Charlotte's Web (cannabis)

In 2014, there was little evidence about the safety or efficacy of cannabinoids in the treatment of epilepsy.[9][12] A 2014 Cochrane review did not find enough evidence to draw conclusions about its use.[10] A 2014 review by the American Academy of Neurology similarly concluded that "data are insufficient to support or refute the efficacy of cannabinoids for reducing seizure frequency."[13]

The Cochrane review suggests cannabinoids be reserved for people with symptoms that are not controllable by other means, who have been evaluated by EEG-video monitoring to confirm diagnosis, and are not eligible for better-established treatments such as surgery and neurostimulation.[14] A second review described four placebo-controlled trials of cannabidiol including 48 people with a disease that was not manageable by other means. Three out of four trials reported some reduction in seizures, but no comparison with placebo was possible due to the small number of people in the trials. The drugs were well tolerated.[15] A third review found that no reliable conclusions about the effect of cannabis on epilepsy could be drawn due to the poor quality of available data, but further research may be warranted because of the good safety profile observed in small clinical trials.[16]

A 2017 study in children with drug-resistant Dravet syndrome, using a comparatively high dose of 20 mg/kg, found cannabidiol reduced convulsive seizures, but not non-convulsive seizures, and resulted in more side effects compared with placebo.[17]

Three phase 3 clinical trials completed in 2017 demonstrated the efficacy of cannabidiol in reducing convulsive seizure activity at doses of 10–20 mg/kg per day in children with treatment-resistant Dravet syndrome and treatment-resistant Lennox-Gastaut syndrome.[18]

Due to the anecdotal nature of the health claims being made medical bodies have published statements of concern.

A 2014 position statement by the American Epilepsy Society stated:

The recent anecdotal reports of positive effects of the marijuana derivative cannabidiol for some individuals with treatment-resistant epilepsy give reason for hope. However, we must remember that these are only anecdotal reports, and robust scientific evidence for the use of marijuana is lacking... at present, the epilepsy community does not know if marijuana is a safe and effective treatment, nor do they know the long-term effects that marijuana will have on learning, memory, and behavior, especially in infants and young children.[19]

Cannabis-derived products were not mentioned in the National Institute for Health and Care Excellence epilepsy treatment guidelines in 2012.[20]

In June 2018, the US Food and Drug Administration approved Epidiolex (cannabidiol as the therapeutic ingredient) oral solution for the treatment of seizures in two forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, for children two years of age and older.[11]

With the main ingredient being classified as "industrial hemp", (Agriculture Improvement act of 2018) Charlotte's Web Oil and other CBD products are legal in all 50 states, as long as the THC content is less than 0.3%.[34]

The publicity associated with Charlotte's Web has inspired a number of legislative bills, some of which are in the planning stages, and others that have been proposed or actually passed. Children, as "uniquely powerful advocates for medicinal pot across the country,"[35] have inspired "the movement to legalize medicinal marijuana," a movement which "has a face like Charlotte’s–and it’s a young one that’s hard to ignore. Lawmakers across the country are pushing legislation to legalize marijuana oil as a treatment for children with epilepsy."[36]

Colorado law permits the use of medical cannabis for eight conditions: cancer, glaucoma, HIV/AIDS, muscle spasms, seizures, severe pain, severe nausea and dramatic weight loss, and muscle atrophy.[23] The publicity surrounding anecdotal reports of successful treatment of intractable epilepsy with cannabinoids is likely to lead to a surge in interest.[9]

In 2013, the parents of a two-year-old with Dravet syndrome confronted New Jersey governor Chris Christie, who signed a bill allowing access for sick children to medical marijuana[27] in a controversy dubbed "pot for tots".[27][37][38]

In 2014, legislative proposals in Utah,[39][40] Arizona,[41] New York,[42] Washington state,[27] Minnesota,[43] and Florida[44][45] were considered, where "even some staunch opponents of medical marijuana now are willing to make an exception" to allow the marijuana extract for medical treatment.[4]

In Utah, Rep. Gage Froerer, R-Huntsville, said in October 2013: "Nothing in federal or state law prohibits the sale or use of hemp products."[28] He pledged to consult with the Utah Substance Abuse Authority, saying: "We need to take a strong look at this and make sure that we as a legislature and we as citizens understand really what this is and what it's not."[46] In November 2013, he said he would address "three components in sponsoring legislation: access, quality control and research. He said the Utah Department of Health would probably be involved in quality-control efforts..."[47] Annette Maughan, President of the Epilepsy Association of Utah, said: "The current Utah law doesn't exclude its use but also doesn't allow for its use. We are in limbo until Utah lawmakers decide what to call it."[46] On March 21, 2014, Gary Herbert, the governor of Utah, signed a bill giving "families access to the marijuana extract for treating epilepsy."[41] The state bill, HB0105, allows import of Charlotte's Web extract across state lines from Colorado to Utah, and covers only use for intractable epilepsy with the consent of a neurologist.[39][40] Also on March 21, 2014, an Arizona court found "that Arizona's medical marijuana law allows consumption of the plant in extract form."[41]

On March 20, 2014, the Florida House of Representatives Budget Committee passed the "so-called Charlotte's Web measure (CS/HB 843)"[45] designed to limit prosecutors' ability to prosecute those in possession of low THC/high CBD marijuana ("0.5 percent or less of tetrahydrocannabinol and more than 15 percent of cannabidiol") used for treating seizures. The law took effect July 1, 2014.[48][49] Since then, Florida legislators have passed a bill with bipartisan support legalizing the use of Charlotte's Web,[50] and Governor Rick Scott signed the "Compassionate Medical Cannabis Act of 2014" (SB 1030)[44][51] into law on June 6, 2014. The law is also referred to as the "Charlotte's Web" law.[52][53] The law specifies the number of distribution centers, which types of nurseries can grow the plants, requires various other controls,[54] and provides funding for research.[44]

• Federal legislation was introduced in 2014 (U.S. 113th Congress 2013-2014) but was never brought to a vote and died in committee.[55][56][57][58]
• Rep. Perry, Scott (R-PA-4) introduced to the U.S. 114th Congress (2015-2016) H.R.1635 - Charlotte's Web Medical Access Act of 2015[59] with 62 bipartisan co-sponsors.[60] It has not been voted on yet, but it has made progress and been referred to the House Committee on Energy and Commerce, the House Committee on the Judiciary, the Subcommittee on Health and the United States House Judiciary Subcommittee on Crime, Terrorism, Homeland Security and Investigations.
• The Therapeutic Hemp Medical Access Act of 2015 (Senate 1333) was introduced (not passed yet) with 11 co-sponsors to amend the Controlled Substances Act to exclude cannabidiol and cannabidiol-rich plants from the definition of marijuana. It was referred to the Committee on the Judiciary.[61]

On October 31, 2017, the FDA sent warning letters to four CBD marketers, including Stanley Brothers Social Enterprises, LLC (d/b/a CW Hemp), the producer of Charlotte's Web. They were warned "against making medical claims about cannabidiol (CBD). The agency also took issue with the businesses marketing CBD products as dietary supplements".[62]

The federal Schedule 1 drug classification[63] blocks broad scientific research on cannabis. However, in late 2015, the United States Drug Enforcement Administration (DEA) eased some regulatory requirements imposed by the Controlled Substances Act (CSA) for those who are conducting FDA-approved clinical trials on cannabidiol (CBD). These modifications will streamline the research process regarding CBD’s possible medicinal value and help foster ongoing scientific studies.[64]

But the Marijuana Policy Project has expressed frustration over the fact that many legislative efforts inspired by Charlotte's Web are aimed at only legalizing low or no THC, high CBD medical marijuana products. They believe that such legislation is too restrictive and ignores claimed benefits of THC, leaving "behind around 98% of the individuals who can benefit from it."[65] Referring to the "Charlotte’s Web Medical Hemp Act of 2014", an editorial in Ladybud Magazine expressed concern that the law "leaves thousands of patients out in the cold without safe, legal access to medical cannabis. It also ignores science that seems to indicate that whole plant medicine is optimal."[66]

Charlotte's Web is named after an American girl, Charlotte Figi, who developed Dravet syndrome (also known as severe myoclonic epilepsy of infancy or SMEI) as a baby. By age three, Figi was severely disabled and having 300 grand mal seizures a week despite treatment.[23][67] Her parents learned about another child with Dravet Syndrome, who had been using a different type of medical marijuana since June 2011, and decided to try marijuana.[68] Her parents and physicians said that she improved immediately. She followed a regular regimen that used a solution of the high-CBD marijuana extract in olive oil. She was given the oil under her tongue or in her food.[23][69] Her parents said in 2013 that her epilepsy had improved so that she had only about four seizures per month, and she was able to engage in normal childhood activities.[23][70]

The type now named after Figi was not the first type her parents tried. As their original supply, a type called R4 that is also high in CBD and low in THC, was running out, they contacted the Stanley brothers. From the Stanleys' stock, they chose the high-CBD variety that has since been renamed to Charlotte's Web.[23] The phrase is a reference to the children's novel of the same name.

Charlotte's story has been featured on two CNN documentaries,[24][26] The Doctors TV show,[71] 60 Minutes Australia,[72] and Dateline NBC,[73] among many other sources. An article in the National Journal detailing the role of several children as "uniquely powerful advocates for medicinal pot across the country" described Charlotte as the "first poster child for the issue...."[35] Her story has led to her being described as "the girl who is changing medical marijuana laws across America,"[6] as well as the "most famous example of medicinal hemp use".[74] On November 13, 2019, Charlottte was the first child featured on the cover of High Times magazine in her "Namesake" role as a "High Times Female 50" award nominee.[75][76] Charlotte Figi died on April 7, 2020.[77][78]

When Charlotte was five years old, her story was featured in the August 11, 2013, CNN documentary "Weed", hosted by Sanjay Gupta.[24] On November 24, 2013, Paige Figi was a guest on The Doctors TV show, where Charlotte's story was told.[71] She was also featured in Gupta's March 11, 2014, CNN documentary "Weed 2: Cannabis Madness".[26] The extract received more publicity on October 6, 2014, when The Doctors TV show again featured a story about usage of Charlotte's Web. The physicians called for a change of the Federal classification.[79] Sanjay Gupta has also expressed his support for Charlotte's Web on The Doctors TV show.[80] On the October 17, 2014 episode of the ABC TV series The View, Paige Figi and Joel Stanley were interviewed by Whoopi Goldberg and Nicolle Wallace.[67]

The CNN documentaries received widespread publicity and popularized Charlotte's Web as a possible treatment for epilepsy and other conditions.[23] Colorado has legalized both the medicinal and recreational use of marijuana, and many parents have flocked there with their suffering children in search of Charlotte's Web and other forms of medical marijuana.[81] In November 2013, CBS Denver reported that "[t]here is now a growing community of 93 families with epileptic children using marijuana daily. Hundreds are on a waiting list and thousands are calling."[8] In October 2014, Time noted the Stanley brothers had a waiting list of "more than 12,000 families."[82] They have been termed "marijuana refugees",[8] "part of a migration of families uprooting their lives and moving to Colorado, where the medicinal use of marijuana is permitted...forced to flee states where cannabis is off limits."[83][84] In November 2014, David Nutt mentioned Charlotte's Web in the Royal Pharmaceutical Society's Pharmaceutical Journal, where he appealed for "the UK government [to] acts on evidence, allowing the use of medicinal cannabis and reducing barriers to its research."[85]

Families who say they have run out of pharmaceutical options have moved to Colorado to access Charlotte's Web. The demand has spurred calls for more research to determine whether these products actually do what is claimed. Amy Brooks-Kayal, vice president of the American Epilepsy Society, stated that epileptic seizures may come and go without any obvious explanation, and that Charlotte's web could cause developmental harm. She recommended that parents relocate so that their affected children could have access to one of the nation's top pediatric epilepsy centers rather than move to Colorado.[86]

The product has been described as the "country's most famous brand of CBD oil",[87] the "largest selling CBD oil in the country",[88] and the "number one brand", with 7% of the market.[89]

In November 2013, Josh Stanley said that Charlotte's web was 0.5% THC and 17% CBD,[21] and that it "is as legal as other hemp products already sold in stores across Utah, including other oils, clothing, and hand creams, but is illegal, federally, to take across state lines."[90] The legalities of selling the product to people who transport it across state lines are complicated, with difficulties for both the sellers and transporters. Regardless of state laws in Colorado and Utah which would allow the practice, it is still a Federal offense to transport hemp products across state lines.[91][92] In September 2014, the content was measured at 0.3% THC.[5]

On August 30, 2018, Charlotte's Web Holdings, Inc. (formerly Stanley Brothers Holdings Inc.) began its launch into the stock market with an initial public offering in Canada: "The offering included a treasury issuance by the company of common shares…moreover, a secondary offering of Common Shares…for total gross proceeds of C$115,115,000 (USD 87,598,872)."[93]