Last month, a U.S. Food and Drug Administration advisory panel unanimously recommended approval of the CBD medication Epidiolex to treat two rare forms of childhood epilepsy. CBD and THC are both found in cannabis plants but are very different compounds. Learn more about how each treats pain here.
CBD Oil: All the Rage, But Is It Safe & Effective?
MONDAY, May 7, 2018 (HealthDay News) — Cannabidiol (CBD) oil has become the hot new product in states that have legalized medical marijuana.
The non-intoxicating marijuana extract is being credited with helping treat a host of medical problems — everything from epileptic seizures to anxiety to inflammation to sleeplessness.
But experts say the evidence is scant for most of these touted benefits.
Worse, CBD is being produced without any regulation, resulting in products that vary widely in quality, said Marcel Bonn-Miller, an adjunct assistant professor of psychology in psychiatry at the University of Pennsylvania School of Medicine.
“It really is the Wild West,” Bonn-Miller said. “Joe Bob who starts up a CBD company could say whatever the hell he wants on a label and sell it to people.”
Cannabidiol is extracted from the flowers and buds of marijuana or hemp plants. It does not produce intoxication; marijuana’s “high” is caused by the chemical tetrahydrocannabinol (THC).
CBD oil is legal in 30 states where medicinal and/or recreational marijuana is legal, according to Governing magazine.
Seventeen additional states have CBD-specific laws on the books, according to Prevention magazine. Those are Alabama, Georgia, Indiana, Iowa, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming.
Strong Evidence for Treating Epilepsy
Only one purported use for cannabidiol, to treat epilepsy, has significant scientific evidence supporting it.
Last month, a U.S. Food and Drug Administration advisory panel unanimously recommended approval of the CBD medication Epidiolex to treat two rare forms of childhood epilepsy.
“That’s really the only area where the evidence has risen to the point where the FDA has said this is acceptable to approve a new drug,” said Timothy Welty, chair of the department of clinical sciences at Drake University’s College of Pharmacy and Health Sciences, in Des Moines, Iowa.
For the rest of CBD’s potential uses, there is simply too little evidence to make a firm conclusion.
For example, some human clinical trials suggest that CBD could be effective in treating symptoms of anxiety, particularly social anxiety, Bonn-Miller said.
This is the potential use for CBD with the most evidence after usefulness in epilepsy, but “there’s a decent gap between those two,” he said.
“There have been clinical trials in adults, but a lot smaller than the epilepsy studies that have been done in kids,” Bonn-Miller said.
CBD’s usefulness as an anti-inflammatory medication is the next most promising, but those results come mostly from animal studies, experts said.
Most Other Uses Largely Unproven
The rest of the potential uses — as an antipsychotic, antidepressant or sleep aid “have all been studied in animals, with only one or two examples of studies in humans,” Bonn-Miller said.
And Welty said the studies that have featured humans for these other CBD uses have either been case reports or studies that did not compare results against a control group that did not use the oil.
“There’s no control, so it’s basically how do you know if we’re dealing with the true effect of the drug or just simply a placebo effect because somebody thinks they’ve been given a drug that will be beneficial?” Welty said.
There also are concerns about both the quality of CBD oil being produced and its potential side effects, the experts added.
Lack of Regulation Also Concerning
Because of the legally murky nature of marijuana, the FDA has not stepped in to regulate products like CBD oil, Bonn-Miller said. States are struggling to put regulations in place, but they don’t have the deep pockets of the federal government.
Meanwhile, a 2017 study led by Bonn-Miller found that nearly 7 of 10 CBD products didn’t contain the amount of marijuana extract promised on the label.
Nearly 43 percent of the products contained too little CBD, while about 26 percent contained too much, Bonn-Miller said.
“CBD is kind of a tricky drug because it’s not very well absorbed orally,” Welty explained. “Less than 20 percent of the drug is absorbed orally. If it isn’t made in the right way, you may not be getting much drug into your systemic circulation.”
Worse, about 1 in 5 CBD products contained the intoxicating pot chemical THC, Bonn-Miller and his colleagues found.
“That’s a problem because THC can increase anxiety. It can actually make seizures worse. Those are the sorts of things you need to be careful about,” Bonn-Miller said.
“If I were a consumer, purchasing it for myself or my kid, I would want to test it so that I knew what it actually had in it, because I couldn’t trust what was on the label,” Bonn-Miller concluded.
Potential Interactions With Other Meds
Studies on CBD also have raised concerns about possible interactions with other drugs.
For example, epilepsy studies found that “there were very clearly increases in the blood levels of some other anti-epileptic drugs when people were on CBD,” Welty said.
This could mean that people taking anti-epilepsy drugs alongside CBD will need to adjust their dosage downward to avoid side effects, Welty noted.
There also is some indication that CBD might harm the liver. About 10 percent of people taking CBD in studies had increases in liver enzymes, which would indicate possible liver damage, Welty said.
“About 2 to 3 percent of individuals taking CBD actually had to discontinue because their liver enzymes went so high it was of concern to the people running the study,” he said.
Welty recommends that people interested in CBD seek out a doctor who has read up on the extract and its potential uses.
“My bottom-line advice is people really need to be under the care of a health care provider who understands CBD. They need to be monitored and managed by that individual, and not just go out and buy CBD thinking it’s going to be the answer,” Welty said.
SOURCES: Marcel Bonn-Miller, Ph.D., adjunct assistant professor, psychology in psychiatry, University of Pennsylvania School of Medicine, Philadelphia; Timothy Welty, Pharm.D., chair, department of clinical sciences, College of Pharmacy and Health Sciences, Drake University, Des Moines, Iowa
THC vs. CBD for Pain Relief: What’s Better?
People with arthritis and other chronic musculoskeletal pain are increasingly turning to cannabis products for relief from different symptoms, such as pain, fatigue, insomnia, and anxiety. In fact, a recent CreakyJoints survey of people with arthritis found that more than half had tried marijuana or CBD for a medical reason.
While cannabis plants are complex and different varieties have different chemical compositions, almost all of them contain some combination of two medically important compounds: tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is responsible for that “high” that people get from marijuana, which may also play a role in pain relief. CBD doesn’t usually cause an intoxicating feeling, but research suggests it, too, may help ease arthritis symptoms.
These two chemicals both show potential in easing pain, but in different ways. Choosing a product rich in THC, CBD, or both could make a difference in the kind of pain relief you experience — if any. (Here are reasons your CBD product might not be working for you.)
Here’s what experts say about the differences between THC and CBD for pain relief.
How THC and CBD May Offer Pain Relief
CBD and THC activate different cannabinoid receptors in your body that can stimulate or inhibit brain chemicals and cause certain effects.
“We know a lot more about how THC works in terms of the molecular mechanism [than CBD],” says Steve Alexander, associate professor of molecular pharmacology at the University of Nottingham Medical School, who researches cannabinoids.
“THC activates certain cannabinoid receptors, one of which is in the nerve cells and the other is in the immune cells. When it activates the one in the nerve cells, it reduces the sensation of pain,” he adds.
The high that THC provides can also play a role in how people experience pain. “A little bit of euphoria can help us not care that we’re experiencing quite as much pain, much in the same way that other pain medications work,” says Angela D. Bryan, PhD, professor of psychology and neuroscience at the University of Colorado Boulder, who has studied cannabis and health.
CBD is much less understood than THC by researchers, although there is anecdotal evidence that it may provide pain relief in some people.
“We’ve got a hypothesis that CBD might have some interference with [the brain chemical] serotonin and some influence on glycine receptors, which may be involved with pain. We think it may do what it does by hitting multiple targets with a fairly light touch,” says Dr. Alexander. “It’s difficult to pick apart — lots of people are trying [to study it], but no one has yet succeeded.”
Researchers have not found much evidence that CBD can offer mental relief from pain. However, the placebo effect may help some individuals experience less pain after taking CBD.
“The human mind is a very powerful thing, and a lot of the ways we experience medication is related to our expectancies about that medication,” says Dr. Bryan.
How CBD Can Help with Anxiety
Scientists suspect that CBD may help relieve anxiety, though. That, in turn, could affect someone’s perception of pain and potentially make them more comfortable. The research is still developing, though, and it’s too early to draw anything conclusive.
“We know that chronic pain patients also have a number of other morbidities, like stress, anxiety, and depression. I’m interested in the possibility that cannabidiol might also have mechanisms by which we can relieve some of those additional problems,” says Dr. Alexander.
That said, CBD may offer pain relief in more physical ways. It seems to show promise in reducing inflammation, which could provide pain relief from autoimmune diseases like rheumatoid arthritis, says Dr. Bryan.
The bottom line: THC seems to have a greater effect on the way the mind perceives pain, whereas CBD may work to ease pain at the local source.
Which Is Better for Pain Relief: THC or CBD?
There’s no definitive answer to the debate between THC and CBD for pain relief. Cannabis is still considered a Schedule 1 drug by the federal government — a legal status that limits the kinds of research that can be conducted.
Using the current research available, Dr. Bryan says she believes that a combination of THC and CBD together shows the most promise for pain relief.
“To the extent that we have good data, it’s unlikely that either THC or CBD on its own is going to be particularly effective for pain. It probably needs to be a combination of the two,” she explained. “We’re totally speculating at this point, but the way they work together might be that CBD has anti-inflammatory properties while THC has properties that can help us better cope with pain.”
CBD and THC: Side Effects and Legal Concerns
THC might not be an option for everyone, though. Some people may live in states where THC is illegal; while others simply don’t want the psychoactive effects of the substance. In those cases, it might be worth trying CBD on its own to see if it offers pain relief for you.
CBD isn’t legal everywhere either. And in states where CBD is legal, laws can vary as to how much THC is permissible in CBD products in order for them to be legally sold. Many states in which certain CBD products are legal require them to contain less than 0.3 percent THC.
Before trying either substance, it’s worth considering potential side effects they may cause. Side effects of CBD include nausea, fatigue, and irritability, according to Harvard Health. CBD can also interact with certain medications (such as blood thinners) and either increase or decrease the concentration of certain drugs in the bloodstream.
THC has its own set of side effects, including sleepiness and lethargy, increased appetite, increased heart rate, coordination problems, dry mouth, red eyes, slower reaction times, memory loss, anxiety, and mood changes.
“It’s quite likely that individuals will respond to different versions of these cannabinoids, and some may not respond at all,” says Dr. Alexander. “There’s a tendency for anecdotal evidence to highlight the positives of people who do respond [to CBD], which is useful, but it’s difficult to measure the numbers of people who don’t get a lasting benefit.”
If you’re interested in trying CBD or THC to manage your pain, talk to your doctor and experiment to see whether CBD or THC (or both) relieves some pain.
You can also learn more in a new, free course on the health effects of THC and CBD, created by Kent Hutchison, PhD, professor of psychology and neuroscience at the University of Colorado in Boulder.
“Start with low doses and go slowly to find out what works for you,” says Dr. Alexander. “I find it difficult to believe that there is one version of cannabis or CBD that will be best for everyone.” Learn more here about how to find your optimal CBD dose.