Hearing a lot about CBD oil for pain management or anxiety? Many CBD products might not be the cure-all they claim to be. Learn more here. Here’s the truth about CBD, from a cannabis researcher Is CBD a cure-all — or snake oil? Jeffrey Chen, executive director of the UCLA Cannabis Research Initiative, explains the science behind the 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 Oil — Are the Benefits Claimed Too Good To Be True?
These days, many of us could certainly go for a miracle cure-all, especially those of us who struggle with chronic pain, overwhelming anxiety, cancer-related symptoms and/or hard-to-treat neurological disorders. So, it’s no wonder that CBD oil is popping up in our search results. But can we really count on CBD oil to positively impact our symptoms in the ways we hope? Internal medicine specialist Paul Terpeluk, DO, explains why CBD oil may not be as effective as we’d like.
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What is CBD?
CBD, or cannabidiol, is just one of more than 100 chemical compounds found in the cannabis sativa plant. But it’s THC (tetrahydrocannabinol), not CBD, that’s the main psychoactive compound in cannabis that gives you a euphoric high.
CBD is pulled from hemp, a type of cannabis plant that contains very low levels of THC, so it doesn’t get you high. CBD oil is simply a product that contains CBD extract and an oil, like coconut oil, typically for topical use.
It’s important to know that since the implementation of the 2018 Farm Bill, the production and sale of CBD products in the U.S. has been legalized on the federal level as long as they contain less than .3% of THC. However, it’s still illegal under some state laws.
Plus, Dr. Terpeluk explains the market has been oversaturated with CBD products — from bath bombs to gummies, lotions, creams, tinctures and oil — none of which are Food and Drug Administration (FDA) approved and may not be 100% pure CBD. As of mid-December 2021, the FDA has only approved one cannabis-derived and three cannabis-related products, all of which you can safely get with a prescription from a licensed healthcare provider.
“There’s no oversight of the majority of CBD products from a regulatory authority,” says Dr. Terpeluk. “Most of the CBD that you’re buying, unless they have a rigorous marketing campaign and quality control that says it’s 100% CBD oil, more than likely, it’s contaminated with other cannabinoids, including THC.”
What are some of the benefits of CBD?
Several studies show the benefits of pure CBD may have wide-ranging positive effects, though. To understand those benefits, it’s important to consider our body’s endocannabinoid system, a complex system of enzymes, neurotransmitters and receptors that plays an important role in the development of our central nervous system. This system helps regulate a variety of functions, including pain, motor control, memory, appetite, inflammation and more. By further studying CBD’s effects in these specific areas, we may better understand how CBD impacts a variety of conditions and disorders.
Helps with neurological-related disorders
The FDA has approved Epidiolex as a treatment for several seizure disorders, including two rare disorders known as Duvet syndrome and Lennox-Gastaut syndrome. Several case studies suggest CBD may also be beneficial to patients who are resistant to anti-epileptic drugs. “With epilepsy, there’s a threshold in your brain that gets excitatory, and you go into a seizure,” says Dr. Terpeluk. “CBD increases that threshold.”
Other studies suggest CBD may also be useful in managing symptoms of multiple sclerosis, Parkinson’s disease and Alzheimer’s disease, as it has neuroprotective, anti-inflammatory properties. More studies are needed, however, as many suggest that it’s not just CBD alone, but a combination of CBD and other cannabinoids, that may help reduce many of these symptoms.
It may assist with pain relief
By interacting with neurotransmitters in your central nervous system, CBD could potentially relieve pain related to inflammation, arthritis and nerve damage (peripheral neuropathy). In one four-week trial, people who had nerve damage in the lower half of their body reported a significant reduction of intense, sharp pain after using a topical CBD oil.
“All of our different anti-pain drugs affect some section of our pain system, whether it’s Tylenol®, Aspirin®, morphine or opioids,” explains Dr. Terpeluk. “No one wants to be addicted to opioids, so if there’s a cannabinoid you can take that’s not addictive but can repress the pain, that would be the Holy Grail with chronic pain.”
Still, he cautions, there’s a lot left to be studied, including whether there are significant adverse long-term effects of CBD when used for pain relief.
“If you’re taking it in an unregulated fashion, you don’t know how much is in there, and you’re not quite sure how it affects you outside of your particular pain,” says Dr. Terpeluk.
It may help with anxiety and mood disorders
Anxiety and mood disorders like depression or post-traumatic stress disorder can have a severe effect on your daily life and may often cause both physical and emotional stress that could lead to other underlying conditions like sleep disorders, high blood pressure, chronic pain and heart disease. It’s too early to understand the full gamut of effects that CBD may have on anxiety and mood disorders, but individual studies seem to suggest varying positive results. In one study of 57 men who received either oral CBD or a placebo 90 minutes before participating in a simulated public speaking test, researchers learned that a 300-mg dose of CBD significantly reduced social anxiety during the test.
And while there are a wide variety of treatments available for anxiety and mood disorders — ranging from talk therapy and counseling to prescribed medications — Dr. Terpeluk suggests the most important thing is to get at the root of the underlying causes of the anxiety you’re experiencing.
“Anxiety is better approached by looking at what’s causing it in your life rather than trying to figure out which drugs can reduce it,” says Dr. Terpeluk.
It might help with cancer-related symptoms
CBD may help with nausea, vomiting and weight loss caused by chemotherapy treatments. The FDA has approved three cannabis-related products to help alleviate these symptoms, as well as help increase the appetite for those who have AIDS. These drugs all contain some level of THC or synthetic THC and are not purely CBD alone.
But some studies seem to suggest that CBD can help decrease the size of tumors and help stop the spread of cancerous cells in skin cancer, breast cancer, prostate cancer and more. As with other areas of study, further human clinical trials are needed to understand the full effect CBD has on various kinds of cancer.
What are the side effects or risks of CBD?
If you’re purchasing CBD oil and other products online or from a local vendor, Dr. Terpeluk says there’s no real way of knowing the purity of the CBD you’re using, as it could be mixed with other cannabinoids, such as the dangerous delta-8, or THC.
“It’s a little bit mysterious. It’s not as harmless as you think,” says Dr. Terpeluk. “If you take CBD oil because you buy it on the market, you have a very high likelihood that you could turn a drug test positive for THC because it could actually contain THC.”
CBD can also affect a variety of medications, including pain medications, antidepressants, antipsychotics and more. It could also cause several side effects that may include:
- Issues with coordination. .
- Drowsiness or fatigue. .
The best advice? Before considering CBD oil or other CBD products, make sure you talk to your healthcare provider to decide whether it’s safe for you and to ensure it doesn’t have harmful interactions with any medications you’re currently taking.
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Here’s the truth about CBD, from a cannabis researcher
Is CBD a cure-all — or snake oil? Jeffrey Chen, executive director of the UCLA Cannabis Research Initiative, explains the science behind the cannabis product.
CBD gummies. CBD shots in your latte. CBD dog biscuits. From spas to drug stores, supermarkets to cafes, wherever you go in the US today, you’re likely to see products infused with CBD. There are cosmetics, vape pens, pills and, of course, the extract itself; there are even CBD-containing sexual lubricants for women which aim to reduce pelvic pain or enhance sensation. CBD has been hailed by some users as having cured their pain, anxiety, insomnia, depression or seizures, and it’s been touted by advertisers as a supplement that can treat all of the above and combat aging and chronic disease.
As Executive Director of the UCLA Cannabis Research Initiative, I’m dedicated to unearthing the scientific truth — the good and the bad — behind cannabis and CBD. My interest was sparked in 2014 when I was a medical student at UCLA, and I discovered a parent successfully treating her child’s severe epilepsy with CBD. I was surprised and intrigued. Despite California legalizing medical cannabis in 1996, we weren’t taught anything about cannabis or CBD in med school. I did research and found other families and children like Charlotte Figi reporting success with CBD, and I knew it was something that needed to be investigated. I established Cannabis Research Initiative in the fall of 2017, and today we have more than 40 faculty members across 18 departments and 8 schools at UCLA working on cannabis research, education and patient-care projects.
So what exactly is CBD and where does it come from? CBD is short for cannabidiol, one of the compounds in the cannabinoid family which, in nature, is found only in the cannabis plant (its official scientific name is Cannabis sativa l.). THC — short for tetrahydrocannabinoid — is the other highly abundant cannabinoid present in cannabis that’s used today. THC and CBD exert their effects in part by mimicking or boosting levels of endocannabinoids, chemical compounds that are naturally produced by humans and found throughout our bodies. Endocannabinoids play an important role in regulating mood, memory, appetite, stress, sleep, metabolism, immune function, pain sensation, and reproduction.
Despite the fact that they’re both cannabinoids found only in the cannabis plant, THC and CBD are polar opposites in many ways. THC is intoxicating and responsible for the “high” of cannabis, but CBD has no such effect. THC is addictive; CBD is not addictive and even appears to have some anti-addictive effects against compounds like opioids. While THC stimulates the human appetite, CBD does not. There are areas where they overlap — in preliminary animal studies, THC and CBD exhibit some similar effects, including pain-relieving and anti-inflammatory properties and anti-oxidant and neuroprotective effects. In some early research, they’ve even shown the ability to inhibit the growth of cancer cells, but years of rigorous studies need to be conducted before we’ll know whether they have the same impact on humans.
Even though humans have been using cannabis for thousands of years, the products available today are not the cannabis that has traditionally been consumed. After cannabis was prohibited at the federal level in 1970 by the US Controlled Substances Act, illicit growers were incentivized to breed strains that had higher amounts of THC, so they could increase their profits without needing larger growing spaces. What they didn’t know was that by driving up THC content, they were dramatically reducing the CBD content. In 1995, after decades of surreptitious breeding, the ratio of THC to CBD was ~15:1, and by 2014 the ratio had jumped to ~80:1 as CBD content further plummeted.
Due to decades of research restrictions in the US and growers’ focus on THC, there are very few human studies that look at CBD and its effects. The strongest evidence we have is that CBD can reduce the frequency of seizures in certain rare pediatric disorders — so much that a CBD-based drug called Epidiolex was FDA-approved in 2018 for this purpose. There is also preliminary human data from small clinical trials with dozens of subjects that suggests CBD may have the potential to be used for conditions like anxiety, schizophrenia, opioid addiction, and Parkinson’s disease. But please note that the participants in these studies generally received several hundreds of milligrams of CBD a day, meaning the 5mg to 25mg of CBD per serving in popular CBD products may likely be inadequate. And even if you took dozens of servings to reach the dosage used in these clinical trials, there is still no guarantee of benefit because of how preliminary these findings are.
But while there is a lack of concrete and conclusive evidence about CBD’s effects, there is considerable hope. Recent legislative changes around hemp and CBD in the US and across the world have enabled numerous human clinical trials to begin, investigating the use of CBD for conditions such as autism, chronic pain, mood disorders, alcohol use disorder, Crohn’s disease, graft-versus-host-disease, arthritis and cancer- and cancer-treatment-related side effects such as nausea, vomiting and pain. The results of these studies should become available over the next five years.
Furthermore, in an effort to protect consumers, the FDA has announced that it will soon issue and enforce regulations on all CBD products. Buyers should beware because the products being sold today may contain contaminants or have inaccurately labelled CBD content — due to the deluge of CBD products on the market, government agencies haven’t been able to react quickly enough so there is currently no regulation in the US whatsoever on CBD products.
While CBD appears to be generally safe, it still has side effects. In children suffering from severe epilepsy, high doses of CBD have caused reactions such as sleepiness, vomiting and diarrhea. However, we don’t know if this necessarily applies to adults using CBD because these children were very sick and on many medications, and the equivalent dose for an average 154-pound adult would be a whopping 1400 mg/day. And while CBD use in the short term (from weeks to months) has been shown to be safe, we have no data on what side effects might be present with chronic use (from months to years).
Right now, the most significant side effect of CBD we’ve seen is its interaction with other drugs. CBD impacts how the human liver breaks down other drugs, which means it can elevate the blood levels of other prescription medications that people are taking — and thus increase the risk of experiencing their side effects. And women who are pregnant or who are expecting to be should be aware of this: We don’t know if CBD is safe for the fetus during pregnancy.
So where does this leave us? Unfortunately, outside of certain rare pediatric seizure disorders, we scientists do not have solid data on whether CBD can truly help the conditions that consumers are flocking to it for — conditions like insomnia, depression and pain. And even if it did, we still need to figure out the right dose and delivery form. Plus, CBD is not without side effects. Here’s the advice that I give to my friends and family: If you’re using CBD (or thinking about using it), please research products and talk to your doctor so they can monitor you for side effects and interactions with any other drugs you take.
So is CBD a panacea or a placebo? The answer is: Neither. CBD is an under-investigated compound that has the potential to benefit many conditions. While it does have side effects, it appears as if it could be a safer alternative to highly addictive drugs such as opioids or benzodiazepines. And thanks to a recent surge in research, we’ll be learning a lot more about its capabilities and limits in the next five years.
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