Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a "high." According to a report from the World Health Organization, "In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD."
How is cannabidiol different from marijuana?
CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
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Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting. If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.
Those aged 35–54 years old (33.9%; aOR 0.60, [95% CI 0.363–0.995], p = 0.048) and 55+ (31.9%; aOR 0.526, [95% CI 0.287–0.964], p = 0.038) had lower odds of using CBD for general health and wellbeing than those aged 18–34 years old (47.7%). Moreover, those aged 35–54 years old (37.1%, aOR 0.561, [95% CI 0.346–0.911], p = 0.019) and 55+ (20.9%; aOR 0.249, [95% CI 0.132–0.470], p ≤ 0.001) had lower odds of using CBD for stress versus those aged 18–34 years old (51.4%). Those aged 34–55 (24.8%) had greater odds of using CBD for chronic pain versus 18–34 years old (14.7%; aOR 2.093, [95% CI 1.122–3.905], p = 0.02). Those aged 55+ (5.1%) had lower odds of using CBD for post-workout sore muscles than 18–34 years old (15.5%; aOR 0.302, [95% CI 0.105–0.868], p = 0.026). Those aged 35–54 years old (43.5%; aOR 0.464, 95% CI 0.28–0.76, p = 0.002) and 55+ (19.8%; aOR 0.149, [95% CI = 0.077, 0.289], p < 0.001) had lower odds of using CBD for self-perceived anxiety versus 18–34 years old (60.4%). Use of CBD for arthritic/joint pain was higher in those 55+ (41.8%) (aOR 8.569, 95% CI [3.792–19.363], p < 0.001) and 35–54 years old (16.7%; aOR 2.295, [95% CI 1.041, 5.061], p = 0.04) in comparison to those 18–34 years old. Those aged 34–55 years old (5.9%) had lower odds of using CBD for skin conditions than those aged 18–34 years old (14.7% aOR 0.42, [95% CI 0.10–0.93], p = 0.03) and those aged 55+ (4.4%) had lower odds of using CBD to improve focus than those aged 18–34 years old (15.3%; aOR 0.248, [95% CI 0.08–0.77], p = 0.017). Moreover, those aged 55+ (23.1% versus 18–34 years old: 41.4%) had lower odds of using CBD for sleep improvement (aOR 0.4, [95% CI 0.21, 0.75], p = 0.004). For endometriosis and menstrual problems, we removed sex from the model finding those aged 34–55 had lower odds of using CBD for menstrual problems (aOR 0.379, [95% CI 0.18–0.796], p = 0.01). Endometriosis did not vary by age. Depression, PTSD, fibromyalgia, ADHD, headache, asthma, THC counteract effects, and restless legs did not vary by sex or age. Confidence intervals could not be generated for Parkinson’s disease, Alzheimer’s disease, autism, multiple sclerosis, epilepsy, cancer, and nausea due to small sample sizes.
Perceived effects of cannabidiol on sleep amongst adult cannabidiol users responding to the question “how does cannabidiol affect your sleep?” Participants were allowed to select multiple options. Y-axis represents percentage of total responses (n = 522)
Other perceived benefits of cannabidiol amongst adult cannabidiol users. Respondents were asked what other benefits or effects they feel from using cannabidiol. Participants were allowed to select multiple options. X-axis is the percentage of total responses (n = 906)
Given the low quality of CBD available on the market, it may be that these individuals were not taking CBD, or that CBD is not efficacious in sleep, so many individuals report better sleep by virtue of the placebo effect, fuelled by marketing (Haney 2020). Another reason may be that CBD is acting on other aspects of stress and anxiety that indirectly reduce sleep problems. Still, in this survey, participants directly attributed improved sleep to CBD. This points to the need for RCTs, as the effect of expectations (i.e. the result of the placebo effect), particularly with compounds advertised as cure-alls (Haney 2020). Suggesting that the placebo effect may contribute to the purported impact of CBD does not reject the potential medical value of CBD, but it does mean we must be wary of the results of observational studies (Haney 2020).
With few variations, the reasons for use in our study were somewhat similar to the results from another study of 400 patients in New Zealand, who were all prescribed sublingual CBD oil with doses ranging from 40 to 300 mg/day (Gulbransen et al. 2020). This study found that the patients had an increase in overall quality of life, including improved sleep and decreased self-perceived anxiety levels and reduced pain scores.
The bioavailability of CBD varies by route of administration (Millar et al. 2019), but is generally low, between 10 and 31% (Millar et al. 2018). Oral routes have the lowest bioavailability due to first-pass metabolism, whilst inhaled routes have the highest bioavailability (Ohlsson et al. 1986). The bioavailability of sublingual CBD is between 13 and 19% (Mechoulam et al. 2002), and greater than the oral route, thus exerting effects at much lower doses, making it more efficient for users. Investigating plasma levels of low-dose sublingual CBD users, and correlating them to the subjective experience, might give important insights into the optimal dose for treating these low-level mental health problems like self-perceived stress, anxiety, and sleep problems.
37.5% of respondents reported using CBD for perceived stress, with 92.2% reporting reduced stress levels, making it the third-highest ranking reason for CBD use amongst our sample. Yet, no studies are looking directly at how CBD affects perceived stress levels. This might in part be because stress, apart from post-traumatic stress disorder, is not classified as a disease according to international disease classification (WHO | Burn-out an “occupational phenomenon”: International Classification of Diseases 2019). With more than 12.8 million working days lost because of work-related stress, anxiety, or depression in the UK (Hse 2019), the relationship between CBD and stress is an area of interest for further research. A recent study surveying social media for comments about perceived therapeutic effects of CBD products revealed that the most frequently discussed symptoms, which are not addressed in the research literature, are indeed stress and nausea (Tran and Kavuluru 2020).
Cannabidiol and THC are just two of the plant’s more than 100 cannabinoids. THC is psychoactive, and CBD may or may not be, which is a matter of debate. THC can increase anxiety; it is not clear what effect CBD is having, if any, in reducing it. THC can lead to addiction and cravings; CBD is being studied to help those in recovery.
But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasn’t been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.
What are the claims?
Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.
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Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.