CBD: Magic elixir or 21st century snake oil?

Unless you drive with your eyes closed, chances are you’ve recently noticed acre after acre of land in Charlotte with leafy green plants shooting out of black plastic-covered mounds. Fields once planted with corn are now filled with hemp, a “more sober” cousin of the cannabis, marijuana, plant.

The explosion in hemp production isn’t being driven by demand for fiber for making rope and baskets but rather the demand for cannabidiol (CBD), a compound in high demand for its purported medicinal properties. This has happened virtually overnight as the passage of the Federal Farm Bill in December 2018 permitted for the first time hemp to be grown legally in the U.S., as long as it contains less than 0.3 percent of THC (the psychoactive compound in marijuana).

The Vermont Agency of Agriculture (VAA) has been quick to provide additional encouragement to Vermont farmers as they search for ways to expand the productivity of their land. In 2019, the VAA received over 780 registrations to grow hemp (requiring a $25 fee), although the number of farmers who are actually engaged in cultivating the crop is likely far lower. Estimates are that the domestic market for CBD products, about $290 million in 2016, may grow to as much as $2.1 billion by 2021.
Caveat emptor

CBD can be found in various forms: 1) as salves, lotions or creams; 2) as tinctures or liquids that can be taken with food or ingested directly; or 3) as pills or tablets. What is generally misunderstood, or ignored, by many is that federal law still prohibits putting CBD in food products (for humans or pets) without the Food and Drug Administration’s (FDA) approval.

CBD products, like vitamins, are mostly marketed as supplements and as a result fall into a hazy regulatory area. Currently, there are no federal or state standards or regulations governing the concentration, purity or use of the stabilizing and delivery agents mixed in with the CBD products. In many cases, products are sold without even a list of ingredients. It’s clearly a buyer-beware situation. This is one thing if you are purchasing a garden tool or a shirt—it’s entirely different if you are buying a product that you plan to rub on your skin or ingest.

Thankfully, CBD does not appear to demonstrate any of the psychoactive properties of marijuana, although with a few notable exceptions there is a dearth of rigorous research exploring its potential health effects. The strongest evidence for CBD’s efficacy as a therapeutic agent comes from studies of its use controlling seizures in people with certain types of epilepsy that have otherwise proven difficult to treat. In fact, the FDA has recently approved the first CBD derived drug, Epidiolex, for treatment of these conditions. However, research into other applications and uses has only just begun. Indeed, while research in Europe has been underway for some time, it wasn’t until 2015 that the FDA loosened regulatory requirements and allowed U.S. researchers to undertake clinical trials on CBD.

Notwithstanding this, there is some tantalizing but unsubstantiated evidence to suggest that CBD may have efficacy as an anti-inflammatory, in moderating chronic pain, and as an anti-anxiety and anti-insomnia agent. But it will take years, perhaps a decade or more, before the research pipeline begins to deliver rigorously vetted, high-quality results that may ultimately drive its adoption as an effective therapeutic agent.

The good news
In the interim, however, there is some modestly good news for those who are tempted by the siren-song of CBD promoters.

First, there appears to be relatively little risk in the use of CBD-containing salves and creams. For example, the use of a CBD-based cream applied to an arthritic hand or knee may provide some relief—either as a placebo or due to its therapeutic properties. Using CBD this way is unlikely to produce any adverse effects.

Second, the research suggests that CBD appears to pose little abuse potential and does not itself further enhance the psychoactive effects of marijuana. An extensive analysis of the literature in 2018 led the World Health Organization (WHO) to conclude that there was no evidence “…of any public health-related problems associated with the use of pure CBD.”
Still there are risks that the WHO report failed to consider. There is evidence that if you are taking other medications, blood thinners for example, CBD can increase blood levels of these drugs. For this reason you should be sure to consult your physician or a pharmacist before using any CBD-based products. Further, there is little that is known about dosage levels or how much CBD one can take. This is an especially serious problem when the product is to be ingested. Recently, both Utah and Virginia have reported persons being exposed to toxic contaminants in CBD products that were marketed online. As with any substance, you should avoid using CBD if you are pregnant or currently breastfeeding.

One additional risk is that the use of CBD may cause some people to delay seeking medical help for treatable conditions, thereby delaying appropriate care.
If you still want to try CBD, consider these guidelines:

  1. Try topical versions of CBD and not the products designated for consumption in food and drink. There are still far too many unknowns about concentration, dosage and other ingredients.
  2. Consult with your doctor or pharmacist first to make sure that other medications you may be taking will not be diminished or strengthened by CBD ingestion.
  3. Be extremely wary of claims and testimonials from CBD marketers.
  4. If you are a pet owner, exercise extreme caution. The benefits of CBD use for pets is even more poorly understood than for humans, while the claims made by marketers are often outrageous.
  5. Buy local products where you know the producer or can easily investigate their products.
  6. Keep up with the latest literature on the topic.

Some consider CBD like WD-40 for the body, a magic substance that when rubbed in or consumed will relieve anxiety and stress, reduce inflammation and banish sleeplessness—similar to what duct tape is to the home handyman. Is CBD just another craze, like “oat bran,” or does it represent a new and effective therapeutic agent? Hopefully, for us and our farmers, the answer will be forthcoming in the future and will be positive. In the meantime, pray for your farming neighbors that this isn’t another “demand bubble” and that we will all be able to benefit from this seemingly magical compound in the coming years.

Jim Hyde is professor emeritus of public health at the Tufts University School of Medicine. He lives in Charlotte.

Information sources
Food and Drug Administration
Mayo Clinic
Harvard Medical School
Consumer Reports
World Health Organization
U.S. Centers for Disease Control and Prevention