Lack of Regulation Also Concerning
Only one purported use for cannabidiol, to treat epilepsy, has significant scientific evidence supporting it.
Because of the legally murky nature of marijuana, the FDA has not stepped in to regulate products like CBD oil, Bonn-Miller said. States are struggling to put regulations in place, but they don’t have the deep pockets of the federal government.
Most Other Uses Largely Unproven
This could mean that people taking anti-epilepsy drugs alongside CBD will need to adjust their dosage downward to avoid side effects, Welty noted.
For example, epilepsy studies found that “there were very clearly increases in the blood levels of some other anti-epileptic drugs when people were on CBD,” Welty said.
“About 2 to 3 percent of individuals taking CBD actually had to discontinue because their liver enzymes went so high it was of concern to the people running the study,” he said.
“At the end of the day [CBD] is a fairly safe compound,” Hill says. “Although, we still need to know a lot more about it, like how it interacts with other medications people may be taking and what are the long-term effects,” he adds. And perhaps his biggest concern: “Sometimes people want to use it instead of evidence-based treatment and that can be a problem clinically in certain situations.”
On that note, Hill cautions to know what you’re getting: “If you’re rubbing a CBD cream onto your skin, it’s not going to be absorbed into your bloodstream,” he says. “It can operate as a local anti-inflammatory, like other over-the-counter products… but CBD may not provide any more relief than those products, and it probably will be considerably more expensive.”
Tinctures, though, remain somewhat shrouded in mystery, in part because of their old-school apothecary-style packaging, but more likely because of how they’re taken: a few drops at a time, under the tongue.
So are there side effects?
The cannabis plant has hundreds of chemicals in it, including more than 120 cannabinoids, Hill explains. Of those cannabinoids, two are most familiar: THC, which produces the euphoric effects or “high” people experience from marijuana, and cannabidiol or CBD, which has some anti-inflammatory, anti-seizure, anxiety-relieving and analgesic properties, according to Low Dog.
Here, Tieraona Low Dog, M.D., an expert on herbal medicine and women’s health, and Kevin Hill, M.D., Director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center and an Assistant Professor of Psychiatry at Harvard Medical School, get to the bottom of CBD tinctures’ mystique.
“The rate and scale of the research just hasn’t kept pace with the interest at this point. A lot of the medical uses for cannabidiol are backed by animal studies only or really no studies. So that’s where it can be a problem.”
At a plant level, the two chemicals operate as opposites, with CBD acting as a buffer of sorts to the effects of THC. “It’s sort of a ying and yang. THC is responsible for the high and CBD doesn’t do that,” Hill explains.