Sorting Out the Confusion On CBD
In the last couple of years, CBD has become such a popular product that it’s even appearing in convenience stores that post large signs in their windows: “We have CBD!” If you think it’s a good idea to purchase a medical supplement at the same place you buy gas for your car, our family practice doctors in Delray Beach would like to give you a little more insight into CBD and the pros and cons of this largely unregulated substance.
Promoted as a safe, effective over-the-counter (OTC) remedy for everything from insomnia to depression to arthritis to seizures, it’s available in tinctures, capsules, creams, and even food products and beverages. As its popularity has soared in recent years, it’s expected to become a $22 billion business by 2022.
But the medical community and federal regulators have raised several concerns about the many health claims associated with CBD and the lack of quality control standards surrounding its production.
This summer, the U.S. Food and Drug Administration (FDA) held its first hearing on CBD to determine how to regulate it. Acting FDA Commissioner Ned Sharpless opened the 10 hours of testimony by expressing doubts about its safety, especially regarding dosage.
“What if someone applies a topical CBD lotion, consumes a CBD beverage or candy and consumes some CBD oil? How much is too much?” he asked.
Last month even the Arthritis Foundation weighed in, offering guidelines for those who want to use CBD to relieve their pain of arthritis, while at the same time not necessarily recommending its use.
“The guidelines are not saying, ‘You should try this,’ ” Kevin Boehnke, who helped develop the guidelines for the Arthritis Foundation said. “They’re saying, “If you want to try, here’s how you should do it.”
What is CBD?
CBD stands for cannabidiol, a chemical compound extracted from the hemp plant known as Cannabis sativa, the same plant that can be bred and processed to produce marijuana. However, it does not produce the “high” associated with marijuana, because it contains only trace amounts of THC, the psychoactive ingredient of the marijuana plant. The cannabidiol is then mixed with a carrier oil for human use.
CBD is produced naturally in the body, and its thought to work by inducing the body to create more of its own cannabinoids. Because of its association with marijuana, CBD has been subject to very little in the way of formal research in the United States, although that is beginning to change.
What is it used for?
Although CBD has been around since the 1940s, it has exploded in popularity since the federal government last year legalized the cultivation of hemp.
Here are a few uses that have received at least some preliminary backing from various research studies, mainly in animals:
- aid in addictive behaviors, such as opioid and nicotine withdrawal;
- relief from anxiety and sleep disorders;
- relief from pain and associated inflammation;
- treating type 1 diabetes; and,
- relief from muscle spasms and nerve pain.
The one area in which CBD oil has been shown to be effective is in treating pediatric epilepsy. The research for this use was conclusive enough that last year the FDA approved the use of a prescription CBD oil to treat two types of this rare disorder in children over the age of two.
Other claims for the product that are largely unproven include relief of glaucoma, headaches, nausea, joint pains, lupus, asthma, and celiac disease, among other conditions.
The FDA, however, this summer sent warning letters to three companies regarding what it called “egregious, over-the-line claims” about CBD’s efficacy in treating drug addiction, cancer, fibromyalgia, and Alzheimer’s disease.
The safety question
Another area of widespread concern involves the safety of the products being marketed. As we are seeing with the recent deaths associated with unregulated black-market vaping products, consumers have no way of knowing whether what they think they’re getting is what’s actually in the preparation.
One 2017 study by Marcel Bonn-Miller, an adjunct assistant professor in the psychiatry department at the University of Pennsylvania’s Perelman School of Medicine, found that nearly 70 percent of the CBD products were mislabeled, containing either significantly more or less CBD than the label claimed.
Then there are the possible side effects, which can occur with any drug or supplement.
Reported side effects for CBD oil include anxiety, diarrhea, nausea, vomiting, dry mouth, reduced appetite, low blood pressure, lightheadedness, drowsiness, and fatigue. In addition, some research suggests that high doses of CBD can increase involuntary muscle movement and tremors in those with Parkinson’s disease, and that some users have recorded dangerously high levels of liver enzymes.
The American Academy of Pediatrics (AAP) also published a study in the journal Pediatrics suggesting that short-term exposure to CBD oil increased the permeability of the placental barrier.
Bottom line? The exploding CBD industry is largely the wild, wild West right now. Just because it’s available everywhere doesn’t mean it’s safe to use. So we recommend caution in using this substance.