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What Are the Benefits of CBD?

More than 60 percent of CBD users were taking it for anxiety, according to a survey of 5,000 people. Does it help?

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By Dawn MacKeen

The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm. Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when “freaking out” over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewart’s French bulldog partakes, too.

What is CBD?

Cannabidiol, or CBD, is the lesser-known child of the cannabis sativa plant; its more famous sibling, tetrahydrocannabinol, or THC, is the active ingredient in pot that catapults users’ “high.” With roots in Central Asia, the plant is believed to have been first used medicinally — or for rituals — around 750 B.C., though there are other estimates too.

Cannabidiol and THC are just two of the plant’s more than 100 cannabinoids. THC is psychoactive, and CBD may or may not be, which is a matter of debate. THC can increase anxiety; it is not clear what effect CBD is having, if any, in reducing it. THC can lead to addiction and cravings; CBD is being studied to help those in recovery.

Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.

What are the claims?

CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep. Part of CBD’s popularity is that it purports to be “nonpsychoactive,” and that consumers can reap health benefits from the plant without the high (or the midnight pizza munchies).

Just as hemp seedlings are sprouting up across the United States, so is the marketing. From oils and nasal sprays to lollipops and suppositories, it seems no place is too sacred for CBD. “It’s the monster that has taken over the room,” Dr. Brad Ingram, an associate professor of pediatrics at the University of Mississippi Medical Center, said about all the wild uses for CBD now. He is leading a clinical trial into administering CBD to children and teenagers with drug-resistant epilepsy.

Is This A Scam?

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Facts about wellness.

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take your money?

Understand Post-Traumatic Stress Disorder

The invasive symptoms of PTSD can affect combat veterans and civilians alike. Early intervention is critical for managing the condition.

  • Removing the Stigma: Misconceptions about how PTSD develops and its symptoms, can prevent people from seeking treatment.
  • Psychedelic Drugs: As studies continue to point to the therapeutic value of substances like MDMA, veterans are becoming unlikely advocates for their decriminalization.
  • SeekingPeace: Mission Within is a Mexican retreat that uses hallucinogens to treat PTSD. Some female U.S. veterans and veteran spouses have turned to it to heal from trauma.
  • Virtual Reality: A treatment using new technology to immerse patients in a simulation of a memory could helpthemovercome trauma.

Does CBD work?

“It’s promising in a lot of different therapeutic avenues because it’s relatively safe,” said James MacKillop, co-director of McMaster University’s Michael G. DeGroote Center for Medicinal Cannabis Research in Hamilton, Ontario.

Last year, the F.D.A. approved Epidiolex, a purified CBD extract, to treat rare seizure disorders in patients 2 years or older after three randomized, double-blind and placebo-controlled clinical trials with 516 patients that showed the drug, taken along with other medications, helped to reduce seizures. These types of studies are the gold standard in medicine, in which participants are divided by chance, and neither the subject nor the investigator knows which group is taking the placebo or the medication.

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While there is hope for treating other conditions with the plant extract, Epidiolex remains the only CBD-derived drug approved by the F.D.A. Most of the research on cannabidiol has been in animals, and its current popularity has outpaced science. “We don’t have the 101 course on CBD quite figured out yet,” said Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

Does CBD help anxiety and PTSD?

For students with generalized social anxiety, a four-minute talk, with minimal time to prepare, can be debilitating. Yet a small experiment in the journal Neuropsychopharmacology found that CBD seemed to reduce nervousness and cognitive impairment in patients with social anxiety in a simulated public speaking task.

However, a double-blind study found healthy volunteers administered CBD had little to no change in their emotional reaction to unpleasant images or words, compared to the placebo group. “If it’s a calming drug, it should change their responses to the stimuli,” said Harriet de Wit, co-author of the study and a professor in the University of Chicago’s department of psychiatry and behavioral neuroscience. “But it didn’t.”

Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.

“Our top therapies attempt to break the association between reminders of the trauma and the fear response,” said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the study’s principal investigator. “We think that CBD, at least in animal models, can help that process happen a lot faster.” While large clinical trials are underway, psychologists say there isn’t compelling evidence yet as to whether this is a viable treatment.

Does CBD help sleep and depression?

Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are looking for new treatments for sleep, that may be a clue,” he said.

But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasn’t been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.

A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. “Over all, we did not find that it panned out as a useful treatment for sleep,” said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.

Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor at the University of São Paulo in Brazil, in an email interview. Of course, it’s difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.

But without clinical trials in humans, psychologists say CBD’s effect on depression is still a hypothesis, and not an evidence-based treatment.

Is CBD harmful?

“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.

Recently, the F.D.A. sent a warning letter to Curaleaf Inc. about its “unsubstantiated claims” that the plant extract treats a variety of conditions from pet anxiety and depression to cancer and opioid withdrawal. (In a statement, the company said that some of the products in question had been discontinued and that it was working with the F.D.A.)

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Dr. Smita Das, chair of the American Psychiatric Association’s Council on Addiction Psychiatry’s cannabis work group, does not recommend CBD for anxiety, PTSD, sleep or depression. With patients turning to these to unproven products, she is worried that they may delay seeking appropriate mental health care: “I’m dually concerned with how exposure to CBD products can lead somebody into continuing to cannabis products.”

Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100 percent natural CBD extracts. They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.

Earlier research found fewer than a third of 84 products studied contained the amount of CBD on their labels. Some users of CBD have also failed drug tests when the product contained more THC than indicated.

This year, 1,090 people have contacted poison control centers about CBD, according to the American Association of Poison Control Centers. Over a third are estimated to have received medical attention, and 46 were admitted into a critical care unit, possibly because of exposure to other products, or drug interactions. In addition, concern over 318 animals poured into the American Society for the Prevention of Cruelty to Animals’ Animal Poison Control Center.

Is CBD a scam or not?

A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. That’s when someone believes a drug is working and symptoms seem to improve.

“CBD is not a scam,” said Yasmin Hurd, director of the Addiction Institute of Mount Sinai in New York City who led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using. “It has a potential medicinal value, but when we are putting it into mascara and putting it into tampons, for God’s sake, to me, that’s a scam.”

CBD Products Do They Work?

Cannabidiol (CBD) is one of the most studied compounds of the cannabis plant. CBD drew attention when it was shown to stop seizures in a group of patients with a form of epilepsy that does not respond to conventional therapies. Potential benefits of CBD might include anti-inflammatory, immune system, and anti-anxiety effects. A great deal more scientific investigation is needed.

The Full Story

There is a term of Greek origin, panacea, that means all-healing. Vitamin D, magnesium, turmeric, and recently cannabidiol (CBD) are some of the products that have enjoyed time in the public eye as the panacea we are all missing. CBD is a chemical compound from the cannabis plant. CBD is not tetrahyrdrocannabinol (THC), which is the main psychoactive substance in cannabis that causes intoxication and is potentially habit forming.

The idea that the cure lies in plants and natural medicine is alluring. After all, humans have relied upon natural medicines much longer than tightly-controlled pharmaceuticals. When drugs are created, a common method is to find a receptor in the body and make a compound to act on that receptor. Cannabinoid-sensitive receptors exist in our bodies (primarily in the central nervous and immune systems), and the cannabinoids that act on them already exist in abundance in the cannabis plant.

CBD does not cause people to become intoxicated or “high” and, so far, has not been shown to be addictive like THC. Cannabis plants today have been cultivated to contain high levels of THC. Hemp plants are cannabis plants that have been cultivated to have low amounts of THC (although not zero) and higher amounts of CBD. Hemp plants are the source of the flood of CBD products on the market, from skincare to latte add-ins.

In America, hemp plants are now legal to grow. However, extracted CBD from hemp plants is a pharmaceutical ingredient according to the United States Food and Drug Administration (FDA). Because of this, CBD cannot be sold or marketed as a dietary supplement or food in the United States. However, Epidiolex, an FDA-approved, prescription CBD medication is available and has been shown to help some people with rare types of epilepsy that are not controlled by other medications.

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Supplements and non-pharmaceutical CBD products are not regulated by the FDA. This means that there is no oversight from the FDA assuring that these products are made in an appropriate environment, are free from contamination, or even contain what they advertise on the label. This has become an important issue in major sports where athletes take supplements or try to use natural products instead of pharmaceuticals. There have been cases in which athletes used CBD products and, during drug screens, tested positive for THC. It might be that the athletes were not telling the truth, or it might be that they unknowingly used an unregulated CBD product contaminated with THC. Because of the lack of FDA regulation, CBD products may be contaminated with THC or other chemicals such as pesticides or heavy metals. In one study from 2017, an analysis of 48 CBD products revealed that less than one-third of the products had accurate labeling about their CBD concentration, and 21% contained THC. People who use CBD products should know that these products may contain potentially dangerous ingredients that can have negative or unwanted medical and legal consequences.

Much of the research on CBD has searched for anti-inflammatory and targeted immune system effects. Steroids are the most commonly used anti-inflammatory agents, but a steroid substitute could be very helpful, because steroids have extensive side effects. However, there are many inflammatory diseases for which chronic steroid therapy is one of the only effective treatments.

Common side effects reported from swallowing CBD products are generally mild and may be related to other components or contaminants present in the product. Drowsiness is the most common side effect, and decreased appetite, nausea, and diarrhea can also occur. Contamination with myrecene, another chemical found in in both cannabis and hemp, may be responsible for some of the sedating effects of CBD. CBD is metabolized by a major enzyme system in the liver and can have drug interactions. In animal studies, chronic CBD use also suppressed male fertility.

Research is ongoing, so more compounds of interest from the cannabis plant are sure to follow. But there are many unanswered questions. Can individual chemicals such as CBD alone provide a benefit, or is the entire plant needed (entourage effect) to realize the full effects? Additionally, studies on safety and use in children need to be pursued. Will CBD users develop tolerance and potentially experience withdrawal? These questions will not be answered until large groups of people taking CBD have been studied.

For now, there is no panacea.

If you are worried about a CBD exposure, check the webPOISONCONTROL ® online tool for guidance or call Poison Control at 1-800-222-1222. Whether you log on or call, expert assistance is available 24 hours a day.

Pela Soto, PharmD, BSHS, BS
Certified Specialist in Poison Information

Poisoned?

Call 1-800-222-1222 or

Prevention Tips

  • Over-the-counter CBD products (topical, oral, or otherwise) have not been studied in children and should not be used by children or adolescents.
  • Tell your doctor about any strange or unwanted side effects that occur after use of CBD products.
  • Ask your pharmacist to check for drug interactions involving regular medications and CBD-containing products.

This Really Happened

A 13-year-old boy was feeling anxious at school. A friend offered him a gummy thought to contain CBD. He went to the school nurse who called the boy’s parents and Poison Control. Poison Control indicated that if it truly was CBD alone, the boy should have no significant symptoms beyond mild sedation or dizziness. With increasing availability of THC-containing products, the school nurse was also informed of symptoms that would be expected with THC in his age group including excitation (anxiety, paranoia) and sedation. When Poison Control followed up on the boy several hours later, he had confessed that the ingestion was actually several days previously and that he had no effects. He was nervous about the exposure and wanted to be sure he was okay.