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)
In our survey, sleep was the second-highest-ranking reason for CBD use. We found that 42.5% used CBD to help with sleep, which is higher than for previously published data on adult CBD users, where it was the fifth-highest reason (Corroon and Phillips 2018). It is well-known that a lack of sleep can cause a variety of physical and mental health effects including raised levels of cortisol(Leproult et al. 1997), anxiety (Babson et al. 2010), and mood disturbances (Brazeau et al. 2010), and both short and long duration of sleep is a significant predictor of death (Cappuccio et al. 2010). A recent controlled study of 300 mg CBD found no effect on any sleep indices (Linares et al. 2018), whilst observational and cross-sectional studies showed improvement in sleep outcomes (Corroon and Phillips 2018; Gulbransen et al. 2020). Preclinical studies have shown mixed results with some doses showing an increase in total sleep time (Chagas et al. 2013) and another study indicating that CBD causes increased wakefulness (Murillo-Rodríguez et al. 2006). Thus, the research on CBD and sleep thus far is mixed. However, as sedation and somnolence are regarded as common adverse effects of CBD in a meta-analysis of clinical trials where high doses are used (Chesney et al. 2020), it may not be surprising that CBD at low doses improved sleep quality and duration.
CBD use patterns
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.
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).
Corroon et al. found a more even distribution between various application methods with the most popular being sublingual CBD (23% vs 72,6% in our study sample). Our approach of recruiting respondents through email databases of non-vape CBD brands may explain why the sublingual administration route is much more frequent in our study than in the American survey.
CBD products are also being marketed for pets and other animals. The FDA has not approved CBD for any use in animals and the concerns regarding CBD products with unproven medical claims and of unknown quality equally apply to CBD products marketed for animals. The FDA recommends pet owners talk with their veterinarians about appropriate treatment options for their pets.
Unlike the FDA-approved CBD drug product, unapproved CBD products, which could include cosmetics, foods, products marketed as dietary supplements, and any other product (other than Epidiolex) making therapeutic claims, have not been subject to FDA evaluation regarding whether they are effective to treat a particular disease or have other effects that may be claimed. In addition, they have not been evaluated by the FDA to determine what the proper dosage is, how they could interact with other drugs or foods, or whether they have dangerous side effects or other safety concerns.
The FDA is actively working to learn more about the safety of CBD and CBD products, including the risks identified above and other topics, such as:
Some CBD Products are Being Marketed with Unproven Medical Claims and Could be Produced with Unsafe Manufacturing Practices
You may have noticed that cannabidiol (CBD) seems to be available almost everywhere, and marketed as a variety of products including drugs, food, dietary supplements, cosmetics, and animal health products. Other than one prescription drug product to treat seizures associated with Lennox Gastaut syndrome (LGS), Dravet syndrome (DS), or tuberous sclerosis complex (TSC) in people one year of age and older, the U.S. Food and Drug Administration (FDA) has not approved any other CBD products, and there is very limited available information about CBD, including about its effects on the body.
In addition, CBD can be the cause of side effects that you might notice. These side effects should improve when CBD is stopped or when the amount used is reduced. This could include changes in alertness, most commonly experienced as somnolence (sleepiness), but this could also include insomnia; gastrointestinal distress, most commonly experienced as diarrhea and/or decreased appetite but could also include abdominal pain or upset stomach; and changes in mood, most commonly experienced as irritability and agitation.
Despite the 2018 Farm Bill removing hemp — defined as cannabis and cannabis derivatives with very low concentrations (no more than 0.3% on a dry weight basis) of THC — from the definition of marijuana in the Controlled Substances Act, CBD products are still subject to the same laws and requirements as FDA-regulated products that contain any other substance.
The FDA is committed to setting sound, science-based policy. The FDA is raising these safety, marketing, and labeling concerns because we want you to know what we know. We encourage consumers to think carefully before exposing themselves, their family, or their pets, to any product, especially products like CBD, which may have potential risks, be of unknown quality, and have unproven benefits.
“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.
Cannabidiol, or CBD, is the lesser-known child of the cannabis sativa plant; its more famous sibling, tetrahydrocannabinol, or THC, is the active ingredient in pot that catapults users’ “high.” With roots in Central Asia, the plant is believed to have been first used medicinally — or for rituals — around 750 B.C., though there are other estimates too.
A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. That’s when someone believes a drug is working and symptoms seem to improve.
Does CBD help sleep and depression?
Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100 percent natural CBD extracts. They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.
“Our top therapies attempt to break the association between reminders of the trauma and the fear response,” said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the study’s principal investigator. “We think that CBD, at least in animal models, can help that process happen a lot faster.” While large clinical trials are underway, psychologists say there isn’t compelling evidence yet as to whether this is a viable treatment.
The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm. Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when “freaking out” over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewart’s French bulldog partakes, too.
Facts about wellness.