Is CBD a Cure-All?
No single compound expanded its market in 2019 quite like CBD did. This cannabinoid owns the year’s bragging rights for new-product diversity, after finding its way into water, lattes, jellybeans, hummus, cosmetics and even doggie treats.
CBD, or cannabidiol, is one of dozens of biologically active ingredients called cannabinoids created by Cannabis sativa plants. CBD only recently earned the most-popular-cannabinoid title — for decades, the crown more likely belonged to THC, the euphoria-inducing compound in marijuana. But not all C. sativa plants contain much THC: Those that do are considered marijuana, while those that don’t are called hemp. Now, the Farm Bill of 2018 has made growing hemp as mainstream as farming corn and soybeans, as long as derivative products contain no more than 0.3 percent THC. The bill also spells out federal regulations on cultivating and producing hemp. And more hemp means more CBD.
Currently, the only FDA-approved CBD-based drug is Epidiolex, which treats seizures from rare types of epilepsy. A study published in May found that synthetic versions of CBD may also work on seizures, based on preliminary studies in rats. What’s more, researchers announced in June that CBD might even work as an antibiotic.
But these results are still preliminary. The FDA has not approved any uses of CBD in food, beverages or dietary supplements — meaning it’s currently illegal for any companies to claim CBD has medical or therapeutic benefits. Outside of these uses, CBD is not federally regulated, so products available to the public can be all over the place in their claims. In September, the Federal Trade Commission sent letters to three companies selling CBD-infused products including oils, capsules and gummies, warning them it was illegal to make health claims without “competent and reliable” evidence.
Despite the lack of proof, some people are turning to CBD as a way to self-treat symptoms like anxiety and pain, sometimes as an alternative to opioids. In 2019, big-name stores like Sephora, Walgreens and CVS started selling products containing CBD, and celebrities started announcing product endorsements.
“CBD is perceived as safe and attractive and is gaining widespread use,” says Simon Haroutounian, chief of clinical pain research at the Washington University Pain Center in St. Louis. But even though the market is booming, the quality of human research is spotty, he says.
Researchers still don’t know how CBD works in terms of enzymatic pathways — that is, how the body eliminates CBD after intake. CBD is probably broken down in the liver, says Haroutounian, but until researchers know which enzymes are involved, they don’t know how CBD interacts with other drugs.
It’s also unclear how much CBD reaches the blood after it’s inhaled or taken orally, and whether enough reaches target tissues. And researchers still don’t have reliable data on how often to administer CBD, or in what doses.
“We are not in a very good position to make claims,” Haroutounian says. “We don’t even know what to tell people about driving impairment, whether they should avoid driving after ingesting a particular amount of CBD.”
Although some data support claims that CBD doesn’t produce the euphoria associated with THC, it’s still psychoactive, says forensic toxicologist Michelle Peace. “By some accounts, CBD relieves anxiety and PTSD symptoms, which means that it has a psychoactive effect,” she says.
If CBD relaxes users, or makes them drowsy, she adds, such effects can impair driving, similar to a sleeping medication that would impair the ability to operate a vehicle.
Sketchy Smoking Sickness
As of Oct. 15, the Centers for Disease Control and Prevention had reported over 1,500 cases — 33 of them deaths — across 49 states and the U.S. Virgin Islands of a lung illness associated with vaping. As of this writing, the cause of the illnesses is still unknown, but could be linked to the nicotine, THC, CBD or any of the other additives found in e-cigarette products.
It’s not the first time people have fallen sick after vaping. The CDC tracked an outbreak of poisonings in Utah in 2017 and 2018 from a fake CBD product that sent people to the ER with symptoms including confusion, hallucinations and seizures. Most of those poisoned had vaped the product.
Peace had already been testing vaping products when someone contacted her after having a bad experience vaping CBD oil. He ended up with a high he hadn’t wanted or anticipated. In work published in January in Forensic Science International , Peace and her team tested the CBD oil he had vaped, plus other products from the same company: They found the synthetic cannabinoid 5F-ADB and dextromethorphan, the active ingredient in cough syrup, either of which could be causing some of the reported side effects. In the same journal in April, a European team reported a case study of an 18-year-old man whose death was related to smoking synthetic cannabinoids, including 5F-ADB.
“I think the tangle of these two industries has created some public health, public safety concerns,” says Peace, who is also a professor at Virginia Commonwealth University.
Once her CBD vaping study came to light, people started contacting Peace to say they, too, thought they’d been poisoned by a CBD product. Peace and her team have been testing those products and calls some of the stories “pretty terrifying.”
But answers and data are on the way. Peace and her team are preparing results of their 2019 follow-up studies for publication. In May, the FDA held a public hearing on the safety and efficacy of CBD products. In June, a bipartisan team of legislators introduced a bill aimed to streamline research, and in September, the National Institutes of Health announced $3 million in new research awards to investigate the use of cannabinoids and other cannabis-based, non-THC compounds for pain management. More than a hundred clinical trials are currently underway.
“There are so many questions,” Haroutounian says. “We need to step back and do diligent work from square one.”
[This story originally appeared in print as "The CBD Cure-All?"]
Even without proof, CBD is finding a niche as a cure-all
Touted as a treatment for a wide range of conditions — including anxiety, pain, inflammation and even cancer — CBD may be the latest version of snake oil. Or perhaps a real relief for numerous ailments.
Nobody really knows which is true because there has been so little solid research on CBD’s effect on humans, experts say.
CBD, or cannabidiol, comes from the hemp plant, a close relative to another member of the cannabis family, marijuana. Both plants contain abundant types of cannabinoids, but marijuana is high in the psychoactive chemical THC, while hemp is rich in CBD, which doesn’t create a buzz but may offer a range of medicinal benefits.
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Even without research to back it up, the trendy CBD has been turning up in a vast array of products, including CBD-infused lattes, massage lotions and baked goods. And that means it’s becoming big business, with sales expected to hit $20 billion in the next few years.
Thus far, there is only one use for CBD approved by the Food and Drug Administration, and that’s as a treatment for two rare forms of epilepsy. But that doesn’t stop true believers like Dr. Joseph Cohen, who runs a cannabis clinic in Boulder, Colorado, from making enthusiastic claims.
“It works for anxiety, it works for pain, it works for inflammation, it works for autoimmune disorders, and there’s a slew of other conditions for which you can get benefit,” said Cohen, a former gynecologist.
There’s no clear evidence that CBD works for any of those things, experts told NBC News. “We don’t know any of that,” said Dr. Margaret Haney, a professor of neurobiology at Columbia University Medical Center and director of Columbia’s Marijuana Research Laboratory.
Health FDA approves cannabis-based drug CBD for epilepsy
“There’s an enormous placebo effect,” she said. “If you go in with this expectation, with all of society saying this will cure whatever ails you, it often will.”
Dr. Jeffrey Chen seconds that opinion. “Certainly there is therapeutic potential from CBD, but the amount of human data is minuscule, and popular access and consumption have far outpaced the science,” said Chen, executive director of the Cannabis Research Initiative at the University of California, Los Angeles. “So if you’re going to take it, you have to understand there is little data and you have to be very careful about the source and you need to talk to your doctor about how it might interact with other drugs you are taking.”
Medical marijuana provides relief, while research catches up
With no one regulating cannabinoids, you often can’t be sure what dose you’re actually getting, Chen said. He recommends buying from medical marijuana dispensaries, which are regulated by local governments.
While FDA testing of CBD for use in epilepsy showed that the chemical was relatively safe and free of side effects, it does appear to interact with other drugs, including antidepressants known as SSRIs and blood thinners, boosting their levels in a person’s system because it inhibits an enzyme that breaks them down, Chen said.
Studies in animals suggest that CBD might help with anxiety, pain and inflammation, but Chen is quick to point out that “the majority of times when we see promising drugs in animals they either don’t work in humans or they have horrible, horrible side effects.”
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One thing experts do know is that unlike THC, CBD doesn’t hook onto cannabinoid receptors in the brain or body, said Michael Zemaitis, a professor of pharmaceutical sciences at the University of Pittsburgh.
Instead, it appears to affect enzymes that break down endogenous cannabinoids — the ones made by our own bodies.
“It seems to have a very broad dampening effect,” Zemaitis said. “That’s part of the reason why you see so many indications” for their use.
In that sense, the effects of CBD are very different from those of opioids, which have specific receptors to plug into, turning on cell machinery in much the same way a key in a car ignition turns on the engine.
There is little information about the medicinal effects of both THC and CBD, mainly because of federal laws on marijuana, experts said. Marijuana and its extracts have long been considered Schedule 1 drugs, defined as having no accepted medical use and a high potential for abuse.
That puts any kind of cannabis in the same category as heroin and LSD, which means researchers have to jump through a lot of hoops to even get any cannabinoids to study, Chen said.
Another big concern for experts is that patients will avoid proven medications in favor of CBD.
“We have a long history of people using snake oil to convince people they’re getting something,” Haney said. “Then there have been more dangerous situations where people turn down effective medications” to use unproven products, like CBD.
Things may change soon when it comes to CBD, Chen said. The 2018 Farm Bill contains language that will legalize industrial hemp, he said, “so we’ll be able to start generating data on what it will work for and what it will not.”
CORRECTION (Dec. 12, 2018, 12:12 p.m. ET): An earlier version of this article misstated the change in the status of hemp, now classified as a Schedule 1 drug, anticipated in the new Farm Bill. It would be legalized, not reclassified as a Schedule 3 drug.
Linda Carroll is a regular health contributor to NBC News and Reuters Health. She is coauthor of “The Concussion Crisis: Anatomy of a Silent Epidemic” and “Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings.”
Dr. John Torres is medical contributor for NBC News
Ali Galante is a medical producer for NBC News, covering health-related topics including the opioid crisis, disease, medical treatments and scientific discoveries.