15:1, and by 2014 the ratio had jumped to
Despite the fact that they’re both cannabinoids found only in the cannabis plant, THC and CBD are polar opposites in many ways. THC is intoxicating and responsible for the “high” of cannabis, but CBD has no such effect. THC is addictive; CBD is not addictive and even appears to have some anti-addictive effects against compounds like opioids. While THC stimulates the human appetite, CBD does not. There are areas where they overlap — in preliminary animal studies, THC and CBD exhibit some similar effects, including pain-relieving and anti-inflammatory properties and anti-oxidant and neuroprotective effects. In some early research, they’ve even shown the ability to inhibit the growth of cancer cells, but years of rigorous studies need to be conducted before we’ll know whether they have the same impact on humans.
Is CBD a cure-all — or snake oil? Jeffrey Chen, executive director of the UCLA Cannabis Research Initiative, explains the science behind the cannabis product.
So where does this leave us? Unfortunately, outside of certain rare pediatric seizure disorders, we scientists do not have solid data on whether CBD can truly help the conditions that consumers are flocking to it for — conditions like insomnia, depression and pain. And even if it did, we still need to figure out the right dose and delivery form. Plus, CBD is not without side effects. Here’s the advice that I give to my friends and family: If you’re using CBD (or thinking about using it), please research products and talk to your doctor so they can monitor you for side effects and interactions with any other drugs you take.
But while there is a lack of concrete and conclusive evidence about CBD’s effects, there is considerable hope. Recent legislative changes around hemp and CBD in the US and across the world have enabled numerous human clinical trials to begin, investigating the use of CBD for conditions such as autism, chronic pain, mood disorders, alcohol use disorder, Crohn’s disease, graft-versus-host-disease, arthritis and cancer- and cancer-treatment-related side effects such as nausea, vomiting and pain. The results of these studies should become available over the next five years.
As Executive Director of the UCLA Cannabis Research Initiative, I’m dedicated to unearthing the scientific truth — the good and the bad — behind cannabis and CBD. My interest was sparked in 2014 when I was a medical student at UCLA, and I discovered a parent successfully treating her child’s severe epilepsy with CBD. I was surprised and intrigued. Despite California legalizing medical cannabis in 1996, we weren’t taught anything about cannabis or CBD in med school. I did research and found other families and children like Charlotte Figi reporting success with CBD, and I knew it was something that needed to be investigated. I established Cannabis Research Initiative in the fall of 2017, and today we have more than 40 faculty members across 18 departments and 8 schools at UCLA working on cannabis research, education and patient-care projects.
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. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. 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.
The evidence for cannabidiol health benefits
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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. 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.
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
On the other hand, a review that included 83 studies (40 of them RCTs) involving over 3,000 people with various mental health conditions found that there was “scarce evidence” to show that cannabinoids improved depression or anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder or psychosis.
The FDA is investigating reports of CBD containing such dangerous contaminants as unhealthy levels of heavy metals (including lead), pesticides, bacteria and fungi. Law enforcement agencies found that 128 samples out of more than 350 tested by government labs in nine states had synthetic marijuana in products being sold as CBD.
Though CBD is legal to sell, the FDA has made it clear that unapproved CBD products cannot be in food, beverages, cosmetics or sold as a dietary supplement; neither can they be marketed with unsubstantiated health claims. CBD can be purchased as oils, tinctures, sprays, creams, capsules, lollipops, chocolates, energy bars, trail mix and gummies, among other things. It can even be vaped. (According to Pam Miles, past president of the Association of Food and Drug Officials, one restaurant chain offered sandwiches infused with CBD as part of a promotion, so you know we’re already there in terms of availability.)
I visited three stores in the San Diego area. At the Golden State Greens shop, the supervisor, Jake C. told me his customers use CBD primarily for stress, anxiety, insomnia and pain, including several cancer patients who found that the product helped them sleep and perhaps regain some weight they’d lost while undergoing treatments. Shawn McManigal, owner of the Injoi CBD store in La Jolla, said a 92-year-old customer of his stopped taking his constipating pain medications after realizing that CBD gummies relieved the pain and allowed him to rest. “I’m not saying this is a miracle cure,” McManigal told me, “but there is science behind it and it really proves what it does.”
Why so popular? Well, CBD is being marketed as a health supplement and a medicine, with the ability to reduce inflammation, lessen pain and reduce anxiety as well as to potentially help alleviate other conditions like post-traumatic stress disorder, some of the side effects of chemotherapy, and even spasticity associated with multiple sclerosis. The Hemp Farming Act of 2018 reclassified hemp from a highly controlled Schedule 1 substance, like marijuana, to an agricultural product that could now be grown and distributed legally.
Jason White, who chairs the World Health Organization Expert Committee on Drug Dependence, told me he believes CBD will prove efficacious for a broader range of seizure types, that it likely has some anti-psychotic efficacy, and that it may help improve the quality of life among those who suffer from Parkinson’s disease. In studies, CBD has been found to treat certain types of seizures, has benefited schizophrenia patients with psychotic symptoms in two of three RCTS, and has improved activities of daily life and sleep in Parkinson’s patients in early trials.
That’s certainly storybook enough. So, is CBD a miracle cure? Despite its promise, if you’re someone who hopes to read that science proves CBD is a wonder product, I’m afraid this isn’t the place to look.