ANECDOTAL ACCOUNTS of health benefits of CBD (a non-psychoactive ingredient of the Cannabis plant) are pouring in from the medical establishment and personal experiences, while research allocations and sales numbers are soaring.
Between 2014 and 2018, the NIH budget for CBD studies went from zero to about $16 million; and CBD sales rose from $100 to $500 million and are projected to exceed $20 million by 2022. Last year, the first CBD product received FDA approval for treating two kinds of epilepsy.
But last month, FDA commissioner Scott Gottlieb warned consumers about the unsubstantiated health benefits of CBD: “These products have not been shown to be safe or effective…deceptive marketing of unproven treatments may keep some patients from accessing appropriate, recognized therapies.”
“The science just isn’t there yet,” Columbia University neurobiologist Margaret Haney told ScienceNews. In Haney’s view, “a gaping chasm separates the surging CBD market and the scientific evidence backing it,” and “messages of CBD’s purported health benefits come from people trying to sell CBD products—not from scientists.”
What Forbes calls the “CBD explosion” took off when industrial hemp—a variety of the Cannabis plant—became legal under the 2018 Farm Bill as long as it contained less than .3% [psychoactive] THC.
But the distinction between the two Cannabis varieties has been changing. Previously, industrial hemp—grown for fiber and seed oil —was a very different plant from the “drug” plant, explains marijuana historian Martin Lee. The key difference used to be the quantity of resin (the source of cannabinoids such as THC and CBD), which are both abundant in marijuana plants but were both almost non-existent in hemp. Also, because of the extraction process, CBD from hemp was more likely to be contaminated by pesticides and heavy metals in the soil.
“The distinction between hemp and other forms of cannabis is fast becoming moot,” according to Lee—notably in the quantities of CBD and THC they contain, although hemp remains legal where marijuana is not. As long as THC levels remain below .3%, high-resin cannabis varietals can qualify as hemp—even when CBD levels approach double digits.
CBD products from hemp are preferred by those who fear the possibility of psychoactive effects —euphoria, sedation—from whatever THC might be present in marijuana-derived CBD. On the other hand, people taking CBD at higher doses report side effects that include fatigue, along with nausea and irritability.
Dosage listed on labels of hemp-derived CBD, which is classified as a supplement and thus unregulated, can be unreliable. In a 2017 study of CBD products, 43% contained less CBD than labeled, while 26% contained more. And in previous FDA testing, some samples contained none.
Cannabinoids extracted from the marijuana plant, on the other hand, are classified as medicine and subject to oversight by the FDA and state regulators. So, for example, marijuana-derived CBD products can be sold in Massachusetts dispensaries that are prohibited by law from providing CBD extracted from hemp.
Most CBD research showing positive medical effects involves preparations from the marijuana plant that contain some THC—as well as high doses of CBD—legally available only to people with medical marijuana cards in 33 states and DC, and often costly. In states like Colorado that allow both medical and recreational marijuana, dispensaries can sell the same products to all consumers, with or without cards.
“Anything we know about CBD for pain comes from research where…you’re looking at the combination of THC and CBD and various components of the plant,” according to Temple University researcher Sara Jane Ward, who has studied CBD over the past twelve years.
And in one study, the 15 men who took 300 mg of CBD became calmer during a stressful public speaking task, compared to those receiving a lower or higher dose (commercially available CBD doses usually hover around 10-20 mg).
On the other hand, doses as low as 25 mg/d decreased anxiety scores for almost 80% of patients, while sleep scores improved for 66% but fluctuated over time, according to a report by psychiatrist Scott Shannon at the University of Colorado, Denver.
“CBD may prove to be an option for managing anxiety, insomnia and chronic pain,” writes Boston clinician and Harvard professor Peter Grinspoon. CBD can alleviate and even eliminate discomfort, but neither CBD nor THC help with severe pain. But adding THC “does increase the analgesic effect of CBD,” according to Grinspoon’s Harvard Health blog.
Walnut Creek, California, clinician Rachna Patel agrees, observing good results with CBD for mild to moderate levels of pain, but that these are “less likely” for severe pain; and for shingles and spinal pain, “some amount of THC is needed.”
Among patients at a Portland, Oregon, pain clinic who report taking CBD, about half say they get some benefit and about half say they didn’t notice anything, according to pain clinician Kimberly Mauer.
Topical CBD has helped control skin diseases such as eczema, psoriasis and acne via anti-inflammatory effects and regulation of immune system imbalances. But, according to Denver dermatologist Robert Dellavalle, “The most promising role for cannabinoids is in the treatment of itch.”
The best advice for CBD consumers is to choose products labeled with clear information about dosage and ingredients. A COA or Certificate of Analysis should include any added ingredients like corn syrup as well as testing done for heavy metals and pesticides. “Broad spectrum CBD” contains all of the plant’s naturally occurring compounds except for THC, while “full spectrum” includes THC, and “CBD isolate” is the compound in its purest form.
Additional ingredients can include “complimentary cannabinoids, terpenes and plant-based adaptogens,” writes Sherrie Nachman on Forbes. Nachman believes the inclusion of these ingredients can be more important than dose in determining the effectiveness of a product.
CBD—either ingested or absorbed through the skin—interacts with the body’s natural cannabinoid receptors “in areas where we’re most deficient—which is why CBD is also considered an adaptogen,” according to Nachman. And that’s the reason CBD affects individuals so differently, based on the different amounts of natural cannabinoids each person’s body is already producing.
Forbes writer Terrell Davis suggests keeping a CBD journal to record which products you try, their level of CBD and how that CBD affects you—and to experiment with different amounts of CBD as well as with other cannabinoids to figure out what works the best.
Meanwhile, marijuana regulations, both federal and state, continue to hamper CBD researchers by making it hard to acquire adequate material for their studies. University of Colorado, Boulder, neuroscientist Kent Hutchison and others have created a mobile pharmacology lab called the CannaVan to collect data on people who’ve taken products they’ve purchased on their own—currently focusing on the CBD’s effects on anxiety and pain.
When Florida clothes designer L.K. tried two different strengths of CBD-only preparations, she found “the weaker one seems to do nothing, and the stronger strength makes me feel woozy.” A third preparation with a little THC (8:1) “seemed to take an edge off my anxiety…perhaps not enough as I am back on Paxil.”
Using my D.C. medical marijuana card, I have received several preparations for chronic pain (including both THC and CBD), but each one put me to sleep too quickly to judge any other effects. I let my card lapse but remain hopeful that the booming interest in marijuana-based preparations means better possibilities coming down the pipeline sometime soon.
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news you can use.