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Does CBD Really Do Anything?

PHOTO ILLUSTRATION BY FIVETHIRTYEIGHT / GETTY IMAGES

As marijuana is legalized in more and more states, the wellness world has whipped itself into a frenzy over a non-intoxicating cannabis derivative called cannabidiol. CBD products can be found on the internet and in health-food stores, wellness catalogs and even bookstores. (A bookstore in downtown Boulder, Colorado, displays a case of CBD products between the cash register and the stacks of new releases.) Celebrities like Gwyneth Paltrow, disgraced cyclist

‘> 1 Floyd Landis and former Denver Broncos quarterback Jake Plummer are all touting CBD products, and according to Bon Appétit, CBD-infused lattes have become “the wellness world’s new favorite drink.”

But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about. After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.

Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.

Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question. What is clear, at this point, is that the marketing has gotten way ahead of the science.

Cannabinoids are a class of compounds that interact with receptors throughout your body. CBD is just one of dozens of cannabinoids found in cannabis, including tetrahydrocannabinol (THC), which is the one responsible for marijuana’s famous high. Medical cannabis is technically any cannabis product used for medicinal purposes, and these can contain THC or CBD or both, said Nick Jikomes, a neuroscientist at Leafly, a website that provides information about legal cannabis. “A common mistake people make is to think that CBD is ‘the medical cannabinoid’ and THC is ‘the recreational cannabinoid.’” That’s inaccurate, he said, because THC is a potent anti-inflammatory and can be helpful for pain.

What makes CBD so appealing is that it’s non-intoxicating, so it won’t get you high, though it “is technically psychoactive, because it can influence things like anxiety,” Jikomes said. Although much of the marketing blitz around CBD centers on the fact that you can take it without getting stoned, there isn’t much research looking at the effects of CBD when used in isolation, with a couple of exceptions. One is the use of CBD to treat seizures: CBD is the active ingredient in the only cannabis product that the Food and Drug Administration has signed off on — a drug called Epidiolex, which is approved for treating two rare forms of epilepsy. Animal models and a few human studies suggest that CBD can help with anxiety, but those are the only conditions with much research on CBD in isolation.

Last year, the National Academies of Sciences, Engineering and Medicine released a nearly 500-page report on the health effects of cannabis and cannabinoids. A committee of 16 experts from a variety of scientific and medical fields analyzed the available evidence — more than 10,000 scientific abstracts in all. Because so few studies examine the effects of CBD on its own, the panel did not issue any findings about CBD specifically, but it did reach some conclusions about cannabis and cannabinoids more generally. The researchers determined that there is “conclusive or substantial evidence” supporting the use of cannabis or cannabinoids for chronic pain in adults, multiple sclerosis-related spasticity (a kind of stiffness and muscle spasms), and chemotherapy-induced nausea and vomiting. The committee also found “moderate” evidence that cannabis or cannabinoids can reduce sleep disturbances in people with obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis, as well as “limited” evidence that these substances can improve symptoms of Tourette’s syndrome, increase appetite and stem weight loss in people with HIV/AIDs, and improve symptoms of PTSD and anxiety.

Donald Abrams was a member of the committee that reviewed the evidence that went into producing the report, and he said that the studies they reviewed overwhelmingly used pharmaceutically available preparations that contain THC, including dronabinol, nabilone and the whole-plant extract spray nabiximols, which contains equal parts CBD and THC. It’s impossible to know whether the benefits of cannabis can also be obtained from CBD alone, Abrams said, because CBD is just one of 400 chemicals present in the plant. So far, CBD in isolation has been studied in only a handful of randomized, placebo-controlled trials (considered the gold standard of evidence in medical research), and the evidence remains sparse.

Still, as the saying goes, absence of evidence isn’t necessarily evidence of absence, and there’s a reason we don’t have a ton of solid research on CBDs yet — “to study it, we need a good source, ” said Ziva Cooper, who is an associate professor at Columbia University and was on the National Academies committee. CBD is hard to get because it’s still technically a Schedule I drug, which limits its availability, Cooper said.

Cooper recently got funding from the National Institutes of Health for a study looking at cannabinoids — including CBD in isolation — as a substitute for opioids, and numerous other clinical trials of CBD are underway. It will be several years before results are available, but these studies should help clarify both what benefits the substance may provide and any side effects it may come with. Most of the adverse effects so far associated with cannabis, such as impairments in short-term memory, coordination and judgment,

Also known as being stoned.

“> 2 come from products that contain THC as well as CBD, Cooper said, but we need to do more studies to find out for sure whether CBD has fewer risks. Studies are also needed to identify the best way to administer and dose CBD. “I get emails from people asking me what dose of CBD to use, and the truth is, we really don’t know,” Cooper said.

In the meantime, some physicians are forging ahead — and cashing in. Joe Cohen is a doctor at Holos Health, a medical marijuana clinic in Boulder. I asked him what CBD is good for, and he read me a long list of conditions: pain, inflammation, nausea, vomiting, intestinal cramping, anxiety, psychosis, muscle spasms, hyperactive immune systems, nervous system degeneration, elevated blood sugar and more. He also claimed that CBD has anti-cancer properties and can regenerate brain cells and reduce the brain’s levels of amyloid beta — a kind of protein that’s been linked to Alzheimer’s disease. I asked for references, noting that most of these weren’t listed in the Academies report or a similar review published in the Journal of the American Medical Association. “I think you just have to Google search it,” he said. It’s true that a preliminary study found hints that cannabinoids might reduce beta amyloid proteins in human brain cells, but the study was done in cells grown in a lab, not in people. As for cancer, the FDA sent warning letters last year to four companies that were selling products that claimed to “prevent, diagnose, treat or cure” cancer.

Those warning letters aside, there’s not a lot of federal oversight right now over the claims being made or the products that are being sold. Cohen warned against buying CBD products online, because “there’s a lot of scams out there.” Yet his clinic sells CBD, and he admits, “I say ‘Don’t buy online,’ but ours is worth doing, because we know what we’re doing. We ship all over.”

Right now, there’s a good chance that you don’t really know what you’re getting from any source. Testing and labeling rules vary by state, but many states that allow legal cannabis also require some kind of testing to verify that the THC and CBD levels listed on the label are accurate. However, this testing is controversial, and results can vary widely between labs, Jikomes said. A study published in March found measurable variations in test results, with some labs consistently reporting higher or lower levels of cannabinoids than others. There are no guarantees that the label accurately reflects what’s in the product. For a 2015 study published in JAMA, researchers tested 75 products purchased in San Francisco, Los Angeles and Seattle and found that only 17 percent were accurately labeled. More than half of the products contained significantly lower levels of cannabinoids than the label promised, and some of them contained only negligible amounts of the compounds. “We need to come up with ways to confidently verify the composition of cannabis products and make this information available to consumers,” Jikomes said.

“All these people are making claims,” Abrams said, but right now, there’s little verification. “It’s the Wild West.”

As marijuana is legalized in more and more states, the wellness world has whipped itself into a frenzy over a non-intoxicating cannabis derivative called cannab…

Cannabis has great medical potential. But don’t fall for the CBD scam

The UK market for cannabidiol, a compound found in cannabis, will soon be worth £1bn. But consumers are being conned

‘What a giddy array of products there are: from CBD water to cooking or massage oils, pills, chewing gum, transdermal patches, pessaries, gin, beer and lube.’ Photograph: MediaWorldImages/Alamy Stock Photo

‘What a giddy array of products there are: from CBD water to cooking or massage oils, pills, chewing gum, transdermal patches, pessaries, gin, beer and lube.’ Photograph: MediaWorldImages/Alamy Stock Photo

Last modified on Mon 1 Jul 2019 12.44 BST

R oll up, roll up, ladies and gentleman, and gather around. Do you, your loved one – or family pet – suffer from any of the following conditions? Cancer, epilepsy, diabetes, arthritis, anxiety, menstrual cramps, insomnia, dry skin, psychosis, Alzheimer’s, dementia, anger, depression, ADHD, Crohn’s and IBS, PTSD, opiate addiction, Parkinson’s, pain of any kind, migraine, or canine uptightness? Then it’s your lucky day.

All can be treated, claim the snake oil salesmen of the modern wild west, with the miracle cure-all: CBD, or cannabidiol. It’s one of the 119 cannabinoids contained in cannabis sativa, indica and ruderalis, and all hybrids thereof; aka weed. CBD is legal and doesn’t get you high – still-illegal cannabinoid THC does that job very efficiently – but it’s fair to say business is blazing.

What a giddy array of products there are: from CBD water (sold in clear bottles that mean the sensitive compound swiftly degrades), to cooking or massage oils, pills, chewing gum, transdermal patches, pessaries, gin, beer and lube. The crown for silliest CBD product of the year, however, belongs indisputably to the CBD-infused pillowcases sold by one hopeful firm of US fabric-makers. Yoga classes offering CBD-assisted asanas and guided meditation have sprung up, with devotees claiming greater flexibility and elevated mood.

Sellers in the UK are careful not to claim any specific medical benefits for the products because of a lack of clinical evidence, so they are instead marketed as food supplements. In this, they are supported by breathless, uncritical media reports on CBD use for airily unspecified “wellbeing” purposes.

There is now no denying the medicinal value of CBD and THC – not even by the British government, which for years maintained that lie even as it rubberstamped the cultivation and export of the world’s largest medicinal cannabis crop.

But the landmark decision in November 2018 to allow UK doctors to prescribe cannabis under extremely limited circumstances, inspired by the cases of Billy Caldwell and Alfie Dingley, whose epilepsy is improved immeasurably by medicinal cannabis products containing both THC and CBD, has left many in a limbo: knowing or believing that cannabis offers a cure, yet remaining unable to access it.

‘Medicinal cannabis products immeasurably improve the epilepsy of Billy Caldwell (above, with his mother, Charlotte).’ Photograph: Charles McQuillan/Getty Images

And so as media reports of miraculous cures for desperate people proliferate, the CBD industry is growing fast. Market research commissioned by the thinktank Centre for Medicinal Cannabis (CMC) estimates that the CBD market in the UK could be worth almost £1bn a year by 2025, equivalent in size to the current entire UK herbal supplement market.

And in many cases, the industry is taking consumers for a ride. Lab tests for the CMC report analysed high-street offerings and found that more than half of the most popular CBD oils sold do not contain the level of CBD promised on the label. And a look at the label of those products shows that many are sold at such low concentrations that even the guesstimated doses, measured in drops, cannot deliver more than a scant few milligrammes of the active ingredient – whereas medical trials use many times more.

Still, mislabelled or low-dose products pale into insignificance when compared to a US case reported in the journal Clinical Toxicology in April. A family unwittingly dosed their child with what was claimed to be CBD oil, but instead contained the synthetic cannabinoid receptor agonist AB-Fubinaca. This chemical is better known as an ingredient in the shortcut to oblivion otherwise known as spice.

Britain is poorly prepared for the wide-ranging changes to cannabis law that are flowering worldwide. British hemp farmers face serious commercial disadvantage as CBD may be legally extracted only from the stem and leaves of hemp crops, not from the flower, where the cannabinoids are produced in greatest profusion. Most CBD is therefore imported: a wasted opportunity to create and control – and tax – a new industry.

What is clear is that legal reform on cannabis, while welcome, is not moving anywhere near quickly enough to benefit millions of patients.

The UK market for cannabidiol will soon be worth £1bn. But consumers are being conned, says science journalist Mike Power