Y’all got any more of that CBD oil??
Marijuana derivatives such as cannabidiol (CBD) have been claimed to cure everything from human gout to anxiety in dogs. As a medical practitioner or as a patient, how do you cut through the haze of reefer madness online? This shareable video is designed to help you do just that. (This one by Doc Vader? Not so much.)
THC vs CBD
THC, or tetrahydrocannabinol, is the psychoactive component of the marijuana plant associated with many of the “desirable” mental effects of recreational cannabis use. The “high” in other words.
But there are lots of “cannabinoids” in marijuana that have different effects, such as CBD. It isn’t psychoactive in the sense that THC is, and so it doesn’t cause the “stoned” effect. But many in the online arena and beyond ascribe beneficial disease-fighting effects to CBD (and to THC, and yet other elements of this complex plant).
What does the evidence say?
Just because CBD is natural doesn’t mean it’s safe or effective. You have to study it and look at the evidence. Unfortunately, high-quality trials are unusual for multiple reasons (one of which is that marijuana is still classified as a Schedule I drug by the DEA… meaning there is no known medical use — this makes it hard to study historically). Still:
- There is evidence that it may reduce seizures in a pair of particular types of rare childhood seizure disorders. There is actually a recent cannabis-based pharmacology therapy approved by FDA for this purpose.
- Claims of anti-inflammatory effects, social anxiety, and general anxiety amelioration are based on small animal studies and small case studies in human and on anecdote.
- What about curing cancer? No reliable evidence beyond anecdotes that likely confuse correlation with causation.
Like much of the Supplement Industrial Complex, there is no good regulation for CBD supplements. These can contain differing amounts of the actual active substance. This means you have NO IDEA how much of the actual drug you’re taking.
Why is this important? Well, turns out, CBD actually interferes with the metabolism of other drugs.
One in five CBD supplements tested contained psychoactive THC.
In trials involving CBD, up to 10% of patients had an elevation of their liver enzymes and 2%-3% had to STOP the drug due to these elevations. Like any pharmacologic agent, natural or otherwise, CBD has adverse side effects.
What about medical marijuana?
Evidence-based guru and Canadian ZDoggMD homie James McCormack (and his co-authors) wrote a recent paper recommending guidelines for how clinicians should use medical marijuana. They reviewed the best quality literature that exists and looked at three conditions for which marijuana was better than placebo. For everything else, the evidence just wasn’t good enough. They do not recommend marijuana as the first-line therapy and do recommend using it as an adjunct to other medications. They actually recommend a medically synthetic form (nabilone), not the smoked version, due to dosing issues among other reasons. James McCormack also rocked out a parody video to highlight the key points!
The evidence-based indications listed in the papers:
- Chronic pain, particularly neuropathic or end-stage cancer pain
- Spasticity due to multiple sclerosis or spinal cord injury
- Post-chemotherapy nausea and vomiting
Marijuana had the strongest indication for post-chemotherapy nausea and vomiting and showed a 30% benefit over placebo.
A small number of people can have acute psychosis, disassociation symptoms, and paranoia (above and beyond placebo). Sedation, dizziness, and low blood pressure are other common side effects. And of course, there’s Cannabis Hyperemesis Syndrome. So, it is not a magical cure, and it has real side effects like any drug. We need to continue studying it and improving our understanding of its risks and benefits. How do we do this? Take it off Schedule I in the U.S. and study the hell out of it. Oh, and legalize it. How is it alcohol and cigarettes are legal and marijuana isn’t? Come on, y’all.
The post originally appeared on ZDoggMD