Contributor: Connie Mester, MPH
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There has been tremendous hype about cannabidiol (CBD), with some claiming it is a miracle cure while others remain skeptical of its true medical value. Part 1 summarized the historical journey and recent market growth of this polarizing topic before concluding with a brief snapshot of the evidence of positive health impact across mental and behavioral health conditions. This second article sheds light on potential risks and ways to decipher misleading marketing claims to identify quality, reputable sellers among the multitude of product options. As misinformation and anecdotal testimonies are replaced with scientific evidence and truth around historical events, CBD will be more accepted in mainstream medicine and has the potential to positively impact mental health improvement.
Recently, the legalization of cannabis in Canada in October 2018 and increasing legalization across the U.S., along with the removal of hemp as an illegal substance under the Agricultural Improvement Act of 2018, known as the Farm Bill, has expanded usage and started to shift the negative stereotypes and politically misguided classification. Hopefully, with continued law changes, necessary research and clinical trials will be funded appropriately to provide evidence of therapeutic value and guidance to clinicians on dosing, medication interactions, and potential positive and adverse effects.
Research shows that CBD has a positive safety profile, with very few minor, infrequent, non-threatening side effects. The most common side effects include dry mouth, change in appetite, red eyes, dysphoria, and sedation/fatigue. The World Health Organization "Expert Committee on Drug Dependence (ECDD) concluded that, in its pure state, cannabidiol does not appear to have abuse potential or cause harm.” So why is a substance with such value not part of mainstream medicine?
What was even more surprising in my literature search is how CBD appears to be better tolerated than routine psychiatric medications, as these prescriptions can be ineffective, have multiple negative side effects, have a high risk of addiction, and can lead to overdose.
CHART 1: Antidepressant Medications vs. CBD [ADULTS]
The desire to move away from harsh pharmaceuticals to more natural, holistic alternatives has been growing. Many are not happy with the adverse effects from prescription anti-anxiety medication or antidepressants. Having another option to reduce symptoms of anxiety and depression, manage stress, and treat symptoms associated with numerous other conditions can be the relief so many are looking for.
With all the positive hype around CBD, one must not overlook the potential adverse effects such as medication interactions, possible toxic additives, and issues with self-medicating. Similar to most of the packaged foods on our shelves which contain chemicals, artificial sweeteners and artificial colors that are harmful to our health , CBD products can also contain contaminants, pesticides, bacteria, impurities, heavy metals, and toxins that can have negative side effects.
To ensure safety and quality, companies must conduct third-party testing for consistency and quality in cultivation, manufacturing, and dispensing. However, certificate of analysis (COA) testing is not mandated and, like the cosmetic industry, the CBD market is not regulated. Just as harmful, potentially toxic ingredients can be put into skin and hair care products by beauty companies, some synthetically produced CBD products can contain chemicals, pesticides, or other harmful contaminants. Quality control and regulatory guidelines will help ensure standards are met, and adequate provisions can clear up confusion from product labels and diminish unsubstantiated marketing claims. With greater transparency, consumers will be better able to identify reputable sources and decipher high-quality ingredients, product potency, and purity.
The tarnished reputation, classification by the Drug Enforcement Administration (DEA )as a Schedule 1 controlled substance, and confusion around legalities leave many people intimidated to use CBD for holistic health. Further, with so many product variations and options, selecting the safest, most appropriate product can be challenging. CBD oil can be consumed in different ways, from ingestibles (tinctures, pills, gummies, capsules, lozenges, lollipops, mouth strips, beverages, food), to topicals (creams, balms, ointments, salves), as well as inhaled products (smoking, vaporizing). And the potency of each dose can vary. Providing insight into what to look for when purchasing CBD products will aid in responsible use.
As the appeal of CBD evolves and the scientific research further validates the positive benefits, product sales will continue to move from dispensaries into mainstream retail brick-and-mortar and online settings. This demand surge fuels the need for further education and research, as consumers, clinicians and public health officials need to be informed. Accurate and up-to-date clinical data validating therapeutic benefits and long-term effects of CBD is not readily available for physicians or therapists to use and incorporate into their treatment recommendations.
There is evidence to “suggest a potential therapeutic role of CBD and nabiximols (cannabis extract) to treat various psychiatric disorders.” Recommendations supporting CBD use for schizophrenia, social anxiety disorder, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), insomnia, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), and Tourette syndrome exist; however the evidence is weak (due to a limited number of studies, not outcomes). By uncovering further evidence that “CBD appears to be a safe drug with no addictive effects,” hopefully scientists can secure funding and appropriate and undiscovered medical applications can be explored. These actions will allow medical and mental health practitioners to adequately harness the therapeutic value of CBD to support mental health improvement.
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 Iffland K and Grotenhermen F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and Cannabinoid Research, 2(1), 139–154. doi:10.1089/can.2016.0034
 CohenK and Weinstein AM. (2018). Synthetic and Non-synthetic Cannabinoid Drugs and Their Adverse Effects - A Review from Public Health Perspective. Frontiers in Public Health, 6, 162. doi:10.3389/fpubh.2018.00162
 World Health Organization. (2017). Cannabidiol-compound of cannabis. Retrieved July 25, 2019 from https://www.who.int/features/qa/cannabidiol/en/on.
 Shannon S, Lewis N Lee H and Hughes S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18–041. doi: 10.7812/TPP/18-041
 Hari V. (2019). How Food Companies Exploit Americans with Ingredients Banned in Other Countries. 100 Days of Real Food. Retrieved on July 26, 2019 from https://www.100daysofrealfood.com/food-companies-exploit-americans-with-ingredients-banned-in-other-countries/.
 Khan R NaveedS, Mian N et al. (2020). The Therapeutic Role of Cannabidiol in Mental Health: A Systematic Review. Journal of Cannabis Research. 2. doi: 10.1186/s42238-019-0012-y.
 NIDA. (2015). Researching Marijuana for Therapeutic Purposes: The Potential Promise of Cannabidiol (CBD). Retrieved on July 26, 2019 from https://www.drugabuse.gov/about-nida/noras-blog/2015/07/researching-marijuana-therapeutic-purposes-potential-promise-cannabidiol-cbd.