Is it worth the hype? That depends.
The easing of hemp laws on state and national levels has increased the proliferation of products derived from the cannabis plant.
But the burgeoning cannabidiol (CBD) market has operated largely without oversight.
“This is why we caution all of our patients,” said Jamesetta Lewis, a doctor at the Mercy Medical Center’s Pain Management Center. “There’s no regulatory body out there looking at these products. Period.”
Lewis said about 50% of her patients are trying CBD, some through the state medical program that allows cannabis products to include higher levels of tetrahydrocannabinol (THC). Results have been “highly variable,” she said.
In July, the U.S. Food and Drug Administration announced it is evaluating “regulatory frameworks” for cannabis-derived products. The agency also asserted that it remains illegal to add CBD to food or market it as a dietary supplement or drug.
An FDA Consumer Update stated that “CBD products are still subject to the same laws and requirements as FDA-regulated products that contain any other substance.”
Meanwhile, buyers are tasked with navigating the health and wellness trend.
“It’s all on the buyer to do their own research about what are the better quality products to use,” Lewis said.
The discerning consumer now can choose from more than 1,000 CBD brands, according to the Brightfield Group. In a report released this year, the cannabis consumer and market research firm predicted CBD will be a $5 billion industry be the end of 2019 and a $23.7 billion industry by 2023.
Does CBD get you high? Not by itself. CBD is a chemical compound in cannabis that interacts with biological cannabinoid receptors. Hemp-derived products cannot legally contain more than 0.3 % THC, the plant’s psychoactive compound.
Source: World Health Organization
Is it addictive? Not according to existing research.
Source: World Health Organization
What are the benefits? Clinical trials have shown CBD can reduce seizures in epilepsy patients with Lennox-Gastaut syndrome or Dravet syndrome.
A National Academies of Sciences, Engineering and Medicine committee, which reviewed research since 1999, released a report in 2017 describing the therapeutic effects of cannabis or cannabinoids, which include CBD and THC. The committee found “conclusive or substantial evidence” for treatment of chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis spasticity. There was “moderate evidence” for treatment of sleep disturbances related to obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis. And “limited evidence” for a host of other medical conditions.
Kelsey O’Connor, an interventional spine specialist at OMNI Orthopaedics in Jackson Township, said patients have tried CBD oil, primarily for low back or joint pain that has not responded well to other treatments. When used like a supplement in conjunction with primary treatment and lifestyle changes — not as a “miracle pill” — it’s shown promise in decreasing the intensity and frequency of pain.
“Some people get relief from it. Some people don’t,” O’Connor said.
Lewis also reported mixed results among patients. Some have noticed improvement in pain or sleep but there’s been no consistent success for a particular condition or product.
“So, I haven’t really seen a reduction in medication use on top of the CBD products,” Lewis said.
Sources: Kelsey O’Connor of OMNI Orthopaedics; Jamesetta Lewis of Mercy Pain Management Center; U.S. Food and Drug Administration; the National Academies of Sciences, Engineering and Medicine
Can it cause harm? Generally, CBD is considered safe with little to no adverse reactions.
The clinical trials of the oral CBD solution approved by the FDA — Epidiolex — involved some side effects: lethargy, diarrhea, decreased appetite, elevated liver enzymes, rash, insomnia and infections. It was noted that patients were taking CBD in conjunction with other medications.
O’Connor cautions people about potential drug interactions and negative effects from ingesting too much.
“I have not seen anybody have any sort of allergic or adverse reaction to it,” she said. “But, again, it’s kind of a case-by-case determination that should be made with your physician regarding the starting of any sort of supplemental treatment.”
Similarly, Lewis has not encountered issues related to drug interactions. She has, however, seen psychoactive effects in patients who’ve purchased cheaper products online without clear content labels or third-party testing.
They’ve reported feeling groggy or sedated, and the center’s urine tests have shown THC in their system.
“It’s only detectable if there are large amounts of THC in that product,” Lewis said.
She encourages people to do their “due diligence” and look for third-party testing to ensure they’re getting the CBD that is advertised.
Sources: Kelsey O’Connor of OMNI Orthopaedics; Jamesetta Lewis of Mercy Pain Management Center; U.S. Food and Drug Administration; World Health Organization
Will it appear on a drug test? Media reports indicate that the occurrence would be rare but possible.
“In theory, it should not,” O’Connor said.
Standard urine tests detect the presence of THC in a person’s body, she said. But if a product contains THC — unlisted or in large enough amounts — there’s a chance it could appear on a drug test.
To patients concerned about failing a drug test, O’Connor recommends avoiding CBD because it’s “still kind of a wild card.”
Sources: Kelsey O’Connor of OMNI Orthopaedics; Forbes; Consumer Reports
How much do you need? The recommended starting dose for Epidiolex, the only CBD prescription drug approved by the FDA for severe epilepsy conditions, is 5mg per kilogram a day. The maximum recommended dose is 20mg of per kilogram of weight a day.
Some retail CBD products provide their own dosage guidelines based on weight, but the average consumer won’t find universal guidelines. A common suggestion is to start with a small amount and increase it over time until the desired effect is achieved.
“The dosing is all over the place with CBD products right now,” Lewis said.
She has patients taking anywhere from 100mg to 1,000mg a day. Lewis said it could take three to four months to know whether the CBD is beneficial.
“And have realistic expectations, realistic expectations that it’s not a cure-all for any medical condition,” she said.
Lewis advises patients to weigh the risks against benefits and, if they proceed with CBD, closely monitor their condition.
O’Connor advises her patients to shop at a health food store or place that specializes in herbal supplements and to try CBD for 10 to 14 days. She said price also can influence patients’ choices.
“It’s real easy to quite quickly be paying $20, $30, $40 for a small bottle,” O’Connor said. “And again, because it’s not FDA regulated, we have no kind of quality control to exactly know the purity and the actual percentage of what is in that oil or supplement that’s actually the CBD compound.”
The FDA has warned companies that claim their unapproved CBD products treat serious diseases. The agency also tested products on the market and found that many didn’t contain the amount of CBD advertised.
Both physicians said they treat CBD like vitamins and supplements, for which a definitive dose is difficult to recommend.
Sources: Jamesetta Lewis of Mercy Pain Management Center; Kelsey O’Connor of OMNI Orthopaedics; U.S. Food and Drug Administration
Reach Kelly at 330-580-8323 or firstname.lastname@example.org
On Twitter: @kbyerREP