More
than 60 percent of CBD users were taking it for anxiety, according to a survey
of 5,000 people. Does it help?
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.
What is
CBD?
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.
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.
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.
What
are the claims?
CBD is advertised as providing relief
for anxiety, depression and post-traumatic stress disorder. It is also marketed
to promote sleep. Part of CBD’s popularity is that it purports to be
“nonpsychoactive,” and that consumers can reap health benefits from the plant
without the high (or the midnight pizza munchies).
Just as hemp
seedlings are sprouting up across the United States, so is the marketing. From
oils and nasal sprays to lollipops and suppositories, it seems no place is too
sacred for CBD. “It’s the monster that has taken over the room,” Dr. Brad
Ingram, an associate professor of pediatrics at the University of
Mississippi Medical Center, said about all the wild uses for CBD now. He is
leading a clinical trial into
administering CBD to children and teenagers with drug-resistant epilepsy.
Does
CBD work?
“It’s promising in a lot of different
therapeutic avenues because it’s relatively safe,” said James MacKillop,
co-director of McMaster University’s Michael G. DeGroote Center for
Medicinal Cannabis Research in Hamilton, Ontario.
Last year, the F.D.A.
approved Epidiolex, a purified CBD extract, to treat rare seizure
disorders in patients 2 years or older after three randomized, double-blind and
placebo-controlled clinical trials with 516 patients that showed the drug,
taken along with other medications, helped to reduce seizures. These types of
studies are the gold standard in medicine, in which participants are divided by
chance, and neither the subject nor the investigator knows which group is
taking the placebo or the medication.
While there is hope for treating other
conditions with the plant extract, Epidiolex remains the only CBD-derived drug
approved by the F.D.A. Most of the research on cannabidiol has been in animals,
and its current popularity has outpaced science. “We don’t have the
101 course on CBD quite figured out yet,” said Ryan Vandrey, an associate
professor of psychiatry and behavioral sciences at Johns Hopkins University
School of Medicine.
Does
CBD help anxiety and PTSD?
For students with generalized social
anxiety, a four-minute talk, with minimal time to prepare, can be debilitating.
Yet a small experiment in
the journal Neuropsychopharmacology found that CBD seemed to reduce nervousness
and cognitive impairment in patients with social anxiety in a simulated public
speaking task.
However, a double-blind study found
healthy volunteers administered CBD had little to no change in their emotional
reaction to unpleasant images or words, compared to the placebo group. “If it’s
a calming drug, it should change their responses to the stimuli,”
said Harriet de Wit, co-author of the study and a professor in the University
of Chicago’s department of psychiatry and behavioral neuroscience. “But it
didn’t.”
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.
“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.
Does
CBD help sleep and depression?
Up in the wee hours
of the night, stuck watching videos of puppies? CBD may be promising as a sleep
aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness,
according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are
looking for new treatments for sleep, that may be a clue,” he said.
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.
A recent chart review of 72 psychiatric patients treated
with CBD found that anxiety improved, but not sleep. “Over all, we did not find
that it panned out as a useful treatment for sleep,” said Dr. Scott
Shannon, assistant clinical professor of psychiatry at the University of
Colorado, Denver and the lead author of the review in The Permanente
Journal.
Sleep can be disrupted for many
reasons, including depression. Rodents seemed to adapt better to stressful
conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical
Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional
antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus
Institute of Advanced Studies in Denmark and an associate professor at the University of São
Paulo in Brazil, in an email interview. Of course, it’s difficult to detect
depression in animals, but the studies that Ms. Joca and her colleagues
reviewed suggested that in models of chronic stress exposure, the mice and rats
treated with CBD were more resilient.
But without clinical trials in humans,
psychologists say CBD’s effect on depression is still a hypothesis, and not an
evidence-based treatment.
Read More Articles Related to Hemp and CBD
Is CBD
harmful?
“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.
Recently, the F.D.A. sent a warning letter to Curaleaf
Inc. about its “unsubstantiated claims” that the plant extract treats a
variety of conditions from pet anxiety and depression to cancer and opioid
withdrawal. (In a statement, the
company said that some of the products in question had been discontinued and
that it was working with the F.D.A.)
Dr. Smita Das, chair of the American
Psychiatric Association’s Council on Addiction Psychiatry’s cannabis work
group, does not recommend CBD for anxiety, PTSD, sleep or depression. With
patients turning to these to unproven products, she is worried that they may delay
seeking appropriate mental health care: “I’m dually concerned with how exposure
to CBD products can lead somebody into continuing to cannabis products.”
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.
Earlier research found fewer than a third of 84 products
studied contained the amount of CBD on their labels. Some users of CBD have
also failed drug tests when the product contained more THC than indicated.
This year, 1,090 people have contacted
poison control centers about CBD, according to the American
Association of Poison Control Centers. Over a third are estimated to
have received medical
attention, and 46 were admitted into a critical care unit, possibly because of
exposure to other products, or drug interactions. In addition, concern over 318
animals poured into the American Society for the Prevention of Cruelty to
Animals’ Animal Poison Control Center.
Is CBD
a scam or not?
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.
“CBD is not a scam,”
said Yasmin Hurd, director of the Addiction Institute of Mount Sinai in
New York City who led a double-blind study of
42 recovering heroin addicts and found that CBD reduced both cravings and
cue-based anxiety, both of which can cycle people back into using. “It has a
potential medicinal value, but when we are putting it into mascara and putting
it into tampons, for God’s sake, to me, that’s a scam.”
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