvulsant effects of the (−) and (+)isomers of cannabidiol and their dimethylheptyl homologs. Molecular targets of cannabidiol in neurological disorders.

It is hard to say what it is doing for her now; it might be helping her sleep at night, but it’s possible that she could sleep as well or nearly as well on a smaller dose. You could certainly talk to her doctors and ask if it might be possible to try reducing her dose, and seeing how she does. You could also ask about trying melatonin to manage any sleep disorders. He’s been in and out of the ER over 10 times now for his body temperature dropping to 91 degrees. Everytime before a trip to the ER, our family has noted severe cognitive loss and confusion.

Nevertheless, it is essential to speak with your physician to discuss potential side effects before using CBD products. Though research to link CBD and gut health remains limited, pre-clinical trials suggest it may support a healthy GI tract and prevent diseases. Since our gut houses endocannabinoid receptors, many believe CBD can support a healthy gut.

The ECS has far-reaching effects on your body, and that’s why cannabinoids are believed to have so many different medicinal uses. Autoimmune diseases (such as MS, lupus, Crohn’s disease, and rheumatoid arthritis) may benefit from multiple functions of cannabinoids because it alleviates pain and inflammation while also regulating the immune system. The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease.

A proprietary CBD nanotherapeutic formulation for subcutaneous administration is being developed by Cardiol Therapeutics the treatment of heart failure with preserved ejection fraction. A nano-technology platform proposed by Medlab Clinical , named NanoCelleTM, that is made up of micelles obtained by mixing oils, glycerol and non-ionic Comment consommer l’huile de CBD ? surfactants is currently undergoing advanced trails. Micelles of nanometer size and positive average Z potential have been observed to deliver lipophilic molecules for absorption across the oral buccal mucosa, bypassing the gastrointestinal tract. Early research into their use in the treatment of pain is underway in Australia .

The participants experienced improvements in pain, walking ability, and muscle spasms . More recently, scientists have discovered that certain components of cannabis, including CBD, are responsible for its pain-relieving effects. Better known as CBD, it is one of more than 100 chemical compounds called cannabinoids that are found in the cannabis plant, Cannabis sativa . Cannabidiol, a non-psychoactive cannabinoid compound inhibits human glioma cell migration and invasiveness. 34th National Congress of the Italian Society of Pharmacology 2009. Like with every substance, it has to be used very carefully and responsibly to get the benefits.

She still gets ideas stuck in her head and scenarios that didnt happen. And is no longer interested or can’t follow a film but keeps herself moving wanting to bath and dress and chattering all the time without noticing if anyone is there. If you can’t find a consultant or if cost is an issue, try to find an educational event in your area, on personal care of people with dementia. They are sometimes offered by non-profits, by memory centers, or even by memory care facilities. I think I have some helpful information to ask my husband’s Doctor on Monday.

Cbd For Improved Blood Pressure

Food and beverage products containing cannabidiol were widely marketed in the United States as early as 2017. Hemp seed ingredients which do not naturally contain THC or CBD were declared by the US Food and health benefits and nutritional facts of microgreens Drug Administration as Generally recognized as safe in December 2018. CBD itself has not been declared GRAS, and under US federal law is illegal to sell as a food, dietary supplement, or animal feed.

It is characterised by pain in the absence of a noxious stimulus and may be spontaneous in its temporal characteristics or be evoked by sensory stimuli . For example, neuropathy is still among the most common diabetes complications, affecting up to 50% of patients, despite recent advances in treatment. There is no effective treatment with which to prevent or reverse neuropathic pain , thus current treatment is only directed at reducing symptoms. The treatment of chronic pain is still an unmet clinical need, where adequate pain relief is obtained using drugs with adverse effects on central nervous system side . The quality of life of neuropathic pain patients is often aggravated by comorbidities such as sleep disorders, depression and anxiety compromise. In the twentieth century the use of cannabis declined somewhat because cultivation of the plant was made illegal in many countries.

They just moved halfway across the country to be closer, and shortly after they moved she started declining rapidly after being pretty stable for several years. Now she keeps insisting her husband isn’t the man she married, and sometimes he is the man she married but she wants a divorce and she constantly is packing suitcases to try and leave him. She wakes up in a panic and then her symptoms calm down later in the day, but then she also has many complaints about mouth pain without a physiological cause that can get her worked up and miserable in the afternoons.

I really would like to try CBD oil but I have no idea what dosage would be could for me. Because there are so many different ways to ingest CBD, there are tons of CBD products to choose from. If you aren’t sure where to start, here are the CBD products we recommend to try if you want to improve your sleep. Not everything is completely understood about how cannabinoids work.

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Please make sure to include specific information including product type, quantities, etc. Also include any other details, and/or contact information, that will help us to complete your quote quickly and efficiently. See what really matters when considering cannabis-based treatments. Historically, hemp has been used to produce fibers and seeds for manufacturing, while marijuana has been used for recreational products. These episodes stem from something else, like drug use or a medical condition.

As I explain in the article, we would normally use them as a very last resort for managing behaviors, and if the issue was sleep, we’d probably start by trying other approaches. Otherwise, I would encourage your family to keep thinking about how you can keep this manageable for your aging mother. This is much easier said than done, since many older spouses will initially rebuff their children’s attempts to get help, for a variety of reasons that I won’t go into now. Hi Leslie, Thank you for your generous and patient replies. My 83-year-old father has been diagnosed with non-specific dementia and has gone from being a fit and active emeritus professor to someone who sits most of the day, reading the same things over and over. He has always had an explosive temper and been given to frequent temper tantrums so it is difficult to say if this is getting worse, but it is getting harder for my aging mother to cope with the outbursts.

For significant paranoia or problematic delusions, we sometimes try a low dose of antipsychotic. As noted in the article, there are a lot of downsides to using these drugs. But if the paranoia and delusions are causing significant distress for the person with dementia or for family, then the benefits may outweigh the risks. In truth, I think it’s a bigger problem that usually families aren’t informed that there isn’t much research supporting the use of many of these medications.

However, as time goes on and more research is conducted, more cannabinoid-based drugs may come on the market for a wider variety of illnesses. Cannabinoids affect your Cannabis Third-Party Lab Tests: Why They Are Important body through the endocannabinoid system . That system is named for substances your body naturally produces—and depends on—that are very like plant-based cannabinoids.

So don’t just go blindly using marijuana to treat your depression, and always consult with your doctor before going on a path of self-medication. This same cannabinoid receptor gets activated by THC, one of the main cannabinoids in marijuana. In theory, this could mean that marijuana, through activating the CB2 receptor, has the potential to help with BPS. But marijuana legalization especially (compared to marijuana-use) has more potential benefits than health-related benefits, as you’ll learn today. Medications like Seroquel are often used for the type of behaviours you describe, and they are tranquilizing anti-psychotics. We use them cautiously in older adults with dementia, and try not to use them long term.

What you should know about using cannabis, including CBD, when pregnant or breastfeeding. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. When buying CBD, look for companies that have had their products tested at third-party laboratories and make the lab reports available to you. (You may need to ask.) They should also display a valid Certificate of Analysis on their website or in their store.

If these approaches can be implemented, medications can be used at lower doses and sometimes not at all. After 4am he was extremely exhausted and fall onto bed and slept barely waking up after every 20minutes then again i told him to sleep again and again, at 7am he was standing in front of the door saying i need to go home. Kindly tell me what to do which medicines should we try, what precautions we should take and how to get him sleep when he is so much hyper. Topical medications have relatively few systemic side-effects. Most oral medications will come with risks and side-effects, but if the pain is really bad, it can be worth considering. My wish is to minimize and /or hopefully eliminate the nasty meds, their side effects, and the monthly expense on my fixed budget.

The participants completed anxiety and sleep assessments at the start of the study and at the first-month follow up. Study participants were given 25 mg of CBD in capsule form. Those that predominantly had sleep complaints took the dose in the evening.

These systems include the endocannabinoid system, endorphin system, endovanilloid system, serotonergic system, and dopaminergic system. While there’s definitely no bad time to smoke hemp flower, there might be better or worse times, depending on what strain we’re talking about. Our customers have found that Lifter makes an excellent morning strain.

It is a common misconception that the legal ability to sell hemp , and hemp extracts and derivatives , makes CBD legal for sale as a supplement or medicine. Nugent S.M., Morasco B.J., O’Neil M.E., Freeman M., Low A., Kondo K., Elven C., Zakher B., Motu’apuaka M., Paynter R., et al. The effects of cannabis among adults with chronic pain and an overview of general harms a systematic review. Poly-ε-caprolactone is another polymer that is widely used in drug delivery systems. This is a biocompatible, biodegradable, FDA-approved, semi-crystalline aliphatic polyester that degrades slowly.

This, once again, highlights the role that quality plays in defining the composition, dosage and related safety of the components extracted from cannabis. Cannabinoids are highly lipophilic molecules (log P 6–7) with very low aqueous solubility (2–10 μg/mL) , that are susceptible to degradation, especially in solution, via the action of light and temperature as well as via auto-oxidation . Formulation can thus play a crucial role in increasing the solubility and physicochemical stability of the drugs. Additionally, other non-CB1 receptor mechanisms of CBD have been proposed, among them its agonism at serotonin 1A receptor (or 5-TH1A), vanilloid receptor 1 and adenosine A2A receptors . The complex physiological and pharmacological mechanisms and interaction of CBD with the endocannabinoid system and other molecular targets are extensively reviewed by McPartland et al. .

Turkanis SA, Smiley KA, Borys HK, Olsen DM, Karler R. An electro-physiological analysis of the anticonvulsant action of cannabidiol on limbic seizures in conscious rats. McPartland JM, Duncan M, Di Marzo V, Pertwee RG. Are cannabidiol and Δ -tetrahydrocannabivarin negative modulators of the endocannabinoid system? Goffin K, Van Paesschen W, Van Laere K. In vivo activation of endocannabinoid system in temporal lobe epilepsy with hippocampal sclerosis. Downregulation of the CB1 cannabinoid receptor and related molecular elements of the endocannabinoid system in epileptic human hippocampus.

Although remaining on antipsychotics is risky, you should be careful about stopping or reducing them. Behavior often gets worse unless a family or care team has put some effort into otherwise supporting the person by responding in a thoughtful manner to their needs. It can also help to provide the person with dementia with additional exercise and enjoyable social activities. Last but not least, consider whether it’s absolutely necessary to use the commode for toileting, and whether it’s necessary to use it every two hours.

The human body contains a specialized system called the endocannabinoid system, which is involved in regulating a variety of functions, including sleep, appetite, pain sensation, and immune system response . Silveira, J. W., Issy, A. C., Castania, V. A., Salmon, C. E., Nogueira-Barbosa, M. H., Guimarães, F. S., Defino, H. L., & Del Bel, E. Protective effects of cannabidiol on lesion-induced intervertebral disc degeneration. Richardson, D., Pearson, R. G., Kurian, N., Latif, M. L., Garle, M. J., Barrett, D. A., Kendall, D. A., Scammell, B. E., Reeve, A. J., & Chapman, V. .

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