Does it seem like everywhere you turn there are stores, friends and articles promoting cannabidiol (CBD)?
In the last few weeks I had a friend ask if it would be good for his arthritis because his pharmacist friend said it helped him. Others have told me it had done wonders for their dogs.
CVS is now carrying CBD
products (creams, sprays and lotions) from Curaleaf Holdings in 800 stores in
eight states (Alabama,
California, Colorado, Illinois, Indiana, Kentucky, Maryland and
Tennessee). Walgreens
is following CVS’s lead and will sell CBD infused products in 1,500 stores in
nine states (Oregon,
Colorado, New Mexico, Kentucky, Tennessee, Vermont, South Carolina, Illinois
and Indiana).
Even
the New York Times Magazine ran an
article a few weeks ago Can CBD Really Do All That? How one molecule from the cannabis plant came to be seen as a therapeutic cure-all.
The FDA held its first public hearing on CBD
to help to better regulate CBD products this past week. The take home message
from the hearing appears to be the public wants CBD products and too many
manufacturers are delivering shoddy goods.
5 Take aways From the FDA’s Hearings on CBD.
So is there science to back
up the hype?
What is CBD?
The second most active
ingredients of cannabis (marijuana), it is derived from the hemp plant and it
does not cause a “high.” CBD can have no more than 0.3% THC (tetrahydrocannabinol the active ingredient in cannabis), while medical
marijuana oil may contain up to 5%.
In the late 19th
century, cannabis was an important component of British and American
physicians’ pharmacopoeia. It’s suspected that the cannabis of this era, and
the tinctures made from them, probably contained much more CBD than modern varieties.
Are there proven health benefits?
CBD has been shown to treat
some severe childhood epilepsy syndromes. The FDA has approved the first
cannabis derived drug for this condition, Epidiolex, which contains CBD.
A
double-blind placebo-controlled study published on May 21, 2019 in the American Journal of Psychiatry demonstrated that Epidiolex can reduce cue-induced craving in individuals that
had been former heroin users. Furthermore, in these individuals, the drug
reduced reports of anxiety, and blood levels of cortisol, a hormone known to
increase under conditions of stress and anxiety.
Zynebra
Pharmaceuticals recently tested a topical CBD product for osteoarthritis knee pain
with mixed results. The Phase 2 clinical study did not meet its primary
endpoint of reducing the average pain score, although there were some
indications it improved function and reduced pain severity.
A small clinical trial of CBD for Crohn’s disease
in Israel in 2017 was also negative, finding “CBD was safe but had no
beneficial effects.”
A recent review of studies on CBD
oil and other forms of cannabis for the management of neurologic disorders was
more positive, finding “there is strongest evidence to indicate benefits in
treatment of spasticity and neuropathic pain in multiple sclerosis.”
Animal studies suggest that
CBD might be beneficial for some conditions including pain, inflammation,
arthritis and anxiety. Note that there is a big difference between animal
studies and clinical trials on humans. Some organizations and promoters of CBD
refer to “studies” without noting these involved animals. This is the case for
Does CBD Oil Really Help Treat Arthritis Pain? April 14, 2019 from the
Rheumatoid Arthritis Support Network
There is a growing body of scientific literature critically
assessing the validity of animal experimentation and raises important concerns
about its reliability and predictive value for human outcomes and for
understanding human physiology. In short, just because it worked in an animal
model doesn’t mean it will be equally successful in humans.
However, there are studies
underway where CBD is being evaluated for a range of conditions including:
addiction, Parkinson’s Disease, schizophrenia, diabetes, MS, autism, cancer,
graft-host disease, anxiety and more.
If you are wondering how one
product could be such a miracle cure, the author of the recent NY Times Magazine article asked the same question.
How could
one family of molecules help so many maladies? The most obvious response is
that they might not; all this research is preliminary and might not pan out.
But scientists often propose a counter-explanation: Many chronic disorders,
even though they seem distinct, are characterized by dysfunction in the same
few pathways. Inflammation and oxidative stress, for example, occur in
schizophrenia, metabolic disorders, heart disease and other ailments..... There
are other examples of a single drug being able to help meliorate a variety of
conditions. We know aspirin as a treatment for fever and headache, for example,
but in low doses it is also used to reduce the risks of stroke, heart attack
and pre-eclampsia in pregnant mothers; it even figures as an adjunct treatment
for schizophrenia. Aspirin has its own downsides — an elevated risk of
bleeding, for instance — but like CBD, its broad utility may be partly
explained by its anti-inflammatory effects. New York Times
Risks?
Though
it's often well-tolerated, CBD can cause side effects, such as dry mouth,
diarrhea, reduced appetite, drowsiness, difficulty with sleep, weight loss,
stomach pain or discomfort, drooling or excessive saliva, problems with walking
and fatigue.
CBD
can also interact with other medications, primarily those that are changed or
broken down by the liver. Medline lists a number of drugs that can interact
with CBD including: blood thinners, codeine, Paxil, ibuprofen, Celebrex,
Elavil, Prevacid, Valium Priolosec, testosterone, Allegra, morphine and various
other drugs, plus possibly caffeine, nicotine, vitamins and nutrional
supplements
In
addition there are legal issues in some states, but most importantly is the
quality control of the product itself. In 2015, the FDA found that many CBD
labeled products, actually contained very little CBD. Two years later, a study
published in JAMA documented that in 84 products sold online, 26% had less CBD than
advertised and 43% had more. As noted above, this was a major issue discussed at yesterday's FDA hearing on CBD.
A
significant safety concern with CBD is that it is primarily marketed and sold
as a supplement, not a medication, which means it’s not regulated by the FDA.
In addition to not knowing therapeutic doses for various conditions, it’s
difficult to know exactly how much CBD you are actually getting in a product
and if there are additives that could be problematic.
Legality
The 2018
Farm Bill was signed into law in December 2018, effectively
legalizing hemp at the federal level by removing it from the federal list of
controlled substances and classifying it as an agricultural commodity. As a
result, CBD from hemp is legal nationwide
at the federal level.
Just
this week the Transportation Security Administration has changed its cannabis
policy to allow passengers to travel with Epidiolex, the FDA version of CBD
that is used to treat epilepsy in children, as well as some CBD oil, "as
long as it is produced within the regulations defined by the law" under
the 2018 Farm Bill, which legalized hemp and hemp derivatives. The TSA's new
rules still ban other forms of marijuana, including CBD oils that have THC, and
cannabis-infused products that are still illegal under federal law.
All
50 states have laws legalizing CBD with varying degrees of restriction. You will need to do the research to see how it applies to the state you live in.
Considering CBD?
Be aware that wild claims,
such as an effective cancer treatment, are just plain bogus. While more
research is needed in humans, there are indications that CBD may be a useful
treatment for managing anxiety, insomnia and chronic pain. That said, science
needs to be the driving force behind new treatments, not a marketing campaign.
People with chronic conditions are often targeted by marketers, so buyer be
ware.
Before trying CBD, it’s
imperative that you talk to your medical provider in order to understand drug
interactions with current treatment regiments. Talk with them about dosing and
the most reliable source possible for purchasing CBD. Finally, there are CBD clinical trials that are open and seeking patients. Check https://clinicaltrials.gov to see if you qualify.
Further Reading
Cannabidiol (CBD)-What we Know and What we Don’t. Harvard Health Publishing
Cab CBD Really Do All That? How one molecule from the cannabis plant came to be seen as a therapeutic cure-all. New York Times Magazine May 12, 2019
No comments:
Post a Comment