CBD Oil? Everything you need to know!

CBD OIL?

Recently, the use of medicinal marijuana has exploded on the medical community as patients are seeking alternative forms for their variety of disorders and conditions. The plant called cannabis sativa produces marijuana, hemp and cannabidiol (CBD) oils. The use of CBD oils continue to surge as individuals seek the medicinal benefits of marijuana without the intoxicating effects of tetrahydrocannabinol (THC) and not “get high”.

CBD oils originate from the flower or leaf of the hemp plant and has been marketed as “full spectrum”. This medicinal use of the CBD or full spectrum hemp oil has less than 0.3% of THC levels while potentially having 12-18% of a CBD component. The delivery of CBD oil can come in the form of oil, balm, spray, capsule, soft gel, oral application or foodstuff.

IS IT LEGAL?

Numerous states have adopted medical marijuana laws as each individual in their respective state will need to verify and confirm the legalities of purchasing and consumption. For example, the states of Idaho, South Dakota and Nebraska have NO LEGAL status for use of marijuana. Furthermore, CBD products cannot be purchased through interstate commerce (not online) as well as most CBD products come from Europe and then processed and sold in the US. Most importantly, the THC levels should not be greater than 0.3%. While individuals can purchase and consume CBD products, medical physicians can only certify and recommend since the Food and Drug Administration has not fully approved CBD oil use for specific conditions. Plus, medical physicians must use their professional opinion on its safety and efficacy as the amount of research remains extremely limited.

IS IT EFFECTIVE?

CBD oil products have been marketed for pain relief, sleeping aid or stress reduction. There has been some research which supports use of CBD oil for chronic pain and spasticity. Furthermore, the FDA approved the CBD oil Epiodiolex that decreased the seizure frequency in specific seizure disorders of Dravet and Lennox-Gastaut syndromes. However, the research and clinical results for CBD oil to reduce migraines, inflammation, anxiety and depression remains limited and lacks powerful evidence. Interestingly though, some researchers propose and suggest the use of CBD oil can be promising for inflammation, pain and opioid abuse.

IS IT SAFE?

Unfortunately, the FDA and other surveys have found companies producing CBD oils have inconsistent ingredients and inaccuracy with labeling as some products have >0.3% THC while also having a lower amount of CBD oil percentage.  Also, due to the relatively new CBD oil products, there has not been any reports of significant or adverse side effects. However, some studies have proposed the use of 300 mg/d for 6 months or even 1200-1500 mg/d for 4 wks as a safe dosage.  The only specific side effects for CBD treatment point toward the treatment of epileptic patients as concern for individuals with decreased liver function with possible drowsiness, diarrhea  and decreased appetite. Plus, studies suggest to be concerned for consuming synthetic CBD products known as “spice” due to hospitalizations from use.

HOW TO CHOOSE? (VanDolah HJ et al study)

Pick CBD oil products with companies that have a:

1. Does it meet the following quality standards?
   1. Current Good Manufacturing Practices (CGMP) certification form the US FDA.
   2. European Union (EU), Australian (AUS) or Canadian (CFIA) organic certification
   3. National Science Foundation (NSF) International certification.
2. Does the company have an independent adverse event reporting program?
3. Is the product certified organic or ecofarmed?
4. Have their products been laboratory tested by batch to confirm tetrahydrocannabinol (THC) levels <0.3% and no pesticides or heavy metals?

Find A Healthcare Provider Now

References

1. Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011;6(4):237-249.

1. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling accuracy of cannabidiol extracts sold online. JAMA. 2017;318(17):1708-1709.

1. Cunha JM, Carlini EA, Pereira AE, et al. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology. 1980;21(3):175-185.

1. Donvito G, Nass SR, Wilkerson JL, et al. The endogenous cannabinoid system: a budding source of targets for treating inflammatory and neuropathic pain. Neuropsychopharmacology. 2018;43(1):52-79.

1. Hurd YL. Cannabidiol: swinging the marijuana pendulum from ‘weed’ to medication to treat the opioid epidemic. Trends Neurosci. 2017;40(3):124-127.

1. Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis Cannabinoid Res. 2017;2(1):139-154.

1. Kuehn B. Synthetic cannabidiol poisoning. JAMA. 2018; 319(22):2264.

1. Louh IK, Freeman WD. A ‘spicy’ encephalopathy: synthetic cannabinoids as cause of encephalopathy and seizure. Crit Care. 2014;18(5):553.

1. Mead A. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law. Epilepsy Behav. 2017;70(pt B):288-291.

1. Peachman RR. Clinicians support medical marijuana use in children with cancer, but lack knowledge. JAMA. 2018; 319(9):852-853.

1. Rubin R. Medical marijuana is legal in most states, but physicians have little evidence to guide them. JAMA. 2017; 317(16):1611-1613.

1. State medical marijuana laws. National Conference of State Legislatures. NCSL website. http://www.ncsl.org/research/ health/state-medical-marijuana-laws.aspx. Accessed June 1, 2018.

1. Trembly B, Sherman M. Double-blind clinical study of cannabidiol as a secondary anticonvulsant. Proceedings of the Marijuana ’90 International Conference on Cannabis and Cannabinoids July 8-11, 1990. Kolympari, Crete.

1. US Food and Drug Administration. Warning letters and test results for cannabidiol-related products, 2015-2017. https:// www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm.

1. VanDolah HJ et al. Clinicians’ Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019 Jun 12. pii: S0025-6196(19)30007-2.

1. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis [published corrections appear in JAMA. 2015;314(5):520, JAMA. 2015; 314(8):837, JAMA. 2015;314(21):2308, and JAMA. 2016; 315(14):1522]. JAMA. 2015;313(24):2456-2473.

1. Zuardi AW, Morais SL, Guimarães FS, Mechoulam R. Antipsychotic effect of cannabidiol. J Clin Psychiatry. 1995;56(10):485-486.

1. Zuardi A, Crippa J, Dursun S, et al. Cannabidiol was ineffective for manic episode of bipolar affective disorder. J Psychopharmacol. 2010;24(1):135-137. 93. Manini AF, Yiannoulos G, Bergamaschi MM