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?
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.
How is cannabidiol different from marijuana?
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.
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.
Facts about wellness.
“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.
Is This A Scam?
A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. “Over all, we did not find that it panned out as a useful treatment for sleep,” said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.
CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep. Part of CBD’s popularity is that it purports to be “nonpsychoactive,” and that consumers can reap health benefits from the plant without the high (or the midnight pizza munchies).
But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasn’t been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.
The survey demonstrated that CBD is used for a wide range of physical and mental health symptoms and improved general health and wellbeing. A majority of the sample surveyed in this study found that CBD helped their symptoms, and they often used doses below 50 mg. Out of the four most common symptoms, three were related to mental health. Self-perceived stress, anxiety, and sleep problems constitute some of society’s biggest health problems, but we lack adequate treatment options. Further research is needed into whether CBD can efficiently and safely help treat these symptoms.
A cross-sectional study of 2409 cannabidiol users from the USA found that the top three medical conditions reported were chronic pain, arthritis/joint pain, and anxiety, followed by depression and insomnia (Corroon and Phillips 2018). A recent survey carried out by Wheeler et al. of 340 young adults, some of whom were CBD users, found the top reasons to be stress relief, relaxation, and sleep improvement. They found edible CBD products to be the most prevalent (Wheeler et al. 2020). Another study of 400 CBD patients in New Zealand observed an increase in overall quality of life, a decrease in perceived pain, depression, and anxiety symptoms, as well as an increase in appetite and better sleep (Gulbransen et al. 2020).
This survey indicated that CBD users take the drug to manage self-perceived anxiety, stress, sleep, and other symptoms, often in low doses, and these patterns vary by demographic characteristics. Further research is required to understand how low doses, representative of the general user, might impact mental health symptoms like stress, anxiety, and sleep problems.
In the past years, cannabidiol (CBD), one amongst hundreds of naturally occurring phytocannabinoids found in the Cannabis sativa plant, has received a lot of attention from scientific communities, politicians, and mainstream media channels. CBD is the second most abundant cannabinoid in the Cannabis sativa plant after delta-9-tetrahydrocannabinol (THC), but unlike THC, CBD is not intoxicating (Pertwee 2008). In many countries, including the UK, there is unsanctioned availability of products containing CBD, from oils and capsules to chewing gums, mints, soft drinks, gummies, and intimate lubrication gels.
A national survey indicated that in the UK, 8–11% of the adult population had tried CBD by June 2019 (Andrew et al. 2019). Studies of Google searches have shown considerable increases in CBD interest, with 6.4 million unique searchers in the USA in April 2019 (Leas et al. 2019). Yet it is clear that scientists, physicians, and governments were not prepared for the rapid surge in CBD use.
Compared with people not using CBD for anxiety, those who did self-medicate used CBD multiple times a day (aOR 3.44, [95% CI 1.70, 7.00], p = 0.001). Moreover, compared with those not using CBD for self-perceived stress, those who were self-medicating also used CBD multiple times a day (aOR 1.97, [95% CI 1.034–3.77], p = 0.039). Those using CBD for sleep improvement had greater odds of using CBD in the evening (aOR 3.02, [95% CI 1.86, 4.93], p ≤ 0.001) and lower odds of using CBD in the morning (aOR 0.157, [95% CI 0.07–0.38], p ≤ 0.001). Those using CBD for self-perceived anxiety had lower odds of using CBD in the evening (aOR 0.56, [95% CI 0.14–0.45], p ≤ 0.001). No associations emerged between those who did and did not use CBD for self-perceived stress on the time of day they used CBD.
Most people were using less than 100 mg (72.9%) per day. Due to the high price and the lack of medical supervision, it is not surprising that non-medical CBD users are taking much lower doses than those used in clinical studies, and those prescribed for specific medical conditions (Davies and Bhattacharyya 2019; Szaflarski et al. 2018). It is important to highlight that 16.8% reported using more than 100 mg per day, and 10.2% did not know how much CBD they were using. The use of high doses CBD is concerning in light of the current FSA recommendation of restricting the dose to 70 mg CBD per day (Cannabidiol (CBD) n.d.), and it stresses the importance of better public information and communication and improved packaging and guidance from brands to consumers.