Cannabidiol
by Dr. Neil Sinha
Lately, more and more patients are asking me about cannabidiol (aka CBD). Is it safe? Is it legal? What are the benefits and risks involved with its use? My standard answer for the last few months is that there is not enough long-term data or research available as CBD is a relatively new substance. Therefore, it is difficult for most physicians to ethically propose its use. However, I decided to do some of my own research to see what objective data is available. Afterall, CBD stores are seemingly popping up everywhere and it does not look as if their popularity is going to die down anytime soon.
What is CBD and how is it different from marijuana?
CBD is the second most prevalent of the active ingredients of cannabis (marijuana). CBD is an essential component of medical marijuana, but it is derived directly from the hemp plant, which is a relative of the marijuana plant. While CBD is a component of marijuana, it by itself does not cause a “high.” 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.”
CBD is the second most prevalent of the active ingredients of cannabis (marijuana). CBD is an essential component of medical marijuana, but it is derived directly from the hemp plant, which is a relative of the marijuana plant. While CBD is a component of marijuana, it by itself does not cause a “high.” 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 CBD legal?
CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it does not habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. The government’s position on CBD is confusing, and depends in part on whether it comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal.
What are the potential 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 difficult childhood seizure disorders (such as Dravet sydrome) which typically do not respond to anti-seizure medications. In a number of studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Recently, the FDA approved the first ever cannabis-derived medicine for these conditions. It is called Epidiolex and it contains CBD.
CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.
Is it safe?
Side effects of CBD include nausea, fatigue and irritability. If you take Coumadin as a blood thinning medication, CBD can increase the level of Coumadin in your blood. 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 and therefore you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other unknown ingredients. Also, the most effective therapeutic dose of CBD for any particular medical condition is not known.
The bottom line on CBD
Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such as CBD is a cure-all for cancer, which it is NOT. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain.
Without sufficient high-quality evidence in human studies we cannot pinpoint effective doses, and because CBD currently is mostly available as an unregulated supplement, it is difficult to know exactly what you are getting.
If you decide to try CBD, talk with your doctor, if for no other reason than to make sure it will not affect other medications you are taking.
