Cannabidiol – or CBD oil – is one of the year’s hottest products. A non-intoxicating marijuana extract, the oil is being touted as a cure for everything from anxiety to seizures to pain, and is finding its way into a myriad products.
Is CBD really a miracle cure for so many ills? UConn Today discussed the issue with C. Michael White, department head and professor of pharmacy practice in the UConn School of Pharmacy.
Q. CBD advertisements seem to be everywhere, in forms including oils and tinctures, vaporization liquid, lotions and creams, and in additives to such projects as cupcakes and beer. Should we all be taking CBD?
A. Some people should be taking CBD, but not most people. There are still a lot of questions to ask before taking the plunge. For example, consider that many of the products sold have little to no real CBD in them. And what if the hype is ahead of human data showing benefits, or if CBD interferes with medication you are already taking? You can also get arrested or fired from your job for possessing or ingesting certain CBD products.
Q. Good questions. Do you have some answers?
A. In my role as a pharmacist and clinical pharmacologist, I have evaluated the evidence behind natural products and drugs of abuse for many years. I recently reviewed the worldwide human trial data on CBD oil for the Journal of Clinical Pharmacology and I can tell you – the CBD hype is different from reality.
One of the first questions to ask is, what is in my CBD product? In 2016, investigators tested 84 CBD products and found that only 31% were labeled correctly. Forty-three percent of products had far less CBD than specified on the label. It was far worse for vaporization liquids, where only 12.5% of products were labeled correctly. In addition, many of the products had more than 0.3% THC in them. THC is the cannabis chemical that gets you high and if the concentration is above 0.3% you can get arrested for possession of marijuana in states where marijuana is illegal. There are cases where this has happened. The FDA has also written numerous letters to CBD manufacturers for false advertisement, and in many cases tested the products for CBD and found little to no actual CBD in them.
There is also a risk for adulteration and contamination. In Utah, people thought they were buying CBD products but they turned out to also contain synthetic marijuana (like in K2 or Spice), leading to 52 cases of harm, including seizures, confusion, unconsciousness, and hallucinations. Finally, in testing of 29 CBD products, 69% of them had excessive levels of the carcinogen called polycyclic aromatic hydrocarbons.
If you are going to use CBD, avoid products that are not verified for potency and lack of adulteration and contamination from an outside independent laboratory. There is an FDA-approved CBD product for children with seizures from Dravet’s and Lennox-Gastaut Syndromes that is only available by prescription. It has a standardized concentration, less than 0.1% THC, and no adulteration or contamination.
Q. Good enough. But does CBD have a place in health care?
A. For seizures that don’t respond well to other drugs, there is enough data to say that CBD does work. However, you need a consistent concentration of the drug. In a major systematic review, our research group found that small changes in anti-epileptic drug blood concentrations resulting from switching between brand and generic drugs increased hospitalizations or use of emergency health care services.
Q. What about CBD for other ailments like anxiety, schizophrenia, Parkinson’s disease, and pain?
A. In anxiety, there are several studies with promising preliminary results, but they only assessed a single dose a couple hours before someone did something anxiety-provoking, like public speaking. There is no evidence to show (one way or the other) that generalized anxiety improves when CBD is used every day. The evidence in schizophrenia, Parkinson’s, and pain is very preliminary, and it is unknown whether benefits will ultimately be seen.
There is evidence that cannabis products with more CBD and less THC cause less anxiety and psychotic effects than products with little to no CBD and high THC. That makes sense, given how CBD blocks some of the same brain receptors that THC stimulates. It doesn’t mean that anxiety and psychosis caused by means other than THC will respond in the same way. Combination CBD and THC products have been shown to reduce pain and muscle spasms, but the data on CBD alone is too preliminary to draw any firm conclusions.
Q. One of the big questions that remains is, can CBD harm you? What’s the risk of just trying it?
A. CBD is generally well tolerated, but has been shown to cause sleepiness, diarrhea, or vomiting, and fatigue or lethargy in 20-30% of users. The impact of CBD on driving or operating heavy machinery has not been adequately assessed. There are a few dozen cases where liver function tests were elevated, suggesting that rarely, the drug could damage someone’s liver. However, these risks are with high quality products, and the risks associated with adulterated and contaminated products could be far worse and more variable.
The greatest health risks may be due to CBD’s drug interaction potential. CBD blocks the breakdown of many other drugs when it is used for a few doses here or there. However, with prolonged daily use, it starts to induce liver enzymes and could cause other drugs to have lower concentrations in the blood. Many prescription seizure medications can be impacted by CBD, so just trying it on your own without appreciating the impact on your other drugs could put you at a greater risk of seizures. States are already starting to take action on some of the CBD hysteria. CBD has been added to all types of trendy baked goods and beverages. New York State, for example, is now barring the use of CBD in food and drink until such time as it is shown to be safe.
Q. So what’s the takeaway – what should we know?
A. CBD is a wonderful new option for patients with epilepsy. It might do all the things the internet says it can for anxiety and other diseases, but right now much of that is speculation and extrapolation, not proof.
If you want to try a CBD product, you need to assure the product you use is tested by an outside laboratory or FDA-approved. If not, you run the risk of being scammed, harmed, or arrested. Tell your doctor and pharmacist you are taking CBD, so you can avoid potentially dangerous drug interactions. Regardless of the product, don’t drive for a couple days after you start a CBD product until you know how the drug is impacting you. If you are getting sick to your stomach or sleepy, a lower dose will likely be more tolerable, but lowering the dose can make CBD less effective. If you see yellowing of your eyes or skin, stop CBD and call your doctor right away, as that can be a sign of liver issues.
Finally, CBD is not a food and shouldn’t be added to cupcakes and drinks simply because it is trendy.