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What Are the Benefits of CBD?

More than 60 percent of CBD users were taking it for anxiety, according to a survey of 5,000 people. Does it help?

By Dawn MacKeen

The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm. Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when “freaking out” over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewart’s French bulldog partakes, too.

What is CBD?

Cannabidiol, or CBD, is the lesser-known child of the cannabis sativa plant; its more famous sibling, tetrahydrocannabinol, or THC, is the active ingredient in pot that catapults users’ “high.” With roots in Central Asia, the plant is believed to have been first used medicinally — or for rituals — around 750 B.C., though there are other estimates too.

Cannabidiol and THC are just two of the plant’s more than 100 cannabinoids. THC is psychoactive, and CBD may or may not be, which is a matter of debate. THC can increase anxiety; it is not clear what effect CBD is having, if any, in reducing it. THC can lead to addiction and cravings; CBD is being studied to help those in recovery.

Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.

What are the claims?

CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep. Part of CBD’s popularity is that it purports to be “nonpsychoactive,” and that consumers can reap health benefits from the plant without the high (or the midnight pizza munchies).

Just as hemp seedlings are sprouting up across the United States, so is the marketing. From oils and nasal sprays to lollipops and suppositories, it seems no place is too sacred for CBD. “It’s the monster that has taken over the room,” Dr. Brad Ingram, an associate professor of pediatrics at the University of Mississippi Medical Center, said about all the wild uses for CBD now. He is leading a clinical trial into administering CBD to children and teenagers with drug-resistant epilepsy.

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Does CBD work?

“It’s promising in a lot of different therapeutic avenues because it’s relatively safe,” said James MacKillop, co-director of McMaster University’s Michael G. DeGroote Center for Medicinal Cannabis Research in Hamilton, Ontario.

Last year, the F.D.A. approved Epidiolex, a purified CBD extract, to treat rare seizure disorders in patients 2 years or older after three randomized, double-blind and placebo-controlled clinical trials with 516 patients that showed the drug, taken along with other medications, helped to reduce seizures. These types of studies are the gold standard in medicine, in which participants are divided by chance, and neither the subject nor the investigator knows which group is taking the placebo or the medication.

While there is hope for treating other conditions with the plant extract, Epidiolex remains the only CBD-derived drug approved by the F.D.A. Most of the research on cannabidiol has been in animals, and its current popularity has outpaced science. “We don’t have the 101 course on CBD quite figured out yet,” said Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

Does CBD help anxiety and PTSD?

For students with generalized social anxiety, a four-minute talk, with minimal time to prepare, can be debilitating. Yet a small experiment in the journal Neuropsychopharmacology found that CBD seemed to reduce nervousness and cognitive impairment in patients with social anxiety in a simulated public speaking task.

However, a double-blind study found healthy volunteers administered CBD had little to no change in their emotional reaction to unpleasant images or words, compared to the placebo group. “If it’s a calming drug, it should change their responses to the stimuli,” said Harriet de Wit, co-author of the study and a professor in the University of Chicago’s department of psychiatry and behavioral neuroscience. “But it didn’t.”

Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.

“Our top therapies attempt to break the association between reminders of the trauma and the fear response,” said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the study’s principal investigator. “We think that CBD, at least in animal models, can help that process happen a lot faster.” While large clinical trials are underway, psychologists say there isn’t compelling evidence yet as to whether this is a viable treatment.

Does CBD help sleep and depression?

Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are looking for new treatments for sleep, that may be a clue,” he said.

But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasn’t been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.

A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. “Over all, we did not find that it panned out as a useful treatment for sleep,” said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.

Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor at the University of São Paulo in Brazil, in an email interview. Of course, it’s difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.

But without clinical trials in humans, psychologists say CBD’s effect on depression is still a hypothesis , and not an evidence-based treatment.

Is CBD harmful?

“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.

Recently, the F.D.A. sent a warning letter to Curaleaf Inc. about its “unsubstantiated claims” that the plant extract treats a variety of conditions from pet anxiety and depression to cancer and opioid withdrawal. (In a statement, the company said that some of the products in question had been discontinued and that it was working with the F.D.A.)

Dr. Smita Das, chair of the American Psychiatric Association’s Council on Addiction Psychiatry’s cannabis work group, does not recommend CBD for anxiety, PTSD, sleep or depression. With patients turning to these to unproven products, she is worried that they may delay seeking appropriate mental health care: “I’m dually concerned with how exposure to CBD products can lead somebody into continuing to cannabis products.”

Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100 percent natural CBD extracts. They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.

Earlier research found fewer than a third of 84 products studied contained the amount of CBD on their labels. Some users of CBD have also failed drug tests when the product contained more THC than indicated.

This year, 1,090 people have contacted poison control centers about CBD, according to the American Association of Poison Control Centers. Over a third are estimated to have received medical attention, and 46 were admitted into a critical care unit, possibly because of exposure to other products, or drug interactions. In addition, concern over 318 animals poured into the American Society for the Prevention of Cruelty to Animals’ Animal Poison Control Center.

Is CBD a scam or not?

A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. That’s when someone believes a drug is working and symptoms seem to improve.

“CBD is not a scam,” said Yasmin Hurd, director of the Addiction Institute of Mount Sinai in New York City who led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using. “It has a potential medicinal value, but when we are putting it into mascara and putting it into tampons, for God’s sake, to me, that’s a scam.”

More than 60 percent of CBD users were taking it for anxiety, according to a survey of 5,000 people. Does it help?

Does CBD oil work for chronic pain management?

Many people use cannabidiol (CBD) to relieve pain. Understanding CBD can help overcome the stigma associated with it.

CBD oil is derived from the cannabis plant. People report using this oil for relief from pain, anxiety, depression, and sleep disorders.

There is limited evidence from human studies to support the benefits of CBD oil, due to restrictions on the use of and research on cannabis. As cannabis is becoming legalized in various regions, research is gaining momentum and shows some promising results.

In this article, we look at how CBD oil works and how people use it to relieve chronic pain.

A small bottle of CBD oil against a green background with a dropper held above it

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CBD is one of more than 100 compounds found in cannabis, called cannabinoids. Many plants contain cannabinoids, but people most commonly link these compounds to cannabis.

Unlike other cannabinoids — such as tetrahydrocannabinol (THC) — CBD does not produce a euphoric “high.” This is because CBD does not affect the same receptors as THC.

The human body has an endocannabinoid system (ECS) that receives and translates signals from cannabinoids. It produces some cannabinoids of its own, which are called endocannabinoids. The ECS helps regulate functions such as sleep, immune-system responses, and pain.

When THC enters the body, it produces a “high” feeling by affecting the brain’s endocannabinoid receptors. This activates the brain’s reward system, producing pleasure chemicals such as dopamine.

Does CBD make you high?

CBD is an entirely different compound from THC, and its effects are very complex. It does not produce a “high” and does not impair a person’s functioning, but it influences the body to use its own endocannabinoids more effectively.

According to a 2015 study published in Neurotherapeutics, CBD influences many other receptor systems in our body and will influence the ECS in combination with other cannabinoids.

For example, CBD can increase the body’s levels of anandamide, a compound associated with regulating pain, which can reduce pain perception and improve mood.

Cannabidiol may also limit inflammation in the brain and nervous system, which may benefit people experiencing pain, insomnia, and certain immune system responses.

For more information and resources on CBD and CBD products, please visit our dedicated hub.

Different varieties of cannabis plants — such as hemp and marijuana — contain different levels of chemical compounds.

How people breed the plant affects the CBD levels. Most CBD oil comes from industrial hemp, which usually has a higher CBD content than marijuana.

Makers of CBD oil use different methods to extract the compound. The extract is then added to a carrier oil and called CBD oil.

CBD oil comes in many different strengths, and people use it in various ways. It is best to discuss CBD oil with a doctor before using it.

According to the National Centers for Complementary and Integrative Health (NCCIH), some evidence suggests that cannabis or CBD could have modest benefits for chronic pain.

While CBD is a promising option for pain relief, research has not yet proven it safe and effective, and the Food and Drug Administration (FDA) have not approved CBD for treating pain.

A 2020 review reports that CBD could have benefits for relieving chronic pain, improving sleep, and reducing inflammation, but that these effects are condition-specific.

More evidence is needed to determine the therapeutic potential of CBD and to determine safe and effective dosages for pain.

Based on the current research, here are some possible benefits of CBD oil:

Neuropathic pain

Neuropathic pain is pain caused by damage to the nerves. This type of pain is common in diseases such as multiple sclerosis, injuries such as herniated discs, and infections such as shingles.

A 2017 review found that CBD helped with chronic neuropathy pain in humans. The researchers looked at 11 randomized controlled trials with 1,219 patients.

However, a 2018 Cochrane review concluded that the potential benefits of cannabis-based medicine might be outweighed by its potential harms.

This research looked into the effects of cannabis-derived medicines, including CBD, for chronic neuropathic pain. It looked at 16 studies and 1,750 participants.

More research is needed to understand the role of CBD in chronic neuropathic pain management, including the risks, benefits, and ideal dosages.

Arthritis pain

A 2016 study in the European Journal of Pain used an animal model to see if CBD could help people with arthritis manage their pain. Researchers applied a topical gel containing CBD to rats with arthritis for 4 days.

Their researchers noted a significant drop in inflammation and signs of pain, without additional side effects.

People using CBD oil for arthritis may find relief from their pain, but more human studies need to be done to confirm these findings.

Multiple sclerosis

Multiple sclerosis (MS) is an autoimmune condition that affects the entire body through the nerves and brain.

Muscle spasms are one of the most common symptoms of MS. These spasms can be so strong they cause constant pain in some people.

One report found that short-term use of CBD oil could reduce the levels of muscle spasms a person feels. The results are modest, but many people reported a reduction in symptoms. More studies on humans are needed to verify these results.

Chronic pain

The same report studied CBD use for general chronic pain. Researchers compiled the results of multiple systematic reviews covering dozens of trials and studies. Their research concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.

A separate study in the Journal of Experimental Medicine supports these results. This research suggests that using CBD can reduce pain and inflammation.

The researchers also found that subjects were not likely to build up a tolerance to the effects of CBD, so they would not need to increase their dose over time.

They noted that cannabinoids, such as CBD, could offer helpful new treatments for people with chronic pain.

CBD currently has a range of applications and promising possibilities.

  • helping people quit smoking
  • managing drug withdrawal
  • treating seizures and epilepsy
  • treating anxiety
  • reducing some effects of Alzheimer’s disease
  • reducing antipsychotic effects for people with schizophrenia
  • potentially combating type 1 diabetes and cancer in the future

Although more research is required to confirm the benefits of CBD oil, it is shaping up as a potentially promising and versatile treatment.

The Food and Drug Administration (FDA) have approved one form of CBD, called Epidiolex, to treat two rare forms of epilepsy and to treat seizures caused by a rare condition called tuberous sclerosis complex.

More generally, marijuana-derived CBD products are not yet legal at the federal level but are legal under the laws of some states.

People should check their state’s laws and those of any place they intend to travel. They must keep in mind that the FDA do not approve or regulate nonprescription CBD products. As a result, labeling may be inaccurate.

The FDA does not regulate CBD for most conditions. As a result, dosages are currently open to interpretation, and people should treat them with caution.

Anyone who wishes to use CBD should first speak to a doctor about whether it will be beneficial or safe, and how much to take.

The FDA has approved a purified form of CBD for some types of epilepsy, with the brand name Epidiolex. People using this medication should follow the doctor’s advice about doses.

Most people tolerate CBD oil well, but there are some possible side effects.

According to a 2017 review in Cannabis and Cannabinoid Research, the most common side effects include:

  • fatigue
  • diarrhea
  • changes in appetite
  • weight gain or weight loss

In addition, using CBD oil with other medications may make those medications more or less effective.

The review also notes that scientists have yet to study some aspects of CBD, such as its long-term effects on hormones. Further long-term studies will be helpful in determining any side effects CBD has on the body over time.

Consult a doctor before using CBD, as it may interact with certain over-the-counter dietary supplements and medicines, as well as some prescription medications — especially those that warn against consuming grapefruit .

CBD might also interfere with an enzyme called cytochrome P450 complex. This disruption could affect the liver’s ability to break down toxins, increasing the risk of liver toxicity.

The patient information leaflet for Epidiolex cautions that there is a risk of liver damage, lethargy, and possibly depression and thoughts of suicide, but these potential side effects are true of other treatments for epilepsy, too.

One study in Frontiers in Pharmacology, suggested cannabinoids’ anti-inflammatory effect may reduce inflammation too much. A large reduction in inflammation could diminish the lungs’ defense system, increasing the risk of infection.

Almost all research on CBD oil and pain comes from adult trials. Experts do not recommend CBD oil for use in children, as there is little research on the effects of CBD oil on a child’s developing brain.

However, people may use Epidiolex for children ages 2 and above who have rare forms of epilepsy.

People should not use CBD oil when pregnant or breastfeeding.

People should use caution when taking CBD products by mouth alongside high-fat meals. High-fat meals can dramatically increase the blood concentrations of CBD, which can increase the risk of side effects.

The FDA does not regulate CBD products in the same way they regulate drugs or dietary supplements, so companies sometimes mislabel or misrepresent their products. That means it’s especially important to do some research and find a quality product.

While many studies have suggested CBD oil is helpful for pain, more research is necessary, especially long-term studies with human subjects.

However, CBD oil does show promise as a treatment for pain. Some scientific and anecdotal evidence suggests that it can help people manage chronic pain in various contexts.

CBD oil is especially promising due to its lack of intoxicating effects and a possible lower potential for side effects than many other pain medications.

People should discuss CBD oil with their doctor if they are considering using it for the first time.

What precautions would you advise if someone wants to try CBD oil to treat pain?

Users should follow legal channels to obtain CBD.

The science is emerging to support its use, especially in a time where most people want to avoid addicting opioids while treating chronic pain.

Because of the changes in social acceptance for the use of the marijuana plant and the urgency to address the opioid crisis, there is funding for clinical trials.

A 2017 study found CBD was effective for chronic neuropathy pain. It may have a role in reducing inflammation as well.

An individual should talk to a doctor first, start with the lowest doses possible, read the information available, and be an informed consumer.

Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Is CBD legal? Hemp-derived CBD products with less than 0.3% THC are legal federally but still illegal under some state laws. Cannabis-derived CBD products, on the other hand, are illegal federally but legal under some state laws. Check local legislation, especially when traveling. Also, keep in mind that the Food and Drug Administration (FDA) have not approved nonprescription CBD products, which may be inaccurately labeled.

Last medically reviewed on November 3, 2020

Cannabidiol or CBD oil has become popular for pain treatment. This article looks at how it works, how to use it, and the benefits and risks of CBD oil.