Cannabidiol (CBD)-what we know and what we don’t
Cannabidiol (CBD) is often covered in the media, and you may see it touted as an add-in booster to your post-workout smoothie or morning coffee. You can even buy a CBD-infused sports bra. But what exactly is CBD? And why is it so popular?
How is cannabidiol different from marijuana, cannabis and hemp?
CBD, or cannabidiol, is the second most prevalent active ingredient in cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. One of hundreds of components in marijuana, CBD does not cause a “high” by itself. According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”
Is cannabidiol legal?
CBD is readily obtainable in most parts of the United States, though its exact legal status has been in flux. All 50 states have laws legalizing CBD with varying degrees of restriction. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. In 2018, the Farm Bill made hemp legal in the United States, making it virtually impossible to keep CBD illegal – that would be like making oranges legal, but keeping orange juice illegal.
The Farm Bill removed all hemp-derived products, including CBD, from the Controlled Substances Act, which criminalizes the possession of drugs. In essence, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) – even though it is the exact same molecule. Currently, many people obtain CBD online without a medical marijuana license, which is legal in most states.
The evidence for cannabidiol health benefits
CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, stop them altogether. Epidiolex, which contains CBD, is the first cannabis-derived medicine approved by the FDA for these conditions.
Animal studies, and self-reports or research in humans, suggest CBD may also help with:
Studies and clinical trials are exploring the common report that CBD can reduce anxiety.
- Insomnia. Studies suggest that CBD may help with both falling asleep and staying asleep.
- Chronic pain. Further human studies are needed to substantiate claims that CBD helps control pain. One animal study from the European Journal of Pain suggests CBD could help lower pain and inflammation due to arthritis when applied to skin. Other research identifies how CBD may inhibit inflammatory and neuropathic pain, which are difficult treat.
- Addiction. CBD can help lower cravings for tobacco and heroin under certain conditions, according to some research in humans. Animal models of addiction suggest it may also help lessen cravings for alcohol, cannabis, opiates, and stimulants.
Is CBD safe?
Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level of blood thinning and other medicines in your blood by competing for the liver enzymes that break down these drugs. Grapefruit has a similar effect with certain medicines.
People taking high doses of CBD may show abnormalities in liver related blood tests. Many non-prescription drugs, such as acetaminophen (Tylenol), have this same effect. So, you should let your doctor know if you are regularly using CBD.
A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot be sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other unknown elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
How can CBD be taken?
CBD comes in many forms, including oils, extracts, capsules, patches, vapes, and topical preparations for use on skin. If you’re hoping to reduce inflammation and relieve muscle and joint pain, a topical CBD-infused oil, lotion or cream – or even a bath bomb — may be the best option. Alternatively, a CBC patch or a tincture or spray designed to be placed under the tongue allows CBD to directly enter the bloodstream.
Outside of the US, the prescription drug Sativex, which uses CBD as an active ingredient, is approved for muscle spasticity associated with multiple sclerosis and for cancer pain. Within the US, Epidiolex is approved for certain types of epilepsy and tuberous sclerosis.
The bottom line on cannabidiol
Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer or COVID-19, which it is not. We need more research but CBD may prove to be a helpful, relatively non-toxic option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies, we can’t pinpoint effective doses, and because CBD currently is typically available as an unregulated supplement, it’s hard to know exactly what you are getting.
If you decide to try CBD, make sure you are getting it from a reputable source. And talk with your doctor to make sure that it won’t affect any other medicines you take.
CBD Oil: Facts You Should Know
Since 2018, one product has exploded onto the market in the United States more than any other, advertising itself as an antidote to sleeplessness, anxiety, stress, pain, and even acne. From tinctures to infused lotions and dog treats, cannabidiol (CBD) has made its way into hundreds of products that claim to enhance wellbeing. But is the hype real? And should you try CBD for yourself?
Although there is plenty of information out there, navigating it can be confusing. As with any new treatment option, you need to do a careful risk-benefit analysis before diving in.
Considering using CBD oil? Here’s what you need to know.
CBD won’t get you “high.”
Many people assume that CBD oil and marijuana are the same thing, but that’s not quite accurate. The Cannabis sativa plant, also known as cannabis or marijuana, has hundreds of different compounds in it. The two most well-known are Tetrahydrocannabinol (THC) and CBD. While THC has psychoactive properties (the “high” feeling that marijuana is well-known for), CBD does not.
There are risks to using CBD.
While excitement over this potentially beneficial treatment is growing, there are a few reasons why you should exercise caution when considering it:
- The clinical evidence is still in its infancy. While there are many anecdotal reports of CBD’s positive effect on everything from insomnia to pain to HIV, the scientific evidence doesn’t yet match the hype. The most promising evidence is for the use of CBD to treat a rare form of childhood epilepsy. In fact, the evidence is so strong in this area, that in 2018 the United States Food and Drug Administration (FDA) approved the first-ever CBD-derived medication to help with this condition.
- CBD is not regulated in the United States in any instance other than one particular epilepsy medication. Without regulation, there is no way to ensure that a product is marketed accurately or that its contents have been measured and dosed appropriately. Many products that claim to contain only CBD actually have higher-than-advertised amounts of THC in them, which can cause unwanted psychoactive effects.
- CBD can cause reactions with other medications. The World Health Organization states that although “CBD is generally well tolerated with a good safety profile. reported adverse effects may be as a result of drug-drug interactions between CBD and patients’ existing medications.” Most experts agree that CBD can interfere with other medications, so it’s important to consult a healthcare provider before trying the oil out yourself.
- The legality of CBD in the United States is. complicated. After the passing of the 2018 Farm Bill, which allowed the non-THC version of the Cannabis sativa plant – hemp – to be used in agriculture, the doors opened for a flood of CBD products made from hemp to enter the market. The laws change constantly, but in general, it is only federally legal to sell CBD products in the United States if a number of restrictions are met, though many states have individual laws stating otherwise. The legality is so complicated that the FDA has taken a backseat to enforcing the federal law – but the organization does firmly state that it is illegal to sell or purchase CBD that is marketed as a dietary supplement or has been added to food.
While there are many anecdotal reports of CBD’s positive effect on everything from insomnia to pain to HIV, the scientific evidence doesn’t yet match the hype.
There might also be benefits to using CBD.
Most experts agree that there needs to be more research on the impact of CBD oil on health conditions, because many of the current studies don’t use a placebo, have mixed results, or are solely based on animal research. However, many also argue that even though the studies are early, they are promising, and that CBD is generally safe. A 2015 systematic review found moderate evidence for the use of cannabinoids to treat chronic pain, but low-quality evidence to support its effect on nausea, vomiting, weight gain in HIV, sleep disorders, or Tourette’s.
The best course of action, then, might be to wait as the body of research grows and the legality and regulations around CBD are streamlined before trying CBD oil to manage a health condition.
Want to use CBD oil now? Do this first.
But if you really want to try it now, here is what the Mayo Clinic’s Clinicians’ Guide to Cannabidiol and Hemp Oils recommends:
- Talk to a healthcare provider first, before you make any decisions. If your provider doesn’t have knowledge of CBD products, ask if they know another provider who does.
- Use products from Europe, where CBD is better regulated and products have an even stricter requirement for maximum THC levels.
- Read labels and fine print carefully. Clinicians recommend using products that are labeled certified organic by the USDA, and whose ingredients are not simply “hemp seed oil.” Also take some time to peruse the company’s website, including their standards section and whether they have an independent adverse reporting program. If these things aren’t listed, skip it. Another helpful guideline is Mayo’s checklist for finding a high-quality product.
Grinspoon, P. (2018 August 24). Cannabidiol (CBD) – what we know and what we don’t. Harvard Health Blog. Retrieved from https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.
Harrison, VJ, Bauer, B, Mauch, K. (2019). Clinicians’ guide to cannabidiol and hemp oils. Mayo Clinic Proceedings; 94(9), 1840-1851.
Whiting, P.F., Wolff, R.F., Deshpande, S. et al. Cannabinoids for medical use: a systematic review and meta-analysis. ([published corrections appear in JAMA. 2015;314(5):520, JAMA. 2015;314(8):837, JAMA. 2015;314(21):2308, and JAMA. 2016;315(14):1522]) JAMA. 2015; 313: 2456–2473.