Cannabidiol (CBD) is often covered in the media and you may see it advertised as a supplement to your post-workout smoothie or morning coffee. You can even buy a sports bra with CBD. 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 abundant active ingredient in cannabis (marijuana). While CBD is a major component of medical marijuana, it is either extracted directly from the hemp plant, marijuana’s cousin, or produced in a laboratory. One of the hundreds of components in marijuana, CBD does not produce a high by itself.
According to a report by the World Health Organization, “In humans, CBD does not exhibit effects indicating any abuse or addiction potential… To date, there is no evidence of public health problems associated with the use of pure CBD.” A recent study in the journal Neuropsychopharmacology concluded that “acute CBD alone is unlikely to significantly impair daily functioning or workplace performance.”
Is cannabidiol legal?
CBD is readily available in most parts of the United States, although its exact legal status changes. All 50 states have laws legalizing CBD with varying degrees of restriction. In December 2015, the FDA eased 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—it 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 drug possession. Essentially, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) – even though it’s the exact same molecule. Many people currently obtain CBD online without a medical marijuana license, which is legal in most states.
The evidence for the health benefits of cannabidiol
CBD has been touted for a wide variety of health conditions, but the strongest scientific evidence is for its effectiveness in treating some of the most severe childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which usually do not respond well to anti-seizure medications. In numerous studies, CBD has been able to reduce the number of seizures and in some cases stop them completely. Epidiolex, which primarily consists of CBD, is the first cannabis-derived drug approved by the FDA for these conditions.
Animal studies and self-report or human studies show that CBD can also help with:
- Anxiety: Studies and clinical trials have investigated the common report that CBD can reduce anxiety.
- Insomnia: Studies show that CBD can help with both falling asleep and staying asleep, in part by helping to manage chronic pain and anxiety.
- Chronic pain: Increasingly, human research is supporting claims that CBD helps control pain. An animal study by European Journal of Pain suggests that CBD may help reduce pain and inflammation due to arthritis when applied to the skin. Other research has identified how CBD can inhibit inflammatory and neuropathic pain, which are difficult to treat.
- Addiction: CBD can help reduce cravings for tobacco and heroin under certain conditions, according to some human studies. Animal models of addiction suggest that it may also help reduce cravings for other addictive substances such as alcohol, cannabis, opiates and stimulants.
Is CBD safe?
Side effects of CBD can include nausea, fatigue, and irritability. CBD can increase the level of blood thinners and other drugs in your blood by competing for the liver enzymes that break down these drugs. Grapefruit has a similar effect on some medications. This interaction is especially important if you are taking a blood thinner, antiepileptic, or immunosuppressive drug, all of which need to have stable levels in your blood.
People taking high doses of CBD may show abnormalities in blood tests related to the liver. Many over-the-counter medications, such as acetaminophen (Tylenol), have the same effect. You should let your doctor know if you regularly use CBD so that he or she can check your liver enzymes periodically.
A significant safety issue with CBD is that it is marketed and sold primarily as a supplement rather than a drug. Currently, the FDA does not regulate the safety and purity of dietary supplements, and no one actually regulates the CBD market. So you cannot be sure that the product you are buying contains active ingredients in the dose indicated on the label.
In addition, the product may contain other unknown elements. If you’re buying CBD, it’s safest to make sure there is independent lab testing certified by the COA (Certificate of Analysis) that should accompany any CBD product.
How can CBD be taken?
CBD comes in many forms, including oils, tinctures, capsules, patches, perfumes, and topical preparations for use on the 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 tincture or spray designed to be placed under the tongue allows CBD to enter the bloodstream directly. Dcotors do not recommend smoking anything, including CBD.
Outside the US, the prescription drug Sativex, which uses CBD as an active ingredient, is approved for muscle spasticity associated with multiple sclerosis and cancer pain. In the US, Epidiolex is approved for certain types of epilepsy and tuberous sclerosis.
The cannabidiol bottom line
Some CBD manufacturers have come under government scrutiny for making wild, indefensible claims, such as that CBD is a cure-all for cancer or COVID-19, which it is not. We need more research, but CBD appears to be a useful, relatively non-toxic option for anxiety, insomnia and chronic pain. Without enough high-quality evidence in human studies, we can’t determine effective doses, and because CBD is currently generally available as an unregulated supplement, it can be difficult to know exactly what you’re getting or to conduct studies.
If you decide to try CBD, make sure you get it from a reputable source. Again, please discuss the use of CBD or other supplements with your doctor to ensure that it will not interfere with other medications you are taking.
