CBD’s Controversial Use In Medicine: Benefits, Risks And Legality

If you are keeping up with modern health and wellness trends, there is a very good chance that you have heard of medical or recreational cannabis. Cannabidiol (also known as CBD) is one of the primary active ingredients of marijuana, but it is not responsible for the high feeling that everyone associates with smoking or ingesting the plant. Instead, CBD is more well-known for its ability to induce a relaxing and calming feeling throughout the body — though some claim it should be used for much, much more.

While CBD was first identified in 1940, it did not gain much commercial traction until CNN aired a documentary called “Charlotte’s Web” in 2013¹. The story focuses on Charlotte Figi, a child suffering from multiple grand mal seizures a day until she started controversial CBD therapy. From this treatment, she was miraculously able to regain her ability to walk, talk, and eat independently, when previously her seizures were too severe to allow her to care for herself. After it was aired, the public interest in CBD skyrocketed — and so did the number of hemp-based products with unverified substantial medical claims.

As the market continues to be flooded with “miracle” CBD products, more research into the true efficacy, benefits, and risks is also being conducted to back these hefty claims. But, despite these efforts, we still know surprisingly little about how CBD truly impacts our overall health and wellness. On top of this, the ever-changing political and legal climate surrounding marijuana and hemp products around the world continues to add barriers to those who want to explore its benefits for themselves.

So, whether you are interested in using CBD oil for your joint pain or are a marijuana enthusiast looking to know more about your favourite herb, learning about the true benefits of CBD is still proving to be harder than it should be.

What CBD actually is (and what it is not)

To better understand CBD, we first need to dive into the vast and incredibly complex world of marijuana. Commonly thought of as a street drug, marijuana is actually a potent natural herb that is packed with different chemical compounds — one of which is CBD.

Cannabidiol is one of 400 different and unique compounds found in the marijuana plant². It is most commonly extracted from the Cannabis sativa plant, which is one popular strain of marijuana. Once separated from the other marijuana compounds, CBD itself is not psychoactive, which is one reason why people feel excited about using it as a pain treatment for children, seniors, and even pets. As a person cannot get a euphoric or “high” feeling from taking straight CBD, the medical community has been eager to find ways to integrate CBD therapy for patients experiencing pain, anxiety, depression, and more.

If you have been looking up various CBD-based oils or tinctures to try, you may have noticed that they are commonly labelled as hemp-based products. This particular wording is based on American law, which states that hemp is defined as “the plant Cannabis sativa L. and any part of that plant, including the seeds thereof and all derivatives, extracts, cannabinoids, isomers, acids, salts, and salts of isomers, whether growing or not, with a delta-9 tetrahydrocannabinol concentration of not more than 0.3% on a dry weight basis.”³

When it comes time to harvest CBD, the gender of the marijuana plant is incredibly important. If the producer is looking to offer hemp products, they should choose to grow male plants, as they are composed of 20% or more of CBD, while female plants often have only 10% of chemical make-up dedicated to cannabidiol⁴.

How cannabinoids work

Like all other medications and pharmaceuticals, cannabinoids bind with and interact directly with receptors on our cells to produce their desired effects. As part of our endocannabinoid system (which is responsible for conducting information about pain and stress throughout the body), there are two primary receptors that CBD binds with⁵:

• CB1 — Commonly found on nerve cells, this receptor is connected to the central nervous system. They play a role in conducting information to the brain and spinal cord.

• CB2 — Often more widespread throughout the body, these receptors are often found on organ cells associated with the reproductive system, immune system, and peripheral nervous system.

We love CBD for its relaxing properties

As CBD continues to grow in popularity, more research into its benefits is being conducted worldwide. While we still don’t know enough to have a definitive list of its possible uses in medical and recreational settings, some of the most commonly reported benefits of CBD use include⁶:

• Reducing feelings of anxiety — Because of its relaxing and calming properties, studies have shown that regular CBD usage can help to reduce feelings of anxiety and stress.

• Helping treat insomnia — As a medical problem that is difficult to treat, it has been found that CBD can be helpful in helping people with insomnia fall asleep and stay asleep throughout the night.

• Reducing chronic pain — Currently, the American medical system relies on narcotic (opioid) medications as the top of the line treatment for chronic and acute pain. But, because these medications are incredibly addictive, medical providers are eager to find other options for treating pain, one of which may be CBD.

• Acting as an anti-inflammatory — Known for being incredibly painful and challenging to manage, inflammation causes significant damage to the body. One study concluded that CBD might serve as an effective anti-inflammatory for those living with chronic osteoarthritis⁷.

• Easing addiction cravings — Acting as a support for those trying to overcome an addiction, research has shown that CBD may be able to reduce cravings for substances like opioids, tobacco, and alcohol.

Another more niche use of CBD is treating rare neurological conditions like Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS)⁸. As childhood epilepsy syndromes, both of these conditions have proven very hard to treat with modern medical treatments. When treated with CBD, many children with these conditions saw the number of seizures they experienced drop sharply or stop completely in some cases — leading to the creation of Epilodex, the first legal and FDA approved cannabis-derived medicine available in the United States⁸.

As just some of the research supported claims currently being explored by the medical community, there is sure to be more benefits found as research continues over the following years. But, this being said, because we still don’t know much about CBD, it is super important for consumers to be wary of substantial health and wellness claims on their favourite hemp-based skincare, medicinal, or lifestyle products. For now, we just need to stick with the old adage that if it seems too good to be true, that is likely because it is!

It can be taken in many different ways

As CBD becomes more accessible across the country and around the globe, more and more variations of how you can use it are popping up, claiming to be the next best thing. From CBD patches, creams, oils, drinks, vape pens, skincare, and more, there is no shortage of options for anyone looking to give it a try.

Unsurprisingly, one of the most popular options of CBD is topical creams and oil used to treat areas of chronic pain. Designed to be absorbed by the skin and used as a localised pain reliever, many people living with inflammatory conditions like arthritis, autoimmune diseases, and more have found benefits from using this style of CBD treatment. With 40% of CBD users claiming that their primary reason for use is pain relief, it is no surprise that these products continue to fly off the shelves⁹.

CBD isn’t without side effects (they just haven’t been confirmed)

Did you know that there are no official side effects of most CBD products? Besides Epidiolex, which is the only federally approved CBD product, no other hemp-based product is regularly inspected or checked by the FDA.

Currently, the FDA does not inspect the purity, safety, or efficacy of any dietary supplement, which is primarily what CBD products are sold as in the American market. This becomes problematic when trying to be an educated consumer, as you can not always trust the products you are buying are truthful in their claims. For example, a recent study found that out of 84 CBD products purchased online, more than ¼ contained less CBD than was on their label, and 18 products contained traces of THC¹⁰.

This being said, there are some general guidelines that are recommended as safety precautions for the use of all CBD products. Currently, CBD is not recommended for anyone who is pregnant or breastfeeding, as it is not well known how CBD will impact the health of the fetus or infant. Additionally, it is not recommended that children take CBD products outside of Epidiolex, which can only be used to treat DS and LGS symptoms.

So, with the FDA not playing an active role in managing hemp products, the legislation and monitoring of CBD is left to the individual states to determine. As a result, this has caused some significant differences in the availability and access to CBD products across the country.

It can interact with prescription medications

Despite our limited understanding of any official side effects, there has been substantial research to better understand the interactions between CBD and common prescription medications. Important to know in order to keep people with other medical comorbidities safe, examples of medications that CBD has been proven to interact with include:

• Blood thinners — As medications commonly used for those living with increased risk of developing blood clots, people who take blood thinner medications must be closely monitored to reduce their risk of developing internal bleeding. Known for interacting with many different substances, a study found that warfarin (a common anticoagulant) interacted with CBD, putting the patient at greater risk of uncontrolled bleeding¹¹.

• Epilepsy medications — Although Epidiolex is approved for the management of chronic seizure disorders, it has been proven to interact with other common antiepileptic drugs. Additionally, if Epidiolex is given in too high of doses, it can induce more severe and frequent seizures in the patient⁸.

• Chemotherapy medications — As super sensitive medications, chemotherapy drugs are often prescribed based on an understanding of a person’s drug metabolism. Because CBD has been proven to slow this rate down, taking CBD while on chemotherapy may result in the development of toxic levels of chemotherapy medications staying in the body.

Other examples of medications that CBD may interact with include antidepressants, anti-anxiety medications, beta-blocker blood pressure drugs, and over-the-counter cold and flu medications. Because of the number of possible risks that these interactions pose, it is always advised that you speak with your primary care provider before taking any CBD product to ensure that it is safe for you to take.

There is an ongoing legal battle

Due to the historical and social stigma surrounding marijuana, the availability of CBD products around the world is significantly different. With large countries like The United States, Canada, The United Kingdom having different opinions of what is legal and what is not, it can make ordering CBD products incredibly difficult, depending on where you live.

This gets even more complicated when considering the difference between medical and recreational use of hemp products. For example, recreational use of CBD is still prohibited in many countries, however, many governments have moved to make possession of CBD a non-criminal offence to reduce the associated punishment. Currently, countries that have legalised recreational use of cannabis include Canada, South Africa, Georgia, Mexico, South Africa, and Uruguay¹².

Interestingly enough, in The United States, while 34 states have legalised the use of medical CBD, it remains a prohibited substance on a federal level¹³.

So, is CBD worth the hype?

So, all things considered, is CBD worth all of the attention it is receiving? While more research is still needed to be done to better understand the full range of benefits and risks associated with taking CBD products, early studies have shown promising results for its possible uses. This being said, modern medical professionals do not currently view CBD as a miracle cure-all drug — and neither should you.

As the legality and efficacy of hemp products is still a hot topic of debate, the best thing consumers can do to stay safe is to consult with their primary care provider before taking CBD supplements. But, as the demand and interest in CBD therapy continues to rise worldwide, we can expect that more concrete answers to our queries about cannabis are sure to come in over the next few years.

Sources:

1. Marijuana stops child’s severe seizures | CNN Health

2. Cannabis, a complex plant: Different compounds and different effects on individuals (2012)

3. Defining hemp: a fact sheet | Congressional Research Service

4. Hemp vs marijuana | Think Hempy Thoughts

5. Cannabinoid receptors and the endocannabinoid system: Signaling and function in the central nervous system (2018)

6. Cannabidiol (CBD)-what we know and what we don't | Harvard Health Publishing

7. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis (2016)

8. Epidiolex (cannabidiol) | Greenwich Biosciences

9. 14% of Americans say they use CBD products | Gallup

10. Labelling accuracy of cannabidiol extracts sold online (2017)

11. An interaction between warfarin and cannabidiol, a case report (2018)

12. Legality of cannabis | Wikipedia

13. Legality of cannabis by U.S. jurisdiction | Wikipedia

The author, Claire Bonneau, is a medical writer and certified trauma operating room nurse.