Women Increasingly Turn to CBD, With or Without Doc’s Blessing
When 42-year-old Danielle Simone Brand started having hormonal migraines, she first turned to cannabidiol (CBD) oil, eventually adding an occasional pull on a prefilled Δ-9-tetrahydrocannabinol (THC) vape for nighttime use. She was careful to avoid THC during work hours. A parenting and cannabis writer, Brand had more than a cursory background in cannabinoid medicine and had spent time at her local California dispensary discussing various cannabinoid components that might help alleviate her pain.
A self-professed “do-it-yourselfer,” Brand continues to use cannabinoids for her monthly headaches, forgoing any other pain medication. “There are times for conventional medicine in partnership with your doctor, but when it comes to health and wellness, women should be empowered to make decisions and self-experiment,” she told Medscape Medical News.
Brand is not alone. Significant numbers of women are replacing or supplementing prescription medications with cannabinoids, often without consulting their primary care physician, ob/gyn, or other specialist. At times, women have tried to have these conversations, only to be met with silence or worse.
Take Linda Fuller, a 58-year-old yoga instructor from Long Island who says that she uses CBD and THC for chronic sacroiliac pain after a car accident and to alleviate stress-triggered eczema flares. “I’ve had doctors turn their backs on me; I’ve had nurse practitioners walk out on me in the middle of a sentence,” she told Medscape Medical News.
Fuller says her conversion to cannabinoid medicine is relatively new; she never used cannabis recreationally before her accident but now considers it a gift. She doesn’t keep aspirin in the house and refused pain medication immediately after she injured her back.
Diana Krach, a 34-year-old writer from Maryland, says she’s encountered roadblocks about her decision to use cannabinoids for endometriosis and for pain from Crohn’s disease. When she tried to discuss her CBD use with a gastroenterologist, he interrupted her: “Whatever pot you’re smoking isn’t going to work, you’re going on biologics,” he told her.
Krach had not been smoking anything but had turned to a CBD tincture for symptom relief after prescription pain medications failed to help.
Brand, Fuller, and Krach are the tip of the iceberg when it comes to women seeking symptom relief outside the medicine cabinet. A recent survey in the Journal of Women’s Health of almost 1000 women show that 90% (most between the ages of 35 and 44) had used cannabis and would consider using it to treat gynecologic pain. Roughly 80% said they would consider using it for procedure-related pain or other conditions. Additionally, women have reported using cannabinoids for posttraumatic stress disorder, sleep disturbances or insomnia, anxiety, and migraine headaches.
Observational survey data have likewise shown that 80% of women with advanced or recurrent gynecologic malignancies who were prescribed cannabis reported that it was equivalent or superior to other medications for relieving pain, neuropathy, nausea, insomnia, decreased appetite, and anxiety.
In another survey, almost half (45%) of women with gynecologic malignancies who used nonprescribed cannabis for the same symptoms reported that they had reduced their use of prescription narcotics after initiating use of cannabis.
The Gray Zone
There has been a surge in self-reported cannabis use among pregnant women in particular. The National Survey on Drug Use and Health findings for the periods 2002–2003 and 2016–2017 highlight increases in adjusted prevalence rates from 3.4% to 7% in past-month use among pregnant women overall and from 5.7% to 12.1% during the first trimester alone.
“The more that you talk to pregnant women, the more that you realize that a lot are using cannabinoids for something that is basically medicinal, for sleep, for anxiety, or for nausea,” Katrina Mark, MD, an ob/gyn and associate professor of medicine at the University of Maryland, in College Park, Maryland, told Medscape Medical News. “I’m not saying it’s fine to use drugs in pregnancy, but it is a grayer conversation than a lot of colleagues want to believe. Telling women to quit seems foolish since the alternative is to be anxious, don’t sleep, don’t eat, or use a medication that also has risks to it.”
One observational study shows that pregnant women themselves are conflicted. Although the majority believe that cannabis is “natural” and “safe” compared with prescription drugs, they aren’t entirely in the dark about potential risks. They often express frustration with practitioners’ responses when these topics are broached during office visits. An observational survey among women and practitioners published earlier this year highlights that only half of doctors openly discouraged perinatal cannabis use and that others opted out of the discussion entirely.
This is the experience of many of the women that Medscape Medical News spoke with. Krach pointed out that “there’s a big deficit in listening; the doctor is supposed to be working for our behalf, especially when it comes to reproductive health.”
Mark believes that a lot of the conversation has been clouded by the illegality of the substance but that cannabinoids deserve as much of a fair chance for discussion and consideration as other medicines, which also carry risks in pregnancy. “There’s literally no evidence that it will work in pregnancy [for these symptoms], but there’s no evidence that it doesn’t, either,” she told Medscape Medical News. “When I have this conversation with colleagues who do not share my views, I try to encourage them to look at the actual risks vs the benefits vs the alternatives.”
The “Entourage Effect”
Data supporting cannabinoids have been mostly laboratory-based, case-based, or observational. However, several well-designed (albeit small) trials have demonstrated efficacy for chronic pain conditions, including neuropathic and headache pain, as well as in Crohn’s disease. Most investigators have concluded that dosage is important and that there is a synergistic interaction between compounds (known as the “entourage effect”) that relates to cannabinoid efficacy or lack thereof, as well as possible adverse effects.
In addition to legality issues, the entourage effect is one of the most important factors related to the medical use of cannabinoids. “There are literally thousands of cultivars of cannabis, each with their own phytocannabinoid and terpenic profiles that may produce distinct therapeutic effects, [so] it is misguided to speak of cannabis in monolithic terms. It is like making broad claims about soup,” writes coauthor Samoon Ahmad, MD, in Medical Marijuana: A Clinical Handbook.
Additionally, the role that reproductive hormones play is not entirely understood. Reproductive-aged women appear to be more susceptible to a “telescoping” (gender-related progression to dependence) effect in comparison with men. Ziva Cooper, PhD, director of the UCLA Cannabis Research Initiative, told Medscape Medical News. She explained that research has shown that factors such as the degree of exposure, frequency of use, and menses confound this susceptibility.
It’s the Data.
Frustration over cannabinoid therapeutics abound, especially when it comes to data, legal issues, and lack of training. “The feedback that I hear from providers is that there isn’t enough information; we just don’t know enough about it,” Mark said, “but there is information that we do have, and ignoring it is not beneficial.”
Cooper concurs. Although she readily acknowledges that data from randomized, placebo-controlled trials are mostly lacking, she says, “There are signals in the literature providing evidence for the utility of cannabis and cannabinoids for pain and some other effects.”
Other practitioners told Medscape Medical News that some patients admit to using cannabinoids but that they lack the ample information to guide these patients. By and large, many women equate “natural” with “safe,” and some will experiment on their own to see what works.
Those experiments are not without risk, which is why “it’s just as important for physicians to talk to their patients about cannabis use as it is for patients to be forthcoming about that use,” said Cooper. “It could have implications on their overall health as well as interactions with other drugs that they’re using.”
That balance from a clinical perspective on cannabis is crucial, writes coauthor Kenneth Hill, MD, in Medical Marijuana: A Clinical Handbook. “Without it,” he writes, “the window of opportunity for a patient to accept treatment that she needs may not be open very long.”
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CBD Oil Has Helped My Anxiety More Than Any Other Wellness Trend
In the June 2015 issue of National Geographic, there is an article titled “Science Seeks to Unlock Marijuana Secrets” accompanied by a photo of a little girl sitting on the floor in a frilly pink romper, opening her mouth like a baby bird as her mother gently titrates a small drop of liquid underneath her tongue.
The liquid is cannabidiol (CBD), a non-psychoactive substance found in marijuana. The little girl is Lily Rowland, a seizure patient who suffered hundreds of episodes daily until she started taking CBD. Once she did, her seizures practically vanished.
CBD is one of the two major molecules in marijuana; the other is tetrahydrocannabinol, or THC. Unlike THC, CBD will not get you high but it does have numerous therapeutic properties. According to dozens of studies, it has been known to treat epilepsy, relieve anxiety, reduce symptoms of schizophrenia, act as an anti-inflammatory and even slow certain types of cancer.
It is, in short, a pretty miraculous substance. It also happens to be easy to obtain: CBD derived from hemp, a type of cannabis largely devoid of THC, is legal to distribute nationally, which is how I found myself in possession of a box of Lord Jones All Natural Old Fashioned High CBD Gumdrops, a bottle of Charlotte’s Web Hemp Extract Oil, a bottle of Plant Alchemy Organic Concentrated CBD Oil and an anxious conviction that I should try alleviating my anxiety by using all this stuff.
I’ve struggled with anxiety for as long as I can remember but it’s gotten noticeably worse in the past two years. There are a number of factors to which I could contribute the uptick: I’m in my mid-twenties and therefore struggling with typical quarter life crisis-related insecurities; I live in New York City, which isn’t known for coddling the mental health of its inhabitants; and I work in media, an industry that consumes and thrills in equal measure.
On top of these very plausible considerations, though, I’ve been wondering whether the increasingly prevalent — not to mention lucrative — state of the wellness-industrial complex has played an ironically negative role in the evolution of my wellbeing. Living as an anxious person in the age of Wellness with a capital “W” is unsettling. It’s unsettling to be told that reducing the discomfort of being a person in the world could be as simple as sprinkling a packet of health dust into my morning smoothie. It’s unsettling to read multiple first-hand accounts proclaiming that a gluten-free diet is the key to better skin, tighter abdominal muscles and a clearer mind. It’s unsettling to be steadily seduced by the mythology that “feeling better” by way of a quick fix is not only possible, but common. Above all, it’s unsettling to slap on one of these wellness Band-Aids with the expectation of seeing life-changing results, and still ultimately feel exactly the same.
I’ve come to approach wellness fads with a strange mixture of cynicism and hope: cynicism because I’ve personally lifted the curtain on so many trends only to discover they’ve been standing on air instead of legs; and hope because the trending power of easy relief is too magnificent to ignore. As I opened the box of Lord Jones All Natural Old Fashioned High CBD Gumdrops and placed one in my mouth one night after work, I tasted hope, cynicism and essence of raspberry.
I waited for the gumdrop to dissolve and felt… nothing. I waited a bit more and felt… nothing! Hmm. I considered what I thought taking CBD would feel like. Maybe like a more subtle version of getting high, even though I know CBD isn’t psychoactive. Maybe like drinking a sip of whiskey — a warm blanket unfolding inside my chest. Maybe like taking NyQuil — drowsiness-inducing. I felt none of these things. Eventually I gave up and went to bed.
Each Lord Jones All Natural Old Fashioned High CBD Gumdrop contains 20 mg of CBD, so the next day I did some research to try to determine the efficacy of this amount for treating anxiety. According to Dr. Nick Jikomes, a neuroscientist turned cannabis industry data scientist, finding the correct dosage really depends on the condition you’re trying to treat: “If you’re using CBD for anxiety, there may be that sweet spot, a middle dosage, that has the best effect, and it can become less effective if you increase the dose,” he told Leafly (the “world’s largest cannabis information resource“).
Overall, there is a startling dearth of information online when it comes to exact CBD dosing recommendations, but I found this POPSUGAR primer (featuring expert input from Dr. Michelle Weiner, a pain management specialist; Dr. Sunil Aggarwal, a practitioner at SageMD; and Dr. Jordan Tishler, president of both InhaleMD and the Association of Cannabis Specialists) to be one of the most helpful resources on the topic. Dr. Weiner echoes Dr. Jikomes’ assertion that there is usually a “sweet spot” dosage for each person depending on factors such as weight, biological makeup and specific symptoms. However, Dr. Tishler describes “reasonable and feasible doses” of CBD at around “10-40 milligrams per day” while also going on to cite anti-anxiety studies that indicate positive results when participants take between 800-1,200 milligrams of CBD per day.
In other words: The territory is murky and trial-and-error is not only accepted but encouraged.
Because I’m impatient, I decided to double my dose of CBD the next time I tried it, this time via a dropper full of mint chocolate-flavored Charlotte’s Web Hemp Extract Advanced (43 mg of CBD per 0.5 mL serving) administered under my tongue after a particularly stressful day. Whoosh. I definitely felt… something. Almost immediately. A bodily sensation that was pleasant but not overwhelming, like immersing myself in a hot bath. It evaporated a few seconds later but in its place there remained a faint sense of calm, so subtle I only noticed because I was looking for it, as if someone had asked the hamster that likes to run inexhaustible circles inside my head to slowwwwwww down. It was nice.
I experimented with different doses of CBD over the course of about a month, ultimately settling on 40-45 mg as my personal “sweet spot.” I also experimented with dosing at different times of day (though it doesn’t make me drowsy, I decided I prefer taking it in the evening) and in the midst of different mental states. I found that if I’m super anxious for a specific reason and my hamster wheel is already spinning out of control, CBD doesn’t help much — it’s just a drop in the bucket (pun intended) at that point. Where it does help is when I’m experiencing low-grade, general anxiety, in which case CBD relaxes me just enough to make an appreciable difference, as if I’ve treated my brain to a 10-minute nail salon massage. In terms of combating insomnia, CBD definitely doesn’t put me to sleep (like, at all), but it does lessen the churn of anxious feelings and thoughts that frequently keep me from falling asleep in the first place.
A word on price: Good CBD is expensive. I say “good” because in addition to the fact that 50 pounds of marijuana only produce one kilo of CBD, the industry is still largely unregulated, which means quality can really vary. I did a good bit of investigating, both online and by asking around, before settling on the three brands of CBD I wanted to try. All of them were kind enough to send me samples to test out for the purposes of this story, but given that the individual products clock in at $45 (for nine Lord Jones gumdrops), $149.00 (for 30 mL of Charlotte’s Web’s highest concentration hemp oil) and $150.00 (for 15 mL of The Alchemist’s Kitchen’s lowest concentration CBD oil), they qualify more as a luxury item than an affordable treatment.
That being said, oh boy have they helped. I’ve been taking CBD once a day for about five weeks now and once I officially observed its impact on my anxiety, I haven’t shut up about it. I reached peak evangelist status over the weekend when a friend came over to my apartment complaining of a stress-induced stomachache and I insisted she take two Lord Jones gumdrops on the spot. Despite the cost, I plan to continue purchasing CBD on my own once my free samples run out. I consider it an investment in my mental health.
My initial impulse to lump CBD with wellness gimmicks and transient health fads was rooted in my own lack of knowledge. Even though the “mainstreaming” of cannabis is a recent phenomenon, ancient cultures grew the plant for herbal medicine as far back as 500 BC, long before jade eggs and juice cleanses existed. Now I’m happy to ground CBD in a new, more thoughtful context that encompasses its history as well as its future.
Do you take CBD? If so, what do you take it for? Let’s discuss.
If you’re interested in reading more about the mainstreaming of cannabis, check out this piece by Otegha Uwagba, “Weed Is Trending, But For Whom.”