February 6, 2020
Medical marijuana has been legal in Illinois for some time now, and recreational marijuana is now legal as well.
But another marijuana product called CBD (cannabidiol) may attract people who would not normally consider using marijuana. CBD products have become readily available, but it has not been extensively researched. As one website put it: “Its current popularity has outpaced science.”
A New York Times article by Dawn MacKeen, published Oct. 16, last year notes that, “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,” and it adds that, among some celebrities, “Martha Stewart’s French bulldog partakes, too.”
According to Brent A. Bauer, M.D., on the Mayo Clinic website, “The usual CBD formulation is oil, but it is also sold as an extract, a vaporized liquid and as an oil-based capsule. Food, drinks and beauty products are among the many CBD-infused products now available online.”
Regarding government oversight, Harvard Medical School’s website notes: “In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license.
“The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.”
What is it used for?
The WebMD.com site describes how CBD works: “Cannabidiol has effects on the brain. The exact cause for these effects is not clear. However, cannabidiol seems to prevent the breakdown of a chemical in the brain that affects pain, mood, and mental function. Preventing the breakdown of this chemical and increasing its levels in the blood seems to reduce psychotic symptoms associated with conditions such as schizophrenia. Cannabidiol might also block some of the psychoactive effects of delta-9-tetrahydrocannabinol (better known as THC). Also, cannabidiol seems to reduce pain and anxiety.”
Currently, the only CBD product approved by the Food and Drug Administration is prescription oil called Epidiolex. It’s approved to treat two types of epilepsy, and hopes are high that it will be helpful with other types.
Peter Grinspoon, MD, contributor to the Harvard Health Publishing/Medical School website says, “CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications.
“In numerous studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking …
“CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.
“CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.”
According to the Mayo Clinic website: “While CBD is being studied as a treatment for a wide range of conditions, including Parkinson’s disease, schizophrenia, diabetes, multiple sclerosis and anxiety, research supporting the drug’s benefits is still limited.”
WebMD.com gives a long list of illnesses where early research results are inconsistent and/or suggest CBD is ineffective as a treatment.
Problems and additives
Mayo Clinic’s website lists some cautions. “CBD use also carries some risks,” it says. “Though it’s often well-tolerated, CBD can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications you’re taking, such as blood thinners.”
Harvard’s Dr. Grinspoon says, “Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does.”
“A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication,” he adds. “Currently, the FDA does not regulate the safety and purity of dietary supplements. So you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.”
Dr. Grinspoon is not the only medical professional who is concerned about other ingredients in CBD products.
The Mayo Clinic website notes “the unreliability of the purity and dosage of CBD in products. A recent study of 84 CBD products bought online showed that more than a quarter of the products contained less CBD than labeled. In addition, THC (the psychoactive ingredient in marijuana that produces a high) was found in 18 products.”
The previously quoted New York Times article also points to product unreliability, saying, “Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100% 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.”
The same article quoted 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.
“It has a potential medicinal value,” he said, “but when we are putting it into mascara and putting it into tampons, for God’s sake, to me, that’s a scam.”
A ‘natural’ product, a specific concern
Erica Laethem, regional director of ethics at OSF HealthCare Saint Anthony Medical Center in Rockford, takes a practical approach to the use of health supplements and the common idea that “because it’s natural, it must be safe.”
“I might lift up that, as Catholics, we don’t believe that because something exists in nature it must be good for you or ought to be used,” she says. “This is called the ‘appeal to nature fallacy.’ Likewise, we don’t believe that simply because something is artificially produced that it is necessarily harmful or bad.”
Pregnancy poses an extra reason for caution.
WebMD.com lists the use of CBD by women who are pregnant under “Special Precautions & Warnings.” It states, “Cannabidiol is POSSIBLY UNSAFE to use if you are pregnant or breast feeding. Cannabidiol products can be contaminated with other ingredients that may be harmful to the fetus or infant. Stay on the safe side and avoid use.”
Overall caution recommended
“Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not,” says, Harvard’s Dr. Grinspoon. “We need more research but CBD may be proven to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting.
“If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.”
Ethicist Laethem echoes his final thought.
“Catholic Tradition sings the praise of medicine and how it can be used to improve lives; however, products like CBD oils are largely unregulated, so prudence is especially necessary,” she says. “For discussions of particular types of medications or natural supplements or remedies, people should talk to their healthcare providers, who can help them navigate the risks and benefits for them, in light of their health circumstances.”