By Jon Johnson
Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT
People take or apply cannabidiol to treat a variety of symptoms, but its use is controversial. There is some confusion about what it is and how it affects the human body. Cannabidiol (CBD) may have some health benefits, and it may also pose risks. Products containing the compound are now legal in many American states where marijuana is not.
This article will explain what CBD is, its possible health benefits, how to use it, potential risks, and issues surrounding its legality in the United States.
In June 2018, the country’s Food and Drug Administration (FDA) approved the prescription use of Epidiolex, a purified form of CBD oil, for treating two types of epilepsy.
What is CBD oil?
CBD is one of many compounds, known as cannabinoids, in the cannabis plant. Researchers have been looking at the possible therapeutic uses of CBD.
CBD oils are oils that contain concentrations of CBD. The concentrations and the uses of these oils vary.
Is CBD marijuana?
Until recently, the best-known compound in cannabis was delta-9 tetrahydrocannabinol (THC).
This is the most active ingredient in marijuana.
Marijuana contains both THC and CBD, and these compounds have different effects.
THC creates a mind-altering “high” when a person smokes it or uses it in cooking. This is because THC breaks down when we apply heat and introduce it into the body.
CBD is different. Unlike THC, it is not psychoactive. This means that CBD does not change a person’s state of mind when they use it.
However, CBD does appear to produce significant changes in the body, and some research suggests that it has medical benefits.
Where does CBD come from?
The least processed form of the cannabis plant is hemp. Hemp contains most of the CBD that people use medicinally. Hemp and marijuana come from the same plant, Cannabis sativa, but the two are very different.
Over the years, marijuana farmers have selectively bred their plants to contain high levels of THC and other compounds that interested them, often because the compounds produced a smell or had another effect on the plant’s flowers.
However, hemp farmers have rarely modified the plant. These hemp plants are used to create CBD oil.
How CBD works
All cannabinoids, including CBD, produce effects in the body by attaching to certain receptors.
The human body produces certain cannabinoids on its own. It also has two receptors for cannabinoids, called the CB1 receptors and CB2 receptors.
CB1 receptors are present throughout the body, but many are in the brain.
The CB1 receptors in the brain deal with coordination and movement, pain, emotions, and mood, thinking, appetite, and memories, and other functions. THC attaches to these receptors.
CB2 receptors are more common in the immune system. They affect inflammation and pain.
Researchers once believed that CBD attached to these CB2 receptors, but it now appears that CBD does not attach directly to either receptor.
Instead, it seems to direct the body to use more of its own cannabinoids.
CBD may benefit a person’s health in a variety of ways.
Natural pain relief and anti-inflammatory properties
People tend to use prescription or over-the-counter drugs to relieve stiffness and pain, including chronic pain.
Some people believe that CBD is a more natural alternative.
Authors of a study published in the Journal of Experimental Medicine found that CBD significantly reduced chronic inflammation and pain in some mice and rats.
The researchers suggested that the non-psychoactive compounds in marijuana, such as CBD, could provide a new treatment for chronic pain.
Quitting smoking and drug withdrawals
Some promising evidence suggests that CBD use may help people to quit smoking.
A pilot study published in Addictive Behaviors found that smokers who used inhalers containing CBD smoked fewer cigarettes than usual and had no further cravings for nicotine.
A similar review, published in Neurotherapeutics found that CBD may be a promising treatment for people with opioid addiction disorders.
The researchers noted that CBD reduced some symptoms associated with substance use disorders. These included anxiety, mood-related symptoms, pain, and insomnia.
More research is necessary, but these findings suggest that CBD may help to prevent or reduce withdrawal symptoms.
After researching the safety and effectiveness of CBD oil for treating epilepsy, the FDA approved the use of CBD (Epidiolex) as a therapy for two rare conditions characterized by epileptic seizures in 2018.
In the U.S., a doctor can prescribe Epidiolex to treat:
- Lennox-Gastaut syndrome (LGS), a condition that appears between the ages of 3 and 5 years and involves different kinds of seizures
- Dravet syndrome (DS), a rare genetic condition that appears in the first year of life and involves frequent, fever-related seizures
The types of seizures that characterize LGS or DS are difficult to control with other types of medication.
The FDA specified that doctors could not prescribe Epidiolex for children younger than 2 years. A physician or pharmacist will determine the right dosage based on body weight.
Other neurological symptoms and disorders
Researchers are studying the effects of CBD on various neuropsychiatric disorders.
Authors of a 2014 review noted that CBD has anti-seizure properties and a low risk of side effects for people with epilepsy.
Findings suggested that CBD may also treat many complications linked to epilepsy, such as neurodegeneration, neuronal injury, and psychiatric diseases.
Another study, published in Current Pharmaceutical Design, found that CBD may produce effects similar to those of certain antipsychotic drugs, and that the compound may provide a safe and effective treatment for people with schizophrenia. However, further research is necessary.
Some researchers have found that CBD may prove to combat cancer.
Authors of a review published in the British Journal of Clinical Pharmacology found evidence that CBD significantly helped to prevent the spread of cancer.
The researchers also noted that the compound tends to suppress the growth of cancer cells and promote their destruction.
They pointed out that CBD has low levels of toxicity. They called for further research into its potential as an accompaniment to standard cancer treatments.
Doctors often advise people with chronic anxiety to avoid cannabis, as THC can trigger or amplify feelings of anxiousness and paranoia.
However, authors of a review from Neurotherapeutics found that CBD may help to reduce anxiety in people with certain related disorders.
According to the review, CBD may reduce anxiety-related behaviors in people with conditions such as:
- post-traumatic stress disorder
- general anxiety disorder
- panic disorder
- social anxiety disorder
- obsessive-compulsive disorder
The authors noted that current treatments for these disorders can lead to additional symptoms and side effects, which can cause some people to stop taking them.
No further definitive evidence currently links CBD to adverse effects, and the authors called for further studies of the compound as a treatment for anxiety.
Type 1 diabetes
Type 1 diabetes results from inflammation that occurs when the immune system attacks cells in the pancreas.
Research published in 2016 by Clinical Hemorheology and Microcirculation found that CBD may ease this inflammation in the pancreas. This may be the first step in finding a CBD-based treatment for type 1 diabetes.
A paper presented in the same year in Lisbon, Portugal, suggested that CBD may reduce inflammation and protect against or delay the development of type 1 diabetes.
Acne treatment is another promising use for CBD. The condition is caused, in part, by inflammation and overworked sebaceous glands in the body.
A 2014 study published by the Journal of Clinical Investigation found that CBD helps to lower the production of sebum that leads to acne, partly because of its anti-inflammatory effect on the body. Sebum is an oily substance, and overproduction can cause acne.
CBD could become a future treatment for acne vulgaris, the most common form of acne.
Initial research published in the Journal of Alzheimer’s Disease found that CBD was able to prevent the development of social recognition deficit in participants.
This means that CBD could help people in the early stages of Alzheimer’s to keep the ability to recognize the faces of people that they know.
This is the first evidence that CBD may slow the progression of Alzheimer’s disease.
Cannabis is legal for either medicinal or recreational use in some American states. Other states have approved the use of CBD oil as a hemp product but not the general use of medical marijuana.
Some state and federal laws differ, and current marijuana and CBD legislation in the U.S. can be confusing, even in states where marijuana is legal.
There is an ever-changing number of states that do not necessarily consider marijuana to be legal but have laws directly related to CBD oil. The following information is accurate as of May 8, 2018, but the laws change frequently.
However, state legislators generally approve the use of CBD oil at various concentrations to treat a range of epileptic conditions. A full list of states that have CBD-specific laws is available here.
Different states also require different levels of prescription to possess and use CBD oil. In Missouri, for example, a person can use CBD of a particular composition if they can show that three other treatment options have failed to treat their epilepsy.
Anyone considering CBD oil should speak with a local healthcare provider. They can provide information about safe CBD sources and local laws surrounding usage.
Also, research local state laws. Most states require a prescription.
Recent developments: CBD oil for epilepsy
In June 2018, the FDA approved the use of CBD to treat two types of epilepsy.
Dr. Scott Gottlieb, writing for the FDA on 25 June, stated:
“Today, the FDA approved a purified form of the drug cannabidiol (CBD). This is one of more than 80 active chemicals in marijuana. The new product was approved to treat seizures associated with two rare, severe forms of epilepsy in patients two years of age and older.”
Dr. Scott Gottlieb
Dr. Gottlieb is careful to point out that:
- The FDA have not approved the use of marijuana or all of its components.
- The association has only approved a purified version of one CBD medication, for a precise therapeutic purpose.
- The decision to approve the product was based on the results of sound clinical trials.
- Patients will receive the medication in a reliable dosage.
Many small-scale studies have looked into the safety of CBD in adults. They concluded that adults tend to tolerate a wide range of doses well.
Researchers have found no significant side effects on the central nervous system, the vital signs, or mood, even among people who used high dosages.
The most common side effect was tiredness. Also, some people reported diarrhea and changes in appetite or weight.
There is still a lack of available long-term safety data.
Also, to date, researchers have not performed studies involving children.
Side effects of Epidiolex
Concerning the product that the FDA approved to treat two types of epilepsy, researchers noticed following adverse effects in clinical trials:
- liver problems
- symptoms related to the central nervous system, such as irritability and lethargy
- reduced appetite
- gastrointestinal problems
- rashes and other sensitivity reactions
- reduced urination
- breathing problems
The patient information leaflet notes that there is a risk of worsening depression or suicidal thoughts. It is important to monitor anyone who is using this drug for signs of mood change.
Research suggests that a person taking the product is unlikely to form a dependency.
Side effects of other uses of CBD
There is often a lack of evidence regarding the safety of new or alternative treatment options. Usually, researchers have not performed the full array of tests.
Anyone who is considering using CBD should talk to a qualified healthcare practitioner beforehand.
The FDA have only approved CBD for the treatment of two rare and severe forms of epilepsy.
When drugs do not have FDA approval, it can be difficult to know whether a product contains a safe or effective level of CBD. Unapproved products may not have the properties or contents stated on the packaging.
It is important to note that researchers have linked marijuana use during pregnancy to impairmentsin the fetal development of neurons. Regular use among teens is associated with issues concerning memory, behavior, and intelligence.
How to use
Using CBD oil is not the same as using or smoking whole cannabis.
A person can use CBD oil in different ways to relieve various symptoms.
If a doctor prescribes it to treat LGS or DS, it is important to follow their instructions.
CBD-based products come in many forms. Some can be mixed into different foods or drinks or taken with a pipette or dropper.
Others are available in capsules or as a thick paste to be massaged into the skin. Some products are available as sprays to be administered under the tongue.
Recommended dosages vary between individuals, and depend on factors such as body weight, the concentration of the product, and the health issue.
Some people consider taking CBD oil to help treat:
- chronic pain
- Parkinson’s disease
- Huntington’s disease
- sleep disorders
Due to the lack of FDA regulation for most CBD products, seek advice from a medical professional before determining the best dosage.
As regulation in the U.S. increases, more specific dosages and prescriptions will start to emerge.
After discussing dosages and risks with a doctor, and researching regional local laws, it is important to compare different brands of CBD oil.