It would be an exaggeration to say that CBD is literally everywhere, but not much. Widely hailed as a miracle cure-oil, it’s been evangelically embraced by young and old, yoga bunnies and gym rats, hipsters and hippies – not to mention opportunistic marketers with a liberal attitude to scientific proof, if not false advertising.
As with any new wellness fad, a healthy dose of scepticism is recommended. But just because evidence is predominantly anecdotal doesn’t mean it’s a complete load of old Goop either. We’re intrigued and open-minded about CBD, but we have some questions. Starting with…
What Is CBD?
Cannabidiol (can-a-bid-eye-ol) is one of more than 100 chemicals called cannabinoids found in the cannabis plant. These interact with your body’s endocannabinoid system, which regulates an array of processes from pain and mood to appetite and sleep. That at least partly explains why CBD is now cropping up everywhere: in vape pens and patches, protein shakes and cocktails, skincare and confectionary. Typically though it’s consumed as an oil or a crystal.
Well, no, actually. Unlike tetrahydrocannabinol or THC, that other household-name cannabinoid, CBD is not psychoactive – in other words, it won’t get you high. CBD tends to be derived from hemp, a variety of cannabis that contains less THC than marijuana and is less likely to incur a knock on the door by the narcs. Hemp was legalised in the US at the end of 2018; in the UK, you need a license from the Home Office, which stipulates that you plant it “sensitively”, ie not near schools, and inform the police. Unsurprisingly, the market stateside is growing like a weed and projected to be worth $2.1bn in 2020 – up 700 per cent from 2016.
So CBD is street legal?
Um, sort of. Technically the US Drug Enforcement Agency still classifies CBD as a maximally restricted Schedule 1 substance – “drugs with no currently accepted medical use and a high potential for abuse” – even though the World Health Organisation states that CBD has “no effects indicative of any abuse or dependence potential”. But if the plant from whence it came is legal to grow under state law, it’s legit.
Any product making medical claims however should still have gone through the FDA’s approval process, but some senators are lobbying to relax this in the interests of “real economic gains”, which definitely won’t result in an alternative-fact free-for-all. The UK’s Medical Healthcare Regulatory Agency meanwhile made noises in 2016 about reclassifying CBD products touted as for medical purposes from less stringently policed supplements to strictly tested medicines requiring licences, but those have so far not been granted.
If it doesn’t get you high, what does CBD do?
If you believe the hype, pretty much everything – CBD has even been trumpeted as a cure for cancer. “Which it is not,” clarifies Harvard Medical School, although the National Cancer Institute states, “Cannabinoids may have benefits in the treatment of cancer-related side effects.”
“It’s been marketed for helping nearly every organ system,” says Kamel Patel, co-founder of Examine.com, an independent site that runs the rule over research on supplements. Anxiety, depression, insomnia, heart disease, liver disease, stroke, diabetes, arthritis, osteoporosis, OCD, PTSD, IBS: whatever ails you, CBD is supposedly good for it.
Is there any, you know, evidence for this panacea’s myriad applications?
Yes, but it’s by no means comprehensive or conclusive. “CBD has mainly been studied for epilepsy, anti-psychosis, and discrete, serious stuff like that,” says Patel. “For general wellness tonic-type stuff, the research is sparse.”
The most compelling evidence is for certain medication-resistant childhood epilepsy syndromes; the US Food and Drug Administration recently approved the use of a drug containing CBD called Epidiolex. But that’s treating specific syndromes that only constitute 5 per cent of epilepsy cases in the US; for alleviating other types of epilepsy, CBD has been shown to be no more effective than a placebo. That’s not to say it doesn’t work on other types – just that there’s no evidence at present to definitively say it does either.
What proof is there that CBD can improve other conditions?
A study demonstrated that CBD applied topically could reduce pain and inflammation from arthritis, but that was conducted on rats. “More study in humans is needed in this area,” is the verdict from Harvard Med School. Studies (on humans) are underway into CBD’s possible applications for alcohol abuse, drug cravings and PTSD that will hopefully prove more conclusive.
Where proof does exist, it’s sometimes for cannabis as a whole, not CBD in isolation. “For example, there’s uncertainty as to whether CBD alone is useful for epilepsy compared to CBD-rich cannabis extracts,” says Patel. Sativex, a lab-produced 50-50 blend of CBD and THC, is approved in the UK for treating multiple sclerosis, but the National Institute for Health and Care Excellence, which advises NHS doctors, gave it “do not recommend” status, ruling it cost-ineffective.
Why then is seemingly everyone taking CBD?
In the hope that it will improve the conditions listed previously, mainly anxiety. In one study, subjects who dropped CBD before public speaking reported less anxiety than those who popped a placebo. (They didn’t know what they’d taken.) Again though, the evidence, while promising, is very much preliminary.
“Anxiety-related research on CBD is typically either just some neuroimaging or a one-day measurement, rather than a multi-week clinical trial,” says Patel. “But given the relatively low side-effect profile, CBD is appealing to consumers, so companies will line up to sell it.”
Side effects of CBD, you say? Should we worry?
Less publicised and desirable consequences of taking CBD can include fatigue, irritability, nausea (ironically, given that it’s marketed as a treatment) and, er, diarrhoea. CBD can also raise the level of other medications in your system, including blood thinners. You should consult your doctor before taking it at the same time as anything else, or indeed at all.
Nobody listens to experts any more. How much CBD should we take?
Good question: there are no guidelines on an effective therapeutic dose of CBD for any given condition. And it’s further complicated by the fact that the contents of CBD products can differ dramatically from what’s on the label. “This is a fairly big problem,” says Patel. A study of CBD products sold online in the US found that over half were underdosed or overdosed – mostly under, which is less of a problem than over, but still.
Some also contained THC, unbeknownst to the purchaser. “Which is pretty bad,” adds Patel. In the UK, you can be fairly certain that products sold in the likes of Holland & Barrett adhere to EU regulations (for now at least). On the Wild West of the World Wide Web, less so. The NHS says of cannabis products bought online, “It’s likely most of these products – even those called ‘CBD oils’ – will be illegal to possess or supply.”
If the evidence for CBD is thin, why is everybody going crazy for it?
You mean, aside from the machinations of the wellness-industrial complex and the spread of legalisation which has absolutely nothing whatsoever to do with the vast amount of money that stands to be made? Probably a combination of other factors.
“Cannabis has a long history, stemming from its traditional use in the east,” says Patel. “People in the west started using it recreationally and therapeutically in the sixties, giving it a somewhat negative connotation; CBD removes that negative connotation but maintains the therapeutic aura. The [relative] lack of side effects, and lack of studies disproving efficacy for different indications, give it a bump.”
That’s to say nothing of our desire for – or susceptibility to the promise of – a magic bullet that solves all our problems in a shot, preferably without having to change our lifestyles.
So what’s the bottom line on CBD: good, bad or gimmick?
“Good: you don’t easily build a tolerance to CBD like you do to THC; it has potential for anxiety reduction,” concludes Patel. “Bad: we don’t know who specifically it would work for – for example, its [anxiety-reducing] properties could be in a subset of people, or change over time. Potential bad: people gravitate towards Band-Aids and don’t address core issues in their life or medical history – this just glosses over them.”