In the past 20 years, cannabis went from an illegal substance to a $1-billion industry with virtually unlimited growth potential.
Legal cannabis sales reached $10.3 billion in 2018, according to New Frontier Data, a cannabis research firm.
When cannabis was taking its first baby steps, herbal medicine was already a consolidated industry.
In 1996, when California became the first U.S. state to register legal cannabis sales, the market for herbal medicine in the U.S. was already worth $4 billion.
Although herbal medicine didn’t experience the exponential growth of cannabis, it has been growing steadily for the past 25 years and is gaining momentum.
A market report from the American Botanical Council states that the U.S. market for herbal medicine has more than doubled since 1996, peaking at $8.842 billion in 2018.
Natural Products, Herbal Medicine And Cannabis
The field of herbal medicine is crossed by many sectors and disciplines, so nomenclatures change according to the source. Botanical products, natural products, herbal medicines and dietary supplements are used interchangeably in some cases, but can have different contextual meanings.
“In the simplest of terms, a natural product is a small molecule that is produced by a biological source,” according to a book on natural drug discovery by Juergen Krause and Gailene Tobin.
"Natural products are considered those formulated without artificial ingredients that are minimally processed,” according to the Natural Product Association, “and include natural and organic foods, dietary supplements, pet foods, health and beauty products [and] 'green' cleaning supplies.
Daniel Fabricant, Ph.D, the Natural Product Association's CEO and president, told Benzinga that herbal medicine products comprise 25-30% of the market for natural products.
Stefan Gafner, Ph.D, the chief science officer at the American Botanical Council, said definitions for these terms are always a bone of contention. We asked how he would define herbal medicine.
“I see it as a way of people treating themselves with botanicals. So basically, it’s taking care of your health needs with botanicals.”
A product can be considered herbal medicine when it includes any part of a plant, like leaves, stems, flowers, roots or seeds.
These products can be sold raw or as extracts, in which the plant is macerated with water, alcohol or other solvents in order to extract their active chemicals.
If a botanical product undergoes synthetic isolation, it ceases to be herb, though it can still qualify as a natural product.
By these definitions, cannabis products can be described as natural products, herbal medicine or both.
Flower buds, tinctures and some forms of whole plant extracts fall into the herbal medicine category. Isolated CBD products do not, yet they can be considered natural products, since they’re plant-derived.
FDA Regulation On Herbal Medicine, Cannabis
Although industry professionals have come up with their own definitions, they don’t necessarily coincide with FDA regulations. Herbs were first regulated by the FDA with the Dietary Supplement Health and Education Act of 1994 (DSHEA), and included in the category of dietary supplements, along with vitamins, minerals, amino acids, enzymes and others.
The main difference between a drug and a dietary supplement is that dietary supplements cannot claim to treat, diagnose, cure or alleviate the effects of diseases.
Drugs can make these claims, and need to demonstrate safety and efficacy to obtain premarket FDA approval. Dietary products do not need FDA approval to be sold.
Cannabis products are, in simplest terms, botanical products.
"Botanical products, depending on the circumstances, may be regulated as drugs, cosmetics, dietary supplements or foods," according to FDA guidance.
Under FDA definitions, CBD products could theoretically fit in the dietary supplements category. Yet products containing CBD and THC cannot be marketed as dietary supplements under FDA regulations because of the “drug exclusion clause” in the Food, Drug and Cosmetics Act.
Herbal Medicine In The Western World
Herbal medicine was synonymous with medicine until the development of modern pharmacology.
In 1890, 59% of U.S. pharmaceutical products were herbal products. Many traditional, indigenous and folkloric herbal treatments were replaced by synthesized drugs in the western world by the beginning of the 20th century.
This type of medicine has prevailed in many other parts of the world.
“There are places around the globe where herbal medicine is the primary source of health care, in part because people do not have access to any other treatment, in part because of their cultural background,” said the American Botanical Council's Gartner.
According to a 2008 report on herbal medicine use in Nigeria, the average cost of developing a new pharmaceutical drug exceeds $800 million.
A 2016 study puts this price at between $2 to $3 billion. This is partly the reason why herbal medicine continues to thrive in developing nations where economic limitations make it extraordinarily difficult to access or develop pharmaceutical-grade products.
Eighty percent of African populations use some form of traditional herbal medicine, according to the World Health Organization. Herbal medicine is also one of the main components of traditional Chinese Medicine and Ayurveda, the medical tradition of the Indian subcontinent.
In the past decade, the use of herbal medicine has been rising in rich and developed countries as well.
What Are The Common Drivers Of Herbal Medicine, Cannabis Growth?
Although cannabis and herbal medicines are regulated by the FDA, both industries share many traits that juxtapose from a consumer perspective.
Cannabis can be considered a type of herbal medicine by many standards, and many cannabis products are certainly marketed that way.
Not only is the growth of both industries rooted in similar causes, but it’s the intersection of the two that has caused them to mutually influence consumer demand.
The Natural Product Association's Fabricant agrees with this interpretation.
“I think it goes both ways. On one side, people go ‘well, look, [cannabis] is just another herbal product, and we use herbal products very safely, very routinely in this country.’ And then the other way, by virtue of [legalization], people go ‘well, OK, I'm using CBD, but I also want to try this botanical now because I'm using CBD.’ I think there's an intersection of the two.”
Although cannabis might be “a juggernaut on its own,” as Fabricant said, it is a natural product, and part of its success is motivated by audiences considering it a natural alternative to other forms of medicine and intoxication.
Natural Products Are Perceived As Healthier
This change in consumer perception is grounded in the idea that products coming from natural sources are healthier than those made in laboratories.
This idea does not have the full backing of rigorous science, but is part of a broader vision of leaning toward sustainability and the rejection of chemical products.
“Look, people drive Priuses, right? People want to get off of petroleum dependence. There are drivers in that regard, that I think are significant,” Fabricant said.
A Disbelief In Conventional Drugs
The use of herbs for medicinal purposes has been documented by many cultures and civilizations for over 5,000 years, with minimal adverse effects.
As a general rule, plants that have caused sustained harms to individuals have already been removed from practice.
The American Botanical Council's Gafner said Western populations have become disillusioned with the results offered by conventional Western medicine and the pharmaceutical industry.
“People may not have had the benefits that they expected, or they may have had adverse events, or they may be afraid of adverse events.”
A study published in the Journal of Applied Pharmaceutical Science states that adverse or side effects from synthetic drugs are behind about 8% of hospital admissions in the United States and cause approximately 100,000 deaths each year.
Although synthesized products can offer consistency and more double-blind, placebo-controlled, peer-reviewed testing, a natural or herbal alternative is perceived by many consumers today as healthier.
Whole Plant Medicine Is Gaining Momentum
Fabricant highlighted the CBD industry’s dichotomy between whole plant extracts and CBD isolate.
This division is merely the expression of the “pharmaceutical drugs vs. herbal medicine” conundrum within the cannabis industry, he said.
'Self Care Is Here To Stay'
Many people are taking some of the practices traditionally associated with institutionalized health care into their own hands, Fabricant said.
People take pride and pleasure in gathering information and applying it to their own health.
While medicine was seen in the past as a way to cure the sick, many products today are used to maintain or improve health in already healthy populations, he said.
“I think we're seeing the concept of self-care is really here to stay. People want control of their health care. They don't want to feel like the only way they can put something in their body is by getting a prescription from their doctor,” Fabricant said.
Dealing With Stress
Finally, one of the largest sales increases seen in this sector comes from adaptogens, which are substances used to reduce stress.
In Gafner's view, overworked lifestyles are making us look for natural ways of coping with the rising stresses of everyday life.
Fabricant also believes that cultural, socio-economic and self-imposed pressures toward productivity are causing individuals to seek out new alternatives to maintain health in an increasingly unhealthy environment.
Scientific Evidence and Consistency: A Shared Challenge
Both the cannabis and herbal medicine industries currently face the difficult task of obtaining scientific consensus behind their efficacy in medical treatment.
Some plants, like gingko or echinacea, are backed by dozens of studies proving their efficacy, Gafner said.
As opposed to synthesized drugs, which provide stable parameters of measurement, herbal remedies can show a lot of variations.
“If you look at echinacea, there's three different species that are used. Sometimes people use the root, sometimes people use the flowering top. Sometimes they use a press [extract], sometimes they use an alcohol extract. So then comparing the data becomes very difficult.”
The problem of chemical inconsistency also exists in supply chain and retail, where herbal products and cannabis have a harder time proving their compositions than synthesized drugs, as chemical compositions of plants can vary depending on environmental reasons and genetic alterations.
Today, consumers are exploring the market in search of healthier ways of achieving and maintaining health.
Cannabis and herbal medicine might still be far behind Big Pharma in terms of scientific evidence. But this isn’t stopping consumers from expressing their voice: a desire for new, natural and sustainable approaches to health care.
Featured image from Unsplash and Pixabay.