At the University of Michigan, Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center, and Daniel Clauw, M.D., a professor of anesthesiology, medicine, and psychiatry, took a look earlier this year at why people were using CBD and found that most people cited relief from chronic pain as their top reason.
"CBD is incredibly accessible, as it is available online from a variety of vendors," Boehnke said. "However, the quality control for safety and potency is widely variable."
They found that there's not enough fact-based evidence available to suggest that CBD should be recommended as a first choice treatment option for chronic pain.
"There's a lot of snake oil out there. We see it every day," Rouiller said. "Somebody will bring me in a bottle of what is supposed to be 1,000 milligrams of CBD tincture, and they're saying it's not working. They're frustrated that they spent all this money on a product that isn't working. And we'll turn the bottle around and look at the fine print on the label. And it'll say 5 milligrams of CBD. So at that point, it's glorified coconut oil."
Grinspoon said even though people swear that CBD products are helping, "in general the enthusiasm has outpaced the hard-core science on the efficacy."
While many people attest that CBD brings them relief from pain and other symptoms, few medical research studies have been done on marijuana and marijuana derivatives like CBD:
-- A study published in the European Journal of Pain in 2016 showed that CBD reduces arthritis pain in rats without side effects, but there haven't been comparable human studies.
-- There have been small studies on the benefits of CBD in treating Parkinson's, social anxiety, schizophrenia and post-traumatic stress disorder, but a 2017 review of those studies by the National Institutes of Health suggested that while there may have been some benefits in using CBD to treat those ailments, the small sample size of the studies (less than 100 patients) couldn't translate into blanket conclusions that CBD was beneficial.
"I've had patients have what seems like a pretty dramatic effect beneficially, and I've had other people say, 'Why did I just waste $60 on this? It didn't do anything,' " Grinspoon said. "It's very variable. It's complicated by the fact that it's not that regulated, so you have to be a savvy shopper to even be sure that you get the right amount of CBD that you're ordering."
For the last few decades, research has been stymied by a national anti-drug sentiment, and federal policy that still considers marijuana an illegal substance.
"It used to be that if you wanted to study whether cannabis or anything cannabis-related is harmful, you could get a huge grant," he said. "But if you wanted to study something beneficial, like does CBD help with pain, you wouldn't get funded by the U.S. government.
That has started to change as research institutes begin more and more studies on the health benefits of marijuana. The International Phytomedicines and Medical Cannabis Institute at Harvard University was launched in May to study the effects of plant-based medicines, including cannabis, and making those medicines available globally.
While there has been a good deal of animal research with cannabis and CBD, Grinspoon noted that animal studies don't always translate perfectly to humans.
"For certain things, we have human data for CBD," he said. "For childhood epilepsy, there was enough human data for the FDA to approve the drug Epidiolex for childhood epilepsy."
What to look for before you buy a CBD product For anyone who decides to try it, Grinspoon's best advice is to choose only CBD products that are independently lab tested.
"Look for a certificate of assurance that they have had independent testing," Grinspoon said. "Don't just take their word for it. You know, if you go into a gas station, you're not necessarily going to get good CBD. But if you go to one of these online places that has a lot of good reviews and has independent lab testing or a COA, certificate of assurance, that they've had independent testing, then you're much more likely to get actual CBD."
And Rouiller suggested that consumers also look at where the product is manufactured and choose American-made products because the soil in other countries where the hemp is grown could be suspect.
"There's a lot of products that are coming in from China and other places where they couldn't care less about the dirt that they're growing in," she said. "That's when you get things like heavy metals."
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