While Epidiolex is approved specifically for treating two forms of childhood epilepsy, Orrin Devinsky, the director of the Comprehensive Epilepsy Center at NYU Langone Health and the lead investigator of two clinical trials of the drug, told CNN he believed there’s a good chance it will be prescribed for “off-label” use. This practice of doctors prescribing drugs to treat conditions for which it is not officially approved is legal and common, according to the US Department of Health and Human Services.
That said, Silberstein has called it “perfectly reasonable” for migraine sufferers to use CBD to counteract migraine-related neck pain and even vomiting and nausea.
In one cringe-inducing study, scientists evaluated rats’ sensitivity to pain by exposing their sciatic nerves with an incision, constricting those nerves with tiny threads, or injecting their paws with bacteria to induce inflammation. Then, they fed them CBD or a placebo every day for a week, and measured how quickly the critters withdrew their legs when exposed to heat or pressure, compared to how they reacted before their respective surgeries or injections.
Oh yeah, nausea. Could CBD help that?
Evelyn Nussenbaum, the mother of the first patient to receive Epidiolex, remembered reading a study about treating seizures with CBD in (you guessed it) rats in 2011, and thinking, “My son needs access to that.” Her son Sam became part of a one-person trial at the University of California-San Francisco. His seizures were drastically reduced without side effects, and in 2015, the doctor overseeing his care co-authored a study of 214 patients with severe childhood-onset epilepsy that showed a 36.5% median decrease in seizures over a 12-week treatment period with oral CBD.
So what do we know about these popular uses for CBD?
Perhaps, and that’s what most current CBD users—some 55%—are hoping.
(In this bonkers and somewhat upsetting 2012 study, scientists observed the behavior of mice, some of which were pre-treated with CBD, after a wild boa constrictor was introduced to an “arena” with them. Spoiler alert: “In no case did a snake eat an experimental mouse.” But the CBD-treated mice did exhibit fewer “panic-like” responses, such as freezing, urinating, or attempting an “explosive escape,” when faced with the snake. Researchers concluded the CBD-treated mice were experiencing less fear than those who got the placebo, despite this truly terrifying scenario. So there’s that.)
Right now, there’s a good chance that you don’t really know what you’re getting from any source. Testing and labeling rules vary by state, but many states that allow legal cannabis also require some kind of testing to verify that the THC and CBD levels listed on the label are accurate. However, this testing is controversial, and results can vary widely between labs, Jikomes said. A study published in March found measurable variations in test results, with some labs consistently reporting higher or lower levels of cannabinoids than others. There are no guarantees that the label accurately reflects what’s in the product. For a 2015 study published in JAMA, researchers tested 75 products purchased in San Francisco, Los Angeles and Seattle and found that only 17 percent were accurately labeled. More than half of the products contained significantly lower levels of cannabinoids than the label promised, and some of them contained only negligible amounts of the compounds. “We need to come up with ways to confidently verify the composition of cannabis products and make this information available to consumers,” Jikomes said.
Still, as the saying goes, absence of evidence isn’t necessarily evidence of absence, and there’s a reason we don’t have a ton of solid research on CBDs yet — “to study it, we need a good source, ” said Ziva Cooper, who is an associate professor at Columbia University and was on the National Academies committee. CBD is hard to get because it’s still technically a Schedule I drug, which limits its availability, Cooper said.
Cannabinoids are a class of compounds that interact with receptors throughout your body. CBD is just one of dozens of cannabinoids found in cannabis, including tetrahydrocannabinol (THC), which is the one responsible for marijuana’s famous high. Medical cannabis is technically any cannabis product used for medicinal purposes, and these can contain THC or CBD or both, said Nick Jikomes, a neuroscientist at Leafly, a website that provides information about legal cannabis. “A common mistake people make is to think that CBD is ‘the medical cannabinoid’ and THC is ‘the recreational cannabinoid.’” That’s inaccurate, he said, because THC is a potent anti-inflammatory and can be helpful for pain.
Those warning letters aside, there’s not a lot of federal oversight right now over the claims being made or the products that are being sold. Cohen warned against buying CBD products online, because “there’s a lot of scams out there.” Yet his clinic sells CBD, and he admits, “I say ‘Don’t buy online,’ but ours is worth doing, because we know what we’re doing. We ship all over.”
Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.
Last year, the National Academies of Sciences, Engineering and Medicine released a nearly 500-page report on the health effects of cannabis and cannabinoids. A committee of 16 experts from a variety of scientific and medical fields analyzed the available evidence — more than 10,000 scientific abstracts in all. Because so few studies examine the effects of CBD on its own, the panel did not issue any findings about CBD specifically, but it did reach some conclusions about cannabis and cannabinoids more generally. The researchers determined that there is “conclusive or substantial evidence” supporting the use of cannabis or cannabinoids for chronic pain in adults, multiple sclerosis-related spasticity (a kind of stiffness and muscle spasms), and chemotherapy-induced nausea and vomiting. The committee also found “moderate” evidence that cannabis or cannabinoids can reduce sleep disturbances in people with obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis, as well as “limited” evidence that these substances can improve symptoms of Tourette’s syndrome, increase appetite and stem weight loss in people with HIV/AIDs, and improve symptoms of PTSD and anxiety.
But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about. After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.
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By now, you’ve probably run into a product containing cannabidiol, also known as CBD. It’s in everything from drinks and pet products to lotions and chewable gummies. Even major drugstore chains have announced they will start carrying CBD products in certain states.
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Experts say cannabidiol products are likely a good choice for some conditions, but evidence is lacking for others.
But many people still don’t really know what CBD is. Is it marijuana? Is it legal? Does it actually work? Is it safe?
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