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With So Many Unknowns, We’re Not Sold on CBD

A look into the substance with big promises, little research, and no regulation.

Source: shutterstock

It is getting increasingly difficult to drive down any main street of an American city without seeing a sign promoting Cannabidiol (CBD). Sellers are touting the potential for better health and pain relief, presenting CBD as a remedy for a wide range of medical conditions.

Forbes recently reported the CBD industry could achieve sales of $20 billion by 2024. A 2019 Gallup poll found one in seven Americans use CBD to treat anxiety, sleep, and pain problems. Google searches show millions of people seeking information on the benefits of CBD oil.

CBD is here and widely accessible, but before you buy into the hype, it’s important to consider the implications for your health and the public at large. Little medical research exists to support the efficacy of CBD use in treating the wide array of medical concerns claimed by broad-brush advertisements.

CBD is one of the active ingredients in marijuana, although CBD is not known to lead to dependence or a euphoric high. Some research supports CBD in the treatment of seizure disorders when used as an alternative for patients who do not respond well to anti-seizure medications. Available as the prescription drug, Epidiolex, CBD is FDA-approved for two rare forms of childhood epilepsy, Lennox-Gastaut and Dravet syndromes. CBD has rumored benefits for sleep disorders, anxiety, posttraumatic stress disorders, and chronic pain, but research is limited, so caution is advised.

The void of high-quality CBD research prevents clinicians from recommending evidence-based treatment strategies for people suffering from many debilitating conditions. Without scientific studies, each person using CBD is participating in an ad hoc, unsupervised research trial. Fortunately, the federal government recently allocated $3 million to study the health benefits of CBD. Until there is enough data, consumers should be aware of key safety considerations:

  • Purity. A major concern with CBD is the unknown purity and safety of a wide array of product forms. The Food and Drug Administration (FDA) does not regulate CBD; therefore, it is not possible to know the safety or effectiveness of what you are taking. In 2019, The Mayo Clinic warned there are no rigorous safety studies on “full-spectrum” CBD oils, oils that contain not only Cannabidiol but the more than 100 kinds of cannabinoids found in the hemp plant in nature. Legally, CBD must contain less than 0.3% Tetrahydrocannabinol (THC). In 2017, Penn Medicine found 1 in 5 products sold online contained 6.4 mg/ML of THC (an amount high enough to cause impairment).
  • Adverse Effects. A 2019 study by Ewing and colleagues found possible liver damage in people using CBD and raised concerns about potential drug interactions. Research does indicate people taking CBD can experience nausea, diarrhea, and interaction with blood thinners. Because of a lack of oversight and regulation, people taking CBD may be taking unwanted additional ingredients. In 2017, 52 people in Utah were sickened by counterfeit CBD.
  • Imprecise Dosing. One of the most critical reasons for human research is to understand the delivery method and the correct dosing amount. Local CBD store owners are typically not medical professionals with experience in treating complicated health conditions or factoring in potential medication interactions. The amount each person needs to treat individual symptoms differs, and there are no dosing guidelines to facilitate informed decisions. For the most part, people are guessing on dosages when they apply a gel, lotion, or ingest drops under the tongue.

Weighing the Pros and Cons of CBD

As health care and helping professionals, we are sensitive to helping people cope with physical and mental conditions. Sound, appropriate research arms us with innovative approaches and supporting information to help people heal from debilitating conditions. For some, it is difficult to wait for this type of research, and they maintain the possible benefits of CBD outweigh the risks of using it. If you are considering taking CBD, be proactive:

  • Talk to your doctor about using CBD oil. Discuss possible side-effects and conflicts with your current medications. Work with a physician and speak openly about the use of CBD.
  • Know exactly what you are taking before starting CBD use. Ask for a certificate from the store and insist on seeing the specific list of ingredients. Ask if the product has been tested by a third party and has a quality assurance stamp.
  • Pay close attention to how your body responds and to side-effects and discuss them with your doctor. With the medical community’s concerns about potential interactions with medications and possible liver problems, be vigilant in attending to any side-effects.
  • Do not give CBD to children or adolescents without a clear treatment plan from a physician.
  • Continue to learn about CBD and pay attention to new research from recognized sources.
  • Advocate for new research initiatives to better study the possible health benefits of CBD.

About the Author: John O’Neill, EdD, LCSW, LCDC, CSAT directs the outpatient programs at Menninger’s Outpatient Services' location in Bellaire, Texas, where he oversees the practice’s interdisciplinary team approach to assessment and treatment. He is a licensed clinical social worker and chemical dependency counselor whose specialties include substance use; gambling problems; the impact of addictions on professionals, including athletes; sexual compulsivity; and emotional stressors for executives and high-functioning professionals.

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