Cannabidiol (CBD) has recently transitioned from an avant-garde medicinal alternative to a panacea-like magical elixir. Today, it is commonly found in products like skin oils, face creams, dog treats, and pharmaceuticals and has slowly gained endorsements from popular medical personalities like Dr. Sanjay Gupta. CBD has been used to treat a wide variety of symptoms, like pain and inflammation, but its proven benefits and legality are highly controversial. With this tsunami of CBD-infused products and ambiguous clinical data, it is difficult to determine whether these products are safe and effective. Here, we present everything you need to know about CBD.
What is CBD?
CBD is the abbreviation for cannabidiol, a highly abundant chemical compound found in the cannabis (marijuana) plant. Until recently, cannabis was most associated with the compound delta-9-tetrahydrocannabinol (THC) which can of create a mild-altering euphoria when smoked or added in cooking. Unlike THC, CBD is devoid of abuse potential, non-psychoactive, and does not change a person’s state of mind when used.
How does CBD oil work?
The human body naturally produces compounds that are chemically similar to CBD called cannabinoids. These cannabinoids bind to receptors called CB1 and CB2 which produce varying effects. CB1 receptors are relatively ubiquitous throughout the body but are highly prevalent in the brain and have been shown to contribute to coordination, movement, emotions, appetite, and mood, among other things. CB2 receptors are predominantly found on the cells of the immune system and have been shown to mediate inflammatory cascades. Initial research suggested that CBD attached to CB2 receptors producing anti-inflammatory effects however, the most current evidence indicates that CBD acts in a multi-modal fashion and, instead of binding CB1 and CB2 directly, allows the body to use its own cannabinoids more effectively.1
What are some of the most studied benefits of CBD oil?
|In 2003, it was demonstrated that CBD has potential anticonvulsant properties.2 Due to its beneficial anticonvulsant effects, the FDA approved the use of a CBD oil called “Epidiolex” for the treatment of Lennox-Gastaut Syndrome and Dravet Syndrome. It is unclear whether over-the-counter (OTC) CBD products are as effective as Epidiolex. Therefore, patients considering the use of CBD oil for the treatment of seizures disorders should seek medical advice from their medical providers before using.3
|Pain and chronic inflammation
|CBD products have been widely used as a natural alternative to OTC pain-relievers despite not having an established role in pain management. Currently, the evidence for the use of CBD is mostly anecdotal however, it does provide a novel, potentially promising approach for the management of chronic pain. To date, there are at least 7 CBD based products in development for the treatment of pain.4 Patients should consult their medical provider before using CBD oil for their pain management.
|Cancer||Cannabinoids are currently used in cancer patients to combat nausea and vomiting, increase appetite, and mitigate pain. In-vitro data has suggested that CBD may help reduce tumor growth and prevent the development of new tumor sustaining blood vessels. More robust clinical data is needed to fully establish CBD’s role in cancer therapy. Currently, CBD may be used as a complementary treatment in combination with current chemotherapy regimens.5|
What are some of the potential side-effects from CBD oil?
There is a lack of evidence exploring the safety and tolerability of CBD oil. To date, the safety and tolerability of CBD oil has been widely studied in patients with seizure or psychotic disorders. More long-term studies need to be conducted to determine the potential long-term effects of chronic CBD use. Sedation is a common side-effect that can be exacerbated in patients taking benzodiazepines, especially diazepam and lorazepam. Applying CBD topically can reduce the degree of sedation but can lead to reduced efficacy as CBD is poorly absorbed through the skin. Gastrointestinal intolerance (e.g. diarrhea and reduced appetite) is also common in patients taking CBD oil orally. It has been suggested that this may be due to the additives, like sesame oil, and not the active compound itself. Data from the Epidiolex clinical trials showed an increase in liver enzymes which may also be seen in patients taking CBD oil orally. CBD oil may increase the risk for liver damage, especially when combined with other medications that can damage the liver (e.g. valproic acid).6 It is very important to get the input of a pharmacist or other medical provider before deciding to use CBD oil.
There is a lot of confusion on whether CBD products represent the newest curative health fad. While it is reasonable to assume that CBD oil is a 21st century snake oil, it is being widely studied as a potential treatment for a diverse array of diseases including post-tramautic stress and alcohol use disorder, pain and inflammation, schizophrenia, insomnia, and cancer. It is important to take any legal hazards into consideration. All cannabis products, with exception to Epidiolex and the THC based Dronabinol, are considered Schedule 1 drugs and remain illegal under federal law (even though cannabis and CBD products are legal in Washington state). CBD research is still in its infancy and much more research is needed to fully solidify its therapeutic application. All patients considering CBD oil as a potential treatment option should seek advice from their pharmacist or medical provider before starting.
- Devinsky O., Cilio M. R., Cross H., Fernandez-Ruiz J., French J., Hill C., et al. (2014). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia55 791–802.
- Wallace, M. J., Blair, R. E., Falenski, K. W., Martin, B. R., and DeLorenzo, R. J. (2003). The endogenous cannabinoid system regulates seizure frequency and duration in a model of temporal lobe epilepsy. Pharmacol. Exp. Ther.307, 129–137.
- (2018, June 25). Press Announcements – FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. Retrieved November 19, 2018, from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm
- Bruni, N., Della Pepa, C., Oliaro-Bosso, S., Pessione, E., Gastaldi, D., & Dosio, F. (2018). Cannabinoid Delivery Systems for Pain and Inflammation Treatment. 23(10), 2478.
- Massi, P., Solinas, M., Cinquina, V., & Parolaro, D. (2012). Cannabidiol as potential anticancer drug. British journal of clinical pharmacology, 75(2), 303-12.
- Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139-154. doi:10.1089/can.2016.0034