Cannabidiol, or CBD, is cropping up in everything from vaping oils to coffee to candy. The CBD industry is growing at a fast rate, and research is mounting about the overall safety and potential benefits of using it to treat various health conditions or ease symptoms. Yet there’s still a lot of confusion and misconceptions about CBD and the laws, regulations, and studies surrounding it.
Here’s a topline review of the CBD landscape as it pertains to medical usage.
1. CBD vs. THC
CBD (cannabidiol) and THC (tetrahydrocannabinol) are the two most abundant cannabinoids found in the cannabis plant. THC is the psychoactive cannabinoid in marijuana that causes a “high.” Unlike THC, CBD does not get people “stoned.” Cannabinoids impact the body’s endocannabinoid system, which helps regulate nervous and immune function, keeping the body in homeostasis. CBD and THC act differently on cannabinoid receptors in the body, but likely work best when combined. Experts refer to this synergy as the “entourage effect.”
2. Hemp-Derived CBD vs. Marijuana-Derived CBD
The cannabis plant is commonly known as hemp or marijuana, depending on the plant’s level of THC. Hemp has a THC level of less than 0.3 percent, while marijuana has THC at higher concentrations. CBD products that contain THC at higher concentrations than in hemp are only legally available in countries and states that have passed recreational or medical marijuana use laws.
3. Forms of CBD
There are several methods of using CBD, with new forms launching every day. Most methods of CBD use fall into one of the following categories.
Oils, tinctures, sprays
Edibles (mints, gummies, lollipops), soft gels, capsules
Creams, lotions, salves
People using CBD for medical purposes are 2.4 times more likely to use a topical form and twice as likely to use an edible form of CBD than general health and well-being users.
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4. Current CBD Laws and Regulations
While individual states have their own legislation regarding legal levels of CBD and THC, nationwide, hemp became legal when the Agriculture Improvement Act, also known as the Farm Bill, passed at the end of 2018. This act removed hemp and hemp-derived products from the Controlled Substances Act (CSA). However, the Drug Enforcement Administration (DEA) still classifies hemp-derived products containing more than 0.3 percent THC as a Schedule I drug under the CSA, on par with heroin, LSD, and marijuana.
The U.S. Food and Drug Administration (FDA) has only approved one CBD product, Epidiolex, to be marketed for therapeutic uses. The FDA currently prohibits the sale of CBD in foods, and has sent warning letters to some CBD companies regarding their marketing practices. Moving forward, the FDA is gathering research and public commentary that it may then use to forge a path for regulating CBD.
5. Health Organization Responses
The reception to CBD for the relief of health symptoms has been largely positive.
The World Health Organization (WHO) has declared that CBD has a “good safety profile” in its 2018 report on the topic.
The Amercican Cancer Society (ACS) has acknowledged the therapeutic benefits of cannabinoids, but holds its position against smoking or vaping cannabinoids in public places and supports the need for continued research on cannabinoid use for cancer patients.
The American College of Physicians (ACP) has supports the anti-inflammatory properties of CBD and has published commentary about cannabinoid dosing for chronic pain management.
The American Epilepsy Society (AES) has called for rigorous research of cannabis products and has stressed the importance of pharmaceutical-grade formulations.
The Arthritis Foundation (AF) has gone on record urging the FDA to expedite the study and regulation of CBD products and has released expert guidelines for safe patient self-management strategies, such as talking to a physician before trying CBD, not using CBD as a substitute for disease-modifying treatment, starting with a small dose, and shopping for reputable products.
6. Side Effects and Risks
An extensive review of CBD’s existing clinical data and animal studies has reported that CBD is safe and has few, if any, side effects. The review also concluded that the common side effects of CBD are often more favorable than those of medications used to treat conditions like epilepsy or mental illness.
Since CBD is often used in addition to other prescriptions or over-the-counter drugs, more research is needed to understand how the cannabinoid interacts with other meds. Using CBD may increase or inhibit another drug’s effectiveness or side effects.
There is a concern that CBD may interfere with liver enzymes, specifically, cytochrome P450 complex, and may temporarily stop the liver from metabolizing other drugs or breaking down toxins. This can lead to higher concentrations of medications in a person’s system. Grapefruit is also known to temporarily inhibit cytochrome P450. If a medication comes with a “grapefruit warning” patients should be especially careful about consuming it with CBD as well.
7. The Latest Research
The popularity of CBD and other cannabinoids as either an alternative or an add-on therapy to treat various conditions has inspired pre-clinical research. Many of the studies have been conducted on rodents, and in many cases researchers aren’t yet sure if the same outcomes can be replicated in humans. The early promising results, however, have spurred further studies and comprehensive reviews of existing data. Currently CBD research exists in several areas:
• Itchy skin conditions (dry skin, dermatitis, eczema)
• Movement disorders (Parkinson’s disease, Huntington’s disease, multiple sclerosis, dystonias)
• Brain-based disorders like bipolar disease or schizophrenia
With the rapid growth in popularity of CBD products, more people are turning to CBD to treat various conditions and ailments. This demand for CBD will spur further research that goes beyond an exploratory nature and produces clearer results, and may bring about new FDA-approved CBD-based prescription medications to treat specific conditions. Anyone interested in cannabinoid research can view the International Association for Cannabinoid Medicines’ compiled list of studies to date.
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