CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.
Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. 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 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) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
The evidence for cannabidiol health benefits
CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it 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 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. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.
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Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that 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 can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s 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 won’t affect other medications you are taking.
Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor at the University of São Paulo in Brazil, in an email interview. Of course, it’s difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.
Recently, the F.D.A. sent a warning letter to Curaleaf Inc. about its “unsubstantiated claims” that the plant extract treats a variety of conditions from pet anxiety and depression to cancer and opioid withdrawal. (In a statement, the company said that some of the products in question had been discontinued and that it was working with the F.D.A.)
“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.
Does CBD help anxiety and PTSD?
“Our top therapies attempt to break the association between reminders of the trauma and the fear response,” said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the study’s principal investigator. “We think that CBD, at least in animal models, can help that process happen a lot faster.” While large clinical trials are underway, psychologists say there isn’t compelling evidence yet as to whether this is a viable treatment.
“It’s promising in a lot of different therapeutic avenues because it’s relatively safe,” said James MacKillop, co-director of McMaster University’s Michael G. DeGroote Center for Medicinal Cannabis Research in Hamilton, Ontario.
A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. That’s when someone believes a drug is working and symptoms seem to improve.
But without clinical trials in humans, psychologists say CBD’s effect on depression is still a hypothesis, and not an evidence-based treatment.
You can see the limits of existing CBD research: multiple small trials that yield conflicting results, along with RCTs and meta-analyses that too often include marijuana and mixed THC/CBD compounds rather than just pure CBD products—many of them in varying amounts. These certainly influence the results, and they also leave consumers rightly wondering what the proper dose for them might be.
As for potential users, “low and slow” was the refrain from the CBD store managers with whom I spoke. With CBD tincture, for example, McManigal recommended placing a half of vial of oil under the tongue—the equivalent of 17 milligrams in his formulation—and waiting 45 minutes to an hour. “If you don’t feel the effect of being more relaxed, use more,” he said.
“You don’t know the dose, you don’t know the formulation and therefore [you don’t know] the absorption,” White told me. “In a lot of places, it’s essentially a backyard pharmacy where people just sort of make it up…. When you get in a situation where people are kind of doing it themselves then that is really out of control.”
Jason White, who chairs the World Health Organization Expert Committee on Drug Dependence, told me he believes CBD will prove efficacious for a broader range of seizure types, that it likely has some anti-psychotic efficacy, and that it may help improve the quality of life among those who suffer from Parkinson’s disease. In studies, CBD has been found to treat certain types of seizures, has benefited schizophrenia patients with psychotic symptoms in two of three RCTS, and has improved activities of daily life and sleep in Parkinson’s patients in early trials.
Why so popular? Well, CBD is being marketed as a health supplement and a medicine, with the ability to reduce inflammation, lessen pain and reduce anxiety as well as to potentially help alleviate other conditions like post-traumatic stress disorder, some of the side effects of chemotherapy, and even spasticity associated with multiple sclerosis. The Hemp Farming Act of 2018 reclassified hemp from a highly controlled Schedule 1 substance, like marijuana, to an agricultural product that could now be grown and distributed legally.
The lack of high-quality studies reflects the hoops one has to jump though to conduct marijuana research. Regulatory barriers need to be streamlined and funding sources need to be identified so that large, well-designed RCTs can be conducted to explore the beneficial and harmful health effects of CBD use, which ultimately would better inform states, the FDA and the public. Currently, there are "This industry is not going to go away. Our sales are up,” one shop owner told me. All the more reason for us to do the research, prove CBD’s efficacy, standardize dosing and ensure quality, among other things. I no longer growl when I pass my local store; the people there genuinely believe they’re doing a good thing. Let’s find out if they’re right.
One of the most comprehensive reports, produced by the National Academies of Sciences, Engineering, and Medicine, examined over 10,000 scientific abstracts and concluded that substantial evidence existed for cannabis and cannabinoid treatment of three conditions: chronic pain, chemotherapy-induced vomiting and muscle spasms. “There was little or no evidence for any therapeutic effects of CBD,” according to oncologist Donald Abrams, one of the study’s committee members. The active components of cannabis have been shown to modulate the immune system and inflammation, yet a WHO report concluded that CBD’s effect on the immune system is unclear, with evidence showing suppression at higher doses but stimulation at lower doses.*