Cannabidiol – or CBD oil – is one of the hottest products of the year. An intoxicating marijuana extract, the oil is advertised as a cure for everything from anxiety to seizures to pain and finds its way into countless products.
Is CBD really a miracle cure for so many diseases? UConn Today discussed the issue with C. Michael White, Head of Department and Professor of Pharmaceutical Practice at UConn School of Pharmacy.
C. CBD ads appear to be everywhere, in forms including oils and tinctures, evaporating liquids, lotions and creams, and in additions to projects such as cupcakes and beer. Should we all take CBD?
A. Some people need to take CBD, but not most people. There are still many questions to ask before you decide. For example, keep in mind that many of the products sold contain little or no real CBD. And what if the noise precedes the data on people showing benefits, or if CBD interferes with the drugs you’re already taking? You may also be arrested or fired for owning or consuming certain CBD products.
Q. Good questions. Do you have any answers?
A. As a pharmacist and clinical pharmacologist, I have been evaluating the evidence behind natural products and drugs for abuse for many years. I recently reviewed data from global studies on people with CBD oil for Journal of Clinical Pharmacology and I can tell you – CBD advertising is different from reality.
One of the first questions I need to ask is what is in my CBD product? In 2016, researchers tested 84 CBD products and found that only 31% were properly labeled. Forty-three percent of products have much less CBD than indicated on the label. It was much worse for evaporating liquids, where only 12.5% of the products were properly labeled. In addition, many products contain more than 0.3% THC. THC is the cannabis chemical that boosts you, and if the concentration is above 0.3%, you can be arrested for possession of marijuana in states where marijuana is illegal. There have been cases where this has happened. The FDA has also written numerous letters to CBD manufacturers about counterfeit advertising, and in many cases has tested CBD products and found little or no actual CBD in them.
There is also a risk of counterfeiting and contamination. In Utah, people thought they were buying CBD products, but it also turned out to contain synthetic marijuana (as in K2 or Spice), leading to 52 cases of damage, including seizures, confusion, unconsciousness and hallucinations. Finally, when testing 29 CBD products, 69% of them had excessive levels of a carcinogen called polycyclic aromatic hydrocarbons.
If you are going to use CBD, avoid products that have not been tested for efficacy and no falsification and contamination by an external independent laboratory. There is an FDA-approved CBD product for children with seizures from Dravet and Lennox-Gastaut syndromes, which is only available on prescription. It has a standardized concentration of less than 0.1% THC and no falsification or contamination.
Q. Good enough. But is CBD a place in healthcare?
A. For seizures that do not respond well to other drugs, there is enough evidence to say that CBD works. However, you need a constant concentration of the drug. In a basic systematic review, our research team found that small changes in blood concentrations of antiepileptic drugs as a result of switching between branded and generic drugs increase hospitalizations or the use of emergency health services.
Question: How about CBD for other diseases such as anxiety, schizophrenia, Parkinson’s disease and pain?
A. Regarding anxiety, there are several studies with promising preliminary results, but they evaluate only one dose a few hours before someone does something alarming, such as public speaking. There is no evidence to suggest (in one way or another) that generalized anxiety improves when CBD is used every day. The evidence for schizophrenia, Parkinson’s disease and pain is very preliminary and it is not known whether there will be any benefits in the end.
There is evidence that cannabis products with more CBD and less THC cause less anxiety and psychotic effects than products with little or no CBD and high THC. This makes sense given how CBD blocks some of the same brain receptors that THC stimulates. This does not mean that anxiety and psychosis caused by drugs other than THC will react in the same way. Combined products with CBD and THC have been shown to reduce pain and muscle spasms, but CBD data alone are too preliminary to draw any definite conclusions.
Q. One of the big questions that remains is can CBD harm you? What’s the risk of just trying?
A. CBD is generally well tolerated, but has been shown to cause drowsiness, 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 several dozen cases in which liver function tests have been elevated, suggesting that the drug can rarely damage someone’s liver. However, these risks are with high quality products, and the risks associated with counterfeit and contaminated products can be much worse and more volatile.
The greatest health risks may be due to the potential for CBD drug interactions. CBD blocks the breakdown of many other drugs when used for multiple doses here or there. However, with prolonged daily use, it begins to induce liver enzymes and may lead to lower concentrations of other drugs in the blood. Many prescription seizure medications can be affected by CBD, so simply trying it on your own without evaluating the effects on your other medications can put you at greater risk for seizures. States are already taking action on some of the CBD hysteria. CBD is added to all types of modern pastries and beverages. New York State, for example, now bans the use of CBD in food and beverages until proven safe.
Q. So what is the conclusion – what do we need to know?
A. CBD is a great new option for patients with epilepsy. He can do whatever the Internet says he can for anxiety and other illnesses, but right now much of that is speculation and extrapolation, not proof.
If you want to try a CBD product, you need to make sure that the product you are using has been tested by an external laboratory or approved by the FDA. If not, you risk being deceived, hurt or arrested. Tell your doctor and pharmacist that you are taking CBD to avoid potentially dangerous drug interactions. Regardless of the product, do not drive for several days after you start using a CBD product until you understand how the drug affects you. If you have a stomach upset or sleepiness, a lower dose will probably be more tolerable, but lowering the dose may make CBD less effective. If you see yellowing of your eyes or skin, stop CBD and call your doctor immediately, as this may be a sign of liver problems.
Finally, CBD is not a food and should not be added to cupcakes and drinks simply because it is fashionable.