• Studies show that cannabis repellents, insecticides, and miticides may help deter arthropods(1). Sandflies are arthropods that carry the Leishmania parasite(2). However, clinical trials have not determined CBD’s efficacy against leishmaniasis.
  • Leishmaniasis causes skin sores or ulcers(3). These sores can cause bleeding and pain(4). CBD is purported to have analgesic (anti-pain) properties(5).
  • Essential oils with low CBD levels may provide antimicrobial benefits(6). However, there is no conclusive evidence that CBD’s antimicrobial potential is effective against the Leishmania parasite.

Research on CBD and Leishmaniasis

No human clinical trials have determined the effectiveness of cannabidiol or CBD in managing leishmaniasis or its symptoms.

However, studies suggest that cannabis-based insecticides, miticides, and repellents may help contribute to arthropod deterrence(7).

Results showed that tetrahydrocannabinol (THC), another well-studied phytocannabinoid next to CBD, may provide nominal deterrence and may be toxic to insects.

THC is a psychoactive cannabinoid known to cause individuals a feeling of “high” and is often linked to marijuana use(8). Marijuana is a cannabis plant variety that contains high amounts of THC(9).

The Leishmania parasite causes leishmaniasis, specifically by an arthropod called the phlebotomine sandfly(10). Thus, deterring this insect may help reduce the incidence of leishmaniasis.

Studies also showed that sandflies eat the Cannabis sativa plant. This outcome suggests that this plant may attract sandflies, allowing humans to create traps utilizing the cannabis plant’s scent(11).

Benefits of CBD for Leishmaniasis

CBD is a compound derived from cannabis plant extracts. Studies suggest that this cannabinoid may have potential therapeutic benefits, such as neuroprotective, anti-inflammatory, and antioxidant effects(12).

Fever is one of the symptoms of leishmaniasis(13). Bacterial infections or inflammatory conditions can cause fever(14). Thus, CBD’s anti-inflammatory properties may help manage inflammation associated with symptoms of leishmaniasis.

Leishmaniasis can also manifest as skin sores or ulcers(15). These sores can cause bleeding and pain(16).

CBD is purported to have analgesic (anti-pain) properties(17). This benefit suggests that CBD may have the potential to help manage pain caused by skin ulcers.

The Leishmania parasite is a protozoan microorganism or microbe. One study mentioned that essential oils containing low levels of CBD may have a role in the cannabis plant’s antimicrobial activity(18).

However, researchers have not conclusively determined if CBD’s antimicrobial potential effectively prevents or minimizes infections caused by the Leishmania parasite.

CBD Dosage and Usage

CBD dosage may vary depending on the individual and their current health conditions, diet plans, exercise regimen, stress levels, and family genetics(19).

The Food and Drug Administration (FDA) has not endorsed a standard CBD dosing guide for leishmaniasis.

However, one dosing suggestion is to take CBD starting with a low dose and gradually increasing the dosage(20).

For instance, first-time CBD users may start with a 10-milligram (mg) dose per day(21).

Some users may claim that this dosage is a good amount to start with CBD. However, individuals should ask a doctor or healthcare provider before deciding on the appropriate CBD dose. There are doctors well versed in cannabis-based products who can provide CBD dosage and usage recommendations.

There are various administration methods that individuals may take, depending on preference, when considering using CBD oil to help manage leishmaniasis or its symptoms. These administration methods include the following:

  • Topical application: This method applies CBD products directly to the skin.

Individuals may use topicals to provide relief to a specific area. The bioavailability of CBD topicals is zero, meaning these products do not get absorbed into the bloodstream(22).

When applied topically, CBD binds to the CB2 receptors in the skin to provide pain relief and help reduce inflammation(23).

CB2 receptors are a part of the endocannabinoid system (ECS), composed of receptors, endocannabinoids, and enzymes(24).

The ECS controls and regulates many of the body’s functions, such as inflammatory and immune responses(25).

Examples of such products are lotions, ointments, creams, salves, lip balms, or pain sticks.

  • Ingestion: The ingestion method involves oral CBD oil intake. This route allows CBD to pass through the digestive tract before spreading into the bloodstream.

Oral CBD products include capsules, softgels, or edibles, such as chews, gummies, cookies, and candies.

Oral delivery is a cost-effective and convenient drug administration method that may work for infections, inflammations, and bowel diseases(26).

  • Sublingual administration: In this method, an individual administers CBD oil under the tongue. The blood vessels absorb CBD to allow the drug to enter the bloodstream directly and bypass the gastrointestinal (GI) tract.

CBD tinctures are sublingual products that use a calibrated dropper for accurate dosing. Some tinctures are formulated with medium-chain triglycerides (MCT) oil, a type of carrier oil, to dilute the CBD concentrate.

Other CBD sublingual products include oromucosal sprays, high-potency oils, or lozenges.

Some CBD oil tinctures have an earthy or grass-like taste that may not appeal to some consumers. As an alternative, individuals may mix CBD oil with food or drinks(27).

  • Inhalation: Inhaling CBD involves delivering the drug into the body through smoking or vaping. CBD enters the lungs and brain before spreading throughout the bloodstream(28).

Consumers considering using CBD vapes must mind its potential risks before using such products.

Despite claims that vaping is a less-harmful option than smoking, reports suggest that vapes are linked to lung disease(29).

Still, inhalation allows CBD to be absorbed quickly in the body, letting the drug take effect within minutes and making this delivery route suitable for conditions like nausea or acute pain(30).

CBD Onset Times

Researchers have not thoroughly investigated the length of time before CBD takes effect for leishmaniasis.

Generally, the different administration methods to deliver CBD may affect the drug’s onset times, as listed below(31):

  • Topical application: 15 to 30 minutes
  • Ingestion or oral administration: 30 to 90 minutes
  • Sublingual administration: 15 to 30 minutes
  • Inhalation: 2 to 15 minutes

In a review on the pharmacokinetics of CBD in humans, researchers noted that oromucosal sprays may take between 1.64 and 4.20 hours to reach maximum plasma concentration. Sublingual drops may take between 1.67 and 2.17 hours(32).

The same study showed that the time to maximum plasma concentration for an orally administered CBD product containing 800mg of CBD may be around three hours. 

Maximum plasma concentration is the peak concentration of the drug in the system after delivery.

CBD Duration of Effects

No extensive clinical trials were conducted analyzing the duration of CBD’s effects on individuals with leishmaniasis.

In general, the length of time for CBD’s effects to remain after the drug’s onset are estimated to be the following(33):

  • Topical application: two to four hours
  • Ingestion or oral administration: six to eight hours
  • Sublingual administration: two to four hours
  • Inhalation: two to four hours

One study showed that the half-life of CBD capsules, each containing 10mg of CBD, is between 2.95 and 3.21 hours. For single oral administration of CBD at 10mg and 20mg doses, the half-life is 1.09 and 1.97 hours, respectively(34).

Half-life is the time taken for a drug’s concentration or quantity within the system to be reduced by half (50%).

Choosing the Right CBD for Leishmaniasis

Individuals may choose a CBD product depending on the extraction method, product category, lab test results, and personal preferences.

Extraction Process

CBD manufacturers extract CBD using various methods based on the brand’s expertise or technology in extracting CBD and other cannabis derivatives. These methods include ethanol, hydrocarbon, and carbon dioxide (CO2) extraction.

  • Ethanol extraction: This method for extracting cannabidiol from the cannabis plant uses ethyl alcohol or ethanol. Ethanol is considered a more efficient solvent than CO2 and safer to work with than butane(35).

For centuries, various cultures have used ethanol to extract medicinal components from plants(36).

  • Hydrocarbon extraction: In this extraction technique, hydrocarbons like butane or propane are used to derive CBD from cannabis plants.

Since hydrocarbons are neurotoxic and flammable, cannabis facilities should have sufficient safety procedures in handling hydrocarbons. Such chemicals not entirely removed from the extracted CBD may become a health and safety hazard.

  • Carbon dioxide extraction: Many medium- and large-scale CBD manufacturers use highly pressurized CO2 for CBD extraction because carbon dioxide is a naturally-occurring substance that leaves no residues(37).

Carbon dioxide is non-combustible and odorless, and the FDA categorizes it as generally recognized as safe (GRAS), especially for food use(38).

Product Categorization

After the extraction process, manufacturers process the CBD extract into various CBD oil products, typically categorized as broad-spectrum, isolate, or full-spectrum.

Broad-spectrum CBD oil contains most of the cannabis plant extracts, including flavonoids and terpenes. However, it contains trace amounts of THC or THC-free(39).

Flavonoids are plant chemicals purported to have antimicrobial and antioxidant potential(40). Meanwhile, terpenes are substances that give cannabis plants their distinct smell and are used as essential oil components(41).

CBD isolates are made of pure CBD. These products do not contain THC or any other cannabinoids and compounds.

Meanwhile, full-spectrum CBD oil is similar to broad-spectrum CBD oil products, except full-spectrum CBD oil usually contains THC.

The combination of cannabinoids and compounds in full-spectrum CBD oil may result in the “entourage effect.” This effect is characterized by the cannabis compounds’ synergistic activity that leads to improved benefits than if such compounds worked individually(42).

Laboratory Testing

Reputable and transparent CBD brands usually send their CBD product samples to third-party laboratories for analysis.

These labs assess the samples and reveal their findings on a certificate of analysis (COA).

COAs provide detailed information about the product’s cannabinoid content, including CBD and THC.

These certificates show whether a CBD oil product’s THC content is within the legal limit. Cannabis or hemp products whose THC levels do not exceed 0.3% are excluded from the controlled substances list under United States federal law(43).

Third-party labs can also analyze for contaminants or toxicity in the product and provide the results in the COA. These contaminants include solvents, heavy metals, or pesticides that can cause a potential health risk to consumers.

Individuals are encouraged to compare the COA results to the information on CBD product’s label to ensure the consistency of the product’s quality and safety. Reputable CBD companies test their products regularly and upload the updated COAs on their websites.

Personal Preferences

Individuals interested in experiencing the “entourage effect” may consider purchasing full-spectrum CBD oil products.

Meanwhile, consumers who prefer not to take THC or experience its psychoactive effects may opt for broad-spectrum CBD oil or isolates.

Individuals may also have other personal preferences and goals before deciding what product to buy.

For example, individuals may choose products based on their personal objectives, such as maintaining a healthy diet, targeting an ideal weight, or making lifestyle changes.

Risks and Side Effects of CBD

Researchers have not extensively studied the adverse effects of using CBD for leishmaniasis or its symptoms.

Overall, CBD’s side effects in humans include drowsiness, fatigue, dry mouth, appetite reduction, and diarrhea(44).

One study in New Zealand analyzed the effects of prescription CBD in 400 individuals(45). Results showed that some participants who took CBD experienced sedation and vivid dreams.

A World Health Organization (WHO) report stated that CBD may have a good safety profile with no reported abuse potential(46). Moreover, one study suggested that humans may tolerate high CBD doses of up to 1,500mg per day(47).

Legality of CBD

The 2018 Farm Bill mandates the U.S. Department of Agriculture (USDA) to establish a framework to regulate hemp production(48).

The law also removed hemp-based products containing no more than 0.3% THC from the definition of “marijuana” under the Controlled Substances Act(49).

As of February 2022, 37 states, including four U.S. territories and the District of Columbia, have legalized using cannabis products for medical purposes(50). In general, all 50 U.S. states have implemented CBD and cannabis laws with varying restriction levels(51)

The FDA advises that marketing CBD products as dietary supplements or labeling such products as food additives is prohibited(52).

Individuals considering using CBD products for leishmaniasis should check whether their state’s laws legally allow the consumption of such products.

What Is Leishmaniasis?

Leishmaniasis is a neglected tropical disease (NTD) usually found in southern Europe and in tropical and subtropical regions.

The disease is typically caused by an infection brought by a protozoan parasite called Leishmania, usually carried by a phlebotomine sandfly(53).

The Centers for Disease Control and Prevention (CDC) identifies 21 of 30 species of the Leishmania parasite that can infect humans. These species include Leishmania major, Leishmania donovani, Leishmania tropica, and Leishmania amazonensis(54).

When the infected sandfly bites, they inject infective promastigotes from their proboscis (tubular mouthpart). Macrophages, a type of white blood cell, phagocytize (ingest) the promastigotes, which transform and multiply to infect other phagocytic cells.

The WHO mentions that leishmaniasis is associated with poverty, malnutrition, weak immune systems, poor housing, and population displacement(55).

The agency also links the disease to adverse environmental factors, such as deforestation, urbanization, irrigation schemes, and dam building.

Types of Leishmaniasis

Leishmaniasis can manifest in different forms among humans. These forms are visceral, cutaneous, and mucocutaneous leishmaniasis.

Visceral Leishmaniasis

Visceral leishmaniasis, also called kala-azar, is among the top parasitic diseases with an outbreak and mortality potential. Individuals with this disease often experience a silent infection, meaning the symptoms do not show immediately(56).

According to the WHO, more than 90% of cases in 2020 occurred in India, Brazil, China, Ethiopia, Algeria, Iraq, Peru, and Pakistan, and an estimated 50,000 to 90,000 individuals are infected annually. If visceral leishmaniasis is left untreated, it can be fatal in more than 95% of cases(57).

Cutaneous Leishmaniasis

Cutaneous leishmaniasis is a non-life-threatening parasitic disease. However, it is the most common form of leishmaniasis and can cause life-long scars in infected individuals(58).

Despite this effect, cutaneous leishmaniasis’ non-fatal nature has caused many health systems, funding agencies, and pharmaceutical companies to pay little attention to this disease(59).

This disease can also cause a significant adverse impact on the community, such as ostracism, economic loss, and less education. Such effects may be even more severe for individuals with limited resources to deal with the disease(60).

Around 95% of cutaneous leishmaniasis cases happen in Central Asia, the Middle East, the Mediterranean basin, and the Americas.

According to the Drugs for Neglected Diseases Initiative (DNDi), cutaneous leishmaniasis is endemic in 87 countries and causes 600,000 to 1 million cases of infection annually. Current treatments are only 50% effective(61).

Mucocutaneous Leishmaniasis

This disease is a complication of cutaneous leishmaniasis and can manifest months or years after skin ulcers heal.

These ulcers can cause partial or total destruction of the mucous membranes in the nose, mouth, throat, and surrounding tissues, resulting in disability.

Mucocutaneous leishmaniasis is also unlikely to self-heal. This disease can be fatal in severe cases, especially among individuals who do not receive treatment(62).

Causes and Symptoms of Leishmaniasis

The CDC reports that an individual becomes infected with leishmaniasis from the bite of a female phlebotomine sandfly. These insects become carriers of the Leishmania parasite by sucking the blood of an infected animal or human(63).

Individuals often do not realize the presence and bites of sandflies because these insects are smaller than mosquitoes, do not make noises, and sometimes make painless bites(64).

Sandflies are usually active during twilight, evening, and nighttime hours. However, even though these insects are less active during the day, they may still bite if they are disturbed.

Aside from sandfly bites, Leishmania parasites can also spread through blood transfusions or contaminated needles. There are also cases of congenital transmission, wherein the disease is spread from the pregnant mother to the baby(65).

Symptoms of visceral leishmaniasis may not immediately manifest in some infected individuals until several months or years later. Symptoms include fever, liver and spleen enlargement, and weight loss.

Other symptoms of this disease include anemia (low red blood cell count), leukopenia (low white blood cell count), or thrombocytopenia (low platelet count).

On the other hand, individuals with cutaneous leishmaniasis can develop sores within weeks or months after the sandfly bite.

The symptoms of this disease range from self-healing, uncomplicated skin lesions to chronic, debilitating, and disfiguring lesions.

Skin sores caused by cutaneous leishmaniasis can appear as lumps (papules), bumps (nodules), or craters with raised edges (ulcers). Infected individuals can also develop swollen glands near the sores(66).

Scabs can appear and cover these small bumps or open lesions. While these sores are usually painless, they can become painful if infected by bacteria(67).

Risk factors are high for individuals who live or travel to places where the disease is commonly found. These places include rural areas and city outskirts.

Examples of individuals at risk for this disease include ecotourists, missionaries, soldiers, Peace Corps volunteers, soldiers, and researchers who conduct studies outdoors at night(68).

Sandflies are active from dusk to dawn. Thus, transmission risk is high during this period.

Diagnosis and Alternative Treatments of Leishmaniasis

An individual may first perform an initial self-diagnosis by determining what part of the world they are located in and if leishmaniasis is found in that region. They can also check if they have leishmaniasis symptoms, such as sores on the skin.

Doctors, healthcare providers, and parasitology experts can perform a diagnosis through laboratory testing.

One test includes taking tissue specimens from skin sores for cutaneous leishmaniasis or bone marrow samples for visceral leishmaniasis. These tissues are examined through molecular tests and under the microscope for parasitic presence(69).

Labs can also perform blood tests that detect antibodies that respond to the parasite. Other facilities have parasite isolation through in vitro culture(70).

One study published in PLOS Neglected Tropical Diseases suggested that a urine-based detection assay may be an effective diagnostic tool to test for visceral leishmaniasis and monitor the treatment of this disease(71).

After diagnosis, leishmaniasis treatment may depend on several factors, such as the disease type, geographic location, parasite species, and associated diseases.

Although the disease is curable, treatment requires the body to be immunocompetent since current medicines cannot eliminate the parasite, and relapse can occur(72).

The only FDA-approved antileishmanial medications are oral miltefosine for visceral and cutaneous leishmaniasis and intravenous liposomal amphotericin B (L-AmB) for visceral leishmaniasis(73).

In North America (the United States and Canada), treatment options for leishmaniasis include parenteral (intramuscular, intravenous, or subcutaneous injections) and oral treatments.

Parenteral treatments include amphotericin B deoxycholate (Fungizone), sodium stibogluconate (Pentostam), and pentamidine isethionate (Pentam 300). Oral methods include fluconazole (Diffucan), ketoconazole (Nizoral), and miltefosine (Impavido)(74).

Other alternative treatments include(75):

  • Leshcutan: This topical ointment consists of 15% paromomycin and 12% methylbenzethonium chloride (MBCL).
  • ThermoMed: A portable, non-surgical device to help treat tropical skin diseases.
  • Cryotherapy: Uses frigid temperatures to freeze and remove abnormal tissue to treat skin conditions.

How One Can Prevent Leishmaniasis

The WHO recommends the following preventive measures to help control or reduce Leishmania infection and the spread of the disease(76):

  • Vector control: Reducing the sandfly population may help reduce disease transmission of the Leishmania species. Control methods include insecticide sprays, insecticide-treated nets, personal protection, and environmental management.
  • Effective disease surveillance: Involves monitoring and prompt action during epidemics.
  • Animal reservoir host control: Involves controlling and monitoring certain species, such as animals, where parasites or pathogens can survive.
  • Social mobilization: The process of educating and engaging the community to facilitate behavioral changes and adopt practices that may help prevent or minimize infectious diseases.
  • Early diagnosis and prompt treatment: Helps reduce the incidence of diseases and minimize the risk of disability or death.

The WHO stated that while there are safe and effective anti-leishmanial treatments, especially for visceral leishmaniasis, these medications may require some expertise to use. The agency also claims to have improved access to such medicines through a medical assistance program and a WHO-negotiated price scheme(77).

  1. A Review of Cannabis Sativa-Based Insecticides, Miticides, and Repellents
  2. Phlebotomine sand flies – Factsheet for experts
  3. About Leishmaniasis
  4. Skin Ulcers
  5. Cannabidiol Primer for Healthcare Professionals
  6. The Antimicrobial Activity of Cannabinoids
  7. A Review of Cannabis Sativa-Based Insecticides, Miticides, and Repellents
  8. Tetrahydrocannabinol
  9. Cannabis (Marijuana) and Cannabinoids: What You Need To Know
  10. Phlebotomine sand flies – Factsheet for experts
  11. How Is Cannabis Connected to Leishmaniasis Infections?
  12. Cannabidiol primer for healthcare professionals
  13. About Leishmaniasis
  14. Fever: Symptoms & Causes
  15. About Leishmaniasis
  16. Skin Ulcers
  17. Cannabidiol Primer for Healthcare Professionals
  18. The Antimicrobial Activity of Cannabinoids
  19. CBD dosing
  20. Ibid.
  21. Page 218 of Healing With CBD
  22. Page 210 of Healing With CBD
  23. Ibid.
  24. An introduction to the endogenous cannabinoid system
  25. The endocannabinoid system: Essential and mysterious
  26. Advances in Oral Drug Delivery
  27. Page 208 of Healing With CBD
  28. Best Way to Take CBD
  29. Can Vaping Damage Your Lungs? What We Do (and Don’t) Know
  30. Best Way to Take CBD
  31. Page 190-193 of Healing With CBD
  32. A Systematic Review on the Pharmacokinetics of Cannabidiol in Humans
  33. Page 190-193 of Healing With CBD
  34. A Systematic Review on the Pharmacokinetics of Cannabidiol in Humans
  35. Page 243 of Healing With CBD
  36. CBD oil: An introduction
  37. Page 243 of Healing With CBD
  38. CFR – Code of Federal Regulations Title 21
  39. Cannabidiol Primer for Healthcare Professionals
  40. Flavonoids as Antioxidants
  41. The Cannabis Terpenes
  42. Page 92 of Healing With CBD
  43. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)
  44. What Are the Benefits of CBD — And Is It Safe to Use?
  45. Cannabidiol Prescription in Clinical Practice: An Audit on the First 400 Patients in New Zealand
  46. WHO Expert Committee on Drug Dependence
  47. Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent
  48. Hemp Production
  49. Hemp Production and the 2018 Farm Bill
  50. State Medical Cannabis Laws
  51. Cannabidiol (CBD)-What We Know and What We Don’t
  52. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
  53. Parasites – Leishmaniasis
  54. Leishmaniasis: Parasite Biology
  55. Leishmaniasis
  56. About Leishmaniasis
  57. Leishmaniasis
  58. Cutaneous Leishmaniasis: Facts
  59. Cutaneous Leishmaniasis: Overview
  60. Cutaneous Leishmaniasis: Facts
  61. Ibid.
  62. Ibid.
  63. About Leishmaniasis
  64. Ibid.
  65. Ibid.
  66. Ibid.
  67. Cutaneous Leishmaniasis: Facts
  68. About Leishmaniasis
  69. Ibid.
  70. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)
  71. Urine-based antigen detection assay for diagnosis of visceral leishmaniasis using monoclonal antibodies specific for six protein biomarkers of Leishmania infantum / Leishmania donovani
  72. About Leishmaniasis
  73. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)
  74. Ibid.
  75. Ibid.
  76. Leishmaniasis
  77. Ibid.
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