I think we’ve all been amazed at the explosion of CBD products, stories, and press coverage since 2018 when CBD was legalized as part of Mitch McConnell’s Farm Bill.  I get questions about CBD all the time from patients and from colleagues who see the popularity and wonder if it could be helpful to them or to their patients.  

In short, however, I think that CBD is “the Emperor’s New Clothes”.  It’s a great product to sell now that it’s legal and otherwise unregulated, but it’s not clearly of any use (or safe, for that matter) for consumers.  It’s principle selling points are that it’s legal and that it doesn’t cause any intoxication.  But does it actually do anything?

Here is a typical question:

“In your opinion is there any therapeutic benefit for any medical condition- or just to boost immunity and general good health any role of full-spectrum CBD oil tinctures?  I am talking about certified full-spectrum CBD oil not the garbage they sell at quick stops– Thank you”

Often I get asked if I’m pro-cannabis or anti-cannabis.  I respond that I am neither.  I am pro-patient.  If it’s safe and effective, I’m all for it!  Similarly people try to cast me as anti-CBD.  I’m not.  I think it has to be proven safe and effective and regulated properly.  That’s all.  

I think that CBD has yet to be proven for any benefit other than for kids with Dravet’s or Lennox-Gastaut Syndromes (rare genetic seizure disorders).  There has been very little high-quality research in adult humans.  Most of the studies are done in cell culture or in mice.  You are not a mouse, are you?!

In mice there is some evidence that CBD can be helpful for pain and anxiety.  There’s no such evidence for pain in humans, and the studies in humans for anxiety look at high-dose, single-dose CBD for stage fright (called situational anxiety), not for ongoing anxiety (called Generalized Anxiety Disorder).  Since situational anxiety and GAD are rather different, it’s not reasonable to generalize from one to the other.  

I suspect that CBD may, in fact, turn out to be useful in specific conditions, but not as a general “boost” or “wellness” product as it is being billed presently.  In cell culture, we’re finding that CBD interacts with a wide-range of receptors across many different systems.  There are also some non-receptor mediated effects. However, the effect of these interactions is still unknown, and until we know what it’s doing we can’t begin to look for therapeutic benefits for people.  Just because it interacts with a receptor doesn’t mean it will provide benefit – it might just as likely mess you up.  Let me remind you that cobra venom is all natural and interacts with receptors, but it’s still quite lethal.  

Further, all preliminary data suggests that CBD must be given at high dose (10-20mg/kg).  For an average 70 kg adult human, that’s 700-1400mg of CBD per day!  In that dose range we can see significant drug interactions (Warfarin, for example) and even some direct liver toxicity.  I suspect that future use of CBD at high dose will require some bloodwork monitoring.

The issue of quality that the question above raises is interesting as none of these products are regulated and therefore properly tested.  Studies have shown that CBD products may have no CBD at all!  They also may contain THC even though that is illegal.  They also have been shown to contain contaminants like heavy metals and pesticides that are harmful to people.  Shockingly, such products occasionally contain adulterants (things added on-purpose) like benzodiazepines or opioids.  Until CBD is properly regulated and tested, we just can’t be sure we’re not getting poisoned.

Worse, we’ve now seen companies faking their own safety analyses – so we can’t even rely on testing by the product manufacturers.

The idea that “full spectrum” products are superior to isolate (pure CBD) or intermediate “spectrum” products also remains to be proven.  The whole concept of the Entourage Effect, that everyone seems to accept as gospel, is just a theory and while supported by lots of observation, remains to be proven.

As a side-note, there is only one way to prove these points.  We need large, placebo-controlled, randomized trials.  Why don’t we have them?  The federal government continues to willfully neglect the data that we do have that conclusively shows that cannabis and cannabinoids DO have medical utility.  In maintaining this posture, the feds effectively block the progress of science and medicine by making doing such studies impractical and by withholding necessary funding.  If this upsets you, as it does me, please donate to the Association of Cannabinoid Specialists who are fighting daily to move the science and practice of cannabinoid medicine forward on Capitol Hill.  cannaspecialists.org/donate 

In the end, I come back to, and stand by, my statement that I am pro-patient.  CBD may be all that, or not.  It doesn’t matter to me.  What matters is that we find out!  And then use it appropriately based on the science.

We, at inhaleMD, take the evidence-based science of cannabinoid medicine very seriously. We are able to synthesize current literature in the best interest of our patients. Hopefully this blogpost has served to express why DIY-ing one’s health care is not in their best interest. Should you wish to learn more, please contact us 617-477-8886. We would be happy to become a part of your treatment team.

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