Cannabidiol (CBD) used, marketed for many conditions, but does it really work?
If the marketers of cannabidiol, or CBD are to be believed, their product can treat everything from insomnia to schizophrenia. CBD is being sold in creams, oils, ointments, gummies and even facial masks.
And consumers are grabbing it up: the market for CBD is growing faster than cannabis, with one recent analysis estimating it will become a $22 billion industry over the next few years.
Recently, The Plain Dealer asked readers about their use of CBD and the questions they have about the exploding popularity of the product. We heard from people using CBD for a wide range of conditions, including anxiety, arthritis pain, depression, migraine headaches and insomnia.
Many readers had two main questions about CBD: Where is it legal to buy it, and does it actually live up to the hype?
We’ll have to get back to the first question after Ohio settles its policy on the sale of hemp and CBD; Recently the Ohio Senate unanimously passed a bill that would make it possible for people to grow, process and sell hemp and CBD derived from the plant. The bill will now head to the House for a vote.
To answer the second question we asked a group of local and national experts on cannabis and cannabidiol to help sort out the myths from the facts.
What is CBD?
Cannabidiol is one of more than 100 chemicals called cannabinoids that can be distilled from Cannabis plants, which include both marijuana and hemp. THC, the component of marijuana that produces a high, and CBD are the most abundant cannabinoids in Cannabis plants, and generally have an inverse relationship: the more THC there is in a plant, the less CBD.
Marijuana, bred to contain lots of THC, therefore has less CBD. Hemp, which generally contains a lot of CBD, has very little THC.
“The effects of [the compounds] are kind of yin and yang,” says Dr. Kevin Hill, director of the division of addiction psychiatry at Beth Israel Deaconess Medical Center in Boston, with THC causing a high and the potential for psychotic symptoms, and CBD causing no high and possibly tamping down anxiety and psychosis in animal models.
Pure CBD, whether it’s derived from hemp or marijuana, should in theory contain no THC and thus not cause any intoxication.
What we know about CBD
For most conditions, we don’t yet know a lot about CBD. “People are suggesting that it’s good for almost and anything and everything, and that is almost certainly not going to be true,” says Dr. Igor Grant, chair of the department of psychiatry at University of California San Diego and director of its Center for Medical Cannabis Research.
Epidiolex, a medication that treats two rare and very severe forms of childhood epilepsy called Dravet and Lennox-Gastaut syndromes, is the first and so far only CBD-based medication to be tested in randomized clinical trials and approved by the Food and Drug Administration (FDA).
The best evidence of CBD’s potential for other conditions comes only from pre-clinical, or animal, trials, which provide some indication that the substance may reduce inflammation, anxiety and psychotic symptoms in the short term, Grant says.
But while there’s promise that CBD may help in these areas, the early evidence is far from conclusive. “I don’t think we can yet say ‘this really works’ for anxiety,” for example, he says.
Anecdotal evidence from patient testimonials abounds when it comes to CBD and the treatment of insomnia, pain and in easing recovery from addiction, but the evidence in these areas is even more shaky, or entirely lacking.
For insomnia, some studies indicate CBD causes sedation, while others show the opposite. It may be other cannabis-derived substances that are mixed in with the CBD that make people drowsy, or even the solutions the CBD is dissolved in, says Hill.
In treating addiction, “there’s no evidence” that CBD works, says Dr. Ted Parran, addiction specialist at St. Vincent Charity Hospital’s Rosary Hall treatment center and an associate professor at Case Western Reserve University School of Medicine. While CBD won’t produce a high and is therefore likely safer than the increasingly popular idea of treating addiction with medical marijuana, there are no trials in people comparing its use against a placebo, the gold standard for measuring effectiveness.
It’s possible CBD may prove useful for people with pain related to inflammation, such as arthritis, because the compound does have anti-inflammatory properties. But little is known about the required dose, and how the CBD should be delivered (whether by an oil, cream or solution) in order to work.
Hill cautions his patients against spending a lot of money on small tubes of CBD to rub on aching joints because even if it helps, it probably won’t be much more effective than other less-expensive topical pain relievers such as Icy Hot or Ben-Gay.
A lot of people assume CBD is safe because it’s considered “natural” and because it’s widely available without a prescription in health food stores and even some gyms and coffee shops.
Research on CBD has provided some good news about the product’s safety when it’s pure: it’s non-intoxicating, meaning it doesn’t produce euphoria or a “high,” and in the clinical trial that led to the FDA’s approval of Epidiolex, the CBD drug did not cause side effects severe enough to discontinue treatment, even at high doses.
In that trial, the most commonly reported side effects were sleepiness (and on the flip side, insomnia) elevated liver enzymes, gastrointestinal symptoms, rash and infections.
One of the biggest problems consumers face is uncertainty about what they’re actually getting. Because the products are primarily marketed and sold as a supplement, they’re not regulated by the FDA. There’s no guarantee of safety or purity, despite what companies claim.
Two recent studies have raised concerns about what’s in the products being sold, with one finding wide variation in both CBD and THC content, and the other turning up potentially dangerous medications and chemicals such as cough medicine and the synthetic cannabinoid known as K2, or Spice.
“If you buy something off the Internet, you may be getting more CBD than you think you’re getting, or you may be getting less,” says Hill. “You might not be getting any at all.”
It may be safest to buy CBD products from state-licensed marijuana dispensaries, he says, because products sold there are more closely regulated and should have been tested for purity.
But all the doctors agreed that if you plan on using CBD, you need to have a conversation with your physician first. And because the evidence of CBD’s effectiveness in treating most conditions is still shaky, at best, you should never forgo another medication in its favor, they say.
Implications for drug-testing
While CBD is not supposed to contain THC, the compound that would produce a positive result for marijuana use, some CBD, particularly if it’s made from marijuana rather than hemp, may contain THC.
Dr. Paul Terpeluk, medical director for employee health at The Cleveland Clinic, says he often fields questions about CBD at the health system, where employees are subject to random drug testing. “If you take this product and you have a high level of THC in your urine and you’re going to claim that it was from this CBD oil, that’s a risk for you,” he says.
It’s one of many reasons Terpeluk advises pretty much everyone to not take CBD. “Why would you take a medication when you don’t know what’s in it,” he says. “I don’t care what it is.”
The bottom line
The doctors are uniformly optimistic about the potential of CBD, but call for more, and better, research before wholeheartedly endorsing it for anything beyond its FDA-approved uses.