Cannabidiol (CBD) use and interest has become extremely popular over the last several years. A 2019 JAMA Network Open article showed not only increasing interest, but it is accelerating year to year from 2016 to 2019. The conclusion of this study suggests public health priority investigation of CBD should catch up with public’s interest.
To evaluate CBD as a potential alternative medial therapy, investigation of CBD has been done by the World Health Organization (WHO), and by Food and Drug Administration (FDA) with consumer updates. These organizational reviews answer some questions about the science, safety, and quality of CBD products.
A comprehensive review of CBD was done in 2018 by the World Health Organization (WHO). The report included the chemistry and substance identification of CBD. The discussion reviewed the potential of CBD converted to tetrahydrocannabinol (THC). In vivo studies suggest transformation to THC can occur, but specific experimental conditions have shown that it does not occur with oral CBD administration. General pharmacology, toxicology and adverse reactions were reviewed with analyses of dependence and abuse potential. Therapeutic applications of CBD epidemiology of medical CBD use were also evaluated.
The findings of this critical review showed there was no evidence of any recreational use or any public health related problems associated with the use of pure CBD. Interestingly about this 27-page review is that several countries have modified their national controls to accommodate CBD as a medicinal product. Since the United States has marijuana as a schedule 1 drug (schedule 1 drug is defined as no accepted medical use with high potential of abuse – other examples are heroin, LSD, methylenedioxymethamphetamine (ecstasy)), there is less acceptance for medicinal use in this country since CBD is associated with THC and cannabis. This is the major roadblock to more potential research on the medicinal use of CBD and acceptance as a possible alternative medical therapy.
The WHO stated no abuse potential with CBD use. Evaluation of research models with animals with CBD exposure failed to substitute THC for any dependence potential. The WHO also felt that with humans, there was no effects of any abuse or dependence potential.
The main summary points of CBD use from the World Health Organization Expert Committee on Drug Dependence:
1- No abuse potential with CBD from minimal effect on conditioned preference/intracranial stimulation from experimental models of abuse and from animal drug discrimination models.
2- Good safety profile with only reported adverse effects from the result of drug interactions with CBD and prescription medications.
3- Unsanctioned medical use of CBD based products with treatment from anecdotal evidence and experience except for one pure CBD product (Epidiolex) that has shown an effective treatment of epilepsy documented by clinical trials.
4- No issues of recreational use or any public health-related problems with pure CBD use.
5- Several countries have modified national controls to accommodate CBD as a medicinal product.
In contrast to the comprehensive CBD review by the WHO, the FDA has been more critical of CBD for consumer safety noted by its review of United States CBD companies and its products. Over the past several years, the FDA has issued warning letters to CBD companies for incorrect marketing or content. The FDA official recommendation is consumers should be wary of purchasing and using CBD products. Warned firms resulted from two major issues:
1- Incorrect CBD levels after testing the chemical content of cannabidiols.
2- Incorrect claims of cure, diagnosis, treatment, and prevention of medical disease.
In addition, an updated FDA consumer CBD update in 2020 summares its major points of concern of CBD use. The FDA recognizes the heightened public interest of CBD from the potential health related benefits however their concern is the many unanswered questions.
The FDA consumer update discusses the potential harmful side effects, unanswered science/safety, and proper quality of CBD products. Unsafe manufacturing practices of CBD production and misleading medical claims by CBD companies are also major concerns of the FDA.
Just as the WHO stated the effectiveness of the pure CBD product, Epidiolex, as a medical treatment, this FDA-approved drug product is also approved as a prescription drug for two rare, severe forms of epilepsy.
The FDA continues to update the public as it understands more about the safety/risks of CBD and the effects of CBD on the consumer. The clinical data evaluating CBD medical benefits and adverse reactions are lacking. The BAK 2 Basics website has medical literature in the CBD Health section showing some of the proven yet limited clinical medical studies. The top priority of the FDA is to protect the public health. More research is necessary and will allow the FDA to disseminate the correct/safe information to the consumers about CBD.
Fortunately, the National Institutes of Health (NIH) association of the National Center for Complementary and Integrative Health (NCCIH) awarded a total of $3 million to nine United States locations to research minor cannabinoids such as CBD in 2019. The studies are to investigate cannabinoids and terpenes as a potential pain-relieving treatment. Each site is evaluating the different mechanism action and effects as an analgesic and anti-inflammatory treatment. The studies will be throughout all regions of the United states and include Boston, San Francisco, North Carolina, New York, Austin, Salt Lake City, Atlanta, Chicago and Philadelphia. This initial NIH grant driven research may prove the worth of medical CBD and may be integrated into future multidisciplinary pain management therapies.
In addition to the documented concerns from the WHO and FDA to CBD consumers, my personal trepidation for the medical use of CBD as a physician is that patients need to understand the important points/questions below before choosing to start CBD as a safe alternative medical treatment:
1- Is it a safe CBD product?
2- Does the patient understand CBD product description and the proper initial CBD dose for different medical ailments?
3- Does CBD interact with your prescription medications?
4- Is the CBD product that is consumed have the absence or presence of a small amount of THC since the presence of the acceptable THC level of < 0.03% may cause consumer to be positive on employment THC testing drug testing?
Contact BAK 2 Basics CBD Medical Consultants for any medical CBD questions. The proper use of medical CBD therapy is based on our clinical experience, patient interactions and research studies. We focus on each patient’s individual needs as it relates to the indication, proper dosing, intake and interaction/side effects with pharmaceutical medications.
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