Medicinal Use of CBD: Does it Cure Everything?
The CBD market has exploded in recent years. CBD is being marketed as a cure for everything under the sun. Local gas stations, salons, veterinary offices, and natural food markets now carry CBD products. What are the true benefits of CBD? Cannabis sativa is the botanical classification of all plants commonly known as hemp or marijuana. Although the same species legally, hemp and marijuana fall into separate categories based on their cannabinoid content. The two main cannabinoids found in C. sativa are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). Any cannabis plant containing 0.3% or less of THC (dry weight) falls in the hemp category, and plants with greater than 0.3% of THC are classified as marijuana.
History and Legality
U.S. production of hemp began in the 1600’s and continued through the 1900’s in various degrees until the 1970 Controlled Substances Act made it illegal. Between 1970 and 2018 hemp imports and then domestic production of agricultural hemp slowly evolved. The 2018 Farm Bill removed hemp from the Controlled Substances Act, making the production and sale of hemp federally legal. The bill did not impact marijuana, which remains a schedule I drug and federally illegal. However, currently 22 states legalize medicinal uses of marijuana and another 11 states + DC have legalized both medical and recreational marijuana use.
The legalization of hemp in 2018 fueled the explosion of CBD products we see today, as CBD is the main cannabinoid found in hemp. Hemp-derived CBD products are federally legal and therefore legal in all states. However, marijuana-derived CBD products remain federally illegal with varied legality at the state level.
Maine legalized all marijuana use in 2016, so all CBD products, whether they are hemp- or marijuana-derived, are legal. However, while marijuana remains federally illegal, interstate travel with marijuana and/or marijuana-derived products, is illegal, even if the product contains only CBD. Understanding the source of any item you’re using is extremely important when considering travel within the US and internationally.
TABLE 1: Biological Actions of CBD
Biological effects of CBD
Studies show that CBD exerts multiple effects in the body (see Table 1), without producing the psychoactive “high” associated with THC. One study in healthy volunteers found no psychoactive effects at doses of 200mg CBD. Although theoretical concern exists about the potential for CBD to convert to THC in the body, evidence doesn’t support this. In multiple studies, there were no appreciable blood levels of THC after administration of varying levels of CBD in people.
Until recently, legal limitations have restricted the ability to study the effects of cannabis in humans. As a result, current evidence supporting the use of CBD for medicinal use is primarily based on animal and test tube studies. Human trials will likely grow significantly in the coming years.
Medical Uses or Health Benefits?
Epilepsy: The use of CBD in the setting of epilepsy, especially in children, is the most-well researched with multiple human trials showing benefit. Most of these studies used very high doses of CBD, ranging from 200mg/day to 200mg/kg/day. Side effects occurred primarily at high doses and included diarrhea, loss of appetite, and somnolence. CBD use in children should only be done under the guidance of a physician.
Pain: Given the analgesic and anti-inflammatory effects, CBD may be useful in individuals experiencing pain. Research shows that CBD may have an analgesic effect in individuals with neuropathic pain resistant to other medications, and a recent human study found topical CBD oil beneficial to individuals with neuropathic pain. Unfortunately, many of the studies on pain used products containing both THC and CBD, so delineating the benefit from CBD remains difficult. CBD may provide benefit for mild to moderate pain, but doses needed to affect severe pain may be both cost and logistically prohibitive.
Psychiatric: Both human and animal studies support the anti-anxiety benefit of CBD. CBD administration reduced symptoms related to social anxiety disorders in two small human trials. In addition, CBD may buffer paranoia and anxiety associated with THC use.
Inflammatory bowel disease: CBD administration reduced Crohn’s-related symptoms and trended toward symptom improvement in ulcerative colitis. Multiple studies demonstrate the benefit of CBD administration for reducing inflammatory pathways and pro-inflammatory cytokines.
Neurological conditions: Animal studies show some benefit in the setting of Alzheimer’s disease, but human trials have not been conducted to confirm. In individuals with Parkinson’s disease, CBD improved symptoms of agitation, nightmares, insomnia, and aggressive behavior. CBD has been shown to improve symptoms related to Multiple Sclerosis, including pain.
Routes of Administration
The primary available options for taking CBD include oral administration and topical application. Newer options for inhalation are becoming available including hemp cigarettes and vape liquids. Topical applications may effectively address superficial muscle/joint pain but lack systemic benefits. Most people using CBD take oral products, typically oils or capsules.
Although popular, oral administration suffers from delayed onset of effect (30-120 min) and limited absorption rates (6-20%). Newer formulations in water soluble preparations may offer increased absorption and quicker onset, but availability remains limited. Research to date has used oral administration of oils/capsules, so therapeutic dosing guidelines are applicable to these formulations only.
CBD is well-tolerated with a good safety profile even at very high doses. Animal and human studies demonstrate minimal to no dependency or abuse potential with CBD use. However, due to concerns about drug-CBD interactions, consult your provider before starting CBD.
Regulations regarding the testing and safety of CBD products remains limited and unenforced. Independent testing of CBD products has revealed contaminants and irregular dosing. The growth of the industry is attractive to many, some of whom may not be interested in quality. When purchasing a CBD product, it would behoove the consumer to do some due diligence on the brands and products.
Cost Vs. Benefit
Interest in the medical use of CBD grows daily, as does the market. While CBD may offer a reasonable option for pain relief, anxiety management, or sleep support, calculating cost vs. benefit is important. Most of the studies cited used CBD doses ranging from 150mg to 600 mg per day. Depending on the product used, the cost per day of these doses would average $12 – $48. Some individuals may experience adequate benefit at a lower dose but moderate to severe symptoms will likely need more robust dosing. Generally, CBD therapy may be more appropriate for those with mild to moderate symptoms compared to those with severe symptoms.
Most CBD oils/tincture labels list the total amount of CBD or Hemp extract within the entire bottle, not a single dose. For accurate dosing, an individual must calculate milligrams (mg) per drop/dropperful and then how many dropperfuls equal their desired dose. Capsule dosing is more straightforward as the CBD content listed is per capsule.
Wholistic Approach and Conclusion
A wholistic approach will optimize the benefits from CBD use, rarely is a symptom or condition caused by one factor. Using CBD as one component of a wholistic approach including dietary changes, lifestyle changes, and mental/emotional support, will be more effective than using CBD alone. Finding a full-spectrum hemp extract with a specified CBD content will likely be more effective than an isolated CBD extract. When using botanical medicine, extracts of the whole plant typically provide superior benefit compared to isolated extracts of one component. However, if taking very high doses of CBD, consider an isolated extract product. Full-spectrum hemp extracts often contain a small percentage of THC, so very high doses of CBD may result in therapeutic doses of THC, causing unintended psychoactive effects.
Renée Lang, ND, FABNO, MPH is a licensed naturopathic doctor in the state of Maine and is board certified in naturopathic oncology (FABNO). She received her naturopathic doctorate from National College of Natural Medicine in 2003. In addition, she received her MPH in 2013 from Johns Hopkins Bloomberg School of Public Health, with additional certification in environmental and occupational health. As a Reiki Master and Shamanic practitioner, Dr. Lang has been incorporating these healing techniques in her practice since 2002. Dr. Lang currently sees patients by appointment at her office in Brunswick. From 2009-2013 she worked as a naturopathic oncology consultant at the Cancer Treatment Centers of America (CTCA) in Philadelphia. While at CTCA, Dr. Lang provided integrative naturopathic care to thousands of individuals with cancer. Visit: www.reneelangnd.com or email: firstname.lastname@example.org for more information or to schedule an appointment.