With respect to safety and adverse effects, topical products may be safer than ingested ones as the common side effects of somnolence and diarrhea are more common in users ingesting the product. It should be used with caution in patients taking anti-seizure medications. Any patient who is taking multiple medications should be aware of potential for drug-drug interactions and should seek the advice of a knowledgeable pharmacist or physician.
By contrast, CBD is not psychoactive, and works through a wide range of other mechanisms of which scientists have conclusively identified only a few. CBD is the second most abundant of the 107 different non-THC cannabinoids (of which only six are psychoactive).
So, while CBD is widely available over the counter, the quality of these unregulated projects is a concern. It is important to know where and how the hemp was raised, if the preparations are tested by an independent lab for consistency of dose and purity from contaminants. Also, considering current epidemic of vaping induced lung injury having some association with THC and CBD oils, vaping or inhaling of CBD should be avoided.
Uses for CBD
Both are plants of the same species, cannabis sativa, but hemp is a subspecies with much lower concentrations of THC. Hemp typically contains less than 0.3% THC and has 3-4% CBD, compared with marijuana which often has THC contents higher than 10%, with less than 1% CBD.
CBD oil is only starting to be robustly studied. Currently PubMed lists only 22 completed clinicals trials of CBD, for a wide range of conditions, such as anxiety, psychosis, movement disorders, PTSD, palliative care uses, substance use disorders, as well as diabetes, Crohn’s, ocular HTN, fatty liver disease, chronic pain. The studies to date have all been small and of low (and very low) quality. Current evidence shows it may provide some relief of anxiety, psychosis, sleep, PTSD, and substance use disorders, but the effect size is small and the results to date are less than overwhelming. Looking forward however, a search of clinicaltrials.gov in October 2019, showed 164 human clinical interventional trials are currently registered and underway for the above listed and many other conditions, most of them for pain or inflammation.
Other than the prescription form Epidiolex, CBD is not FDA approved for any clinical uses and is considered a dietary or herbal product. Therefore, there is no regulation of its extraction from hemp nor its formulation into it various forms, which include oils for ingestion (tincture and capsules), topical balms and formulations for vaping. An alarming 2017 study in JAMA showed that only 30% of the CBD preparations available online were accurately labelled as to how much CBD they contained. The other 70% were divided equally between those that were under-labeled and those over-labeled. Even more alarming, however, was that 21% contained THC — many with enough THC to cause a positive urine drug screen for marijuana. The presence of heavy metals and pesticides in less quality preparations have also been noted.
Many physicians and pharmacists are using CBD with reported success, including pain specialists, orthopedic surgeons, sports medicine physicians, as well as primary care providers. Topical preparations are very commonly used for musculoskeletal or inflammatory pain and reportedly have an effect for 2-3 hours. The ingested oil preparations have been used for pain, sleep and anxiety with some individually reported success. There are even preparations available for the use in hyperactive or anxious pets!
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Will these trends change your life — or
Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.
Does CBD work?
A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. “Over all, we did not find that it panned out as a useful treatment for sleep,” said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.
Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are looking for new treatments for sleep, that may be a clue,” he said.
Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor at the University of São Paulo in Brazil, in an email interview. Of course, it’s difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.
Earlier research found fewer than a third of 84 products studied contained the amount of CBD on their labels. Some users of CBD have also failed drug tests when the product contained more THC than indicated.