Hi, I'm Dr. Tracey Marks, a psychiatrist
and I make mental health education videos.
CBD or Cannabidiol
has become a popular go to drug
to use for a variety of problems.
If you don't know that much about CBD,
here's the quick back story.
The marijuana plant also called cannabis,
is made up of over 100
chemical substances called cannabinoids.
The most abundant cannabinoid
is THC or tetrahydrocannabinol.
It has mind-altering properties.
The second most abundant cannabinoid is cannabidiol,
also known as CBD for short.
It does not have the mind-altering properties.
So, when people refer to marijuana, the plant,
they're usually referring to something
that has a combination of THC and CBD.
Marijuana is illegal in many states
but more and more states
are allowing for the recreational use of marijuana
as well as medical use, called medical marijuana.
With medical marijuana,
the amount of THC you get can be adjusted
such that you have a high percentage of THC
or a low percentage.
CBD on the other hand is legal
because it does not have the mind-altering properties.
So that's the landscape of this situation.
There's only one FDA-approved
CBD prescription medication, called Epidiolex.
It's approved for a specific kind of seizure disorder.
But you can get CBD without a prescription
and it's being marketed for all kind of problems.
Pain, anxiety,
PTSD,
depression,
and ADHD among other things.
However, there really isn't strong research evidence
showing that CBD consistently
and effectively treats these disorders.
For example, the Veterans Administration did a big analysis
looking at several studies
for the use of cannabis and pain and PTSD.
Now, just to be clear, they looked at studies using cannabis
which included THC and CBD.
Nevertheless, in the VA analysis, they find,
they found what they call,
low strength evidence
that cannabis may eliminate neuropathic pain
but there wasn't enough evidence that it was beneficial
for other types of pain like arthritis.
And this was using cannabis
with a THC/CBD content of 1-1 or 2-1.
The 2-1 means that it had twice as much THC as CBD.
What's low strength evidence?
Low strength evidence means
that the testing was not very rigorous
or there may have been inconsistent results,
like one study was positive
while the other one was negative.
To really have strong evidence,
you need to see results that can be replicated
so each time you get the same kind of results.
There have been other organizations
that have analyzed data and conducted their own research.
And to date, the evidence is still inconsistent
on the ability of cannabis and especially CBD alone
to improve these disorders.
In fact, in November 2019,
the FDA published a news release on their website
warning 15 companies
for illegally selling products containing CBD.
I'll post the link to their website
so you can see the companies
that received the warning letters.
The FDA makes it completely transparent.
They even give you a link to the letter
that they sent to the company.
Yikes.
The FDA is serious.
They even have sharing links
so you can spread the word about their warnings.
I don't know how I feel about that part.
If you visit the site in this letter,
you can see that it looks like a great source of CBD,
a very legitimate looking business.
You may say, I thought CBD was legal,
so why is the FDA saying it's being sold illegally?
Because if you make statements about a product
healing or treating a disease,
the FDA considers your product a drug.
And if you're marketing a drug,
you have to follow very strict regulations
usually around showing effectiveness
and establishing safety.
The FDA also has rules about marketing products
as a dietary supplement.
So why is the FDA being so hardcore about this?
They speak to this on their website
about their concerns for safety.
Here's another page where they talk about
what you need to know if you're going to use CBD.
As with any supplement,
just because it's natural,
doesn't mean it won't cause problems for you.
Some of the side effects include liver injury
and changes in alertness.
Also, it's still unknown what the long term effects will be
for people who use it regularly.
And get this,
there were animal studies
that showed decreased testicular size,
sperm count and testosterone.
And these changes even occurred in the male offspring
when the mother's were given CBD.
Do these findings cross over to humans?
We don't know.
It may not, but you won't know until you know.
Does this mean you shouldn't use CBD?
Not necessarily,
but it does mean you need to be aware of the safety concerns
and the fact that it may not work for you.
In my own practice,
I've seen people say that it helped with their pain
more than it helped with their anxiety.
And it seems to be pretty hit or miss.
The reason I don't officially recommend it to patients
is sourcing issues.
When I drive home from work,
I see signs on the streets saying, get your CBD here.
How are these people manufacturing this product?
On the FDA website,
it says that they're investigating some reports
of CBD containing unsafe levels of contaminants
such as pesticides, heavy metal, and THC.
So, I think we need some more control
over how you get the product.
When it comes to using CBD,
I think that we're still at the beginning stages
of exploring and recognizing what disorders it can help.
The good news is,
the research on the medical use of cannabis has not stopped
so just because we don't have good evidence now,
doesn't mean it won't come.
The drug Sativex is approved to treat neuropathic pain
and other types of pain,
but it's not available in the United States.
It's still in the clinical trials phase here in the U.S.
However, this drug contains a 1-1 ratio of THC to CBD
just like the drugs in the Veterans Administration studies.
So, does this mean we really do need THC
to get the therapeutic effect of cannabis?
If so, that can mean taking CBD alone is a waste
because it subjects you to side effects
without giving you enough benefits.
These are questions that are still need to be answered.
So hopefully in the near future
the science will catch up
and we'll have a better understanding
of what CBD can actually do
and how much of it you need
to do what you want it to do.
In the meantime,
it's experimental to use it for pain
and other psychiatric disorders.
Just investigate the source of it,
look into the company that produces it,
and be aware of the side effects.
See ya next time.