Medical Marijuana and CBD: Miracles or Menace? (Part 2)

Cannabidiol (CBD) is an essential component of medical marijuana but is just one of the over 100 active components found in the plant. (Of note, tetrahydrocannabinol or THC is one of the main chemicals that causes the “high” that goes along with marijuana use.

Medical Marijuana and CBD: Miracles or Menace? (Part 2)

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What is CBD?

Cannabidiol (CBD) is an essential component of medical marijuana but is just one of the over 100 active components found in the plant. (Of note, tetrahydrocannabinol or THC is one of the main chemicals that causes the “high” that goes along with marijuana use. It is fat-soluble after ingestion and is quickly distributed to fat tissue, the spleen, liver, and lungs.) CBD by itself does not cause intoxication and doesn’t have addictive potential, according to reports from the World Health Organization.

CBD can be extracted from the marijuana or hemp plant. The vast majority of CBD on the market is derived from the hemp plant, which is a cousin of marijuana. (They are both in the Cannabis family.) It is interesting to note that the two plants are produced very differently. Marijuana is bred for high concentrations of psychoactive content (THC) and grown in different ways to selectively maximize these qualities. Hemp is grown to generate fiber and seeds and other common items while containing only traces of psychoactive compounds. Industrial hemp is versatile, durable and sustainable. It grows quickly, in various environments, and doesn’t require pesticides. In fact, hemp actually benefits the soil by removing toxins.

What is it used for?

CBD is typically used by people suffering from anxiety, insomnia, certain types of chronic pain and spasticity. CBD may help decrease pain and inflammation from arthritis and may help treat neuropathic pain. It has been shown to be effective in treating certain types of epilepsy in children.

Is it legal?

The federal government still considers CBD in the same class as marijuana, although the DEA enforcement efforts tend to target criminal activity. Each state has its own laws regarding CBD with varying degrees of restriction.

Is it Safe?

A review of the literature, which is a thorough summary of previous research on the topic of CBD was done. The purpose of this review was to summarize, objectively evaluate and clarify previous research related to the safety and side effects of CBD. Overall, they found that CBD is safe. The authors of the review acknowledged that the European Industrial Hemp Association commissioned and paid them to do this comprehensive review. Most of the studies had some limitations that should be noted. Some studies were only carried out for a few weeks or contained only a small number of participants, hence extracting the safety of long term use or generalizing results to the population as a whole is difficult to do. The studies in the review had minimal data looking at the effect CBD has on the immune system or hormones. CBD has been shown to increase the level of Coumadin in the bloodstream and blocks the ability of certain enzymes to break down medications for proper elimination (using the same mechanism that grapefruit juice does to alter the metabolism of certain medications). This may cause the level of the medication in the bloodstream to rise, leading to potential side effects or toxicity.

CBD is typically used orally or topically. The most common side effects when CBD is taken by mouth are nausea, fatigue, and irritability.

The biggest concern is that CBD is marketed and sold as a supplement, therefore the FDA doesn’t have the ability to regulate and ensure the purity or safety of the supplement you may be taking. There is no guarantee that the product you buy has any of the active ingredients listed on the label or in the dose they say it is. A supplement may contain various unknown elements, which could have unfavorable effects, also.  

Without proper studies, we don’t know the therapeutic dose of CBD for specific medical conditions nor the upper limit in order to prevent or minimize side effects.

Summary

CBD may be an effective way to help manage insomnia, anxiety and chronic pain but more high-quality studies are necessary.  Be thoughtful and steer away from companies that claim it is the cure-all for almost everything. You should discuss over-the-counter medications and supplements you are taking with your provider to avoid drug interactions, potential side effects or toxicity.  

Conclusion

It is understandable that many patients are embarrassed to bring up the topic of medical marijuana or CBD with their health care provider.  Many physicians and clinicians have not embraced the concept of medical marijuana or CBD because there aren’t rigorous studies and proof of the benefits and risks.  There are side effects and potential drug interactions. However, individual providers are learning and doing their own research to understand the applications of its use.  Be open and honest with your provider. Be willing to discuss all types of therapy and medications and cooperatively make the best decision regarding the treatment of your symptoms or condition.

Kristen Wright, FNP

Canyon View Women’s Care

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

https://www.health.harvard.edu/blog/medical-marijuana-2018011513085

Gillespie, B. (2019) Marijuana: Ancient Medicine, the Devil’s Playground, or Medical Miracle? Elite Healthcare Nursing Continuing Education, 50-62.

https://www.healthline.com/nutrition/cbd-oil-benefits#section1

https://www.medicalnewstoday.com/articles/320984.php#1

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Medical Marijuana and CBD: Miracles or Menace? (Part 1)

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