SAN DIEGO—Cannabidiol (CBD) has quickly entered the mainstream, but there is a dearth of evidence about the effects of the cannabis byproduct, a speaker told a large audience at Psych Congress 2019. The vast majority of attendees said they have patients who are using CBD.
Psych Congress Steering Committee member Andrew Penn, MS, NP, PMHNP-BC, said there is a lot of anecdotal data about CBD, some forms of which became legal under the 2018 Farm Bill, but very little clinical trial data.
“In the absence of information, we have stories. Stories are sometimes helpful, sometimes they’re misleading,” said Penn, Associate Clinical Professor, School of Nursing, University of California, San Francisco. “There may be benefit. We don’t know.”
Penn reviewed the history of cannabis, through the relaxation of cannabis laws in the last 10 to 15 years and the US Food and Drug Administration’s first approval of a cannabis product, in 2018 . He said 33 states now have some degree of legalization.
As cannabis has become more mainstream, a common perception has developed that CBD is “the good guy” and 9-tetrahydrocannabinol (THC) is “the bad guy.” The truth is far more complicated than that, Penn said, noting that 554 different compounds have been identified in the cannabis plant and 113 of those are cannabinoids.
One reason for the misconception is that THC has more intoxicating properties. Penn said. “CBD may not be intoxicating, but it certainly has psychoactive properties.” As for safety, he said it seems reasonable to say CBD is relatively safe.
CBD is being used or studied for several mental health conditions, Penn said, including anxiety, post-traumatic stress disorder, depression, sleep, and autism. Nearly 100 clinical trials are going on or planned.
“The reality is we have to practice in an environment where we don’t have a whole lot of data,” he said. “Until those studies are done, our patients are going to keep using this drug.”
The speaker offered several recommendations for clinicians with patients interested in or using CBD:
• Don’t view CBD as an “either-or” with other medications; consider combining it with other treatments.
• Encourage patients to obtain CBD from a reputable source, titrate slowly, and keep records of how it affects them.
• Avoid products with high amounts of THC, which Penn said he has seen cause a lot of a problems.
• Use an oral form rather than inhaling it to avoid respiratory irritation.
• Do not exceed .25 mg/kg a day for oral doses.
He likened the current guidance around CBD to the guidance for vitamins and supplements, which can make only vague claims about health benefits.
“We’re really in this in-between place,” he said. “We’re not really sure where this is going.”
“Confused about cannabidiol (CBD)? A scientific and rational examination of its risks and benefits in psychiatry.” Presented at Psych Congress 2019: San Diego, CA; October 4, 2019.