CBD Oil – What are the Health Benefits?
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
CBD (cannabidiol) is widely available, and is being used used by more and more people every day. But what is it useful for? Does it really work? And just as important, is it safe? In this third and final installment of our series on CBD we'll focus on the evidence that can help answer those questions.
The Good News
There are lots of reasons to believe that CBD might be an effective remedy for a variety of disorders. Chemicals from Cannabis plants have been used for hundreds of years to treat different ailments. More recently, scientists identified the endocannabinoid system within the human body. It consists of naturally-made chemicals that bind to cannabinoid receptors in the nervous system. Basic research has found that this system can have effects on anxiety, sleep, pain, mood, and much more. So it's reasonable to believe that taking cannabinoids like CBD might work within this same endocannabinoid system to improve health.
In fact, enough good-quality research has been done to prove that pure CBD is effective in the treatment of two rare types of seizure disorders. The FDA (Food and Drug Administration) approved Epidiolex, a pure CBD formulation, in 2018, and it is currently on the market as a prescription medication. So it's clear that CBD has at least one medical use.
The Bad News
Other than Epidiolex though, there's little, if any, good-quality research involving CBD. Some research used CBD formulas that contained THC or other cannabinoids so that it's impossible to know what role CBD played. Other research was done with few patients, or without randomization or blinding of test subjects, which both help ensure study results can be trusted.
Effects on Health
Research in test tubes and animals, as well as some preliminary research in humans, has suggested the CBD might be useful to treat insomnia, pain, anxiety, Parkinson's disease, and other ailments. And many health professionals believe CBD may have a role in treating these common problems. But both scientists and clinicians are waiting for good-quality research to provide that evidence. They are reluctant to recommend the use of a product that has no proven benefit.
Meanwhile, though, CBD manufacturers and marketers are taking advantage of the little research that's out there. The lack of regulation on the industry results in labelling that claims the products are useful for a variety of conditions. And it's working -- there's currently a lot of money in CBD sales. Statistics from 2019 showed nearly $1 billion was spent during that year in the US. The images here are just two examples of advertising meant to make us believe the proof is already there.
Along with the lack of evidence about effectiveness of CBD, there's not much research to help us with correct dosing either. And because CBD is not approved by the FDA, there's little expert guidance. So how much CBD is needed to treat chronic pain? Anxiety? Insomnia? We just don't know.
Since we know so little about effective doses for most conditions, it makes sense to start with a relatively low dose of CBD. Think about what effect you're looking for -- is it better sleep, decreased anxiety, ability to walk without so much discomfort? Keep a journal of your symptoms so you can tell whether it's working or not. Then talk to your pharmacist about adjusting the dose upwards slowly if you're not getting the effect you want (AND are free from side effects!)
CBD is available in many different formulations ,so look at the label carefully. Sometimes CBD content is listed per drop of solution, other times it's listed by the amount in the entire container. And read the Certificate of Analysis so you know exactly what's in the product you're purchasing.
One thing that does seem to be clear - CBD is relatively safe in a pretty broad range of doses. The best information comes from the research done on Epidiolex, which showed that somnolence, fatigue, decreased appetite, and sleep disorders were the most common side effects. Epidiolex dosing for seizure disorders is relatively high compared to the CBD products found over the counter, though, so it's unclear how that information will translate into routine use.
It's important to note that CBD products may contain up to 0.3% THC. And some manufacturers may be selling mislabelled product as well, containing more than the legal amount of THC. If you may be subject to drug testing for work or other purposes, be aware that taking CBD and other cannabinoids may result in a positive test for THC.
The fact that CBD is a naturally-occurring compound doesn't mean it can be used without concern for safety. As it turns out, basic research has shown that there are many possible drug interactions. But there hasn't been enough clinical research yet to tell us whether they're of major importance. CBD is metabolized by a family of enzymes that also metabolize other drugs, so it's may alter how the other drugs are metabolized. If you're taking prescription medications, be sure to check with your pharmacist to learn what possible problems to watch for.
The Best way to take CBD
This is another good question. CBD is available in many dosage forms, including tinctures to absorb under the tongue, oils and gummies to take by mouth, aerosols for vaporizing, creams and lotions for application to the skin, and more. How well is CBD absorbed into the body from these different products? Is it absorbed better or more quickly if taken under the tongue than just swallowed? There are no good answers yet for these questions. The information we have so far points toward absorption that's quite variable from person to person, and from time to time even within the same person. Only time and more research will tell us how it's best administered.
Many people, health professionals and non-health professionals alike, hope that research will show that CBD has health benefits, and is safe to boot. But because there's not much information to go on right now, it's important to weigh risks and benefits before deciding whether to try CBD. Consider the possible side effects and drug interactions and how they might affect you. Consider whether the possibility of a positive drug test would affect your livelihood. Then get some advice from an objective source, use your best judgment, and make the decision that's right for you. And keep your eyes open for new research findings on CBD, and new laws governing its use and sales.
I hope this series has helped you see that there are no quick answers to the use of CBD. Your local pharmacist may be able to help you. But if they're still learning about CBD and unable to give you guidance please contact us at BetterMyMeds. And as always, we welcome your comments and questions, either by posting below or sending us a message directly!