Summary of Key Findings

CBD Survey Results: Cultivating Wellness

Summary of Key Findings

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This observational study validated some well-established facts about CBD – namely that it has a strong safety profile1 and is extraordinarily effective at ameliorating pain2 and anxiety.3 Participants reported significant improvements in pain and mood regardless of the underlying medical condition.

That said, the study also showed that CBD is not a panacea – as some would claim – for all that ails us. Some symptoms were decidedly less responsive to CBD products. For example, CBD was not particularly useful in helping people with gastrointestinal diseases maintain a healthy weight. Nor did it have much of an impact on PMS- related bloating, cancer-related diarrhea and constipation, or low sex drive during menopause.

Nonetheless, it was astonishingly effective at simply making people feel better – most likely because of its impact on pain, mood, and sleep.

The survey also found that there were few adverse effects, which is consistent with studies showing that CBD is safe and well-tolerated even at high doses.4

Who is using CBD?

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The first question we set out to answer was who is using CBD? Based on this survey, it appears that the typical CBD user is white, well-educated, over 45, female, and living in the US.

To some extent, this skewing towards females may reflect their greater utilization of healthcare services in general5, and alternative medicines in particular6. It may also reflect the fact that the two most prevalent conditions for which participants reported using CBD – pain and anxiety – affect women disproportionately.78

Regarding ethnicity, as mentioned, the vast majority of survey participants were white. In the US, which is where the majority of participants were located, this may be due to the high costs of CBD therapeutics, the greater utilization of alternative therapies by Caucasians9 and/or a wariness of cannabis on the part of communities of color that have borne the brunt of the US drug war.

CBD users in this survey also skewed older. Almost two-thirds were over the age of 44, and almost 20% were seniors over the age of 64. This finding may be explained by CBD’s popularity for treating pain and sleep problems, ailments that are common among the elderly, particularly in the US where half of older adults report suffering from chronic “bothersome” pain10 and half report regular sleep disturbances.

What kind of product are people using?

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Participants were more likely to be using CBD from hemp rather than cannabis. (This is unsurprising given that the latter is still illegal in most of the world.)

They tended to favor CBD tinctures and topicals over traditional modes of taking cannabis, i.e. smoking and edibles. They typically used CBD products multiple times per day and used more than one type of product (most often a tincture with a topical).

Few participants were able to say how much CBD (or THC) they were taking, suggesting an urgent need for both better product labeling and consumer education. Almost half of participants had been using CBD for under six months.

What are people using CBD for?

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The vast majority of participants reported using CBD to alleviate pain (particularly inflammatory pain), to improve mood and sleep, and/or for general wellness.

Around 10% reported using CBD products to treat severe, debilitating, treatment-resistant conditions, including brain injuries, epilepsy, multiple sclerosis, autism spectrum disorder, Parkinson’s disease, and Alzheimer’s disease.

Most participants were using CBD for more than one condition, and there was a notable clustering of certain conditions.12 Pain, mood issues, and sleep problems correlated closely. A significant number of participants using CBD for pain reported suffering from fibromyalgia and/or arthritis though we had not asked specifically about these conditions. There was also a notable correlation between addiction and ADD/ADHD, and addiction and PTSD; participants who were using CBD for ADD/ADHD or PTSD were three times more likely than the average participant to be using CBD for alcoholism or addiction.

CBD’s impact and efficacy

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The survey asked about CBD’s impact on six quality of life measurements: Pain, mood, sleep, physical function, energy or motivation, and the ability to socialize. A majority of participants reported some improvement across all measures, but the most significant were in the areas of pain and mood.

Forty percent of participants reported having one or more side effects. These were typically mild. The most common side effects were dry mouth, tiredness, dry or bloodshot eyes, and increased appetite.

Of great interest were the efficacy reports for specific conditions. The survey asked about 17 different conditions for which CBD is sometimes used, including alcoholism/addiction, ADD or ADHD, Alzheimer’s disease, autism spectrum disorder, brain injury (e.g. stroke, TBI, tumor), cancer, diabetes, epilepsy and other seizure disorders, gastrointestinal disease (e.g. Colitis, Crohn’s, IBS), depression, anxiety and other mood disorders, motion sickness, pain, Parkinson’s disease, hormonal conditions (e.g. PMS, menopause), multiple sclerosis, PTSD, and sleep problems. The survey asked what type or stage of disease the person had (e.g. type 1 or type 2 diabetes), and how they felt CBD impacted the common symptoms of that disease.

Here are some of the findings regarding the efficacy of CBD for specific conditions:

  • CBD for Pain: Most participants taking CBD for pain indicated that they got meaningful relief. Just under 90% of participants of this group reported some improvement in the frequency and duration of their pain, with 60% reporting that CBD made these aspects “much better.” Most significant though was CBD’s impact on the perception of pain intensity: Before taking CBD, the average pain score was 6.85; when taking CBD, the average pain score was 2.76, representing a 60% decrease in intensity.
  • CBD for Sleep: Participants taking CBD for sleep were more likely to report having problems staying asleep than getting to sleep though most people reported having difficulty with both. Participants reported that CBD helped them get to sleep more quickly, reducing the average time from about an hour to 20 minutes. They also reported waking up much less often – 1.4 times per night versus 4.3 or about a third as many times. Without CBD, almost three-quarters of participants reported waking up tired; with CBD, 9% reported waking up tired. The reported improvements in how people reported feeling upon waking is likely explained by improvements in the ability to stay asleep. People taking CBD for sleep were somewhat more likely to also use some THC than the average participant.
  • CBD for Anxiety, Depression & Other Mood Disorders: Almost 90% of participants using CBD for a mood disorder reported that they had anxiety. For most, anxiety went hand-in-hand with depression. Participants reported that CBD had significant effect as both an anti-anxiety agent and anti- depressant. It performed especially well at mitigating feelings of nervousness; 92% of participants experienced some relief from this symptom, and 68% reported that feelings of nervousness were “much better” with CBD. CBD also performed well at relieving panic attacks, mitigating mood swings, and quelling feelings of agitation, irritability, and sadness. CBD was less effective at mitigating difficulties concentrating, a lack of interest in activities, and digestive upset; almost a fifth of people report no change in these symptoms. Moreover, 3% of people using CBD for a mood disorder reported that the ability to concentrate worsened with CBD.
  • CBD for Hormonal Issues: Among people taking CBD for PMS, menopause, or other female hormonal conditions, CBD appears to be highly effective in addressing mood disturbances and pain. It also appears to help mitigate night sweats and, to a lesser degree, hot flashes associated with menopause. CBD was less effective at ameliorating bloating common to menstruation; and it was less effective at mitigating sexual discomfort, low sex drive, and dry skin associated with menopause. About 5% of people reported that their CBD product made PMS-related food cravings worse, an effect that may be attributable to THC’s well-known tendency to cause the “munchies.”
  • CBD for PTSD: Among people taking CBD for PTSD, CBD appears to be highly effective in addressing a range of symptoms, particularly anxiety, anger, irritability, depression, mood swings, and panic attacks. CBD also appears helpful, though less so, in mitigating unwanted thoughts, nightmares, and heart palpitations in people with PTSD.
  • CBD for Gastrointestinal (GI) Diseases: Among people taking CBD for GI diseases, particularly IBS (Irritable Bowel Syndrome), CBD appears to be extremely helpful for relieving abdominal cramps or pain, nausea or vomiting, and indigestion. Many participants also found it helpful for fatigue though some found it made them more tired. CBD appears to be less effective at helping people with GI diseases maintain a healthy weight; half of participants in this group reported either no change or a worsening of this symptom.
  • CBD for ADD / ADHD (Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder): Among people with ADD/ADHD, CBD appears most helpful with staying on task, minimizing distractibility, and mitigating agitation or irritability. It appears less effective at minimizing the tendency to lose things and procrastinate (common to ADD/ADHD) and sometimes made those symptoms worse.
  • CBD for Cancer: Among people taking CBD for cancer, CBD was most helpful with ameliorating nausea and vomiting. Many participants also found it helpful for appetite, neuropathy (numbness or tingling), and weakness. As mentioned earlier, CBD was markedly less likely to help with cancer-related constipation and diarrhea. The most significant side effects were with memory and concentration issues. People taking CBD for cancer were more likely than the average participant to be taking some THC. This may be due to THC’s efficacy as a pain reliever13 or to well-publicized preclinical data suggesting that both THC and CBD may have tumor-fighting properties.14
  • CBD for Diabetes: Participants taking CBD for diabetes were asked their average blood sugar levels before and after they started taking CBD. Though average blood sugar levels with CBD were still high, they showed significant improvements over the pre-CBD levels, decreasing from 178 to 130 on average. Participants also reported significant improvements in neuropathy-type symptoms (i.e. nerve pain, tingling or numbness), and some improvements in their ability to maintain a healthy weight.
  • CBD for Alcoholism / Addiction: Among people using CBD for addiction, most (70%) were seeking to abstain from their substance of abuse (as opposed to using less or getting through withdrawal). CBD appeared to be extremely helpful for getting and staying off opiates. This is consistent with observational studies that have noted that many patients voluntarily decrease the number of opiates they are using—or go off opiates completely—when they use them in conjunction with cannabis, as well with animal and preclinical studies suggesting that cannabis and CBD may reduce the risk of relapse.xv CBD was also reportedly helpful for reducing or eliminating alcohol consumption. It was comparatively less helpful as a smoking cessation aid. Twenty-four percent of tobacco users experienced no change, and 4% report using more tobacco after introducing CBD.
  • CBD for Brain Injury: Among people using CBD for a brain injury (typically a TBI), CBD proved most helpful for relieving headaches, irritability, and agitation. CBD was less helpful for balance issues. In a small percentage of participants, CBD seemed to make issues with memory, concentration, and self- expression worse.
    1. For information on the safety of cannabidiol:

      • Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. (2011). Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent. Current Drug Safety, 6(4), 237-249. doi:10.2174/157488611798280924.
      • Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and Cannabinoid Research, 2(1), 139-154. doi:10.1089/can.2016.0034
      • Martin-Santos, R., Crippa, J. A., Batalla, A., Bhattacharyya, S., et al. (2012). Acute Effects of a Single, Oral dose of d9- tetrahydrocannabinol (THC) and Cannabidiol (CBD) Administration in Healthy Volunteers. Current Pharmaceutical Design, 18(32), 4966-4979. doi:10.2174/138161212802884780
    2. For information on cannabidiol and the treatment of pain:

      • Committee on the Health Effects of Marijuana. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. (A Report of the National Academies of Science, Engineering, and Medicine.) The National Academies Press, 2017.
      • Britch, S., Wiley, J., Yu, Z., Clowers, B., & Craft, R. (2017). Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. Drug Alcohol Depend, 175:187-197. doi:10.1016/j.drugalcdep.2017.01.046
      • Fine, PG, and M J Rosenfeld. “Cannabinoids for Neuropathic Pain.” Current Pain and Headache Reports, vol. 18, no. 10, ser. 451, Oct. 2014. 451, doi:10.1007/s11916-014-0451-2.
      • Iskedjian, Michael, et al. “Meta-Analysis of Cannabis Based Treatments for Neuropathic and Multiple Sclerosis-Related Pain.” Current Medical Research and Opinion, vol. 23, no. 1, 2006, pp. 17–24., doi:10.1185/030079906x158066.
      • Johnson, J R, et al. “Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain.” Journal of Pain Symptom Management, vol. 39, no. 2, Feb. 2010, pp. 167–179., doi:10.1016/j.jpainsymman.2009.06.008.
      • McDonough, Patrick, et al. “Neuropathic Orofacial Pain: Cannabinoids as a Therapeutic Avenue.” The International Journal of Biochemistry & Cell Biology, vol. 55, 2014, pp. 72–78., doi:10.1016/j.biocel.2014.08.007.
      • Nielsen, Suzanne, et al. “The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: A Systematic Review of Reviews.” Current Neurology and Neuroscience Reports, vol. 18, no. 2, 2018, doi:10.1007/s11910- 018-0814-x.
      • Nurmikko, Turo J., et al. “Sativex Successfully Treats Neuropathic Pain Characterised by Allodynia: A Randomised, Double-Blind, Placebo-Controlled Clinical Trial.” Pain, vol. 133, no. 1, 2007, pp. 210–220., doi:10.1016/j.pain.2007.08.028.
      • Rog, D, et al. “Oromucosal Δ9-Tetrahydrocannabinol/Cannabidiol for Neuropathic Pain Associated with Multiple Sclerosis: An Uncontrolled, Open-Label, 2-Year Extension Trial.” Clinical Therapeutics, vol. 29, no. 9, 2007, pp. 2068– 2079., doi:10.1016/j.clinthera.2007.09.013.
      • Russo, Ethan B., et al. “Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine.” ChemInform, vol. 38, no. 47, 2007, doi:10.1002/chin.200747254.
      • Russo, Ethan. “Cannabinoids in the Management of Difficult to Treat Pain.” Therapeutics and Clinical Risk Management, Volume 4, 2008, pp. 245–259., doi:10.2147/tcrm.s1928.
      • “Illuminating Results of CBD Patient Survey.” Project CBD: Medical Marijuana & Cannabinoid Science.
    3. For information on cannabidiol and the treatment of anxiety:

      • Bergamaschi, M, et al. “Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naive Social Phobia Patients.” Neuropsychopharmacology, vol. 36, 2011, doi:10.1038/npp.2011.6.
      • Blessing, E, et al. “Cannabidiol as a Potential Treatment for Anxiety Disorders.” Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics. 2015, doi:12. 10.1007/s13311-015-0387-1.
      • Campos, Alline C., et al. “Cannabidiol, Neuroprotection and Neuropsychiatric Disorders.” Pharmacological Research, vol. 112, 2016, pp. 119–127., doi:10.1016/j.phrs.2016.01.033.
      • Crippa, Jos. Alexandre S, et al. “Neural Basis of Anxiolytic Effects of Cannabidiol (CBD) in Generalized Social Anxiety Disorder: A Preliminary Report.” Journal of Psychopharmacology, vol. 25, no. 1, 2010, pp. 121–130., doi:10.1177/0269881110379283.
      • Soares, Vanessa P., and Alline C. Campos. “Evidences for the Anti-Panic Actions of Cannabidiol.” Current Neuropharmacology, vol. 15, no. 2, 2017, pp. 291–299., doi:10.2174/1570159x14666160509123955.
    4. Armentano, P. (2012, September). CBD: Safe at High Doses. Retrieved June 26, 2019, from https://www.projectcbd.org/medicine/cbd-safe-high-doses Martin-Santos, R., Crippa, J. A., Batalla, A., Bhattacharyya, S., et al. (2012). Acute Effects of a Single, Oral dose of d9-tetrahydrocannabinol (THC) and Cannabidiol (CBD) Administration in Healthy Volunteers. Current Pharmaceutical Design, 18(32), 4966-4979. doi:10.2174/138161212802884780
    5. Vaidya, V., Partha, G., & Karmakar, M. (2012). Gender Differences in Utilization of Preventive Care Services in the United States. Journal of Women’s Health, 21(2), 140-145. doi:10.1089/jwh.2011.2876
    6. Alwhaibi, M., & Sambamoorthi, U. (2016). Sex Differences in the Use of Complementary and Alternative Medicine among Adults with Multiple Chronic Conditions. Evidence-Based Complementary and Alternative Medicine,2016, 1-8. doi:10.1155/2016/2067095
    7. Carpenter, G., & Patil, M. (2017). Gender Differences in Pain. Oxford Medicine Online. doi:10.1093/med/9780190217518.003.0005
    8. Mclean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research,45(8), 1027-1035. doi:10.1016/j.jpsychires.2011.03.006
    9. Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey. (1999). Complementary Therapies in Medicine,7(3), 191-192. doi:10.1016/s0965-2299(99)80132-0
    10. Patel, K. V., Guralnik, J. M., Dansie, E. J., & Turk, D. C. (2013). Prevalence and impact of pain among older adults in the United States: Findings from the 2011 National Health and Aging Trends Study. Pain, 154(12), 2649-2657. doi:10.1016/j.pain.2013.07.029
    11. Neikrug, A. B., & Ancoli-Israel, S. (2010). Sleep Disorders in the Older Adult – A Mini-Review. Gerontology, 56(2), 181-189. doi:10.1159/000236900
    12. Russo, E. B. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis and Cannabinoid Research, 1(1), 154-165. doi:10.1089/can.2016.0009
    13. For information on THC, CBD, and pain:

      • Committee on the Health Effects of Marijuana. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. (A Report of the National Academies of Science, Engineering, and Medicine.) The National Academies Press, 2017.
      • Lötsch, J., et al. “Current Evidence of Cannabinoid-Based Analgesia Obtained in Preclinical and Human Experimental Settings.” European Journal of Pain, vol. 22, no. 3, 2017, pp. 471–484., doi:10.1002/ejp.1148.
      • Johnson, Jeremy R., et al. “An Open-Label Extension Study to Investigate the Long-Term Safety and Tolerability of THC/CBD Oromucosal Spray and Oromucosal THC Spray in Patients With Terminal Cancer-Related Pain Refractory to Strong Opioid Analgesics.” Journal of Pain and Symptom Management, vol. 46, no. 2, 2013, pp. 207–218., doi:10.1016/j.jpainsymman.2012.07.014.
      • Johnson, J R, et al. “Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain.” Journal of Pain Symptom Management, vol. 39, no. 2, Feb. 2010, pp. 167–179., doi:10.1016/j.jpainsymman.2009.06.008.
    14. For information on CBD, THC, and cancer:

      • Adinolfi, Barbara, et al. “Anticancer Activity of Anandamide in Human Cutaneous Melanoma Cells.” European Journal of Pharmacology, vol. 718, no. 1-3, 2013, pp. 154–159., doi:10.1016/j.ejphar.2013.08.039.
      • Anderson, Susan P., et al. “Impact of Medical Cannabis on Patient-Reported Symptoms for Patients with Cancer Enrolled in Minnesota’s Medical Cannabis Program.” Journal of Oncology Practice, 2019, doi:10.1200/jop.18.00562.
      • Aviello, Gabriella, et al. “Chemopreventive Effect of the Non-Psychotropic Phytocannabinoid Cannabidiol on Experimental Colon Cancer.” Journal of Molecular Medicine, vol. 90, no. 8, 2012, pp. 925–934., doi:10.1007/s00109-011-0856-x.
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      • Blasco-Benito, Sandra, et al. “Appraising the ‘Entourage Effect’: Antitumor Action of a Pure Cannabinoid versus a Botanical Drug Preparation in Preclinical Models of Breast Cancer.” Biochemical Pharmacology, vol. 157, 2018, pp. 285–293., doi:10.1016/j.bcp.2018.06.025
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      • Dall’ Stella, Paula B., et al. “Case Report: Clinical Outcome and Image Response of Two Patients with Secondary High-Grade Glioma Treated With Chemoradiation, PCV, and Cannabidiol.” Frontiers in Oncology, vol. 8, 2019, doi:10.3389/fonc.2018.00643.
      • Deng, L., et al. “Quantitative Analyses of Synergistic Responses between Cannabidiol and DNA-Damaging Agents on the Proliferation and Viability of Glioblastoma and Neural Progenitor Cells in Culture.” Journal of Pharmacology and Experimental Therapeutics, vol. 360, no. 1, 2016, pp. 215–224., doi:10.1124/jpet.116.236968.
      • Fisher, T, et al. “In Vitro and in Vivo Efficacy of Non-Psychoactive Cannabidiol in Neuroblastoma.” Current Oncology (Toronto, Ont.), Multimed Inc., Mar. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4791143/.
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      • Johnson, J R, et al. “Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain.” Journal of Pain Symptom Management, vol. 39, no. 2, Feb. 2010, pp. 167–179., doi:10.1016/j.jpainsymman.2009.06.008.
      • Ligresti, A. “Antitumor Activity of Plant Cannabinoids with Emphasis on the Effect of Cannabidiol on Human Breast Carcinoma.” Journal of Pharmacology and Experimental Therapeutics, vol. 318, no. 3, 2006, pp. 1375–1387., doi:10.1124/jpet.106.105247.
      • Marcu, J. P., et al. “Cannabidiol Enhances the Inhibitory Effects of 9-Tetrahydrocannabinol on Human Glioblastoma Cell Proliferation and Survival.” Molecular Cancer Therapeutics, vol. 9, no. 1, 2010, pp. 180–189., doi:10.1158/1535-7163.mct-09-0407.
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      • Nabissi, Massimo, et al. “Triggering of the TRPV2 Channel by Cannabidiol Sensitizes Glioblastoma Cells to Cytotoxic Chemotherapeutic Agents.” Carcinogenesis, vol. 34, no. 1, 2012, pp. 48–57., doi:10.1093/carcin/bgs328.
      • Pacher, Pál. “Towards the Use of Non-Psychoactive Cannabinoids for Prostate Cancer.” British Journal of Pharmacology, vol. 168, no. 1, 2012, pp. 76–78., doi:10.1111/j.1476-5381.2012.02121.x.
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      • Rocha, Francisco Carlos Machado, et al. “Systematic Review of the Literature on Clinical and Experimental Trials on the Antitumor Effects of Cannabinoids in Gliomas.” Journal of Neuro-Oncology, vol. 116, no. 1, 2013, pp. 11–24., doi:10.1007/s11060-013-1277-1.
      • Russo, Ethan. “Cannabinoids in the Management of Difficult to Treat Pain.” Therapeutics and Clinical Risk Management, Volume 4, 2008, pp. 245–259., doi:10.2147/tcrm.s1928.
      • Russo, Ethan B., et al. “Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine.” ChemInform, vol. 38, no. 47, 2007, doi:10.1002/chin.200747254.
      • Sharma, Manju, et al. “In Vitro Anticancer Activity of Plant-Derived Cannabidiol on Prostate Cancer Cell Lines.” Pharmacology & Pharmacy, vol. 05, no. 08, 2014, pp. 806–820., doi:10.4236/pp.2014.58091.
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      • Takeda, Shuso, et al. “Cannabidiolic Acid, a Major Cannabinoid in Fiber-Type Cannabis, Is an Inhibitor of MDA-MB-231 Breast Cancer Cell Migration.” Toxicology Letters, vol. 214, no. 3, 2012, pp. 314–319., doi:10.1016/j.toxlet.2012.08.029.
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