There are concerns that CBD might interact negatively with other drugs, specifically blood thinners like wafarin. But there’s no specific guidance on which medications to avoid mixing with the extract.
Plenty of companies, restaurants, and cookbook authors are now folding CBD into their recipes. But does the ingredient have the same therapeutic effect when it’s baked in a brownie pan at 360 degrees Fahrenheit or seared in a skillet with sea bass and lemon rinds?
All that variability, both in the plants and the products that are derived from them, makes CBD more challenging to test for medicinal purposes. It’s also often mixed with THC when treating chronic pain or life-threatening illnesses, so it take many extra layers of research to isolate the purely physical perks from the psychoactive ones.
How much should people take?
This post has been updated with new information from the Food and Drug Administration.
There’s also the question of which forms of CBD are safe enough for consumers but strong enough to make a difference. For neurological conditions like anxiety or apnea, the chemical needs to be absorbed into the bloodstream to have maximum impact. That means it needs to be ingested, inhaled, or rubbed in at high concentrations. But as health reporter Sarah Jacoby wrote in Self while vetting her own CBD buys, many of the proteins that trigger pain and inflammation are located between the skin and veins. So, any cream or gel that wants to counter aching joints and tight muscles needs to be able to get through the dermis but not as deep as the blood vessels. That’s a tall order for any drugstore formula.
Figi’s neurologist put her on a low dose of a specially bred strain of medical cannabis, later dubbed “Charlotte’s Web.” The effects were almost immediate. The seizures slowed from daily to weekly events, and soon, the kid was living life almost normally. After close to two years of the oral treatment, the doctors decided to wean Figi off other epilectic medications.
“There are many unanswered questions about the science, safety, quality, and physiological effects of CBD that need to be addressed before one can identify the effects of various chemical reactions on its efficacy,” Shelke says. Part of the issue with cooking with the extract is that the purity and the concentration is often unknown. This makes it even harder to know how it will interact with other ingredients, and whether that combination will help or harm a person. Bottom line: It’s better to avoid highly processed products or prepared meals with CBD, especially if you’re new to the compound.
On the other hand, a review that included 83 studies (40 of them RCTs) involving over 3,000 people with various mental health conditions found that there was “scarce evidence” to show that cannabinoids improved depression or anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder or psychosis.
As for potential users, “low and slow” was the refrain from the CBD store managers with whom I spoke. With CBD tincture, for example, McManigal recommended placing a half of vial of oil under the tongue—the equivalent of 17 milligrams in his formulation—and waiting 45 minutes to an hour. “If you don’t feel the effect of being more relaxed, use more,” he said.
“You don’t know the dose, you don’t know the formulation and therefore [you don’t know] the absorption,” White told me. “In a lot of places, it’s essentially a backyard pharmacy where people just sort of make it up…. When you get in a situation where people are kind of doing it themselves then that is really out of control.”
The lack of high-quality studies reflects the hoops one has to jump though to conduct marijuana research. Regulatory barriers need to be streamlined and funding sources need to be identified so that large, well-designed RCTs can be conducted to explore the beneficial and harmful health effects of CBD use, which ultimately would better inform states, the FDA and the public. Currently, there are "This industry is not going to go away. Our sales are up,” one shop owner told me. All the more reason for us to do the research, prove CBD’s efficacy, standardize dosing and ensure quality, among other things. I no longer growl when I pass my local store; the people there genuinely believe they’re doing a good thing. Let’s find out if they’re right.
I visited three stores in the San Diego area. At the Golden State Greens shop, the supervisor, Jake C. told me his customers use CBD primarily for stress, anxiety, insomnia and pain, including several cancer patients who found that the product helped them sleep and perhaps regain some weight they’d lost while undergoing treatments. Shawn McManigal, owner of the Injoi CBD store in La Jolla, said a 92-year-old customer of his stopped taking his constipating pain medications after realizing that CBD gummies relieved the pain and allowed him to rest. “I’m not saying this is a miracle cure,” McManigal told me, “but there is science behind it and it really proves what it does.”
That’s certainly storybook enough. So, is CBD a miracle cure? Despite its promise, if you’re someone who hopes to read that science proves CBD is a wonder product, I’m afraid this isn’t the place to look.
According to a WHO report, CBD is generally well-tolerated with a good safety profile, and in humans it exhibits no effects that would indicate potential for abuse or dependence. The side effects are generally mild and may include sleepiness, diarrhea, mood changes, etc., but concerns exist of potential liver injury, medication interactions, and male fertility issues. White said there is little known about the effects of sustained and/or cumulative use of CBD, or its use in special populations like adolescents, the elderly and pregnant women.