Verdant Notes: Today we're continuing our discussion surrounding the most prevalent answered and outstanding questions surrounding Cannabidiol (or "CBD").
"What Is CBD? Everything to Know About the Weed Derivative Everyone's Buzzing About" - Continued
What is CBD used for—and does it work?
Success stories like Oliver’s are everywhere, but there’s not a lot of data to back up those results. That’s because CBD comes from cannabis and, like nearly all other parts of the plant, is categorized by the Drug Enforcement Agency (DEA) as a Schedule 1 drug—the most restrictive classification. (Others on that list: heroin, Ecstasy, and peyote.) This classification, which cannabis advocates have tried for years to change, keeps cannabis-derived products, including CBD, from being properly studied in the U.S.
That leaves those touting CBD’s effectiveness pointing primarily to research in mice and petri dishes. There, CBD (sometimes combined with small amounts of THC) has shown promise for helping pain, neurological conditions like anxiety and PTSD, and the immune system—and therefore potentially arthritis, diabetes, multiple sclerosis, cancer, and more.
Most human studies of CBD have been done on people who have seizures, and the FDA recently approved the first CBD-based drug, Epidiolex, for rare forms of epilepsy. Clinical trials for other conditions are promising, but tiny. In one Brazilian study published in 2011 of people with generalized social anxiety disorder, for example, taking a 600-mg dose of CBD (higher than a typical dose from a tincture) lessened discomfort more than a placebo, but only a dozen people were given the pill.
Without much research, doctors in states where cannabis is legal are learning through trial and error. Cohen says thousands of his patients swear that CBD helps their inflammation, pain, and anxiety. He himself started taking 50 mg a day in the hope that it might prevent later dementia—and his migraines immediately disappeared.
Scott Shannon, M.D., assistant clinical professor at the University of Colorado, recently sifted through patient charts from his four-doctor practice to document CBD’s effects on anxiety. His study, as yet unpublished, found “a fairly rapid decrease in anxiety scores that appears to persist for months,” he says. But he says he can’t discount a placebo effect, especially since “there’s a lot of hype right now.”
And without high-quality trials, experts don’t know how much is best for a given purpose. The staff at Roth’s dispensary told her, “Try some once or twice a day and see what happens.” (Half a dropper’s worth was a good amount for her.) One thing scientists feel confident about is that CBD is not dangerous. It won’t damage vital organs even at doses as high as 5,000 mg a day, Marcu says, and nobody has died from simply overdosing on a cannabis product.
Cohen has found that chronic conditions including autoimmune diseases and pain syndromes can be helped with a 6-mg under-the-tongue tincture (the fastest delivery system) or a 25-mg capsule taken twice a day. Dosages for topical products like lotions are especially hard to determine—there’s no clarity on how much CBD gets into the system through the skin.
Are there CBD side effects to consider?
Dosage is important, because CBD can have side effects—the most common are tiredness, diarrhea, and changes in appetite and weight—so it’s best not to take more than you need. As CBD becomes more prevalent, says J. Michael Bostwick, M.D., a psychiatrist at Mayo Clinic in Rochester, MN, “I’m reasonably certain new kinds of side effects will emerge.”
Lisa Hamilton, a jeweler and doula in Brooklyn, NY, knows about the side effects. She recently tried CBD for the shoulder pain that plagued her five years after an accident. Her doctor certified that she was in chronic pain, which under New York State law allowed her to buy from a state dispensary. One Friday, she swallowed two 10-mg capsules, the amount recommended at the dispensary, then took another two on Saturday. “By Sunday, it felt like I’d gotten hit by a truck. Every muscle and joint ached,” Hamilton says. She cut back to one pill a day the following week, but still felt hungover. She stopped after that.
Another concern is about medications with which CBD might interact. This won’t be an issue with most drugs, says Sunil Kumar Aggarwal, M.D., Ph.D., a palliative medicine physician and scientist who studies cannabis and integrates it into his Seattle medical practice. The exceptions are blood thinners, IV antibiotics, and other drugs whose exact dosing is crucial and must be monitored closely, he says. (Of course, if you have a health problem, talk to your doctor before using CBD, and never take it instead of seeing your physician for a serious condition.)
Is CBD legal?
Under federal law, cannabis (from which both CBD and marijuana are derived) is illegal everywhere, although the laws against it aren’t generally enforced in states that have legalized marijuana. Some manufacturers claim that CBD culled from legally imported industrial hemp, which has little to no THC, is fine to ship across the U.S., but many experts disagree, noting that because hemp comes from the same species as marijuana, cannabis sativa, all CBD falls under the DEA’s Schedule 1 designation. “This creative interpretation of the law runs afoul of reality,” says the Brookings Institution, a Washington, DC, think tank.
To make matters more confusing, nine states (including California, Washington, and Colorado) let residents buy cannabis-based products with or without THC. Nearly two dozen other “medical marijuana states” allow the sale of cannabis, including capsules, tinctures, and other items containing CBD or THC, at licensed dispensaries to people whose doctors have certified that they have an approved condition (the list varies by state but includes chronic pain, PTSD, cancer, autism, Crohn’s disease, and multiple sclerosis). Sixteen more states legalized CBD for certain diseases. But because all these products are illegal according to the federal government, cannabis advocates are cautious. “By and large, the federal government is looking the other way,” says Paul Armentano, deputy director of the Washington, DC–based National Organization for the Reform of Marijuana Laws (NORML), but until federal laws are changed, “this administration or a future one could crack down on people who produce, manufacture, or use CBD, and the law would be on its side.”
Stay tuned for the last segment [ Part Three ] coming soon!
References & Resources
What is CBD? Everything to Know About the Weed Derivative Everyone's Buzzing About (source article)
What is CBD? Everything to Know About the Weed Derivative Everyone's Buzzing About (source pdf)