In the meantime, some physicians are forging ahead — and cashing in. Joe Cohen is a doctor at Holos Health, a medical marijuana clinic in Boulder. I asked him what CBD is good for, and he read me a long list of conditions: pain, inflammation, nausea, vomiting, intestinal cramping, anxiety, psychosis, muscle spasms, hyperactive immune systems, nervous system degeneration, elevated blood sugar and more. He also claimed that CBD has anti-cancer properties and can regenerate brain cells and reduce the brain’s levels of amyloid beta — a kind of protein that’s been linked to Alzheimer’s disease. I asked for references, noting that most of these weren’t listed in the Academies report or a similar review published in the Journal of the American Medical Association. “I think you just have to Google search it,” he said. It’s true that a preliminary study found hints that cannabinoids might reduce beta amyloid proteins in human brain cells, but the study was done in cells grown in a lab, not in people. As for cancer, the FDA sent warning letters last year to four companies that were selling products that claimed to “prevent, diagnose, treat or cure” cancer.
Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.
But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about. After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.
Cooper recently got funding from the National Institutes of Health for a study looking at cannabinoids — including CBD in isolation — as a substitute for opioids, and numerous other 2 come from products that contain THC as well as CBD, Cooper said, but we need to do more studies to find out for sure whether CBD has fewer risks. Studies are also needed to identify the best way to administer and dose CBD. “I get emails from people asking me what dose of CBD to use, and the truth is, we really don’t know,” Cooper said.
Donald Abrams was a member of the committee that reviewed the evidence that went into producing the report, and he said that the studies they reviewed overwhelmingly used pharmaceutically available preparations that contain THC, including dronabinol, nabilone and the whole-plant extract spray nabiximols, which contains equal parts CBD and THC. It’s impossible to know whether the benefits of cannabis can also be obtained from CBD alone, Abrams said, because CBD is just one of 400 chemicals present in the plant. So far, CBD in isolation has been studied in only a handful of randomized, placebo-controlled trials (considered the gold standard of evidence in medical research), and the evidence remains sparse.
Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question. What is clear, at this point, is that the marketing has gotten way ahead of the science.
Still, as the saying goes, absence of evidence isn’t necessarily evidence of absence, and there’s a reason we don’t have a ton of solid research on CBDs yet — “to study it, we need a good source, ” said Ziva Cooper, who is an associate professor at Columbia University and was on the National Academies committee. CBD is hard to get because it’s still technically a Schedule I drug, which limits its availability, Cooper said.
So is it possible that despite all this anecdotal evidence, low-dose CBD is a placebo? Sure, because, say it with me: We don’t know anything about CBD. “Unfortunately,” says Baron, “we are nowhere near close to having any definitive trials on effectiveness for most symptoms claimed to benefit from CBD with trials that are scientifically relevant, such as prospective randomized placebo-controlled trials.”
Dez, a Middle Eastern restaurant in New York City, offers soft-serve ice cream topped with CBD-infused olive oil. Dez
Roocroft explained his company’s low dose by saying, “Everyone’s different, so when it comes to microdosing, they can control their cup of coffee, which is a 6-ounce serving per brew.” He’s not the only person I talked to who used the term “microdosing.” Blessing says he’s misusing the term. Microdosing means using very small amounts of very powerful drugs; sometimes, this can have extremely mild or even totally different effects from what is considered a full dose. But the key is microdosing still has a provable effect.
The dosages in consumer CBD products are very low
Research and regulation of cannabis in general is decades behind other crops and drugs because of its long prohibition. We’re in the early stages of a chaos period that will last a decade at minimum — a substance has to be legal in order for scientists to figure out how it works and for the government to figure out how to ensure it’s safe. Clinical trials take years to complete and will have to build on each other to create a competent understanding. Coupled with modern technology’s ability to disseminate truths, half-truths, and complete lies, this means we’re in a phase ripe for scams, intentional and not.
The Alchemist’s Kitchen and Clover Grocery are high-end stores that cheerfully tell customers where they source their products from and only stock brands with similarly transparent sourcing. This CBD usually comes from cannabis plants farmed in Colorado or Oregon, or, increasingly, states not normally associated with the cannabis trade. EarthE CBD, a prominent online seller of CBD products, for example, sources from local farms in New Jersey; it also publishes lab results on its website showing that its products have been tested to have no THC and the amount of CBD the company says they should have.
Despite this, CBD is something nobody knows much about, and certainly nobody is monitoring it properly. CBD is widely marketed as a supplement, despite the Food and Drug Administration saying it does not qualify as such (this is because it is an active ingredient in drugs which are either approved or under investigation to be approved). According to the FDA, the 2018 farm bill “preserved the agency’s current authority to regulate products containing cannabis or cannabis-derived compounds,” though the agency has largely ignored CBD up until now. On the FDA’s FAQ page, a vague answer maintains there are “many factors in deciding whether or not to initiate an enforcement action”; the agency plans to hold a public meeting and generally fact-gather “in the near future.” The Department of Agriculture handles research grants and pilot programs for hemp, but that’s where its involvement ends.
Blessing also notes that in lower doses, like 5 mg or even less, THC does about the same thing that CBD does in very high doses: lightly stimulates that CB1 receptor. It is not impossible that if you’re actually feeling something from a CBD supplement, it’s because that supplement contains some THC. Or who knows what else!