Cannabidiol, or CBD oil, is one of the most popular products of the year. A non-intoxicating marijuana extract, the oil is promoted as a cure for everything from anxiety to seizures and pain, and is being introduced in a myriad of products.
Is CBD really a miraculous cure for so many ailments? UConn Today discussed the issue with C. Michael White, head of department and professor of pharmaceutical practice at the UConn School of Pharmacy.
Q. CBD ads seem to be everywhere, in forms such as oils and tinctures, spray liquids, lotions and creams, and additives for projects like cupcakes and beer. Should we all take CBD?
A. Some people should take CBD, but not most. There are still many questions to ask before taking the plunge. For example, consider that many of the products sold have little or no real CBD. And what if the hype is ahead of human data showing benefits, or if CBD interferes with the medication you’re already taking? You may also be arrested or fired for having or ingesting certain CBD products.
Q. Good questions. Do you have any answers?
A. In my role as a pharmacist and clinical pharmacologist, I have been evaluating the evidence behind natural products and drug abuse for many years. I recently reviewed data from global human trials on CBD oil for 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’s in my CBD product? In 2016, researchers tested 84 CBD products and found that only 31% were labeled correctly. Forty-three percent of the products had much less CBD than specified on the label. It was much worse for vaporization liquids, where only 12.5% of the products were labeled correctly. In addition, many of the products contained more than 0.3% THC. THC is the cannabis chemical that makes you drugged and if the concentration is above 0.3% you can be 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 fake advertising and in many cases tested the products for CBD and found little or no real CBD in them.
There is also a risk of adulteration and contamination. In Utah, people thought they were buying CBD products, but it turned out they also contained synthetic marijuana (like K2 or Spice), causing 52 cases of damage, including seizures, confusion, unconsciousness, and hallucinations. Finally, in testing 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 have not been verified for potency and lack of adulteration and contamination by an independent external laboratory. There is an FDA-approved CBD product for children with seizures of Dravet 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. Pretty good. But does CBD have a place in health care?
A. For seizures that do not respond well to other drugs, there is enough data to say that CBD works. However, you need a constant concentration of the drug. In a major systematic review, our research group found that small changes in blood concentrations of antiepileptic drugs resulting from the switch between brand-name and generic drugs increased hospitalizations or the use of emergency health care services. .
Q. What about CBD for other diseases such as anxiety, schizophrenia, Parkinson’s disease, and pain?
A. In anxiety, there are several studies with promising preliminary results, but they only evaluated a single dose a couple of hours before someone did something that causes anxiety, such as public speaking. There is no evidence to show (one way or another) 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 eventually be seen.
There is evidence that cannabis products with more CBD and less THC cause less anxiety and psychotic effects than products with little or no high CBD and THC. This makes sense, given how CBD blocks some of the same brain receptors that THC stimulates. It does not mean that anxiety and psychosis caused by means other than THC respond in the same way. Combined CBD and THC products have been shown to reduce muscle pain and spasms, but data on CBD are only too preliminary to draw firm conclusions.
Q. One of the big questions left is, can CBD hurt you? What is the risk of just trying it?
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 using heavy machinery has not been adequately assessed. There are a few dozen cases in which 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 much worse and more variable.
The greatest health risks may be due to the potential for interaction with CBD drugs. CBD blocks the breakdown of many other drugs when used for some doses here or there. However, with prolonged daily use, it begins to induce liver enzymes and could cause other drugs to have lower concentrations in the blood. Many prescription seizure medications can be affected by CBD, so just trying it on your own without appreciating the impact on your other medications could put you at increased risk for seizures. States are already beginning to take action against part of the CBD hysteria. CBD has been added to all kinds of bakeries and trendy drinks. New York State, for example, now bans the use of CBD in food and beverages until it is proven safe.
Q. So what is takeaway food? What do we need to know?
A. CBD is a wonderful new option for patients with epilepsy. You may be doing all the things the internet says you can for anxiety and other illnesses, but right now much of that is speculation and extrapolation, not proof.
If you want to test a CBD product, you need to make sure that the product you are using is tested by an external lab or FDA approved. Otherwise, you run the risk of being scammed, harmed or arrested. Tell your doctor and pharmacist that you are taking CBD so that you can avoid potentially dangerous drug interactions. Regardless of the product, do not drive for a couple of days after starting a CBD product until you know how the drug affects you. If you have a stomach upset or are sleepy, a lower dose is likely to be more tolerable, but lowering your dose may make CBD less effective. If you see that your eyes or skin are yellowish, 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.
