In the first two decades of the 21st century, cannabis legislation has made significant strides – but nowhere have these changes been more apparent than in the United States. The country, which was once engulfed by “reefer madness,” has struck a much more positive tone on cannabis in recent times, with major changes at state level on both medical and recreational legislation, despite both Democrat and Republican federal governments keeping the plant classified as a Schedule 1 narcotic.

While there have been ongoing battles over the years between cannabis businesses and the Drug Enforcement Agency (DEA), who have clashed on state and federal law, it’s important to look at the wider picture. As of 2018, an impressive 46 states out of 50 have brought in at least one piece of cannabis legislation. For states with a more liberal slant, such as Colorado, California and Oregon, this has meant full legalization at medical and recreational level. More hesitant states, like Alabama, have been reluctant to relax restrictions around psychoactive cannabis, but are embracing non-psychoactive CBD-based oils as a treatment for intractable epilepsy.

Despite criticisms that these states are lagging behind given the research which purports the benefits of medical cannabis, that nearly all states are moving in a pro-legalization direction is remarkable, after decades of negative press and Washington’s continued opposition. It is testament to America’s political system that big changes can be made in lower levels of government, and then other states can consider adopting these changes if they have worked. In the case of cannabis, patients from all over America – and indeed the world – have relocated or visited legal states to access medication that they are unable to get back home.

In Alabama, legislation called “Leni’s Law” was passed to improve access to cannabis oil for qualified patients in the state, after the story of 4-year-old Leni Young brought attention to the issue. The Young family had to move from Alabama to Oregon to get hold of a working cannabis medicine, but the new legislation means fewer families will have to make such treks.

Progression of CBD in the United States
The rapidly rising support for cannabis in the US is largely thanks to the renewed interest in cannabidiol (CBD), a non-intoxicating part of the herb that doesn’t induce a “high” or affect cognitive impairment. Furthermore, while cannabis potent in THC has been found to cause mental health issues with sustained use or abuse, studies on CBD have shown the complete opposite. Indeed, CBD may even become a leading treatment for schizophrenia and psychosis, two conditions often associated with heavy cannabis use.

CBD is not a new discovery – Israeli researchers isolated and defined the cannabinoid’s chemical structure in the 1960s, alongside psychoactive tetrahydrocannabinol (THC). However, the therapeutic effects of CBD remained a mystery for many years – researchers knew of certain benefits, such as the compound’s anti-psychotic qualities, but were unsure as to why it worked. This is, surprisingly, not that uncommon, and the mechanism that SSRIs, a classification of antidepressant drugs works in, is also not well understood – and these drugs are taken by 13 percent of the US population. However, the secrets behind CBD’s medicinal properties began to unravel from the early 1990s onwards, as researchers happened across the endocannabinoid system (ECS), which is present in the central and peripheral nervous system.

CBD makes many complex interactions with the ECS, but it can ultimately be considered as a regulator of the system, helping to moderate inflammation, control pain sensation, alleviate anxiety and even positively influence mood. CBD does this in a couple of ways. Primarily, the cannabinoid blocks enzymes so that the concentration of anandamide and 2-AG, two endocannabinoids, is increased. Anandamide is an endogenous analogue of THC and is the same to the ECS as endorphins are to the body’s opioid system. CBD can also impact the binding affinity of receptors inside and out of the ECS, which serves to amplify or suppress various effects. For instance, CBD’s anti-psychotic properties come from the cannabinoid being a negative allosteric modulator of the CB1 receptor.

It is these sorts of discoveries which have enhanced the reputation of medical cannabis as a first-choice medication and as an alternative for patients who have endured bad experiences with pharmaceutical, prescription drugs. In states with relaxed medical legislation or comprehensive recreational legislation, patients are finding that they can improve their lives with cannabis and CBD products in numerous ways, from aiding post-workout recovery, to relieving headaches and even reducing chronic pain.

Widespread availability of CBD
Even though the US federal government continues to restrict cannabis and cannabis-derived products, there is much greater access to hemp-based products, thanks to the 2014 Farm Bill, that legalized products made from hemp, with a caveat that they contain a maximum of 0.3 percent THC – this was considered a way to kickstart the hemp market, although a bill to allow cultivation has only been approved in 2018. What the progression in legislation has done, however, is bring products such as CBD vape oil and e-liquid, alongside pain creams, tincture oils, syrups, capsules and CBD edibles to the market.

Many of these are made with full extracts from the hemp plant, but consumers are also able to purchase CBD-isolate products or have been amped up with terpenes. Terpenes are compounds that carry an aroma, which is synonymous with cannabis, but these can also increase therapeutic value – some hemp-based CBD products are given “indica,” “hybrid,” and “sativa” tags to theoretically make them more suitable for certain conditions (e.g. anxiolytic terpenes such as linalool for managing anxiety).

This sort of innovation is essential for the development of the cannabis industry, and to improve the plant’s reputation among the general public. In 2018, a poll was released by Pew Research showing that support for federal recreational legalization has risen to 62 percent, with 34 percent opposing. This is double the 31 percent support in 2000, and up 50 percent on 1969. Millennials, Gen-Xers, Boomers and the Silent Generation are all more supportive for legalization now than they were at the turn of the millennium.

The future for CBD and cannabis
The short and long-term future for cannabis in the United States, and indeed all over the world, looks a positive one. Europe and Latin America are beginning to embrace the herb, and as more studies showcase the benefits of cannabis, and its undeniable potential to treat various mental health conditions in a safe manner, more liberal legislation looks likely. The effectiveness of cannabis as an anti-inflammatory may prove particularly useful in combatting depression, if it continues to be shown that the mental health disorder is exacerbated by brain inflammation.

At a federal level, cannabis-based medicine received a big breakthrough in 2018 when the Food and Drug Administration (FDA) approved Epidiolex, a CBD-based drug manufactured by GW Pharmaceuticals, a British company. The medicine is intended for the treatment of intractable forms of epilepsy, and those where patients are not helped by approved medication. With the enaction of the Right to Try legislation for terminally ill patients in 2018, it remains to be seen if this will significantly increase the availability of not-yet-approved cannabis solutions.
More growth in the CBD market is very probable, as more people give up cigarettes and move over to vaping. And as nutritionists, doctors, personal trainers and others get more acquainted with the endocannabinoid system, the popularity of CBD as a health supplement should increase, too, just as vitamins, minerals and omega-3 products have.