I’ve gotten this question many times over the last couple years and only recently do I have a complete answer. Like everyone else, getting trusted information from what’s available online has been a bit frustrating.
Even at psychiatric conferences, I felt some of the answers from my colleagues seem to conflict. There’s still a lot of unanswered questions but I feel it is important to share where things are at in tracking this nationwide trend.
The story begins with the reality that 22 million people are currently using cannabis in the U.S.—a number that has doubled over the past 10 years. That may have something to do with the perception that cannabis is less dangerous than alcohol or other substances. Today’s cannabis contains 140 active compounds which includes THC (Delta 9 tetrahydrocannabinol) and CBD (cannabidiol). However, CBD can be derived from hemp or cannabis sources (hemp has lower levels of THC <0.3%). THC is the only compound that is intoxicating. CBD is non-intoxicating but technically is psychoactive because it does affect how you feel and think. CBD has been shown to have anti-anxiety and antipsychotic properties as well as being an analgesic, anti-emetic, and anti-cancer. CBD also buffers the negative effects of THC.
The good news is CBD is safe and non-addictive and shows promise in relieving anxiety for some. CBD has FDA approval for 2 pediatric epilepsy syndromes. The not so good news about CBD is that like all supplements, it is not regulated and often mislabeled. In fact, only 30% of CBD supplements are accurately labeled which means there is a fairly good chance that the CBD you buy will contain other compounds such as THC. However, this problem can be mitigated by only purchasing brands that have 3rd party certification about the ingredients. Along the same lines, there can also be contaminants if the CBD is derived from industrial hemp sprayed with pesticides. The FDA has announced that it will soon issue and enforce regulations on all CBD products so these concerns should decrease over time.
We are also still learning about how CBD interacts with medications which could turn out to be its most significant side effect. CBD impacts how the human liver breaks down other drugs, which means it can elevate the blood levels of other prescription medications that people are taking—and thus increase the risk of experiencing side effects. For example, we already know CBD can raise serum levels of the mood stabilizer, Lamotrigine, and the anti-anxiety medication, diazepam. High doses of CBD in children has been associated with sleepiness, vomiting, and diarrhea but we don’t know if this necessarily applies to adults using CBD.
What most psychiatrists are saying at this point in late 2019 is that the evidence for CBD is promising but that its widespread use is ahead of the science and would recommend evidence based treatments. It has been difficult to do studies as the funding is lacking but there are currently studies being done with CBD and the treatment of schizophrenia, opioid addiction, anxiety, neuropathic pain and Parkinson’s disease. We will know a lot more about CBD, its capabilities and limits, in the next few years. For now, if you’re using CBD (or thinking about using it), please find pure high quality CBD and talk to your doctor so they can monitor you for side effects and interactions with any other drugs you take. Dosing is dependent on many factors (age, timing, how dose is given, other medications) and hasn’t been studied either. The best advice is to start low and go slow.