In 42 children with drug-resistant epilepsy, pharmaceutical CBD (Epidiolex) achieved 2.4 times higher blood levels than artisanal CBD products, with higher levels linked to more side effects but no statistically significant difference in seizure reduction.
Pediatric neurologists, families choosing between CBD products, and medical cannabis regulators.
Pharmaceutical CBD: 124 ng/mL vs. artisanal: 51 ng/mL serum levels
What the researchers found
Mean serum CBD was 124 ng/mL for pharmaceutical CBD vs. 51.1 ng/mL for artisanal CBD (p=0.022). The pharmaceutical group had a median 50% seizure reduction vs. no change in the artisanal group, though this difference was not statistically significant (p=0.199). Higher CBD concentrations were associated with increased adverse effects.
Why it matters
Patients and families often choose artisanal CBD products for cost reasons, but this study shows pharmaceutical CBD achieves significantly higher blood levels, which may translate to better seizure control.
The numbers in context
42 patients; pharmaceutical CBD: 124 ng/mL serum level; artisanal CBD: 51.1 ng/mL (p=0.022). Pharmaceutical group: median 50% seizure reduction. Artisanal group: no change (p=0.199).
How the study worked
Retrospective chart review of 42 patients with pharmacoresistant epilepsy treated with either artisanal CBD oil or pharmaceutical CBD (Epidiolex). Serum CBD concentrations, seizure frequency, and side effects tracked.
What this study cannot tell us
Retrospective, non-randomized. Small sample size. Artisanal product composition and dosing not standardized. Seizure reduction difference was not statistically significant (may be underpowered). No blinding.
How to read the evidence
Retrospective comparison with significant bioavailability finding, but seizure outcomes were not statistically different.
When this study was published
Published in 2022.
The bigger picture
The CBD product marketplace ranges from pharmaceutical-grade to unregulated artisanal products. This study provides one of the first direct comparisons of blood levels, offering data for the ongoing debate about product quality and interchangeability.
Questions still open
- Would higher-dose artisanal CBD achieve equivalent blood levels? Is the lack of significant seizure difference due to low power or true equivalence? Should clinicians recommend pharmaceutical over artisanal CBD?
Common questions
Are all CBD products equally effective for epilepsy?
Do higher CBD blood levels mean more side effects?
Read the original research
Variability in Serum Concentrations and Clinical Response in Artisanal Versus Pharmaceutical Cannabidiol Treatment of Pediatric Pharmacoresistant Epilepsy.
The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 27(6), 558-563
Citation
Cohen, Nathan T; Bahar, Burak; Conry, Joan A; Schreiber, John M. (2022). Variability in Serum Concentrations and Clinical Response in Artisanal Versus Pharmaceutical Cannabidiol Treatment of Pediatric Pharmacoresistant Epilepsy.. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 27(6), 558-563. https://doi.org/10.5863/1551-6776-27.6.558
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