It’s being infused into coffee, baked into cookies and even showing up in dog treats. And odds are you’ve seen the store signs popping up all over advertising its different forms, maybe even right in your neighborhood. “CBD SOLD HERE” or “WE SELL CBD.” Retailers in our region – and all over the country – are jumping on the bandwagon for Cannabidiol (CBD) oil, a trendy health product. Non-medical sources claim that the non-intoxicating marijuana extract can help with everything from sleepiness and anxiety to depression and inflammation, but what do you really know about it? And what does it really contain?
“One of the most common questions that patients have been asking lately is about CBD oil,” says Chasse Bailey-Dorton, MD, MSPH, chief of integrative oncology at Atrium Health’s Levine Cancer Institute Center for Supportive Care and Survivorship.
Also, due to lack of regulation, a CBD product could still contain enough THC to cause someone to fail a drug test. CBD oil can also interact with certain medications, cause a rash or upset stomach and affect the liver.
“As with any herb or supplement, there is the potential for CBD oil products to interact with someone’s regular medication or chemotherapy – making them more toxic or less effective,” says Dr. Bailey-Dorton.
William Wright, MD, an addiction psychiatrist at Atrium Health, says additional research is needed.
“We don't know all the neurophysiological mechanisms of these substances or other unintended consequences,” Dr. Wright says. “Some of the known side effects of CBD are drowsiness and sleepiness. This type of effect is often dangerous – is it OK to drive while using CBD? And we are still unsure of the potential misuse, abuse or addictive experience that CBD may have with some users.”
He also adds that these products are still allowed to contain up to 0.3 percent THC – and that some studies show that CBD can actually delay the clearance of THC, extending its high.
“The other issue is that the doses of CBD in pre-clinical research have been usually been around 300 mg or higher. We just do not currently have enough research to know proper dose, side-effects, interactions or indications for treatment. The hype and marketing are very far ahead of the science.”
A synthetic pure CBD product (Epidiolex) was approved by the U.S. Food and Drug Administration in June 2018 as a treatment for two rare and severe childhood seizure disorders – Lennox-Gastaut syndrome and Dravet syndrome – for patients 2 years old and older. However, like other drugs, Epidiolex requires close monitoring in patients to make sure it’s not affecting liver functions or interfering with other medications. There is also preliminary evidence that CBD products may be useful for anxiety, pain or sleep issues.
However, any claims that CBD or cannabis can be used to treat cancer are without evidence, Dr. Bailey-Dorton says.
“And because cannabis is classified as a schedule 1 drug (as classified by the U.S. Drug Enforcement Administration), this has limited the ability to conduct research with the product," she adds.
“One of the most common questions that patients have been asking lately is about CBD oil,” says Chasse Bailey-Dorton, MD, MSPH, chief of integrative oncology at Atrium Health’s Levine Cancer Institute Center for Supportive Care and Survivorship.
So What is CBD?
Cannabis is made up of over 100 different chemical components with THC (tetrahydrocannabinol) and CBD (cannabidiol) being the predominant two components, Dr. Bailey-Dorton says. THC is what gives a person the “high” psychoactive symptoms, whereas CBD does not cause any “high.” Industrial hemp – as opposed to the marijuana plant – is used to make a variety of things including paper, clothing, building materials, biofuel, food products and more. It has minimal THC (less than 0.3 percent) and high CBD levels and therefore is used as the main source for CBD products.Regulations and Reactions
However, backing for CBD by clinicians lacks support in part because CBD is being produced without regulation, a scary thought to what may be else may be hiding in these products. Dr. Bailey-Dorton does not recommend the use of CBD oil to patients at this time. “Patients need to be aware that there are a lot of fraudulent claims and products on the market in regard to CBD oil because it is unregulated. Many of the products have little if any actual CBD as ingredients.”Also, due to lack of regulation, a CBD product could still contain enough THC to cause someone to fail a drug test. CBD oil can also interact with certain medications, cause a rash or upset stomach and affect the liver.
“As with any herb or supplement, there is the potential for CBD oil products to interact with someone’s regular medication or chemotherapy – making them more toxic or less effective,” says Dr. Bailey-Dorton.
William Wright, MD, an addiction psychiatrist at Atrium Health, says additional research is needed.
“We don't know all the neurophysiological mechanisms of these substances or other unintended consequences,” Dr. Wright says. “Some of the known side effects of CBD are drowsiness and sleepiness. This type of effect is often dangerous – is it OK to drive while using CBD? And we are still unsure of the potential misuse, abuse or addictive experience that CBD may have with some users.”
He also adds that these products are still allowed to contain up to 0.3 percent THC – and that some studies show that CBD can actually delay the clearance of THC, extending its high.
A Green Future?
With Canada recently legalizing marijuana, many trials are being planned to hopefully give a definitive answer in regard to dosing and use of CBD products, says Dr. Bailey-Dorton.“The other issue is that the doses of CBD in pre-clinical research have been usually been around 300 mg or higher. We just do not currently have enough research to know proper dose, side-effects, interactions or indications for treatment. The hype and marketing are very far ahead of the science.”
A synthetic pure CBD product (Epidiolex) was approved by the U.S. Food and Drug Administration in June 2018 as a treatment for two rare and severe childhood seizure disorders – Lennox-Gastaut syndrome and Dravet syndrome – for patients 2 years old and older. However, like other drugs, Epidiolex requires close monitoring in patients to make sure it’s not affecting liver functions or interfering with other medications. There is also preliminary evidence that CBD products may be useful for anxiety, pain or sleep issues.
However, any claims that CBD or cannabis can be used to treat cancer are without evidence, Dr. Bailey-Dorton says.
“And because cannabis is classified as a schedule 1 drug (as classified by the U.S. Drug Enforcement Administration), this has limited the ability to conduct research with the product," she adds.
CBD Laws in the Carolinas
CBD oil is legal in 30 states where medicinal and/or recreational marijuana is legal, according to Governing magazine. According to the National Conference of State Legislatures, North Carolina and South Carolina are two of 13 states that have CBD-specific laws in place, which allow use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations or as a legal defense.
Recently in North Carolina, selling edible products containing CBD has been deemed illegal, according to the North Carolina Department of Agriculture and Consumer Services. Local businesses have been notified that the sale of CBD in food, drinks and animal food violates state and federal law.
