I get a lot of questions about CBD and love to share what I have learned in my research deep dives into this fascinating compound. References are listed below.
What is CBD?
Cannabidiol, or CBD, is a non-intoxicating component of the cannabis plant with enormous therapeutic potential. Researchers are currently studying the effects of CBD on a wide range of conditions including chronic pain, insomnia, PTSD, anxiety, epilepsy, dementia and more. Extensive preclinical research and some clinical studies have shown that CBD has strong anti-oxidant, anti-inflammatory, anticonvulsant, anti-depressant, anti-psychotic, anti-tumoral, and neuroprotective qualities.
How does CBD interact with the endocannabinoid system? And what the heck is the endocannabinoid system, anyway?
The endocannabinoid system is an integral part of our neuro-immuno-endocrine network. This is the system of organ and tissue signaling in the human body that sends and receives chemical messages affecting many aspects of human health including mood, pain, inflammation, stress response and immune function. Our bodies produce their own cannabinoids—endocannabinoids—primarily anandamide, and 2-AG (2-arachidonoylglycerol). A 'phytocannabinoid' or plant-derived cannabinoid like CBD or THC can activate the same receptors in the body and have similar or stronger effects than our endocannabinoids. This is similar to how morphine derived from the poppy plant can reduce pain by activating the body’s endorphin receptors. We know the very specific receptors that THC activates in the body, primarily CB1 and CB2 receptors in the brain, but are still learning the many different receptors that CBD interacts with. One research article estimated CBD may interact with 65 different receptors in the human body, leading scientists refer to CBD as a “promiscuous” compound (made me lough out loud the first time I read that in a dry research article!)
What are cannabinoids?
Cannabinoids (e.g., THC and CBD) are the chemical compounds made by cannabis plants that can affect the human body. They work by imitating compounds our bodies naturally produce, called endocannabinoids, that affect nerve, brain and immune cell activity. Currently, there are two known primary cannabinoid receptors: CB1 and CB2 receptors. Although these two cannabinoid receptors have been studied relatively extensively, there are more cannabinoid receptors being examined.
CB1 receptors are located in the central nervous system, and in some peripheral tissues. They affect appetite, muscle control, pain, cognition, thermoregulation, and our stress response.
CB2 receptors are primarily found in immune cells, and at a lower density in the central nervous system. CB2 activation is associated with immune function and immune cell proliferation, inflammation, and pain.
Will CBD make me feel high?
Cannabidiol (CBD) has many health benefits, without producing the psychoactive, euphoric effects of THC. “Relaxing but not intoxicating” is how some of my patients have described the effect. That said, I did have one patient that felt that a low dose of CBD made her feel high. This is why I recommend starting with very low dosages.
Is CBD safe?
CBD exhibits no effects on humans indicative of any abuse or dependence potential.
To date, there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.
Chronic use and high doses up to 1,500 mg/day of CBD are reportedly well tolerated in humans.
Are CBD products legal in all 50 states?
Yes, as long as they are derived from hemp, not marijuana, and contain less than 0.3% THC. No medical marijuana card is required to buy or use hemp-derived CBD products.
What is the difference between hemp and marijuana?
Although both hemp and marijuana are technically variants of the Cannabis sativa plant, there are significant differences between them. Hemp is considered “industrial” under current regulations, and is defined as having less than 0.3% THC. In the US, the legal definition of industrial hemp (as defined in Section 7606 of the Agricultural Appropriations Act of 2014), is "the plant Cannabis sativa L. and any part of such plant, whether growing or not, with a delta-9 tetrahydrocannabinol concentration of not more than 0.3 percent on a dry weight basis.” Marijuana generally refers to Cannabis sativa plants that have a high concentration of THC, and the word stems from the recreational use of THC rich cannabis for the purpose of getting “high.” Hemp plants possess a high concentration of CBD, with only traces of THC, and hemp extracts are associated with medicinal use.
How to choose a CBD product?
Make sure the product you buy has been third party lab tested for the 3 P’s: Potency (how much CBD is in it), Purity (any residual solvents from extraction process) and Pesticides. Third party lab testing should be available on the product website. Unfortunately, CBD labels on products are often inaccurate and unreliable as far as their CBD content. A JAMA 2017 study found that nearly 70% of all CBD products sold online contained either higher or lower concentrations of the drug than indicated on the label. CBD products should be lab tested to verify they are free of pesticides, and other contaminants. It is best to avoid products extracted with toxic solvents like BHO, propane, hexane or other hydrocarbons. Opt for products that utilize cleaner extraction methods such as supercritical CO2. Beware of CBD vape pen oil that contains propylene glycol. When overheated, this chemical additive produces formaldehyde, a carcinogen, as a byproduct, according to a 2015 report in the New England Journal of Medicine.
Will CBD extract influence results of a urine drug test?
Most drug tests screen for the psychoactive compound THC, not cannabidiol (CBD). However, full-spectrum hemp extracts may contain trace amounts of THC, so could cause a positive result in a urine drug screen, especially when taken at high doses.
Will CBD interact with my other medications?
At low doses of CBD, less than 150mg total per day, it is unlikely that significant drug-herb interactions will occur. However it is always possible that drug-herb interactions can occur, and this is more likely the higher the dose. CBD and other plant cannabinoids can potentially interact with many pharmaceuticals by inhibiting the activity of cytochrome P450, a family of liver enzymes. Talk with your health care provider or pharmacist before trying CBD if you are taking a medication where maintaining a certain blood level is critical, such as anti-seizure, anti-viral or blood-thinning medications.
Does CBD affect appetite?
Unlike THC, CBD has negligible effects on appetite and satiety.
Does CBD cause side effects?
Typically CBD is not associated with many side effects but these have all been reported: - Dry mouth - Drowsiness - Lightheadedness - Rarely can cause feelings of mild intoxication
What is the right dosage of CBD?
An effective dosage can range from as little as a 5mg of CBD per day up to 150mg per day. Make sure to start low and go slow. Take a few small doses over the course of the day rather than one big dose. Use the same dose for several days. Observe the effects and if necessary adjust the amount. Don’t overdo it.
Szaflarski JP, Bebin EM, Cannabis, cannabidiol, and epilepsy—from receptors to clinical response. Epilepsy Behav. 2014;41:277-82
Miller RJ, Miller RE. Is cannabis an effective treatment for joint pain? Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):59-67. Epub 2017 Sep 28. Review. PubMed PMID: 28967368
Spelman K. “Silver Bullet” Drugs vs. Traditional Herbal Remedies: Perspectives on Malaria. HG J Am Bot Coun 84:44-55.
Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011 Aug;163(7):1344-64
Shimon Ben-Shabat S et al. An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Euro J Pharmacol. 1998;353:23–31
Szaflarski JP, Bebin EM, Cannabis, cannabidiol, and epilepsy--from receptors to clinical response. Epilepsy Behav. 2014;41:277-82
Fasinu PS et al. Current Status and Prospects for Cannabidiol Preparations as New Therapeutic Agents. Pharmacotherapy 2016;36(7):781-96
Campos AC et al. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders. Front Pharmacol. 2017 May 23;8:269
World Health Organization, WHO Expert Committee on Drug Dependence, Thirty-ninth Meeting Geneva November 2017
Bergamaschi et al Safety and side effects of cannabidiol, a Cannabis sativa constituent (NCBI/NIH). Curr Drug Saf. 2011 Sep 1;6(4):237-49.
The Real Risk of Buying Medical Marijuana Online by Amanda MacMillan Nov. 7, 2017 TIME Health