CBD Products Do They Work?

The Bottom Line

Cannabidiol (CBD) is one of the most studied compounds of the cannabis plant. CBD drew attention when it was shown to stop seizures in a group of patients with a form of epilepsy that does not respond to conventional therapies. Potential benefits of CBD might include anti-inflammatory, immune system, and anti-anxiety effects. A great deal more scientific investigation is needed.

The Full Story

There is a term of Greek origin, panacea, that means all-healing. Vitamin D, magnesium, turmeric, and recently cannabidiol (CBD) are some of the products that have enjoyed time in the public eye as the panacea we are all missing. CBD is a chemical compound from the cannabis plant. CBD is not tetrahyrdrocannabinol (THC), which is the main psychoactive substance in marijuana that causes intoxication and is potentially habit forming.

The idea that the cure lies in plants and natural medicine is alluring. After all, humans have relied upon natural medicines much longer than tightly-controlled pharmaceuticals. When drugs are created, a common method is to find a receptor in the body and make a compound to act on that receptor. Cannabinoid-sensitive receptors exist in our bodies (primarily in the central nervous and immune systems), and the cannabinoids that act on them already exist in abundance in the cannabis plant.

CBD does not cause people to become intoxicated or "high" and, so far, has not been shown to be addictive like THC. Marijuana plants are cannabis plants that have been cultivated to have high levels of THC. Hemp plants are cannabis plants that have been cultivated to have low amounts of THC (although not zero) and higher amounts of CBD. Hemp plants are the source of the flood of CBD products on the market, from skincare to latte add-ins.

While cannabis plants have been cultivated, used, and even prescribed by doctors for epilepsy, pain, and anxiety around the world, there was a shift as the pharmaceutical companies began to produce more medications. It is thought that targeted political and financial campaigns against cannabis, and the use of plants in general, painted them as something only unsavory, unsophisticated characters used. Eventually marijuana became illegal.

In America, hemp plants are now legal to grow. However, extracted CBD from hemp plants is a pharmaceutical ingredient. Epidiolex is an FDA-approved CBD product that has been shown to help some people with rare types of epilepsy that are not controlled by other medications. Sellers of other CBD products cannot make any medical claims or they might violate FDA regulations.

Supplements and non-pharmaceutical CBD products are not regulated. This means that there is no oversight body such as the FDA assuring that these products are made in an appropriate environment, are free from contamination, or even contain what they advertise on the label. This has become an important issue in major sports where athletes take supplements or try to use natural products instead of pharmaceuticals. There have been cases in which athletes used CBD products and, during drug screens, tested positive for THC. It might be that the athletes were not telling the truth, or it might be that they unknowingly used an unregulated CBD product contaminated with THC.

Much of the research on CBD has been looking for anti-inflammatory and targeted immune system effects. This could be very helpful, because steroids are our most commonly used anti-inflammatory agents. Steroids have extensive side effects and should be used for the shortest time possible. However, there are many chronic inflammatory diseases for which chronic steroid therapy is one of the only therapies that provides relief to some patients.

Common side effects reported from swallowing CBD products are mild and possibly not related to CBD, but rather from other components present in the product. For example, drowsiness is the most common side effect. However, this is not in line with the studies on the action of CBD. It is thought that contamination with myrecene, another chemical found in in both marijuana and hemp plants, could be responsible for the sedating effects. Nausea has also been reported. CBD is metabolized by a major enzyme system in the liver and can have drug interactions. Ask your pharmacist or call Poison Control to run a drug interaction check if you are going to start a CBD product.

Research is ongoing and more compounds of interest from the cannabis plant are sure to follow. Can individual chemicals such as CBD alone provide a benefit, or is the entire plant needed (entourage effect) to realize the full effects? Additionally, studies on safety and use in children need to be explored. Will CBD users develop tolerance and potentially experience withdrawal? This question will not be answered until large groups of people taking CBD have been studied.

For now, there is no panacea.

If you are worried about a CBD exposure, check the webPOISONCONTROL® online tool for guidance or call Poison Control at 1-800-222-1222. Whether you log on or call, expert assistance is available 24 hours a day.

Pela Soto, PharmD, BSHS, BS
Certified Specialist in Poison Information


For More Information

Jones B. I tried $130 CBD oil to treat my anxiety. Science Insider; 2019 Aug 10 [cited 2019 Nov 30].

Cannabis (marijuana) and cannabinoids. Bethesda (MD): NIH National Center for Complementary and Integrative Health; 2018 Oct 25 [cited 2019 Aug 17].

Russo E. The pharmacology of cannabis cannabinoids and terpenes. Cannabis Hemp Conference and Expo; 2017 Jun 22 [cited 2019 Nov 30].

Williams F. Take two hours of pine forest and call me in the morning. Outside; 2012 Nov 28.


References

Campbell CT, Phillips MS, Manasco K. Cannabinoids in pediatrics. J Pediatr Pharmacol Ther. 2017 May-Jun ;22(3):176-85.

Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M. Cannabinoids as novel anti-inflammatory drugs. Future Med Chem. 2009 Oct;1(7):1333-49.

Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011 Aug;163(7):1411-22.

Russo EB. Cannabidiol claims and misconceptions. Trends Pharmacol Sci. 2017 Mar;38(3):198-201.

Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011 Aug;163(7):1344-64.

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Over-the-counter CBD products (topical, oral, or otherwise) have not been studied in children and are not recommended.
  • CBD products are unlikely to cause a serious problem if accessed by a curious child. However, there is an element of unknown because the products are not regulated, so they might contain other chemicals.
  • Ask your pharmacist to check for drug interactions involving regular medications and supplement products like CBD.

This Really Happened

A 13-year-old boy was feeling anxious at school. A friend offered him a gummy thought to contain CBD. He went to the school nurse who called the boy's parents and Poison Control. Poison Control indicated that if it truly was CBD alone, the boy should have no significant symptoms beyond mild sedation or dizziness. With increasing availability of THC-containing products, the school nurse was also informed of symptoms that would be expected with THC in his age group including excitation (anxiety, paranoia) and sedation. When Poison Control followed up on the boy several hours later, he had confessed that the ingestion was actually several days previously and that he had no effects. He was nervous about the exposure and wanted to be sure he was okay.