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is cbd oil really the new miracle cure

The coexistence of CBD both in supplement form as well as in prescription form raises the question about whether or not CBD oil should be treated as a drug or as a supplement. As has been discussed on this blog repeatedly, drugs are typically considered unsafe and unproven until evidence shows otherwise. Regulators tend to take a different approach with supplements and “natural” products, generally assuming these products have long histories of use and are safe until evidence emerges to show otherwise. In countries like Canada where there are cannabis-based products available based on medical authorization and simultaneously via retail channels, sellers may be obtaining the same products from the same producers – they are just branded differently. Fortunately, for the sake of this post, whether it’s sold as a “drug” or as a “supplement” doesn’t matter – what is relevant is the evidence base.

Substances that have pharmacological effects will also have side effects, and cannabinoids and CBD oil are no exception. Importantly, CBD oil can interfere with the effects of numerous prescription drugs owing to its effects on specific liver enzymes. Depending on the drug, levels can be raised or lowered, so anyone that takes prescription drugs must carefully verify the risk of drug interactions when CBD oil is consumed.

CBD is an extract from cannabis leaves or flowers, typically dissolved in an edible oil. The extraction process and solvents used can dramatically affect the final product – from characteristics like taste and colour but also the CBD:THC ratio as well as other cannabinoid ingredients. Edible oils are a popular delivery form, especially for people seeking something more discreet than smoking or vaping. Edible oils can contain large amounts of CBD, and if the manufacturing is consistent and of high quality, doses should be predictable and reproducible from drop-to-drop and from bottle-to-bottle.

Does CBD oil “work”?

Medical (prescription) products based on cannabis or that contain cannabinoids are available in many countries. Epidolex is an FDA-approved CBD extract that is approved for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. There is also Marinol, which is a synthetic THC approved for nausea and vomiting associated with chemotherapy, and for the treatment of AIDS-related anorexia. There is also medical cannabis available based on medical authorization in many countries. While many expected the medical cannabis market to disappear with the legalization of cannabis, it continues to exists in countries like Canada.

I’ll cut to the chase and tell you that overall, the evidence for CBD oil isn’t impressive at all. There is something “there” for sure – CBD oil has pharmacological and drug-like effects. But the enormous enthusiasm is backed by very weak evidence, and the efficacy is well-established only for a few circumstances. Dravet syndrome and Lennox-Gastaut syndrome have been established as responsive to CBD. There are studies but a lack of convincing evidence for Parkinson’s disease and other movement disorders, schizophrenia, insomnia and anxiety disorders. Whether or not CBD is useful for treating chronic pain is unclear. When you have a licensed, regulated and quality controlled product, it’s probably safer than opiates, but there’s a lack of evidence to substantiate the grandiose claims made about the ability of CBD to be an effective pain control medication.

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CBD oil seems to have a better side effect profile than THC-containing products, including cannabis, but the lack of robust study makes any itemization of side effects a challenge. Aggression/anger, irritability/agitation, and sleepiness have been reported with CBD products like Epidolex so they should be expected with CBD oil.

Cannabidiol (CBD) oil is everywhere and seemingly in everything these days. It’s touted as a panacea for a massive range of illnesses and conditions, and even recommended as a daily supplement to help one smooth out the rough edges of life. CBD is one of the many chemical compounds called cannabinoids that is isolated from cannabis (marijuana). Cannabis contains over 400 chemicals including at least 120 cannabinoids, which are chemicals that stimulate cannabinoid receptors in the body. Yes, your body has cannabinoid receptors and you actually produce your own cannabinoids. The most well-studied cannabinoids that are isolated from cannabis are delta-9-tetrahydrocannabinol (THC) and CBD. CBD is not psychoactive like THC, and there are hundreds if not thousands of producers and products now on the market, sold everywhere from country markets to pet stores to pharmacies. Like most panaceas, the hype outpaces the evidence.

The exception to this: "There is one prescription product that's achieved FDA approval for treating seizures in children with a rare form of epilepsy," says Edward Mariano, M.D., M.A.S., a professor of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine. There's also a CBD/THC combo drug called Sativex that shows promise at alleviating cancer pain that is chugging along through phase 3 clinical trials, on track to be approved by the FDA. 

CBD is a natural compound called a cannabinoid found in hemp and marijuana, two varieties of the Cannabis sativa plant. Cannabinoids influence signaling pathways between cells (basically how cells talk to each other), potentially impacting multiple systems in your body. However, unlike its chemical cousin THC (which is only in marijuana), CBD does not have psychoactive effects, meaning it won't get you stoned. "In fact, our bodies naturally churn out chemicals that are very similar to CBD," says Debbie Petitpain, M.S., R.D.N., spokesperson for the Academy of Nutrition and Dietetics.

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(Sativex is already available in 29 countries.)

Is CBD Safe?

Google "CBD oil" and you'll find pages and pages of articles, ads and studies. Makers claim the popular hemp extract-sold online and available in many states in health and natural food stores-may help treat a long list of health problems, from acne to anxiety, chronic pain to cancer. But is it safe, and does it work? Here's a quick guide to what you need to know.

As a treatment for many other conditions, experts say it's too soon to tell. The World Health Organization notes that CBD is generally well tolerated and has a good safety profile. Much like vitamins and supplements, though, CBD isn't subject to government oversight for safety or efficacy in the U.S., but the FDA notes that it could have side effects (namely diarrhea, drowsiness and irritability), may interact with other medicines you're taking and shouldn't be used by pregnant or nursing women. There may be long-term side effects too.

Most of the studies showing promise have been conducted with mice. A report in the European Journal of Pain showed that topical CBD diminished pain and inflammation associated with arthritis in rodents. And rats that were given CBD for seven days displayed fewer signs of pain and anxiety, according to a 2010 study in the journal Pain. Another report—this one a review of research in the journal Neuropsychopharmacology Reviews—boldly stated that there's "an overwhelming body of convincing preclinical evidence" (preclinical meaning not tested in humans) that indicates cannabinoids can block inflammatory and nerve-based pain. But according to Petitpain, "We need more clinical research to really show who benefits, and at what dose."

"There may be some benefit for those with sleep problems, anxiety or pain, but the evidence to support this is largely anecdotal," says Brent A. Bauer, M.D., director of research for the Integrative Medicine and Health Program at the Mayo Clinic in Rochester, Minnesota. Currently, there's a lack of high-quality studies in humans about CBD's efficacy. That's because prior to the 2018 Farm Bill, which made CBD derived from hemp federally legal, hemp was highly restricted. "This made it very difficult for medical centers to obtain products to test in clinical trials," says Bauer. "Basically, obtaining CBD required a lot of red tape, which discouraged research."

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There are drug interactions too. Add CBD to other drugs you’re taking and it might produce unexpected side effects, or cause those drugs to be less efficient. I wouldn’t take CBD without checking with my doctor or pharmacist to assure me there were no risky drug interactions.

Next up was soy and resveratrol, so-called superfoods that could lower rates of heart disease and cancer; then coenzyme Q10, touted to prevent statin-induced muscle damage. All fell from grace when definitive studies were conducted.

You take additional risks if the CBD product is not certified by an outside laboratory. Without that, bacterial, fungal or heavy metal contamination of the CBD becomes more likely – so does mixing of the CBD with synthetic drugs. Many independent evaluations already show many products do not contain the amount of CBD they claim; some provide much less.

How strong is the CBD data?

Antioxidant vitamin cocktails were once believed the new stars of the nutrition world. The cocktails, with vitamin E, beta-carotene and vitamin C, supposedly reduced the risk of heart disease, stroke and cancer. That story – derived from single-cell and small-animal studies – was captivating. Imagine taking a vitamin pill to halt free radical damage or keep your arteries from hardening.

CBD is neither a miracle or snake oil. So far, the evidence – or lack of it, for most ailments – suggests the risks may outweigh the benefits.

CBD is a drug. The FDA allows it to be sold as a cosmetic and prescription product, and you can also buy it without a prescription. But just because it’s in lots of things (seltzer, cupcakes and beer, to name a few) does not mean it’s risk-free. In the largest evaluation, high doses of CDB induced mild liver damage in 17% of the people taking it. Severe or irreversible damage would have occurred had researchers not stopped the subjects from taking more. If you’re taking CBD at home, without medical supervision, you would not know about the liver damage until it was acute.

On behalf of the Journal of Clinical Pharmacology, in 2020 conducted a review that evaluated the evidence supporting the use of CBD.