Mayo Clinic Q&A: Be Careful with Nonprescription CBD Products
DEAR MAYO CLINIC: I’m interested in trying CBD for knee pain. I see CBD for sale everywhere — even at gas stations. How do I figure out which kind to buy? Are CBD products that are available without a prescription safe and effective?
ANSWER: When it comes to trying products made with cannabidiol, or CBD, that you can buy without a prescription, be careful. There’s some preliminary research that shows potential benefits of using CBD for certain medical problems, particularly pain, sleep disorders, and anxiety. But at this time, there’s no consistent oversight to ensure the purity and safety of nonprescription CBD products or to verify claims manufacturers make about them. Before you try CBD, talk to your healthcare provider.
CBD is a chemical found in marijuana, but it doesn’t contain tetrahydrocannabinol, or THC, the psychoactive ingredient in marijuana that produces a high. The typical formulation of CBD is a liquid that you take orally. But CBD is sold as an extract, a vaporized liquid, and an oil-based capsule, too. There also are many CBD-infused products, including food, drinks, and beauty products.
The only CBD product specifically approved by the Food and Drug Administration is Epidiolex, a prescription medication that’s used to treat two types of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Aside from Epidiolex, which is approved nationwide, laws vary from state to state regarding other forms of CBD.
CBD production is not tightly regulated. That means it’s difficult to know exactly what’s in the CBD products for sale in your community or if the dose listed on the container matches what actually is in the product. Some CBD products include chemicals and herbs, such as echinacea, that may or may not be listed on the label. One study of 84 CBD products bought online found that more than one-quarter of the products contained less CBD than labeled. In addition, THC was found in 18 of those products.
At this time, there is no definitive evidence to support the effectiveness of nonprescription CBD to treat specific medical problems. But research is ongoing into CBD as a treatment for a wide range of conditions, including pain, sleep disorders, anxiety, Parkinson’s disease, schizophrenia, diabetes, and multiple sclerosis. Some evidence suggests that CBD may be useful in treating pain, indicating that there could be a role for CBD as an alternative to opioid medication for challenging chronic pain or to treat opioid addiction.
Before you try nonprescription CBD for any medical concern, you need to talk with your healthcare provider. There are a few reasons for that. First, CBD can interfere with other medications, so it’s important to review your current medications with your healthcare provider to confirm that CBD won’t affect them.
Second, CBD can cause side effects, including dry mouth, diarrhea, reduced appetite, drowsiness, and fatigue. It also can affect liver function. Before you begin taking CBD, your healthcare provider may recommend a liver function test, along with follow-up tests while you’re taking CBD, to check that your liver is not being damaged.
Third, if you and your healthcare provider decide CBD may be worthwhile for you, he or she can help you determine which product to buy. Certain brands and preparations of nonprescription CBD have been tested to verify the amount of CBD they contain and identify other ingredients in them. Your healthcare provider can help you find one of those verified products.
Do not take a nonprescription CBD product without consulting your healthcare provider first. Although CBD shows some promise, many CBD products on the market today are poorly regulated, and manufacturer’s claims about their benefits are unsubstantiated, so it’s important to proceed with caution. — Brent Bauer, MD, Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, Minnesota
Is CBD safe and helpful? More human studies needed, says Mayo Clinic study
26 Aug 2019 — A growing body of pre-clinical and clinical evidence suggests that cannabidiol (CBD) oils may hold promise for treating conditions such as chronic pain and opioid addiction, according to a review of the latest research on the subject, to be published in September in Mayo Clinic Proceedings. However, the authors note that more research involving humans is needed before health care providers can definitively classify CBD as helpful and safe. With their latest findings, the researchers are advising physicians to expand their knowledge on the cannabis extract to best advise their patients.
CBD oils and products have become increasingly popular with consumers as ways to find relief from aches and pains, anxiety, sleep disturbances and other chronic issues. However, most studies of the cannabis extract have been conducted on mice.
“There are many intriguing findings in pre-clinical studies that suggest CBD and hemp oil have anti-inflammatory effects and may be helpful with improving sleep and anxiety,” says Brent Bauer, M.D., Director of Research for the Mayo Clinic Integrative Medicine program. “But trials in humans are still limited, so it is too early to be definitive about efficacy and safety.”
Dr. Bauer asserts that there is reason for concern about a growing number of reports of liver injury in patients who have used CBD products. With increasing patient interest in CBD and hemp oil products, it is important that clinical research moves ahead to better understand their potential value and safety, he highlights.
“Careful selection of a health care product is crucial, and though these products do not have Food and Drug Administration (FDA) approval for therapeutic use, patients continue to ask for them and use them. Physicians need to become better informed about these products, and it’s important that human trials examine issues of efficacy and safety,” says Dr. Bauer.
With CBD a hot consumer trend, physicians may find it easy to dismiss it as unproven and untested, note the researchers. Dr. Bauer encourages health care professionals develop expertise on these products and not to easily dismiss their patients’ interest in CBD.
“We encourage physicians to not disregard their patients’ interest in these products and keep both a clinical curiosity and a healthy skepticism about the claims made,” he says. “Chronic pain management continues to challenge patients and physicians, and these therapies are a promising area that needs more research. For patients struggling with chronic pain, physicians taking time to listen to them and address their questions compassionately but with an evidence-based approach can help them make informed decisions.”
The variety of CBD and hemp oil products, and the limited regulation of these products, is a concern for health care professionals, according to the study. The variability of state laws regarding production and distribution of hemp and CBD products adds to the complexity of decision-making for consumers and physicians.
No rigorous safety studies have been done on “full spectrum” CBD oils, which contain a variety of compounds found in the hemp plant, not just CBD. Moreover, there are important distinctions between marijuana, hemp and the different components of CBD and hemp oil, and some clinicians may not be aware of them, as highlighted by coauthor Karen Mauck, M.D.
“Other than Epidiolex, a purified form of plant-derived CBD which was approved in 2018 for treatment of severe forms of epilepsy, all other forms of CBD are not approved by the FDA but are sold in a variety of formulations, including oral or topical oils, creams, sprays and tablets,” says Dr. Mauck. “They contain variable amounts of CBD, may contain other active compounds and may have labeling inaccuracies. Before using CBD or hemp oils, it’s important to consult with your physician about potential side effects and interactions with other medications.”
The legalization of marijuana for medicinal purposes has spurred intense interest by consumers in over-the-counter products containing CBD and hemp oil, which are now available in a broad range of edible, topical and vapable formats.
By Benjamin Ferrer
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