Not
that long ago, I would not have been able to tell you what the acronym
“CBD” stood for, let alone what it was used for. CBD, or cannabidiol, is
most commonly extracted from hemp, but it can also come from marijuana
plants, which is why it is sometimes confused with its trippy chemical
cousin THC. Unlike CBD, THC produces a high when smoked or eaten.
Today, we are living in a CBD world, with tinctures, ointments and vaping oils popping up everywhere. Celebrities from Gwyneth Paltrow to Willie Nelson are CBD believers, and if you frequent the right coffee shops, you can even get a shot of cannabidiol in your latte.
In
my small North Carolina town, a flier at the local convenience store
exhorts me to “experience the phenomenon” of CBD products, promising it
can provide “relief from” diabetes, alcoholism, schizophrenia, back and
knee pain, and other conditions.
“Everybody who buys the product comes back and raves about it — including my mother,” the enthusiastic checkout clerk says.
And, I must add, including me.
I
am now taking a CBD tincture daily. After all the hype, I wanted to see
whether it might have a positive impact on my lifelong struggle against
depression. (To be clear, the tincture I use is based on hemp-derived
CBD, which contains less than 0.3 percent THC, which is short for
tetrahydrocannabinol. That’s not enough to get high even if I drank the
entire bottle, several experts explained.)
Despite
the growing popularity of CBD, the science supporting the claims
remains pretty slim at this point. So why so much interest in a
substance researchers still know so little about? I’d say hype, hope and
big bucks. To date, the Food and Drug Administration has approved only one drug containing CBD, Epidiolex,
for previously uncontrollable pediatric seizures. (To get the FDA’s
okay, a new drug must be rigorously studied in clinical trials.)
The Hemp Business Journal estimates that the hemp CBD market totaled $190 million last year in a category that didn’t exist five years ago.
By 2022, the Brightfield Group,
a cannabis and CBD market research firm, says sales are expected to
reach $22 billion. The December passage of the 2018 farm bill will
certainly help; the measure amended the term “marihuana” to exempt hemp
as a controlled substance as long as it contains no more than 0.3 percent THC. Laura Freeman,
chief executive of Homestead Alternatives, a Kentucky maker of CBD
products, told me that “this is the first bright spot we’ve had in
farming in a long time.
We finally have a crop that has potential.”
With that kind of enthusiasm, as one CBD-user asked me, “What’s the harm?”
That’s
an excellent question, says Donald Abrams, an oncologist and professor
of clinical medicine at the University of California at San Francisco.
In fact, he says, “we really don’t know anything” about CBDs.
Abrams is a member of a National Academies of Sciences, Engineering and Medicine committee that issued the most comprehensive report to date on the evidence related to the health benefits of cannabis and cannabinoids.
That
report did not include hemp-based CBD; it covered only CBD products
that included THC derived from marijuana, also known as medical
marijuana. (Remember: it’s the THC that makes users high and it’s why
medical marijuana is still illegal in many states.) Abrams says,
however, that in vitro and animal studies do suggest many potential
therapeutic applications for hemp-based CBD.
Several
studies have found CBD to be harmless, which is to say safe, but that’s
very different from proving its effectiveness. Abrams told me there
have been only five randomized clinical trials that have looked at CBD,
until the Epidiolex studies. The largest of those studies was a 24-person trial.
Yep, that’s small.
Even
if there were more evidence that CBD works wonders, we would still have
the question of what CBD-based products actually contain.
Not
all states require CBD manufacturers to accurately label their
products. With scant regulation, consumers should be skeptical. The
source matters, too, since heavy metals or other contaminants have been
found in some hemp grown in China or Eastern Europe.
“People
who are buying them on Amazon, or at their local health food store, are
really working without a [safety] net,” says Michael Backes, author of
“Cannabis Pharmacy: The Practical Guide to Medical Marijuana.”
In
a 2017 study, Marcel Bonn-Miller, an adjunct assistant professor in the
psychiatry department at the University of Pennsylvania’s Perelman
School of Medicine, said his team found that nearly 70 percent of CBD products they analyzedwere mislabeled.
About
40 percent of the 84 items were “under-labeled,” meaning they had
significantly more CBD than indicated. In addition, approximately a
quarter were “over-labeled,” meaning consumers not only are paying good
money for an ingredient they are not getting but also may not be getting
a large enough dose to achieve any potential therapeutic benefit. More
concerning, Bonn-Miller says, is that some CBD products may contain THC
in amounts that could make you intoxicated or impaired
Yikes
— users could inadvertently drive under the influence, test positive on
a workplace drug screen or experience what Bonn-Miller calls “a number
of negative consequences, ranging from addiction to cognitive
impairment, anxiety — particularly at high doses — and risk of
psychosis.”
Speaking of doses, just what is the right amount?
The
“recommended serving size” on my bottle of CBD tincture is 1 milliliter
a day. I think I speak for most consumers when I say serving size is
the way to measure chocolates, not medicines. But the FDA won’t allow
CBD producers to make any marketing claims — which includes recommended
doses. Other brands may recommend a greater or smaller daily dose
because doses aren’t standardized and because CBD products come in
different strengths. As Abrams told me, it’s really “the wild west” out
there.
Despite these concerns, Ziva Cooper, an
associate professor of clinical neurobiology at Columbia University’s
Irving Medical Center, who is doing research with CBD, says “based on
animal studies, there seems to be a lot of promise for a number of
disease states,” including its potential effects on inflammation, which
could make it effective against multiple sclerosis, autoimmune disorders
and addiction. More important, she told me, CBD may be therapeutic for
“ailments for which there aren’t necessarily great medicines” — such as
those pediatric seizure disorders and many others.
About
three months ago, I added a CBD tincture to the selective serotonin
reuptake inhibitor medication I take for depression. My
psychopharmacologist told me there was no specific contraindication or
reason against taking both, but stressed that there’s no data on how the
two behave together. There are some known contraindications with other
medications, including Warfarin, codeine and oxycodone, but not SSRIs.
“It’s not that there’s no contraindication,” Cooper said.
“We just don’t
know.”
Taking
Bonn-Miller’s advice, I found the batch number on the bottle of my
tincture and called the manufacturer in Kentucky to verify what’s in it.
Fortunately, the label was exactly on the mark in terms of CBD content.
The testing lab also confirmed there were no heavy metals in my
product.
I hope that reputable makers would be honest about lab analyses
of what’s in their CBD products, but, if not, how would we know? The
answer: we wouldn’t.
Since I’ve been using CBD,
my mood has been significantly elevated and stable, although I
understand my experience proves nothing. The placebo effect can be strong,
especially for health symptoms modulated by the brain. Cooper
encouraged me to continue talking with my doctor because “these powerful
stories, as well as evidence from preclinical or animal studies, help
drive the basis for rigorous studies.”
Such
rigor is what’s needed to prove — or disprove — the anecdotal
information about CBD.
A market this size, with such enormous health
consequences, should be based on more than hype and hope.
No comments:
Post a Comment