Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.
Dr. Smita Das, chair of the American Psychiatric Association’s Council on Addiction Psychiatry’s cannabis work group, does not recommend CBD for anxiety, PTSD, sleep or depression. With patients turning to these to unproven products, she is worried that they may delay seeking appropriate mental health care: “I’m dually concerned with how exposure to CBD products can lead somebody into continuing to cannabis products.”
“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.
Does CBD work?
Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.
Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are looking for new treatments for sleep, that may be a clue,” he said.
This year, 1,090 people have contacted poison control centers about CBD, according to the American Association of Poison Control Centers. Over a third are estimated to have received medical attention, and 46 were admitted into a critical care unit, possibly because of exposure to other products, or drug interactions. In addition, concern over 318 animals poured into the American Society for the Prevention of Cruelty to Animals’ Animal Poison Control Center.
Just as hemp seedlings are sprouting up across the United States, so is the marketing. From oils and nasal sprays to lollipops and suppositories, it seems no place is too sacred for CBD. “It’s the monster that has taken over the room,” Dr. Brad Ingram, an associate professor of pediatrics at the University of Mississippi Medical Center, said about all the wild uses for CBD now. He is leading a clinical trial into administering CBD to children and teenagers with drug-resistant epilepsy.
CBD oil contains CBD mixed with an inert carrier oil, such as coconut oil or hemp seed oil. The bottled oil, called a tincture, is sold in various concentrations. There are also CBD capsules, CBD gummies, and under-the-tongue CBD sprays.
Clinical research has shown that CBD oil can trigger side effects. Severity and type can vary from one person to the next.
CBD oil may also increase liver enzymes (a marker of liver inflammation). People with liver disease should use CBD oil with caution, ideally under the care of a doctor who can regularly check blood liver enzyme levels.
Part of this response could be explained by the way that CBD acts in the brain. In low doses, CBD may act as an agonist to several receptor sites, meaning it acts similarly to surrounding molecules that normally bind to the receptor, enhancing the signalling of those receptor sites. At higher doses, however, too much activity at the receptor site can lead to an opposite effect, negating the beneficial effects of CBD.
There is currently no known “correct” dose of CBD oil. Depending on individual needs and what is being treated, the daily dose may range between 5 and 25 mg.