CBD has gained a lot of attention over the past couple of years. Some might say it's overrated, others swear by it. And by now you've possibly even been given a gummie or CBD oil by a helpful friend. But what is it exactly, and can it really help you? Or is it just today's snake oil?
If you're curious about CBD and whether it might be helpful for you, you've come to the right place.
CBD (cannabidiol) is a chemical known as a cannabinoid. It is one of over 100 different cannabinoids found in the cannabis plant. Other cannabinoids include THC (tetrahydrocannabinol), CBN (cannabinol), and CBG (cannabigerol). CBD may be found in higher or lower amounts depending on the strain of cannabis.
One of the reasons for its popularity is that it is non-psychoactive, unlike THC (the cannabinoid responsible for causing a "high").
In some products (e.g. pure pharmaceutical CBD formulations) it is used in isolate form, separated from the other chemicals in the plant, such as other cannabinoids, terpenoids, and flavonoids. In other products it exists as part of an extract from the cannabis plant. When you hear a phrase such as "full-spectrum CBD oil", it usually means the oil was made from a whole-plant extract, and contains those other beneficial plant compounds.
The human body actually produces its own cannabinoids, called endocannabinoids, and these form part of a system of chemicals and receptors called the endocannabinoid system (ECS). The existence of this system was only discovered in the 1990's.
Cannabinoid receptors have been found in pretty much every part of the body, from our skin to our intestines. We now know that this system is involved in several bodily processes including pain, stress, metabolism, and immune function.
Exactly how CBD works is not entirely clear, and research is ongoing. So far, researchers have not been able to find a receptor that the CBD molecule binds to (unlike for THC). One theory is that CBD somehow regulates or moderates the effect of other cannabinoids, perhaps by preventing them from being broken down. This may make those other cannabinoids more present in our body and give rise to the health benefits associated with CBD.
People are using CBD to treat a variety of medical conditions. Some people use it for anxiety, others use it for pain, and still others claim it helps them with sleep.
That being said, there is very little scientific evidence supporting its use for these conditions. In most cases all we have to go on at the moment are personal accounts and in some cases physicians' clinical experience.
CBD has been researched enough to achieve US Food and Drug Administration approval as a treatment for two rare and severe forms of childhood epilepsy, known as Lennox-Gastaut syndrome and Dravet syndrome. Epidiolex, from GW Pharmaceuticals, contains high levels of CBD and has been approved for this application.
In one study, research showed that dogs being treated with CBD for osteoarthritis were more active and had less pain. Another study concluded that CBD can contribute to reducing inflammation resulting from psoriasis. Yet another study suggested CBD could be a treatment for psychosis. CBD also shows potential as a treatment for Alzheimer's disease.
But just about everybody agrees that more research is needed, especially on humans, before we can say with certainty what the effects of CBD are, both positive and negative.
As mentioned, CBD is non-intoxicating whereas THC can be at high enough amounts. But there is always at least trace amounts of THC in the CBD products sold under license from Health Canada.
At present, most products will be labelled for both their CBD content and their THC content. Some products will also summarize the content as a ratio of CBD to THC, e.g. 20:1 or 1:1.
Having some THC present is not necessarily a bad thing. There is some evidence to suggest that CBD is less effective (or even non-effective) without at least some THC. And CBD seems to make THC's pain-fighting qualities work better at lower doses. Finally, CBD may also counteract the anxiety-inducing effect of THC.
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There are many kinds of CBD products available, but perhaps the most popular and well-known is CBD oil. CBD oil is made by diluting concentrated cannabis plant extract with a carrier oil.
In most cases the carrier oil is a benign MCT oil (medium chain triglyceride), however some manufacturers are using olive oil, which may benefit those with allergies or digestive sensitivities. The level of CBD (and THC) in the finished product is controlled through the dilution of the concentrated extract.
CBD oil is sold in small bottles (often with a dropper), packaged in gel capsules (similar to Vitamin E), or in a pump spray.
High-CBD cannabis extract and/or CBD oil (or CBD isolate in some cases) is also being added to food and beverages, such as gummies, chocolates, infusers and sports drinks.
CBD is also being put into topical creams, purporting to deliver more targeted pain relief or help with skin conditions.
For those who prefer to smoke (not recommended) or vaporize their cannabis, there are varieties of dried cannabis that are rich in CBD. There are also vaporization cartridges for use with vape pens (similar to e-cigarettes).
CBD is generally safe and well-tolerated, however people may experience dry mouth, diarrhea, and/or drowsiness, usually at relatively high doses. The effects wear off within hours.
CBD does interfere with liver enzymes that are involved in metabolizing certain drugs, such as blood thinners. The result is that you may have more of these drugs in your system than you would without the CBD present. Your doctor may want to do additional blood testing to ensure that your other medications are at the right levels after you've begun taking CBD. A good rule of thumb is if your medication has a "grapefruit warning", there is a potential interaction with CBD as well. We always recommend using CBD only under the supervision of a health care professional.
A recent study in mice showed a potential negative interaction when CBD is taken with acetaminophen, but scientists are still trying to determine if these results translate to humans.
In Canada, there are two main channels for buying products containing CBD: retail and medical.
In the retail channel, you may find CBD products at retail stores or on-line at government-run websites (each province has slightly different rules).
In the medical channel you can order CBD products directly from licensed producers or from others who have licenses to sell medical cannabis products to patients. You will need a prescription to order.
In all of these cases, the providers are selling products that are inspected by Health Canada, with strict rules around pesticides, herbicides, mould and other contamination.
You may find other unlicensed retailers on-line who are selling black market products. These products are unregulated and may contain more or less CBD than advertised, along with other potentially harmful contaminants.
How you use CBD depends a lot on the product format you're using, e.g. oil, spray, edible, or vaporizer.
The general rule of thumb is start low, go slow, and stay low.
Again, our standard advice is to use CBD under the supervision of a health care professional. This will ensure your safety as well as giving you a better chance of finding the right product and dose, faster.
When it's working as intended, the only thing you should notice is an absence or reduction in pain, or reduced anxiety, or a better night's sleep (or all of the above).
If you are taking a high CBD ratio product (e.g. 20:1 CBD-to-THC), this small amount of THC is unlikely to cause any psychoactive effects.
But because you are slowly introducing CBD to your body, you may not feel the effects right away. We've even had patients say "I didn't think it was doing anything--until I stopped taking it".