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.
WHO Report Finds No Public Health Risks Or Abuse Potential For CBD
In this Monday, Nov. 6, 2017, photo, a syringe loaded with a dose of CBD oil is shown in a research . [+] laboratory at Colorado State University in Fort Collins, CO. (Credit: AP Photo/David Zalubowski)
A World Health Organization (WHO) report has found no adverse health outcomes but rather several medical applications for cannabidiol, a.k.a. CBD, despite U.S. federal policy on this cannabinoid chemical.
According to a preliminary WHO report published last month, naturally occurring CBD is safe and well tolerated in humans (and animals), and is not associated with any negative public health effects [PDF].
Experts further stated that CBD, a non-psychoactive chemical found in cannabis, does not induce physical dependence and is “not associated with abuse potential.” The WHO also wrote that, unlike THC, people aren’t getting high off of CBD, either.
” To date, there is no evidence of recreational use of CBD or any public health related problems associated with the use of pure CBD,” they wrote. In fact, evidence suggests that CBD mitigates the effects of THC (whether joyous or panicky), according to this and other reports.
The authors pointed out that research has officially confirmed some positive effects of the chemical, however.
The WHO team determined that CBD has “been demonstrated as an effective treatment for epilepsy” in adults, children, and even animals, and that there’s “preliminary evidence” that CBD could be useful in treating Alzheimer’s disease, cancer, psychosis, Parkinson’s disease, and other serious conditions.
The Herbal Chef CEO and Head Chef Chris Sayegh measures the dose of CBD cannabis extract as he . [+] prepares medicated food for an event, in Tacoma, Washington on July 19, 2016. (Credit: JASON REDMOND/AFP/Getty Images)
In acknowledgement of these kinds of discoveries in recent years, the report continued, ” Several countries have modified their national controls to accommodate CBD as a medicinal product.”
But the U.S., the report noted, isn’t one of them. As a cannabis component, CBD remains classified as a Schedule I controlled substance, meaning it has a “high potential for abuse” in the federal government’s view. Nevertheless, the “unsanctioned medical use” of CBD is fairly common, experts found.
For many CBD users in the U.S., the substance’s mostly unsanctioned and illegal state creates problems, especially as a wave of online (mostly hemp) and store-bought CBD oils and extracts have allowed patients to take the treatment process–and the risks involved in buying unregulated medicine–into their own hands and homes.
While CBD itself is safe and found to be helpful for many users, industry experts have warned that not all cannabis extracts are created equally, purely, or with the same methods of extraction.
And while reports of negative reactions to pure CBD are very few and far between, researchers are able to say that the cannabinoid wouldn’t be to blame alone. ” Reported adverse effects may be as a result of drug-drug interactions between CBD and patients’ existing medications,” they noted.
As the cannabis reform nonprofit NORML reported, the WHO is currently considering changing CBD’s place in its own drug scheduling code. In September, NORML submitted written testimony to the U.S. Food and Drug Administration (FDA) opposing the enactment of international restrictions on access to CBD.
The FDA, which has repeatedly declined to update its position on cannabis products despite a large and ever-growing body of evidence on the subject, is one of a number of agencies that will be advising the WHO in its final review of CBD.
Perhaps this time around the FDA will listen, and learn something.
The report was presented by the WHO’s Expert Committee on Drug Dependence, and drafted under the responsibility of the WHO Secretariat, Department of Essential Medicines and Health Products, Teams of Innovation, Access and Use and Policy, Governance and Knowledge.