A family doctor’s opinion & comprehensive review of CBD
I’ve been in family medicine for almost 20 years. I focus on preventing chronic disease and helping my patients reach their ideal health through lifestyle and nutrition change. If you want to know more about me, click here.
I reviewed dozens of medical resources before writing this article, and I hope you find the information helpful. The resource links are scattered throughout the body of the article. If you want more information, please let me know.
Disclosure: This post contains affiliate links. If you click through them and make a purchase, I may receive a small commission without an extra cost to you. For more information about affiliate links, go here.
Many of my patients are “confessing” to their use of CBD oil (cannabidiol) recently, with the hope that it will free them from medications that I prescribed.
My patients aren’t purposely trying to go against my medical advice. I understand. They are all looking for a treatment that is natural and safe.
CBD comes from cannabis, which is a plant that grows out of the ground. It’s from nature, so that’s got to be safe. On the other hand, prescription medications seem so fake and processed compared to the greenery provided by Mother Nature. Right?
Physicians can’t ignore patients’ use of CBD either. According to Consumer Reports, in January 2019, there were an estimated 64 million Americans who had tried CBD in the past 24 months. CBD was most commonly used to treat symptoms of anxiety. Other statistics:
- 1 out of 7 people said they use CBD every day
- 40% of people in their 20s report trying CBD
- 32% of people age 30-44 report trying CBD
- 23% of people age 45-59 report trying CBD
- 15% of people 60 or older report trying CBD
- 37% of people use CBD for anxiety
- 63% report that it was extremely or very effective
- 24% of people use CBD for joint pain
- 38% reported extremely or very effective
- 10% of people use CBD for better sleep
- 52% reported that it was extremely or very effective
- 22% of people taking CBD were able to replace an Rx or OTC medication
- 36% replaced Rx opioids with CBD
- 33% replaced a Rx anxiety drug with CBD
- 23% replaced a Rx sleep drug with CBD
- 74% of people who use CBD
These statistics demonstrate the importance of physicians and other clinical providers to know and understand cannabis and its’ derivatives.
Common questions I hear from patients
In this article, I will answer some common questions and provide you the most important take-away points:
- What are DEA Drug Schedules?
- What is cannabis?
- Hemp vs. Marijuana– what’s the difference?
- THC vs. CBD – what’s the difference?
- How does the FDA feel about CBD?
- How does cannabis affect the human body?
- Is CBD safe?
- What is CBD used for?
- What should I look for in a CBD product?
- How will I respond to my patient’s cannabis use?
- Take-home points
Honestly, I didn’t know how to answer these questions. My basic cannabis knowledge did not come from my medical education. The primary source of my understanding was movies like Wayne’s World or Cheech and Chong that highlight only recreational use and abuse.
Wayne and Garth probably aren’t recognized as reliable medical resources, so, I scoured professional medical and scientific journals for information on cannabis. I learned significant facts that made me appreciate the potential benefits that could come from CBD!
Disclosure: I am not an expert in cannabis. This article contains information that I personally gathered from my own research. I encourage you to read further and come to your own conclusion on cannabis and CBD, and as always, discuss with you personal physician before using any product for medicinal purposes.
What are DEA Drug Schedules?
First of all, it’s important to understand what DEA drug schedules are because these are the categories (schedules), determining a drugs’ potential for medical use as well as the potential for abuse and addiction.
In contrast, Schedule 5 drugs have a small potential for abuse or dependence when compared to the other four schedules.
Here is more information on the DEA Drug Schedules:
Given the definition of a Schedule 1 Controlled Substance, wouldn’t alcohol, sugar, coffee, soda, Oreos, and Cheetos be classified as Schedule 1 as well? I think so!
Because of the perceived lack of medical uses, practicing physicians have little to no need to be educated on Schedule 1 drugs. Researchers, too, have had no motivation to invest time or money into understanding these.
Now that you have an understanding of DEA drug schedules, let’s move on to cannabis.
What is cannabis?
Cannabis is a plant genus that is in the Cannabacaea family and has recorded human use dating back over 15,000 years. C. sativa, C. indicas, and C. ruderalis are the most commonly recognized species, distinguished by their unique oils, chemical, qualities, and uses.
Take a look at the different plant species and notice the differences in the leaf size and shape:
Farm Bill 2018 defines hemp
Botanically, hemp and marijuana are both varieties of Cannabis sativa species. It’s important to understand these terms and what they mean, as their definitions have changed over time, creating public confusion.
In the 2018 Farm Bill, hemp was formally removed from the US DEA Schedule 1 Controlled Substance List and legalized in all 50 U.S. states. This bill described hemp as a cannabis plant, cannabis-derived, or cannabis- instilled product with <0.3% THC content.
What is hemp?
Now the confusion.
As I mentioned above, the botanical or scientific classification of “hemp” and “marijuana” was based on the plants’ chemical makeup and its’ properties. In recent years, the definition of hemp and marijuana changed. Because of the 2018 Farm Bill and high public awareness, the widely accepted definitions are now based on the amount of THC in the plant and whether it produces a high.
What is marijuana?
Again, if the plant or plant-derived product has a THC content >0.3%, it is federally ILLEGAL. Each state has its laws on each form of cannabis and its legality.
THC vs. CBD – What’s the difference?
Now that we understand that the new definitions of hemp and marijuana are based on the amount of THC in them, let’s review what THC is and how it differs from CBD.
Cannabis plants all contain essential oils. The two most recognized oils are THC (TetraHydroCannabinol) and CBD (CannaBiDiol).
It’s all about the high
THC is one of the many active compounds found in all cannabis plants and is responsible for producing a “high”.
CBD is one of the essential oils found in cannabis plants and does not cause a “high.” It is vital to know whether the CBD was derived from the hemp plant or the marijuana plant, as CBD is found in all cannabis species.
Plants are also bred for specific ratios of THC: CBD, depending on the qualities desired. High THC: CBD ratio leads to more psychoactive effects. Low THC: CBD ratio has very minimal or no psychoactive effects.
How does cannabis affect the human body?
Introducing the EC system
Within the last 25 years, there has been a discovery of an internal cannabis system in the human body, called the endocannabinoid system. Who knew that there were cannabis receptors found in many tissues of the body, especially our brains! Currently, there are dozens of published studies focusing on the endocannabinoid system. Scientists have discovered at least two types of cannabis receptors, called CB1 and CB2. The receptors are found in the brain, digestive tract, liver, and skeletal system and have different effects when activated.
How THC and CBD affect the EC system
THC activates the CB1 receptors in the brain which causes a release of dopamine, a feel-good neurochemical, thus a feeling of euphoria.
CBD, on the other hand, does not activate the endocannabinoid system. Instead, it inhibits other compounds that affect the EC system. One study posted in the journal Neurotherapeutics in 2015 detailed several pathways that CBD helps regulate and was shown to limit inflammation and oxidative stress.
Researchers are exponentially becoming more knowledgeable of the physiologic role of endocannabinoids in the body’s normal function and different medical conditions. With researchers now able to access cannabis for research and development, We will be seeing novel uses of cannabis for medical conditions affecting several body systems.
The endocannabinoid system is quite complex and outside the scope of this article, but if interested in learning more about the neuroscience of cannabinoids, check out Pharmacology Review and Healthline for further information. The science community is just beginning to understand the full potential of cannabis and its derivatives.
Is CBD safe?
As with other drugs, there are well-documented tolerable side effects of CBD. Many of these side effects are related to the metabolism of CBD in the liver, the unreliability of the purity, and the unknown dosing.
Common side effects
- increases blood level of coumadin (blood thinner)
- dry mouth
- decreased appetite
There have also been several studies reporting adverse drug events stemming from drug-drug interactions and CBD’s effect on drug metabolism in the liver. In general, if a prescribed medication or OTC product cautions about avoiding the consumption of grapefruit while taking the medication, it has the potential for interacting with CBD and causing harm.
Common adverse effects in the body
Here are the most common adverse effects noted in one study cited in the Journal of Clinical Medicine:
- elevated liver enzymes
- sleep disturbances
- drug-drug interactions
What is CBD used for?
In June 2018, the FDA approved the first-ever cannabis-derived medicine for two childhood seizure disorders, Dravet Syndrome and Lennox-Gastaut Syndrome. The new medication, Epidiolex, is derived from CBD and has strong scientific evidence for its’ effectiveness.
CBD acts on the brain’s receptors for serotonin which is a neurotransmitter that regulates mood and behavior. Because of these properties, CBD is commonly used for:
- Insomnia (for both falling asleep and staying asleep)
- Chronic pain due to inflammation (arthritis) and neuropathy
- Pain due to Multiple Sclerosis
CBD has many promising applications, but research still has to be done. A few uses of CBD that are being studied:
- Smoking cessation
- Drug withdrawal
- Effects of Alzheimer’s disease
- Anti-psychotic treatment for schizophrenia
- Type 1 Diabetes
- Blood pressure reduction
- Some cancers
What should I look for when choosing a CBD product?
Before purchasing a CBD product, ask some questions. There are many questions to ask, but I listed what I feel are the most important ones to ask:
Is it hemp-derived?
Remember that hemp-derived products should be low in THC. To be legal, the THC content should be < 0.3%
Where was it grown and is it free of pesticides?
The safest CBD products are derived from cannabis plants that are organically grown, without pesticides or other contaminants. Colorado undergoes spot-testing of their hemp products by state agricultural programs to check for THC levels or use of illegal pesticides.
Pesticides have been implicated in several types of cancers, so it is vital to do your research prior to using these products.
How much THC is in the CBD?
Remember that the legal CBD products should have < 0.3% THC.
Is the CBD company transparent?
To assure product quality, reputable companies will use testing methods in their lab and should adhere to high scientific standards as outlined by respected standard-setting organizations: Association of Agricultural Chemists (AOAC), the American Herbal Pharmacopoeia (AHP), and the U.S Pharmacopeia (USP). The lab should openly provide its’ certificate of analysis (COA) which shows how a product performed on tests checking for THC levels and the presence of contaminants. Look for “ISO 17025” on the COA – this indicated whether the lab meets the high testing standards.
What are the state laws surrounding CBD?
Rules for marijuana and hemp may differ, so know the laws of the state you reside in. Here is an interactive 2019 map from Governing The States and Localities.
To read more on how to choose a CBD product, check out the Consumer Report’s article, How to Shop for CBD.
How does the FDA feel about CBD?
At the time of this writing, the sale, manufacturing, and the distributing of cannabis or cannabis-derived products is a FEDERAL crime.
At the state level, the laws around cannabis vary widely.
The conflicting cannabis laws between state and federal government has caused confusion, to say the least. This means that if you live in a state that has legalized cannabis, and you set up a store to sell CBD, you could technically be charged with a federal crime even though it is legal in your state.
Enforcement of the federal law is unlikely but absolutely possible. Remember that hemp and marijuana are both in the cannabis family, and cannabis is still a Schedule 1 drug (no medicinal use, high potential for addiction, abuse, and safety not established).
It is illegal to grow, market, transport, sell, distribute or use any Schedule 1 drug. Yes, that includes holding a medical marijuana card, regardless of whether it was appropriately prescribed by a physician. The doctors prescribing medical marijuana, landlords to CBD shops, banks doing business with CBD retailers, and the consumer of CBD are all breaking a federal law technically, regardless of the state law.
The confusion surrounding the legality of cannabis could be solved if it were removed from the Schedule 1 drug list. Given preliminary positive results of many small studies, and that one CBD product was FDA-approved (Epidiolex), it won’t be long before the safety and medical uses of cannabis is outlined.
The federal agencies have heard the uproar surrounding cannabis and in order to show Americans that they are committed to protecting the public, they created an internal agency to support the development of cannabis-derived product regulation. The goal is to prevent unsubstantiated claims that CBD and cannabis products can “cure” serious illnesses, which puts a naive population at risk.
Federal agencies responded to the public’s concerns in several ways. On April 2, 2019, the FDA commissioner, Scott Gottlieb released a public statement that outlined the steps it would take to evaluate these products, and there was a public hearing on May 2019 for the public to discuss their views and safety of CBD. The FDA also set up a Cannabis Q&A website that answers the most frequently asked questions regarding cannabis and its’ derivatives.
So, what’s going on at the state level?
At the time of this writing, ten US states and the District of Columbia had fully legalized all forms of cannabis, but the list is growing. In 2018 elections, Missouri, Michigan, and Utah legalized some form of cannabis.
Each state has developed its laws surrounding the use of the plant and its products. States have varying degrees of legality depending on the form of cannabis used or the reason for use.
It’s challenging to keep up with the rapidly changing laws. I recommend referring to this interactive U.S. Map of Marijuana Legality for any questions about specific states.
How will I respond to patients’ cannabis use?
I can understand the public concern regarding cannabis. Before researching this topic, I only thought of marijuana as an illegal substance that people sought intentionally to achieve a high. I didn’t think of cannabis as a remedy for medical problems because I didn’t know there were other effects, aside from the high.
Millions of people are exploring these cannabis-derived products to relieve chronic conditions, not get high. I’m sure there are people who are using cannabis only to achieve a high, not as a treatment for a medical condition. In my opinion, the public’s concern has centered around the intent of cannabis use- for a high? or for medicinal purposes? The public may feel better knowing that there are forms of cannabis that are not psychoactive. It’s time to educate the public about the differences!
Let’s compare hemp to other over-the-counter products like caffeine pills, ginger supplements, or vitamin B12 stress tabs. There is also St. John’s Wort, valerian root, jasmine, or chamomile to improve mood, lower anxiety, and treat physical symptoms such as pain, headache, cramps, hot flashes, or fatigue.
Have you tried any of these OTC products to treat symptoms? Did you know there is no FDA-approved use of these products for any of the symptoms listed? Similar to hemp-derived products, other non-FDA-approved products are widely used for their medicinal effects.
Now, here’s my confession-
I have used ginger to treat a nervous stomach, aloe to soothe the skin, and green tea to stimulate energy, and yes, I have tried hemp-derived CBD for insomnia. The article- Natural Products Derived From Plants As a Source of Drugs, from the Journal of Advanced Pharmaceutical Technology and Research, reminds us about how many of our modern-day, FDA-approved treatments have been born from millennium-old use of natural plants and substances. (penicillin and aspirin) .
Who knows, maybe cannabis will have the same outcome!
With that said, when asked about the dosing, safety, and uses of cannabis and its products, I can’t recommend or prescribe until I hear from the FDA. I will continue to provide my patients with the same education as I would anyone asking me about other non-FDA-approved treatments.
Now that I understand that hemp-sourced CBD is legal and low in THC-content, I’m more open and comfortable with its use. I’ll continue to remain open to my patients’ use of home remedies, herbals, or supplements that are not (yet) FDA-approved. I want to stay open to the possibility that there might be health benefits that have not yet been researched. After all, believing in any treatment is the first step to achieving effectiveness, right?
I hope you now have a better understanding of this very relevant topic! I do, and I feel more prepared to answer my patient’s questions now!
Here are the important take-away points:
- Tell your physician or clinical provider about your use of cannabis, CBD, hemp and its derivative when receiving care to prevent drug interactions or serious adverse effects
- Cannabis product labeling should include THC: CBD ratio and the THC content
- CBD product labeling should clearly include whether it was derived from hemp or marijuana
- Know the cannabis-related laws in the state of use
- Know the THC: CBD ratio of the product, as this determines its legality and clinical effects
- Check the product for quality and testing
- CBD derived from marijuana is ILLEGAL
- THC content < 0.3% is HEMP and IS LEGAL in ALL 50 States
- THC content > 0.3% is FEDERALLY ILLEGAL, but check the state’s laws for details
- Purchase from only trusted companies who have third-party testing for quality
- Do not use cannabis products if you have liver disease or take other medications that are metabolized through the liver
- Don’t believe claims that seem too good to be true
Please comment and share your experience with CBD! I’d love to know how the public feels about it. Is it useful for you? Why do you use it?
Learn more about me, click here.