(Sativex is already available in 29 countries.)
"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."
Believers in cannabidiol oil, or CBD oil, say this hemp-derived product can produce modern medical miracles, from treating depression to curing cancer. But are these benefits too good to be true?
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.
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."
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.
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.
But despite all the positive press, money and pop culture noise, the science remains pretty foggy. There is no doubt that CBD is an interesting compound. And the liberalization of the laws in many jurisdictions throughout the world is leading to a lot of intriguing research on the plant. To date, however, there is little or no evidence to support the vast majority of the wellness and performance claims we are seeing in pop culture. As noted by the World Health Organization in a 2018 review of CBD: “for most indications, there is only pre-clinical evidence.” In other words, there aren’t a lot of studies involving humans.
And, of course, celebrities have also played a big role. Melissa McCarthy’s CBD toe therapy was reported in the press as a logical application of an emerging therapy. No scientific proof required.
All this positive press might also lead people to overlook the possible risks associated with cannabis products. One study, for example, found that the positive portrayals of the health applications of cannabis have an impact on the perception of recreational use. And while the emerging evidence suggests that CBD is well tolerated, we need to recognize that we don’t have a lot of safety data, particularly in the context of long-term use.
In addition, purchasing a cannabis product still comes with a bit of ideological cache. Cannabis is, or so its proponents want us to believe, the anti-Big Pharma drug of choice. Its secret benefits have been hidden from the masses by a number of nefarious players, most notably the biomedical industrial complex (or so the story goes). “News” websites like Natural News have played to this intuitively appealing narrative with headlines that declare, “Big Pharma and the government are suppressing marijuana’s medicinal benefits.” This kind of messaging adds to the allure of cannabis and allows it to maintain a smidge of counter-culture cred, even if your cat is dabbling in the same products. (In reality, pharmaceutical companies are also getting into the cannabis game.)
Most of the cannabis-focused wellness products contain cannabidiol, commonly referred to as CBD. This is a cannabis extract that does not contain the buzz-inducing THC. Almost overnight, CBD is absolutely everywhere. It is often portrayed as some kind of cure-all. There are CBD-infused shampoos, toothpastes, lotions and soaps. CBD is being used and promoted by professional athletes as a way to facilitate recovery and as an anti-aging compound.
After the accident, Horn did sessions of cognitive behavioural therapy, which he found helpful. He didn’t take antidepressants, because he was concerned about the side-effects; he did smoke cannabis, though he didn’t always like feeling stoned. “I suffered from some PTSD symptoms, flashbacks,” he says. “And some other issues.”
Horn’s adult life had been spent in the shadow of a horrific accident that took place when he was 22. In June 2006, he had been shooting at a target with an air rifle in the garden of his family home; his parents are the music producers Jill Sinclair and Trevor Horn. Horn didn’t realise his mother was nearby, and a stray pellet lodged in her neck and severed an artery. Sinclair experienced hypoxia, which caused irreversible brain damage, and she spent years in a coma before dying in 2014.
McGuire sighs. “If you look at the labels of the street products, it’s very difficult to know what’s actually in them. And there’s a huge variety between products, so that’s a really important message to get across: that a lot of what people may be taking in good faith may be having absolutely no effect at all, other than a placebo effect.”
McGuire’s work is ongoing, but he doesn’t hide his excitement about CBD. “It’s the hottest new medicine in mental health by some margin,” he says. “There’s huge interest in it as a potential new treatment.”
Horn’s CBD comes from Lithuania and is sold as “ethical and organic”. He accepts that the doses of CBD in the products are significantly lower than might be used in medication or clinical trials, but he’s not sure how relevant that fact is. “From what they are finding out about the endocannabinoid system, little and often of the right product is probably as effective as a huge amount,” he says.