I’ve been fielding a lot of questions about CBD and wanted to synthesize a few of those conversations. I am approaching this from the western medicine perspective which uses clinical trials as the standard for evaluating the use and safety of a medicine. There are obviously many way to look at healing and plant medicine that are equally valid.
First, most CBD research is underpowered and low quality. If we’ve learned anything from the monster that is big pharma in our country, it’s that if you want to prove something, you can design a study to do so. Most of the CBD studies that I’ve read so far have had low numbers, poor controls, and very speculative discussions of their findings. I say all of this mainly to emphasize that what we don’t know about CBD and marijuana in general far outweighs what we do know and if we ever want to have good data, our priority should be rescheduling marijuana (currently DEA schedule 1, meaning no medical value, no research allowed) so that research is permitted. Without adequate studies anything said about the medical value of marijuana and it’s constituents is well educated guessing.
With that disclaimer out of the way, there are some trends in the available research that I predict will be solidified by further studies. Firstly, CBD is very safe. I have yet to see any study that showed harm from CBD, even in doses of 1.5 grams daily for greater than a month. This, obviously, should be the point of departure for research on any new medicine and I do not currently have any concerns that trying CBD can hurt the patients that I recommend it to. The other perspective on its safety, is that CBD may have no effect at all. Placebos work very well for many conditions in many people and I am not aware of any study that has compared CBD against a placebo. Nonetheless, I think it is reasonable to say that CBD is safer than ibuprofen, tylenol, or SSRIs.
CBD probably works best as a whole plant preparation with some amount of THC in it. The best ratio of CBD:THC has not been determined. One study showed that with a ratio of 8:1 CBD:THC, the cognitive effects were abolished (no high feeling), but they did not study high doses of this ratio. There is also the unknown role of various terpenes in different strains of marijuana which can dramatically alter the effects of the plant on the user regardless of the concentrations of CBD or THC. Almost all modern recreational marijuana has had the CBD bred completely out of it.
CBD probably helps best with pain, anxiety, and inflammation. Meditation also provably helps with all of these. There was a decent study that showed an additive effect of THC and ibuprofen, providing better pain relief than either compound alone. Several practitioners that I know regularly recommend (and use themselves) CBD for social anxiety and report good effects, but again, there is not any high quality data to support this yet.
If we step away from the evidence based perspective, my conversations with other practitioners and patients, and my own experiences with various preparations lead me believe that CBD is safe enough to try for a variety of conditions including acute and chronic pain, inflammatory states, anxiety, depression characterized by rigid or repetitive thought, and potentially psychosis. It is difficult to determine the appropriate dose and frequency of use, but 10mg twice a day of a whole plant preparation is a good place to start. Increasing the dose and incorporating small amounts of THC may lead to better results. There are no harmful drug interactions that I am aware of and CBD without THC appears safe in children, although I do not recommend administering anything besides love and healthy food to children without the guidance of a physician.
Try CBD. It wont hurt you. Worst case, it might make your wallet a little lighter, but it may be a safe way to treat pain, anxiety, and depression without side effects or dependency.